Correlation of light microscopic findings with transmission electron microscopy within a vascular occlusion device.

Host response to an implanted biomaterial is a complex process involving microscopic changes in extracellular matrix (ECM) composition. Reliable pathology analysis is imperative for accurate assessment of the tissue response to an implanted device. Plastic histology is commonly used for histology evaluation of medical devices to assess the device-tissue interface; however, this technique is prone to variable staining that can confound histology interpretation. Appropriately, we propose using transmission electron microscopy (TEM) to confirm histologic ECM findings in order to provide sufficient host-response data. Tissue response to an absorbable shape memory polymer intravascular occlusion device with a nitinol wire backbone was evaluated. Representative plastic-embedded, micro-ground sections from 30-day, 60-day, and 90-day timepoints were analyzed. ECM regions were selected, and ultrathin sections were created for TEM evaluation. Histological changes in ECM composition were compared for light microscopy (LM) and TEM findings; specifically, TEM fibrillary patterns for collagen and fibrin were used to confirm LM results. Throughout this study, LM reveals inconsistent staining in plastic-embedded sections. TEM, on the other hand, provides clear insight into the tissue response by morphologically discerning distinct fibrillary patterns within ECM structures; loose to dense collagen surrounds the implant as fibrin degrades, demonstrating progression of postimplant ECM maturation. Moreover, TEM serves as a definitive method for confirming tissue substrate morphology when LM findings prove ambiguous.

Chemical characterization, antioxidant and antimicrobial activity of propolis obtained from Melipona quadrifasciata quadrifasciata and Tetragonisca angustula stingless bees.

In this study, we investigated the chemical composition, and antioxidant and antibacterial properties of ethanolic extracts of propolis (EEP) from Melipona quadrifasciata quadrifasciata and Tetragonisca angustula. Chemical composition of EEP was determined by colorimetry and chromatographic (HPLC-DAD and UPLC-Q/TOF-MS/MS) analysis. Antimicrobial activity of EEP was evaluated against gram-positive (S. aureus, methicillin-resistant S. aureus, E. faecalis) and gram-negative (E. coli and K. pneumoniae) bacteria by the minimal inhibitory concentration (MIC) test using the microdilution method. Furthermore, the growth curve and integrity of cell membrane of S. aureus and E. coli were investigated using standard microbiological methods. HPLC-DAD analysis showed that the EEP of M. quadrifasciata quadrifasciata has a more complex chemical composition than the EEP of T. angustula. Moreover, UPLC-MS analyses of M. quadrifasciata quadrifascita indicated flavonoids and terpenes as major constituents. The bactericidal activity of both EEPs was higher against gram-positive bacteria than for gram-negative bacteria. The EEP from M. quadrifasciata quadrifasciata presented MIC values lower than the EEP from T. angustula for all tested bacteria. The EEP from M. quadrifasciata quadrifasciata caused lysis of the bacterial wall and release of intracellular components from both E. coli and S. aureus. Our findings indicate that the chemical composition of propolis from stingless bees is complex and depends on the species. The extract from M. quadrifasciata quadrifascita was more effective against gram-positive than gram-negative strains, especially against S. aureus and methicillin-resistant S. aureus compared to T. angustula extract, by a mechanism that involves disturbance of the bacterial cell membrane integrity.

Immersion research education: students as catalysts in international collaboration research.

BACKGROUND: This paper describes an international nursing and health research immersion program. Minority students from the USA work with an international faculty mentor in teams conducting collaborative research. The Minority Health International Research Training (MHIRT) program students become catalysts in the conduct of cross-cultural research. AIM: To narrow the healthcare gap for disadvantaged families in the USA and partner countries. METHODS: Faculty from the USA, Germany, Italy, Colombia, England, Austria and Thailand formed an international research and education team to explore and compare family health issues, disparities in chronic illness care, social inequities and healthcare solutions. USA students in the MHIRT program complete two introductory courses followed by a 3-month research practicum in a partner country guided by faculty mentors abroad. The overall program development, student study abroad preparation, research project activities, cultural learning, and student and faculty team outcomes are explored. RESULTS: Cross-fertilization of research, cultural awareness and ideas about improving family health occur through education, international exchange and research immersion. Faculty research and international team collaboration provide opportunities for learning about research, health disparities, cultural influences and healthcare systems. The students are catalysts in the research effort, the dissemination of research findings and other educational endeavours. Five steps of the collaborative activities lead to programmatic success. CONCLUSIONS: MHIRT scholars bring creativity, enthusiasm, and gain a genuine desire to conduct health research about families with chronic illness. Their cultural learning stimulates career plans that include international research and attention to vulnerable populations.

