Fish-like aquatic propulsion studied using a pneumatically-actuated soft-robotic model.

Fish locomotion is characterized by waves of muscle electrical activity that proceed from head to tail, and result in an undulatory pattern of body bending that generates thrust during locomotion. Isolating the effects of parameters like body stiffness, co-activation between the right and left sides of the body, and frequency on thrust generation has proven to be difficult in live fishes. We use a pneumatically-actuated fish-like model to investigate how these parameters affect locomotor force generation. We measure thrust as well as side forces and torques generated during propulsion. Using a statistical linear model we examine the effects of input parameter combinations on thrust generation. We show that both stiffness and frequency substantially affect swimming kinematics, and that there are complex interactive effects of these two parameters on thrust. The stiffer the backbone the more impact that increasing frequency has on thrust production. For stiffer models, increasing frequency resulted in higher values for both thrust and lateral forces. Large side forces reduce swimming efficiency but this effect could be mitigated by decreasing undulatory wavelength and allowing appropriate phasing of left and right body movements to reduce amplitudes of side force.

Expanded dog leukocyte antigen (DLA) single nucleotide polymorphism (SNP) genotyping reveals spurious class II associations.

The dog leukocyte antigen (DLA) system contains many of the functional genes of the immune system, thereby making it a candidate region for involvement in immune-mediated disorders. A number of studies have identified associations between specific DLA class II haplotypes and canine immune hemolytic anemia, thyroiditis, immune polyarthritis, type I diabetes mellitus, hypoadrenocorticism, systemic lupus erythematosus-related disease complex, necrotizing meningoencephalitis (NME) and anal furunculosis. These studies have relied on sequencing approximately 300 bases of exon 2 of each of the DLA class II genes: DLA-DRB1, DLA-DQA1 and DLA-DQB1. In the present study, an association (odds ratio=4.29) was identified by this method between Weimaraner dogs with hypertrophic osteodystrophy (HOD) and DLA-DRB1∗01501. To fine map the association with HOD, a genotyping assay of 126 coding single nucleotide polymorphisms (SNPs) from across the entire DLA, spanning a region of 2.5 Mb (3,320,000-5,830,000) on CFA12, was developed and tested on Weimaraners with HOD, as well as two additional breeds with diseases associated with DLA class II: Nova Scotia duck tolling retrievers with hypoadrenocorticism and Pug dogs with NME. No significant associations were found between Weimaraners with HOD or Nova Scotia duck tolling retrievers with hypoadrenocorticism and SNPs spanning the DLA region. In contrast, significant associations were found with NME in Pug dogs, although the associated region extended beyond the class II genes. By including a larger number of genes from a larger genomic region, a SNP genotyping assay was generated that provides coverage of the extended DLA region and may be useful in identifying and fine mapping DLA associations in dogs.

[Progress in diagnostic evaluation of platelet function disorders]. / Fortschritte in der Thrombozytenfunktionsdiagnostik.

Both for diagnosis of congenital and acquired platelet dysfunction as well as for therapy monitoring after application of platelet function inhibitors various methods have been established for evaluation of platelet function. In contrast to the gold standard of platelet function testing, the light transmission aggregometry in platelet rich plasma the Point-of-care (POC) analyzers allow fast analysis of platelet function without extensive laboratory work up. The conditions of the pre-analytical phase, however, are still of enormous importance in the prevention of medical errors. There is increasing clinical data in monitoring the effect of platelet aggregation inhibitors, showing that quantitative determination of the platelet function degree correlates with risk of increased bleeding or stent thrombosis. However, it is still unclear, which is the optimal test system, to predict the clinical outcome of these patients.

[Significance of platelet function tests]. / Stellenwert der Thrombozytenfunktionsdiagnostik.

Numerous laboratory tests are in use to detect congenital or acquired platelet function disorders. Platelet aggregometry, using ADP, collagen, arachidonic acid or ristocetin as inductor is the standard test system for diagnosis. It is also used to detect platelet non-response to antiplatelet therapy. Studies have demonstrated that laboratory assessment of platelet non response to aspirin or clopidogrel is associated with adverse outcomes, and they indicate the importance of adjusting antiplatelet therapy in patients with a low degree of platelet inhibition. Nevertheless, a standardized method for identifying these patients is still missing.

