Parent experiences of a remote patient monitoring program enabling early discharge from the neonatal intensive care unit with nasogastric tube feeding.

BACKGROUND: This exploratory study examined parents' experiences with "Growing at Home" (G@H), a remote patient monitoring program for stable infants discharged from the Neonatal Intensive Care Unit (NICU) with continued need for nasogastric tube feeding. METHODS: We used classical content analysis to identify and refine emergent themes from 13 semi-structured key informant interviews. RESULTS: The primary emergent theme was the desire to return to normalcy, which was expressed as a primary motivator for participating in G@H. Parents reported G@H assisted them in transitioning from the NICU's highly medicalized setting to establishing a new normal with incorporation of their infant into their lives and families. Parental preparation is important, as some parents experienced challenges that indicate the program may not be suitable for all families. CONCLUSIONS: Parental experiences offer insight into benefits and challenges of early discharge from the NICU and highlight opportunities to support families beginning in the NICU and as they transition home.

Excessive range of statin dose in Western Australian primary care.

BACKGROUND: Statins are very effective in reducing coronary disease and ischaemic stroke but guidelines although evolving have not been clear on statin dose. AIM: To audit and review community statin prescribing. METHODS: A retrospective audit of the type and dose of statin dispensed was undertaken at five pharmacies in and around Perth, the capital city of Western Australia. Patients were de-identified. RESULTS: Statins made up 6.5% of all prescriptions. Statin dose when adjusted for different potency effectively varied 64-fold between patients. Rosuvastatin and atorvastatin accounted for 79% of prescriptions, at a mean dose of 10 times the effective dose 50. CONCLUSION: The extraordinarily wide variation in statin dose is at odds with the more consistent doses of other drugs used in the management of arterial disease. Unnecessarily high statin dosing increases side-effects and may not improve clinical outcomes appreciably. Rational prescribing of statins based on the pharmacodynamic evidence, with lower doses in most patients, combined with close attention to reduction of smoking, blood pressure and weight, is likely to reduce arterial disease most efficiently and safely.

Physical properties of K(x)Ni(2-y)Se2 single crystals.

We have synthesized K0.95(1)Ni1.86(2)Se2 single crystals. The single crystals contain K and Ni deficiencies not observed in KNi2Se2 polycrystals. Unlike KNi2Se2 polycrystals, the superconductivity is absent in single crystals. The detailed physical property study indicates that the K0.95Ni1.86Se2 single crystals exhibit heavy-fermion-like characteristics. The transition to a heavy fermion state below T ~ 30 K results in an enhancement of the electron-like carrier density whereas the magnetic susceptibility shows little anisotropy and suggests the presence of both itinerant and localized Ni orbitals.

Phase diagram of K(x)Fe(2-y)Se(2-z)S(z) and the suppression of its superconducting state by an Fe2-Se/S tetrahedron distortion.

We report structurally tuned superconductivity in a K(x)Fe(2-y)Se(2-z)S(z) (0 ≤ z ≤ 2) phase diagram. Superconducting T(c) is suppressed as S is incorporated into the lattice, eventually vanishing at 80% of S. The magnetic and conductivity properties can be related to stoichiometry on a poorly occupied Fe1 site and the local environment of a nearly fully occupied Fe2 site. The decreasing T(c) coincides with the increasing Fe1 occupancy and the overall increase in Fe stoichiometry from z = 0 to z = 2. Our results indicate that the irregularity of the Fe2-Se/S tetrahedron is an important controlling parameter that can be used to tune the ground state in the new superconductor family.

A bi-prism interferometer for hard X-ray photons.

Micro-fabricated bi-prisms have been used to create an interference pattern from an incident hard X-ray beam, and the intensity of the pattern probed with fluorescence from a 30 nm-thick metal film. Maximum fringe visibility exceeded 0.9 owing to the nano-sized probe and the choice of single-crystal prism material. A full near-field analysis is necessary to describe the fringe field intensities, and the transverse coherence lengths were extracted at APS beamline 8-ID-I. It is also shown that the maximum number of fringes is dependent only on the complex refractive index of the prism material.