Epidemiology of invasive neonatal Cronobacter (Enterobacter sakazakii) infections.

About 120-150 neonatal Cronobacter spp. (Enterobacter sakazakii) infections have been described. An analysis of current case numbers, epidemiological measures and risk factors is warranted. Data of microbiologically confirmed cases, published between 2000 and 2008, have been analysed statistically. More than 100 neonatal Cronobacter infections have been reported in this period. The overall lethality of the 67 invasive infections was 26.9%. The lethality of Cronobacter meningitis, bacteraemia and necrotising enterocolitis (NEC) was calculated to be 41.9% (P < 0.0001), <10% and 19.0% (P < 0.05), respectively. Logistic regression models (P < 0.0001) revealed a higher gestational age at birth and parentage not from Europe as significant factors for a higher reporting probability of neonatal Cronobacter meningitis. Neonates with Cronobacter meningitis not originating from North America have a higher risk for lethal outcome than other neonatal Cronobacter infections (P < 0.0001). Continental differences of risk factors for Cronobacter meningitis and for the lethal outcome of neonatal meningitis should be elucidated. Neonatal Cronobacter infections are mainly associated with the contamination of infant formula and of the relevant cleaning and preparation equipment. Eleven neonatal Cronobacter infections, not caused by contaminated infant formula, have been retrieved. Other environmental sources of infection should be considered. Consistent and sufficiently informative data of invasive neonatal Cronobacter infections should be recorded in a centralized reporting system.

[Enterobacter sakazakii in powdered infant formula]. / Gesundheitliches Gefährdungspotenzial von Enterobacter sakazakii (Cronobacter spp. nov.) in Säuglingsnahrung.

Under inadequate hygienic conditions, opportunistic bacteria may multiply in powdered infant formula (PIF) and cause severe, often fatal neonatal infections. Enterobacter sakazakii has obtained Public Health relevance causing neonatal meningitis (often fatal), bacteremia and necrotizing enterocolitis. At highest risk are neonates up to two months of age. The new genus designation Cronobacter spp. nov. has been proposed to replace Enterobacter sakazakii. Enterobacter sakazakii is relatively resistant to osmotic and dry stress and may survive in PIF more than 2 years. (Inter)national organisations (EFSA, FAO, WHO, ESPGHAN, DGKJ, OGKJ, ISO) published their opinions recently. Manufacturers can minimize the risk of contamination of PIF by continuously improving technologies and by microbiological surveillance. Institutional and private consumers may reduce the risk of infection by using appropriate hygienic procedures.

Assessment of strategies in families tested by Finnish families.

The aim of this paper was to describe testing a Finnish version of the assessment of strategies in families (ASF) instrument and its construct validity and reliability in Finnish families. The ASF instrument is based on Friedemann's framework of systemic organization and the version used in this study consists of 25 items, each containing three statements. The instrument was developed to estimate family functioning in reaching the four targets of the framework of systemic organization. It provides sub-scores for the targets, family stability (system maintenance and coherence), family growth (system change and individuation), control (system maintenance and system change) and spirituality (individuation and coherence). Data were collected from patients attending the outpatient clinics of pulmonary and rheumatic diseases (N=196). Questionnaires were given to patients capable of understanding the questions and they returned questionnaires by mail directly to researchers. Construct validity was tested with exploratory factor analysis. Factor analysis was done with 22 items. The four factor solution was best suited. Two items were eliminated because of low factor loadings and crossloading. The total of 20 items were left in the instrument. Crohnbach's alpha was used to measure internal consistency. It was computed for each target separately and the total tool. There were discrepancies in the assignment of process dimensions which were expected because of cultural perceptions. The total instrument had a reliability of 0.85. The result of the analyses was a pretested tool with subscales for stability, growth, control and spirituality that have acceptable reliability and concept validity. Less satisfactory was the small number of items representing individuation. Another weakness is the lack of statistical distinction between system maintenance and coherence. The instrument is also usable in these subscales, but it needs further development and retesting. Items need to be added to express individuation, possibly some others. The new items will be formulated freely, paying attention to culture. However, the tool appears good enough to be used as measurement in various research studies.