Vascular endothelial growth factor causally contributes to the angiogenic response upon ultraviolet B irradiation in vivo.

BACKGROUND: Ultraviolet (UV)-B irradiation has been shown to be an inducer of vascular endothelial growth factor (VEGF) in primary keratinocytes and epidermal cell lines in vitro. OBJECTIVES: To determine the expression pattern and the causal role of VEGF in the UVB-mediated angiogenic response in vivo in human skin and in a mouse model. METHODS: Skin biopsies or epidermal lysates thereof were studied for VEGF expression following UVB irradiation at a dose of 50 or 60 mJ cm-2, respectively, using immunostaining and a VEGF-specific highly sensitive sandwich enzyme-linked immunosorbent assay. The VEGF-dependent increase in vessels upon repetitive UVB irradiation was studied in skh-1 hairless mice using immunostaining for factor VIII-related antigen (FVIII RAG) in the presence and absence of intraperitoneally injected neutralizing VEGF antibodies. RESULTS: VEGF was found to be induced in the epidermis following UVB irradiation of human and mouse skin. Repetitive UVB irradiation of skh-1 hairless mice resulted in an increase in FVIII RAG positive vessels in the skin. UVB-induced angiogenic response could be partly abrogated by neutralizing antibodies against VEGF, while isotype-matched IgG control antibodies did not reveal any suppressive effect. CONCLUSIONS: Our results support previous in vitro data and show the in vivo relevance of VEGF as a paracrine inducer of cutaneous vessels after UVB irradiation.

Chronological ageing and photoageing of the fibroblasts and the dermal connective tissue.

In recent years, the exposure of human skin to environmental and artificial UV irradiation has increased dramatically. This is due not only to increased solar UV irradiation as a consequence of stratospheric ozone depletion, but also to inappropriate social behaviour with the use of tanning salons still being very popular in the public view. Besides this, leisure activities and a lifestyle that often includes travel to equatorial regions add to the individual annual UV load. In addition to the common long-term detrimental effects such as immunosuppression and skin cancer, the photo-oxidative damage due to energy absorption of UV photons in an oxygenized environment leads to quantitative and qualitative alterations of cells and structural macromolecules of the dermal connective tissue responsible for tensile strength, resilience and stability of the skin. The clinical manifestations of UV/reactive oxygen species (ROS)-induced disturbances result in photoaged skin with wrinkle formation, laxity, leathery appearance as well as fragility, impaired wound healing capacities and higher vulnerability. Strategies to prevent or at least minimize ROS-induced photo-ageing and intrinsic ageing of the skin necessarily include protection against UV irradiation and antioxidant homeostasis.

Solar UV irradiation and dermal photoaging.

The skin is increasingly exposed to ambient UV-irradiation thus increasing risks for photooxidative damage with long-term detrimental effects like photoaging, characterized by wrinkles, loss of skin tone and resilience. Photoaged skin displays alterations in the cellular component and extracellular matrix with accumulation of disorganized elastin and its microfibrillar component fibrillin in the deep dermis and a severe loss of interstitial collagens, the major structural proteins of the dermal connective tissue. The unifying pathogenic agents for these changes are UV-generated reactive oxygen species (ROS) which deplete and damage non-enzymatic and enzymatic antioxidant defense systems of the skin. As well as causing permanent genetic changes, ROS activate cytoplasmic signal transduction pathways in resident fibroblasts that are related to growth, differentiation, senescence and connective tissue degradation. This review focuses on the role of UV-induced ROS in the photodamage of the skin resulting in clinical and biochemical characteristics of photoaging. In addition, the relationship of photoaging to intrinsic aging of the skin will be briefly discussed. A decrease in the overall ROS load by efficient sunscreens or other protective agents may represent promising strategies to prevent or at least minimize ROS-induced photoaging.

Responses and concerns of healthcare providers to medication errors.