Diamond kinoform hard X-ray refractive lenses: design, nanofabrication and testing.

Motivated by the anticipated advantageous performance of diamond kinoform refractive lenses for synchrotron X-ray radiation studies, this report focuses on progress in designing, nanofabricating and testing of their focusing performance. The method involves using lift-off and plasma etching to reproduce a planar definition of numerically determined kinoform refractive optics. Tests of the focusing action of a diamond kinoform refractive lens at the APS 8-ID-I beamline demonstrate angular control of the focal spot.

Cholesterol--when is lower better?

When recommending how to treat a patient's lipid profile with drugs, there are two common misinterpretations of the data that are often quoted to support the current enthusiasm for the lower the cholesterol, the better.

Therapeutic and financial outcomes using a pulsating low-air-loss surface for patients surviving severe posterior burns.

Patients with posterior burns require extensive stays in the intensive care unit for recovery. The authors hypothesized that pulsating low-air-loss therapy would decrease the intensive care unit length of stay for burn patients, resulting in a potentially significant reduction in charges to payors. Eighty-one posterior burn patients enrolled in the primary study were randomly assigned to a pulsating low-air-loss surface (study group) or a nonpulsating low-air-loss surface (control group). The 54 survivors in this analysis (the secondary study) were well matched for age, pre-existing conditions, and total body surface area burned. Average intensive care unit length of stay was less for the study patients compared with the control patients--40 days versus 64 days (P < .05). Control patients used specialty surfaces for 49 days and study patients used them for 38 days. Based on a daily intensive care unit charge of $1,000 and the average daily specialty surface rental charge, the study patients averaged potential charges of under $44,000 in comparison to more than $67,000 for control patients. These data suggest that treatment of posterior burns with pulsating low-air-loss therapy may be of great clinical and financial benefit, decreasing the intensive care unit length of stay and potentially contributing to reduced charges to payors.

Development of a decision tree for support surfaces: a tool for nursing.

The use of specialty support surfaces can be clinically beneficial for at-risk patients, but can prove costly if their use is not closely monitored. A decision tree can guide health care providers in selecting the most appropriate support surface based on the patient's condition. The process used by one medical center to develop and test a decision tree for specialty support surfaces selection is described.

Nifedipine increases microvascular permeability via a direct local effect on postcapillary venules.

Calcium-channel antagonist drugs are prescribed widely for angina and hypertension. A limiting side effect is edema, which can make heart failure worse. We show that nifedipine, a dihydropyridine-type calcium-channel antagonist, can increase vascular permeability in rat skeletal muscle and skin when injected locally. In nifedipine-injected cremaster muscle, the copper content, used to quantify Monastral blue dye accumulation, was 15.0 +/- 2.4 microgram/g compared with 5.3 +/- 0.7 microgram/g in control preparations (P < 0. 05). The injection of nifedipine in rat skin in vivo increased local plasma leakage in injected sites from 5.5 +/- 1.1 microliter in control sites to 9.9 +/- 2.5, 17.0 +/- 2.4, 24.3 +/- 5.9, and 23.3 +/- 5.4 microliter in sites injected with 10(-10), 10(-9), 10(-8), or 10(-7.2) mol/site, respectively (P < 0.05 in each case compared with control). Vascular labeling techniques using light microscopy, electron microscopy, and microanalysis show that the microvascular site of leakage is not from capillaries but from postcapillary venules of 12-36 micrometer in diameter, the same site that controls the edema response in inflammation. Nifedipine can act within the microcirculation to increase the permeability of the postcapillary venule.

Cardiac inotropes inhibit the oedema caused by nifedipine in rabbit skin.