Perceived family dynamics of persons with chronic pain.

This qualitative study was conducted to gain an understanding of the experiences of persons with chronic pain and their relationships with family members and the family as a whole. The framework of systemic organization was used to define the areas of investigation guiding the formulation of broad questions relative to family functioning. Thirty persons with chronic pain (age 31-82 years, 73% women, 83% married, 83% European-American, 17% African-American) participated in the study. A semi-structured interview was conducted to elicit narrative descriptions of the participants' perspective of the pain experience and family functioning. The data were analysed using a constant comparison method of analysis described by Strauss. The dominant themes that emerged included: (i) emotional distress, (ii) distancing from family members, (iii) inability to share difficult feelings, (iv) intense mutual involvement with family members and identification with others' problems, (v) family isolation from community, and (vi) attempt at healing. A mid-range theory developed out of the data and explicated with the framework of systemic organization, was one of balancing and counterbalancing connectedness (spirituality) with personal autonomy or separateness (control) in order to find congruence for the family and individuals within. The pain sometimes acted as a mechanism regulating the distance and closeness among family members. Based on this information, nurses can facilitate better understanding among family members, encourage autonomy, assist individuals to express feelings and needs more directly, and facilitate members to respond to each other.

Family involvement in the nursing home.

The focus of this study was the influence of preestablished family behavior patterns, family orientation of nursing home policies, and practices and caregiver and elder characteristics on the family members' expectations for involvement in the nursing home and the actual involvement 6 months later. The conceptual model was based on findings of Montgomery's nursing home study and open systems principles applicable to families. Data were collected through telephone interviews with 216 family members of residents in 24 nursing homes in southern Michigan. Regression analyses revealed that measures of preestablished patterns of family behavior accounted for 19% to 31% of variance in measures of expected family involvement. Expected family involvement, resident activities of daily learning (ADL), and caregiver relationship accounted for 11% to 23% of variance in measures of actual family involvement. Opportunity for family leadership in resident care had a mild effect of moderating the amount of family direct care and learning activities in the nursing home.

Family involvement in the nursing home: family-oriented practices and staff-family relationships.

Staff-family cooperation in caring for elders in nursing homes is recommended but poorly understood. Family involvement and staff-family interactions in nursing homes with differing family orientations were investigated. Friedemann's (1995) system-based family theory guided the study. Of all 208 licensed nursing homes in southern Michigan, 143 completed a survey about their family-oriented practices. Family orientation was ranked accordingly. Twenty-four nursing homes were randomly selected to conduct semistructured telephone interviews with 177 family members. Data were analyzed by thematic interpretation. Findings showed a wide range of involvement patterns that promoted family connectedness, maintenance of control, growth, and learning. Families desired various types of staff cooperation and were given such opportunities in homes with high family orientation.

[Do nurse clinicians influence the working climate and the quality of care? 2. Results]. / Beeinflussen Pflegeexpertinnen Arbeitsklima und Pflegequalität? Zweiter Tell: Die Resultate.

The second part of this report contains the most important knowledge and the results gained through the study carried out at the Inselspital Berne, Switzerland, concerning the influence a clinical nurse practitioner has on work environment and patient satisfaction. Nurses who had the support of a clinical nurse practitioners had better guidelines at their disposal and got more feedbacks than the others. There were, however, no great differences between the units with a clinical nurse practitioner and those without one regarding communication, motivation for further education and support in difficult patient situations. The motivation for higher education was remarkably high on all units. However, the nurses on the units with a clinical nurse practitioner showed more interest in psychological and social matters and they had according literature at their disposal. The patients were generally satisfied, although there were differences regarding trust of the patients in nurses. Patients of units with a clinical nurse practitioner addressed nurses more frequently and easily with their problems and questions than patients from other units. This case study showed that clinical nurse practitioners play an active and important role concerning teamwork, particularly by giving feedbacks and helping to create an atmosphere of support regarding personal continuing education, using all available resources, discussing patient situations, evaluating them and finding solutions.

