To Identify and Support Youths Who Struggle with Living-Nurses' Suicide Prevention in Psychiatric Outpatient Care.

Nurses working in psychiatric care daily encounter youths who are struggling with living. Despite this, nurses' suicide-prevention work is seldom addressed in research or in recommendations for care. The overall aim of this paper is to discuss how nurses, with their caring science perspective, may contribute to suicide prevention. The paper presents how nurses in psychiatric outpatient care may identify and support suicidal youths, according to experts in suicide prevention. The interviews with six experts in suicide prevention resulted in three themes: Engagement necessary but demanding, Acknowledgement of warnings signs and Supportive relationship. The respondents elaborated on how suicide-risk can be assessed. A good rapport with the youths was stressed and the recommended act of care included: to listen openheartedly without interrupting as well as to listen after risk- and protective factors to emphasize or to penetrate. To ask about suicidality as well as to let the person elaborate on what's important for him or her. To endure in the patients' suffering as well as steering the conversations toward hope. The paper also presents warning signs that need to be noticed according to the experts and the literature consensus. Our findings suggest that communication in suicide-prevention is an "art and act" that cannot be reduced to a method or simple guidelines. We argue that the recommended acts of care demand sensitivity and skills and that nurses as well as the domain of caring science may contribute to this competence.

Body and self: a phenomenological study on the ageing body and identity.

The aim of the study was to investigate how older people (60+) experience the ageing body and how these experiences affect aged peoples' sense of identity. Explorative, open ended, interviews were conducted with 13 respondents between the ages of 63 and 82, recruited from a retired peoples' organisation, Church organisations, and from the working population. The qualitative data was analysed with a phenomenological method, the so called EPP method, the empirical phenomenological psychological method. The results showed that generally the experience of the ageing body has to do with a changed life world, reactions to this change in terms of body and self, and finding ways to feel at home in this changed situation. Results are presented as three typologies, reflecting the different ways in which the respondents described this general experience: existential awakening, making it good enough, and new possibilities. The results give support to the research that points out the importance of activity for the self esteem of the elderly. According to this study, however, the meaning of "activity" can vary and can have different sources of motivation. Respondents in only one typology expressed frustration over limitations of the ageing body. Respondents exhibited entirely different ways of relating to the fact that death was approaching, which raises questions about how the elderly experience this impending horizon. Finally, the gender differences in this small study were quite clear: all the male respondents belonged to the typology "New possibilities", raising questions about gender aspects concerning the meaning of freedom, appearance, activity, and self esteem.

A phenomenological study of fibromyalgia. Patient perspectives.

OBJECTIVE: To describe the way in which the fibromyalgia patients understand the meaning of their illness. DESIGN: Qualitative, empirical phenomenological psychological method. SETTING: A collaborative transdisciplinary interview study of patients' described experiences of living with fibromyalgia. No therapeutic relationships existed between patients and researchers. SUBJECTS: Eighteen patients with fibromyalgia were interviewed. Ten of the 18 taped interviews were transcribed and analysed. MAIN OUTCOME MEASURES: Patients' narratives, described experiences of living with fibromyalgia. RESULTS: The patients were intensively involved in efforts to get their self-images as ill persons confirmed. Their experience was that the disease started dramatically, with a variety of capriciously appearing symptoms of unknown cause that gave rise to the suffering. The fibromyalgia patients seemed to develop strategies to cope with a precarious self-image and find ways to manage the thought of what the future would bring. CONCLUSION: The meaning structures revealed in the patients' ways of describing their experiences of living with fibromyalgia seemed to be partially constituted by their efforts to stand forth as afflicted with a disease, which could be a way to help them to manage the demands that they placed upon themselves.

Doctors' attitudes to fibromyalgia: a phenomenological study.