1. We have shown previously that exposing the rat or rabbit microcirculation to nifedipine increases the permeability of the post-capillary venule, the segment of microcirculation that is known to control inflammatory oedema. 2. In the present study modulation by the inotropes isoprenaline, dopexamine and dobutamine of nifedipine-induced oedema was examined in the rabbit skin microcirculation by measuring the localised leakage of 125I-radiolabelled albumin after the i.d. injection of agents. 3. Coinjection of isoprenaline (10(-11) moles per site), dopexamine (10(-10) moles per site) or dobutamine (10(-10) moles per site) suppressed significantly (P < 0.05) the oedema response to nifedipine (10(-7.2) moles per site) in the rabbit dorsal skin microcirculation. 4. To confirm the oedema suppresser effect of the inotropes, dopexamine or dobutamine were also coinjected with histamine 10(-8) + PGE2 10(-10) moles per site, or bradykinin 10(-10) + PGE2 10(-10) moles per site. Both inotropes at 10(-10) moles per site reduced significantly (P < 0.05) the leakage of albumin caused by bradykinin + PGE2 and histamine + PGE2. 5. When measured by laser Doppler, basal local skin blood flow increased at 30 min by 57 +/- 14% with nifedipine 10(-7.2) moles per site and 15 +/- 11% with isoprenaline 10(-11) moles per site. Isoprenaline did not suppress the blood flow response to nifedipine, the response to coinjection being 68 +/- 11%. 6. Oedema caused by nifedipine can be suppressed by low concentrations of beta-adrenergic agonists that do not suppress the blood flow response to nifedipine. This suggests that cardiac inotropes can influence non-inflammatory changes in microvascular permeability.

Exosporial membrane plasticity of Clostridium sporogenes and Clostridium difficile.

This investigation examines the morphological alterations of the exosporial membranes of Clostridium sporogenes ATCC 3584 and Clostridium difficile ATCC 43594 and 9689 endospores in relation to their possible function during germination in the attachment/colonization process of these pathogenic bacteria. There is no reported function for the exosporial membrane, nor exosporial appendages, of clostridial endospores. Advances in high resolution, scanning electron microscopy (SEM) permit the examination of these delicate, morphological projections on intact spores in the process of attachment. The morphological plasticity of the exosporial membrane projections during activation and germination was examined to determine whether the appearance of these exosporial projections coincided with attachment of the spores to the nutritive substrate, and whether this attachment could be altered by physical agitation, cation competition with Ba2+, chelation with EDTA, or treatment with colchicine. Following incubation, activated spores could not be removed from the agar surface by agitation in water (pH 7.2 or 9.1), nor by agitation in buffer or colchicine, indicating that some form of adherence or attachment to the agar had taken place. When agitated in the presence of Ba2+ or EDTA in phosphate buffered saline or EDTA in water, all activated spores detached from the agar and exhibited decreased exosporial projections and minimal, if any, attachment structures to the agar surface. Activated clostridial spores were found to attach to agar by delicate extensions of the exosporium that could be disrupted by EDTA or Ba2+ exposure, but were unchanged when shaken in buffer or water.

Comparison of diltiazem and verapamil on rat microvascular permeability.

Calcium channel antagonists are among the most widely prescribed cardiovascular drugs. Their benefit is limited by the side effect of edema, the microvascular mechanism of which is not known. We compared the local effect on edema formation in rat skin and skeletal muscle of two calcium channel antagonists, diltiazem and verapamil, and determined if the edema effect correlated with changes in microvascular flow. An increase in microvascular flow can potentiate edema formation by increasing microvascular hydrostatic pressure and the proportion of the bed that is perfused. Diltiazem, but not verapamil or control, injected s.c. in scrotal skin caused plasma albumin leakage visualized as local bluing of tissue in rats that had been pretreated with Evans blue dye systemically. Topographic studies using Monastral blue dye showed that in the underlying cremaster muscle, diltiazem increased leakage of dye particles not from capillaries but from postcapillary venules. The postcapillary venule is associated with inflammatory edema, suggesting a direct effect of diltiazem on endothelial permeability. The local injection of diltiazem also increased significantly (P < 0.05) plasma leakage quantified as the local accumulation of systemically injected 125I-radiolabeled albumin, from 14.5 +/- 2.0 and 6.9 +/- 1.0 microliters in control sites to 30.0 +/- 7.3 and 18.0 +/- 2.5 microliters in dorsal skin and abdominal rat skin, respectively. In contrast, verapamil at similar doses did not increase plasma albumin leakage significantly. At the doses that caused local skin edema, diltiazem had less effect on microvascular skin blood flow, measured by a laser Doppler flow probe, (12.6 +/- 5.3% at 15 min and 2.8 +/- 8.4% change at 30 min) than verapamil (39.0 +/- 7.3% at 15 min 30.0 +/- 6.7% change at 30 min, P < 0.01). The microvascular effects of these two calcium channel antagonists differ in that diltiazem had a significant effect on microvascular permeability whereas verapamil had a significant effect on microvascular blood flow.