A triangulation approach to testing a family instrument.

Sequential triangulation was used to test the validity of the Assessment of Strategies in Families (ASF), a screening tool for family effectiveness, and its application to families experiencing chronic pain. First, 30 subjects with chronic pain completed the questionnaire. Next, for the purpose of item validation, the subjects explained their thought process for each choice on the questionnaire. Results showed that they interpreted the items as intended. Subjects then responded to a semistructured interview about their perception about family stability and growth patterns. Thematic analysis suggested a tendency toward isolation from the community, intense involvement in each other's lives, and rigid control of family operations. ASF results reflected the trends by a low family-growth subscore, and a high or low stability score, depending on the success in achieving cooperation of family members. The findings suggest the instrument is valid and appropriate to screen families with chronic pain.

[Do clinical nurse practitioners affect the working environment and the quality of care?]. / Beeinflussen Pflegeexpertinnen Arbeitsklima und Pflegequalität?

This correlational study examined the influence of a new kind of advanced nurse practitioner in Switzerland with the role of providing complex care, consulting with patients and families, fostering the growth of staff, enhancing team functioning and contributing to nursing knowledge through research. Based on systems theory the perception of staff about their work environment and their motivation to engage in continuing education as well as the patients' satisfaction with care and trust in the nurses were measured outcomes. Instruments were constructed for this study, tested and standardized. Data from three hospital units with an advanced practitioner were compared to three units without a practitioner similar in size, staffing, patient acuity and system of nursing care. Staff reported better guidelines for care, more frequent feedback and better professional advice on units with an advanced practitioner while the quality of communication, professional stimulation and support with difficult patients was comparable on all units. Motivation to further one's education was generally high. In units with an advanced practitioner, there was increased interest in psychosocial topics, and the availability of such literature was better. Patients were highly satisfied in all units, but there was a slight difference in patient trust. It was somewhat easier for patients on units with an advanced practitioner to ask the nurses questions. The study suggested that the advanced practitioner should contribute most by strengthening team cohesion through constructive feedback as well as enhancing a climate for continuing learning through better resources, guided case discussions and opportunities for shared problem solving.

In vivo electrochemical measurements of serotonin clearance in rat striatum: effects of neonatal 6-hydroxydopamine-induced serotonin hyperinnervation and serotonin uptake inhibitors.

Diffusion and clearance of extracellular serotonin (5-HT) was examined using in vivo chronoamperometry with "delayed-pulse" recordings after pressure ejections of 1 to 60 picomoles 5-HT into rat striatum at a fixed distance from a Nafion-coated carbon fiber electrode. Signals obtained were identified based on the signal characteristics to consist of 5-HT. Clearance times of 5-HT decreased, while amplitudes and rise times increased with serotonergic hyperinnervation induced by neonatal 6-hydroxydopamine (6-OHDA) lesions of dopamine (DA) neurons. Local applications of the 5-HT uptake inhibitors zimelidine or fluoxetine, in conjunction with 5-HT ejections, produced increased clearance times in both normal and 6-OHDA-treated animals. Thus, direct in vivo evidence was obtained for the importance of high affinity nerve terminal uptake as a key mechanism for clearance of 5-HT from the extracellular space. Inhibitors of 5-HT uptake appear to prolong the extracellular presence of 5-HT by increasing its clearance time.

o-Phenylenediamine-modified carbon fiber electrodes for the detection of nitric oxide.