Besides specific technical skills, successful encounters with patients require an understanding of the many ways in which patients may express themselves. This qualitative study reports on the clinical experiences of doctors when meeting patients with fibromyalgia (FM). Ten strategically chosen rheumatologists and 10 GPs in central Sweden were interviewed. The interviews were taped, transcribed and analysed in accordance with the empirical, phenomenological, psychological method. The analyses indicate that doctors try to comply with the wishes and demands of patients, and at the same time avoid perceptions of personal frustration. They are inclined to be objective and to act instrumentally, apparently in order to keep in touch with what gave biomedical meaning to an otherwise incomprehensible phenomenon. The meaning structures revealed by doctors' descriptions of FM and of relating to FM patients were characterized mainly by the way in which the doctors were (i) managing their clinical uncertainty, (ii) adhering to the biomedical paradigm, (iii) prioritizing diagnostics, (iv) establishing an instrumental relationship, and (v) avoiding recognizing FM as a possible biomedical anomaly.

The development of novel and selective p56lck tyrosine kinase inhibitors.

Early T-cell receptor mediated signal transduction involves the activation of several tyrosine protein kinases. One of these tyrosine kinases, p56lck, is expressed primarily in T-cells and Natural Killer (NK) cells and has been shown to be critical for their proliferative and effector functions. Indandiones have been identified as a potent and selective chemical class that inhibits p56lck.

Antihyperglycemic activity of novel naphthalenyl 3H-1,2,3,5-oxathiadiazole 2-oxides.

A series of naphthalenyl 3H-1,2,3,5-oxathiadiazole 2-oxides was prepared and tested for antihyperglycemic activity in the db/db mouse, a model for type 2 (non-insulin dependent) diabetes mellitus. Substitution at the 1-, 5-, or 8-positions of the naphthalene ring with a halogen was found to be beneficial to antihyperglycemic activity. 4-[(5-Chloronaphthalen-2-yl)methyl]-3H-1,2,3,5-oxathiadiazole++ + 2-oxide (45), one of the most potent compounds in this series, was selected for further pharmacological evaluation.

Deciduous dental microwear of prehistoric juveniles from the lower Illinois River valley.

Scanning electron microscopy was used to study age-related changes in the dental microwear of 36 prehistoric juveniles ranging from 6 to 27 months of age. Juveniles from horticultural (Middle Woodland) and agricultural (Mississippian) groups were studied to allow an investigation of the impact of diet on deciduous microwear. Inclusion of both molars and incisors in the sample permitted identification of age at earliest appearance of wear and comparisons between the age-related microwear characterizing different tooth types. Data on feature frequency and enamel surface characteristics were analyzed. Microwear feature frequencies generally increase with age and/or exposure to wear. Enamel surface characteristics show consistent qualitative changes associated with both age and exposure to wear. Molars and incisors differ for such surface characteristics in a way that make biomechanical sense, given the relative bite forces characterizing these teeth. Dietary reconstruction based on deciduous microwear is complex because of the effects of both age and exposure to wear on feature frequencies and enamel surface characteristics. Nonetheless, the present analyses suggest that 1) diets differed for younger and older juveniles within each cultural group and 2) the Middle Woodland juvenile diet was both harder and more varied in physical consistency than the Mississippian juvenile diet.

Cervical osteotomy and manipulation in ankylosing spondylitis: successful general anesthesia after failed local anesthesia with sedation.

Ankylosing spondylitis is a disease that may deform any portion of the spine. Local anesthesia is generally recommended when undertaking corrective procedures for this problem. We present a case where local anesthesia was deemed unsatisfactory. Prior tracheal intubation facilitated the use of general anesthesia.

The effect of advancing age on the sympathetic response to laryngoscopy and tracheal intubation.