The effect of the menstrual cycle on exhaled nitric oxide and urinary nitrate concentration.

Exhaled nitric oxide (NO), early morning urinary nitrites/nitrates and urinary female sex steroid conjugates were measured daily to investigate whether there was a variation in NO generation during the menstrual cycle. Exhaled NO concentrations and early morning urine samples were taken for 30 consecutive days in five healthy normotensive women with proven ovulation. The urine samples were analysed for nitrite-nitrate creatinine ratios, oestrone-3-glucuronide (EG) and pregnanediol-3-alpha glucuronide (PG). The mean (95% CI) exhaled NO concentration was 52 ng g-1 in the 150 readings and the mean molar urinary nitrate-creatinine ratio was 0.18. There was no temporal relationship between the measurement of NO production and urinary sex steroid conjugates within the menstrual cycle. These findings suggest that oestrogens do not modulate exhaled NO concentration and appear not to increase the production of the early morning urinary nitrates in healthy premenopausal women. There was also no sex difference in exhaled NO generation.

Cross-shaped bandpass filters for the near- and mid-infrared wavelength regions.

A photolithographic process has been used to form cross-shaped patterns in 3-µm-thick nickel foils. Patterns with cross arm dimensions in the 10-20-µm range, and with periodicities in the 16-26-µm range, yield self-resonant bandpass filters for wavelengths in the 20-25-µm region. Transmittances as high as 80% were achieved with center wavelength-to-bandwidth ratios (λ(R)/Δλ) of ~5. We present a simple empirical formula that relates the wavelength of peak transmittance, or resonant frequency, with cross dimensions and periodicity.

Cholesterol and the coronary endothelium.

The root causes of atherosclerosis lie in cellular events that precede the clinical presentation of the disease by many years. The initiating events centre around the response of endothelial cells to chronic injury, such as that sustained in hypercholesterolaemia. These responses involve the activation, attachment and migration of leucocytes and platelets.

Captopril increases skin microvascular blood flow secondary to bradykinin, nitric oxide, and prostaglandins.

Angiotensin converting enzyme inhibitors (ACEIs) are a cornerstone of treatment of hypertension and heart failure yet their mechanism of action is still debated. This study was designed to test whether the ACEI captopril increases skin microvascular blood flow by a bradykinin-dependent mechanism. Local changes in microvascular blood flow were measured in the skin of rabbits and of human volunteers using a laser Doppler flow probe. Captopril injected intradermally increased skin blood flow over the dose range of 10(-12)-10(-8) mol site in rabbits and humans. In both species the response was abolished by coinjecting either a nitric oxide synthase (NOS) inhibitor or a cyclooxygenase inhibitor. Intradermal bradykinin also increased rabbit skin microvascular blood flow; at 10(-11) mol site it increased mean +/- SE basal blood flow by 88 +/- 12%. The responses to bradykinin or captopril were abolished by coinjecting a bradykinin antagonist, a specific bradykinin B2 receptor antagonist, or inhibitors of NOS or cyclooxygenase. Injecting a specific angiotensin II receptor antagonist at a dose that antagonized the constrictor effects of exogenous angiotensin II did not cause a significant increase in rabbit skin blood flow. This suggests that endogenous angiotensin II does not influence microvascular blood flow in this model. The results indicate that captopril increases skin microvascular blood flow in rabbits and humans secondary to an increase in endogenous tissue bradykinin; this stimulates B2 receptors with subsequent release of prostaglandins and nitric oxide. ACEIs may increase microvascular perfusion by a bradykinin-dependent mechanism.