Nitric oxide (NO.) sensors were prepared using o-phenylenediamine (o-PD) and Nafion to modify the surface of 30 microns diameter carbon fiber electrodes. These electrodes were compared with nickel porphyrin-type NO. sensors that have already been described. High-speed chronoamperometry, amperometry, and differential pulse voltammetry were used to compare the performance of sensors modified with various combinations of Nafion, o-PD, or nickel(II) meso-tetrakis(3-methoxy-4-hydroxyphenyl) porphyrin (Ni-TMPP), in order to determine which electrodes had the most sensitivity and selectivity for NO. Our findings showed that electrodes treated with Nafion first, followed by o-PD, were very sensitive to NO., with a detection limit of 35 +/- 7 nM. In addition, o-PD electrodes were also very selective against ascorbate (> 600:1), dopamine (> 300:1), and nitrite (> 900:1). Moreover, in the range of 0-6 microM NO., o-PD electrodes displayed excellent linearity (R2 > or = 0.997). In contrast, Ni-TMPP electrodes (with Nafion) had significantly poorer detection limits (76 +/- 12 nM) and were less selective against dopamine (< 5:1) and nitrite (< 200:1). Ni-TMPP electrodes were also less linear than o-PD electrodes (R2 > or = 0.911). Finally, we tested the in vitro and in vivo performance of the o-PD electrode in terms of its ability to detect NO. release from isolated rat renal arterioles and to measure NO. diffusion in the extracellular space of the rat brain.

In vivo electrochemical studies of the dynamic effects of locally applied excitatory amino acids in the striatum of the anesthetized rat.

The actions of locally applied excitatory amino acids (EAAs) on dopamine nerve terminals in the striatum of the urethane-anesthetized rat were investigated. Rapid (5 Hz) in vivo electrochemical recording was used to measure the amplitude and duration of dopamine (DA) overflow elicited by the local application of glutamate, N-methyl-D- aspartate (NMDA), kainate, quisqualate, quinolinate and DL- alpha-amino-3-hydroxy-5-methylisoxazolepropionic acid. EAAs were pressure ejected into the striatum via a pipette positioned 300 +/- 30 mum away from the electrochemical working electrode. Brief (5s) applications of the EAA agonists directly elicited DA-like electrochemical signals with amplitudes averaging about 2 microM. In some instances, putative increases in ascorbic acid-like signals were detected. Repeated applications of glutamate agonists in the same brain site resulted in diminished electrochemical responses, compared to the complete reproducibility seen after repeated applications of 120 mM potassium. Low doses of NMDA (10 mM barrel conc), which did not cause a detectable increase in the electrochemical baseline signal, significantly potentiated (50%) potassium-evoked DA overflow. These results indicate that low levels of endogenously released glutamate may modulate overflow when DA nerve terminals are depolarized, while higher concentrations of glutamate may directly elicit increases in extracellular levels of DA and/or ascorbic acid.

Effects of ALANON attendance on family perception of inner-city indigents.

This study investigated the perception of family functioning of rehabilitating inner-city substance abusers and one of their family members. Subjects were 39 residents of a treatment center and 39 family members. The design was compromised experimental, comparing the group who had family members in ALANON (n = 36) with a nonrandomized control group whose family members had no help (n = 42). Data were collected three times: at the beginning of the abuser's treatment, at the end, and one month after treatment. Subjects completed two family functioning instruments: Assessment of Strategies in Families (ASF) and Family APGAR. Repeated-measure MANOVAs yielded significant differences in all family scores between the ALANON and the control groups. An increase in the perception of family effectiveness was most pronounced between time 2 and time 3, after the substance abuse program was completed. Family members changed their perceptions more than the abusers and maintained their favorable family perception, even though five of the abusers had relapsed shortly after discharge. At 3 months after treatment, the relapse rate for addicts in the ALANON group (n = 15) was 39% compared with 61% for addicts in the control group (n = 18). The difference was not of statistical significance due to the small group sizes, however. Evidence suggests the usefulness of ALANON in empowering families and assisting them in reevaluating the family system more positively.

Effects of the putative antidepressant, ABT 200, on the clearance of exogenous norepinephrine in rat cerebellum.