The effect of aging on the hemodynamic and sympathetic response to tracheal intubation was evaluated in 27 patients aged 18 to 80 years, ASA Class I and II, given atropine 0.4 mg and diazepam 10 mg as premedication and thiopental, 4.0 mg/kg, and succinylcholine 100 mg for anesthesia induction. Laryngoscopy and tracheal intubation was performed 60 seconds after induction. The elderly had significantly less chronotropic response to intubation 2, 3, 4, and 5 minutes after induction so that the maximum increase in heart rate above awake values was negatively correlated with age (R = -0.66, P less than 0.001). Baseline systolic blood pressure (SBP) and mean BP increased significantly with age (R = 0.81, P less than 0.001 and R = 0.76, P less than 0.001, respectively) but age was not significantly related to increases in SBP and mean BP following intubation. Baseline plasma norepinephrine (NE) levels increased with age ( R = 0.51, P less than 0.01). Following intubation, mean plasma NE concentrations were significantly higher in elderly patients than young patients, despite the diminished heart rate response. Heart rate (HR) per pg/ml of NE, a measure of cardiac sensitivity to beta stimulation, was therefore significantly less 2, 3, and 4 mins after induction in elderly patients than in younger patients. To determine if this alteration in cardiac sensitivity to endogenous catecholamines was reflected by changes in beta receptor function on lymphocytes, beta receptor density and the proportion of receptor binding agonist with high affinity (%RH) were measured. No significant correlation between beta-receptor affinity for agonist, %RH, or receptor density was found with age, HR, or HR per pg/ml NE.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of propofol and thiopental for the induction of anesthesia.

We compared the safety, efficacy, and side effects of induction of anesthesia with propofol (2.5 mg/kg), a new intravenous agent, and thiopental (4.0 mg/kg) in 62 patients in American Society of Anesthesiologists class I or II. There was no significant difference between induction times for the propofol (40.0 +/- 2.0 sec) and thiopental (44.0 +/- 4.0 sec) groups. Propofol administration produced a significant fall (P less than .05) in systolic blood pressure (SBP), from 134.1 +/- 2.6 mm Hg before injection to 128.3 +/- 2.4, 118.2 +/- 2.7, and 114.4 +/- 2.8 mm Hg one, two, and three minutes after injection, respectively. Diastolic blood pressure (DBP) fell significantly (P less than .05) during the three postinjection periods. Heart rate (HR) rose significantly (P less than .05), from 78.6 +/- 3.1 beats per minute before injection to 89.4 +/- 3.4 beats per minute one minute after injection. In patients given thiopental, SBP fell significantly (P less than .05), from 131.7 +/- 2.7 mm Hg before induction to 126.4 +/- 3.4 and 126.9 +/- 4.0 mm Hg two and three minutes after injection, respectively. The DBP did not change significantly in the thiopental group, but the HR rose significantly (P less than .05), from 73.3 +/- 2.8 beats per minute before injection to 83.9 +/- 3.0, 90.1 +/- 2.3, and 84.2 +/- 2.4 beats per minute one, two, and three minutes after injection, respectively. In 94% of patients given propofol, there were apneic periods of more than 60 seconds, compared to 50% in the thiopental group (P less than .05). There was a significant difference (P less than .05) between groups for the incidence of pain on injection; 31% of the patients receiving propofol had pain, compared to 3% of those receiving thiopental.

Holographic correction of aberrations using PLZT.

We describe the aberration correction capabilities of a holographic recording device made of antiferroelectricphase (7.6/70/30) ion-implanted lead lanthanum zirconate titanate. After a review of holographic aberration correction and a description of the device's holographic storage mode, we describe the experiment used to store a hologram which reduced approximately ten waves of aberration to a fifth of a wave. Star tests and interferograms demonstrate the accuracy of the correction.

Coxsackie B5 heart disease. Demonstration of inferolateral wall myocardial necrosis.

A case of Coxsackie B5 viral myopericarditis is presented in which the diagnosis of inferolateral wall myocardial necrosis was made on the basis of specific cardiac enzyme changes and radionuclide myocardial imaging. This localized damage may have resulted from coronary arteritis with resulting infarction or necrosis secondary to preferential viral involvement of the inferolateral wall of the myocardium. Hepatitis and cerebral embolism complicated the case, with the latter suggesting endocardial disease.