This descriptive, correlational study examined the responses and concerns of healthcare professionals about making medication errors and estimated patient harm from such errors. A systematic random sample of nurses, pharmacists, and physicians (N = 402) completed a self-report survey about a medication error they judged to be serious. Respondents were guilty, nervous, and worried about the error. They feared for the safety of the patient, disciplinary action, and punishment. A few subjects indicated that they never reported the errors. The most frequent symptoms associated with errors were neurologically based. The injury suffered by patients was not severe overall according to the harm scales. Weak correlations were found for the harm scales and responses and concerns. The authors suggest a supportive environment for the provider following an error and continuous quality improvement efforts to eliminate system-based errors.

Making nursing work visible inside and outside the profession.

The hidden work of nursing is explored in order to explain why the details of nurses' work stay inside the profession and why nurses should continue to display it on the outside. Examples of hidden work are examined, including the work of knowing how, knowing the patient, body work, comforting work, and helping people die a good death.

Substruction: illustrating the connections from research question to analysis.

This article examines the process of theoretical substruction as a heuristic device to assist graduate students and beginning investigators identify the conceptualization and operationalization phases of research proposals. As a thinking process, substruction enables investigators to delineate the foundational elements of studies. Creating the figure during substruction helps researchers increase their knowledge of the theoretical, empirical, or descriptive links between the conceptual and operational components of a study. Consequently, the researcher ascertains the fundamental pattern of the study. A qualitative and a quantitative example of substructed studies are included.

Relationship between nurse caring and patient satisfaction.

A correlational study examined patients' (n = 335) reports of nurse caring and satisfaction with nursing care, using the Caring Behaviors Inventory and Patient Satisfaction Instrument. A strong, positive correlation (r = 0.78, p < .001, R2 = 61.46%) was found. The outcomes of this study have important implications for adult health nurses.

Health risks and health promotion for older women: utility of a health promotion diary.

Elderly women require health screening and health promotion services from nurses and other health care providers. Nurses serving this population require knowledge of age-specific health screening and health promotion services. A case study from a geriatric nurse practitioner's practice demonstrates the complexity of these activities. A diary of such services can help nurses focus on elderly women's needs for health promotion interventions.

A program evaluation approach to drug administration education.

To evaluate the education of undergraduate nursing students in drug administration, the faculty of La Salle University School of Nursing structured a program evaluation plan using a curriculum map. Faculty track the cognitive, affective, and psychomotor skills involved in drug administration. For example, all clinical nursing courses and the pharmacology course contain dosage and intravenous solution calculations in didactic material and tests. Program evaluation of the outcomes of medication administration education is continuous throughout the curriculum.

Interventions used by staff nurses to manage "difficult" patients.

Interventions utilized by nurses to manage "difficult" patients and outcomes indicating successful interventions were investigated. Themes included getting the difficult patient label, difficult patient behaviors, reflecting on the label and passing it on, coping with a difficult patient, interventions that worked, and interventions that did not work. Clues indicating that patient behavior was changing were also identified.

Creating and implementing guidelines on caring for difficult patients: a research utilization project.

Difficult patients challenge the resourcefulness of nurses. Considering the results of a focus group study, guidelines are designed for the care of difficult patients. Four case studies present the use of the guidelines, including interventions and outcomes.

Nursing students' experience bathing patients for the first time.

This study describes nursing students' experience bathing an adult patient for the first time. The students feared giving their first patient a bath and voiced concern about harming him or her. They discovered that it was easier when they were paired with another student and acknowledged being supported by fellow nursing students. Beginners were uncomfortable about exposing and touching the patient's private body parts and were surprised when patients helped them through the bath.

Clinical inference by nursing students and experienced nurses concerning harmful outcomes occurring after medication errors: a comparative study.

Clinical inference is part of the clinical decision-making process and precedes judgment and action. It is an integrated response to patient cues and other evidence and a necessary skill for all nurses. The purpose of this study was to compare undergraduate and graduate nursing students' use of clinical inference in rating harmful outcomes for patients occurring after medication errors. The Medication Error Outcome Scale, a simulation methodology using medication error vignettes, was used to compare undergraduate and graduate students' use of clinical inference. Kruskal-Wallis analysis of variance showed that there was a statistically significant difference (P = .04) among freshman, junior, senior, baccalaureate, and Master's students' use of clinical inference in regard to perceived harm occurring after a medication errors. Post hoc Mann-Whitney U tests indicated that senior and baccalaureate students' use of clinical inference differed significantly (P = .005). This study suggests that clinical experience shapes clinical inference.