ABT 200 [(RR,SS)-3-phenyl-1-[1',2',3',4'-tetrahydro-5',6'-methylenedioxy- 1'-naphthalenyl-methyl]-pyrrolidine methanesulfonate] is a potent alpha 2-adrenoceptor antagonist (Ki = 1.2 nM) with modest norepinephrine uptake-blocking activity (IC50 = 841 nM) that is currently under clinical evaluation as an antidepressant. The effects of ABT 200, nomifensine (an inhibitor of catecholamine uptake), and rauwolscine (a selective alpha 2-adrenoceptor antagonist) on the clearance of exogenous norepinephrine in the cerebellum of urethane-anesthetized rats was investigated using a vivo electrochemistry. Chronoamperometric recordings were continuously made at 5 Hz using Nafion-coated, single carbon fiber electrodes. When a calibrated amount of norepinephrine was pressure-ejected at 5-min intervals from a micropipette adjacent (290-330 microM) to the electrode, transient and reproducible norepinephrine signals were detected. In response to systemic ABT 200 (30 mg/kg i.p.) or nomifensine (30 mg/kg i.p.), the signals increased in both amplitude and time course, indicating significant inhibition of the norepinephrine transporter. A lower dose (15 mg/kg i.p.) of either ABT 200 or nomifensine had no effect in this paradigm. Local application of ABT 200 (400 microM) or nomifensine (400 microM) prior to pressure-ejection of norepinephrine also significantly increased the amplitude and time course of the norepinephrine signals. In contrast, systemic administration of rauwolscine (30 mg/kg i.p.) or vehicle solution, and local application of vehicle solution, had no effect on the norepinephrine signals. These data indicate that at the higher dose evaluated, both ABT 200 and nomifensine inhibit cerebellar norepinephrine uptake in vivo.

Effects of glial cell line-derived neurotrophic factor on developing and mature ventral mesencephalic grafts in oculo.

The search for trophic factors that can support injured dopaminergic neurons and can enhance dopaminergic graft survival and outgrowth for therapeutic uses in Parkinson's disease has lately focused on members of the transforming growth factor (TGF) beta super-family. In this paper we have studied the effects of a member of the TGB beta family, glial cell line-derived neurotrophic factor (GDNF), on immature and mature ventral mesencephalic tissue grafted to the anterior chamber of the eye. The results confirm that GDNF increases survival of TH-positive neurons and enhances TH-immunoreactive nerve fiber formation when the grafts are treated during their development. The distribution of nerve terminals is densest within the area of TH-immunoreactive neurons and at the surface of the grafts. However, there is no change in the number of calcium-binding protein (CaBP)-positive neurons, suggesting that the subpopulation of TH-positive neurons that is increased are the CaBP-negative neurons of the ventral tier of pars compacta. Terminals from those neurons form the striatal patches during normal development. When the grafts are treated with GDNF after maturation, no change in TH-positive cell survival is seen but an increase of nerve terminals is still found within the cell dense area of the graft. Potassium-evoked dopamine release, measured using in vivo chronoamperometry, revealed significantly increased extracellular overflow in transplants treated with GDNF during development. The dopamine uptake blocker nomifensine significantly increased the time for clearance of the released dopamine. These data suggest that GDNF treatment of immature grafts enhances survival of TH-positive neurons, which would have innervated the striatal patches, and also increases TH-immunoreactive nerve fiber formation and dopamine release. Furthermore, GDNF treatment of mature grafts also increases dopamine fiber formation within the TH-positive neuronal area, indicating that adult dopaminergic neurons are also responsive to this agent.

Family health and mental health six years after economic stress and unemployment.

This study is a follow-up of 39 working class couples who were interviewed after suffering economic stress or unemployment and again six years later. Repeated measures related to economics, stress, family functioning, anxiety, and depression were collected and analyzed for couples and for husbands and wives separately. A model of long-term coping was suggested for future testing. Initially stressed families appeared to grow stronger. Mental health correlated negatively to family problems. Depressed wives seemed to maintain their depression over time if they perceived family life as stressful. Irrespective of marital problems, husbands were less likely to stay depressed.

Perceptions of inner city substance abusers about their families.

This study involved 12 in-depth interviews of inner city rehabilitating substance abusers. An exploration of their perception about their families of origin and their families of today was the purpose of this study. The topic outline, coding system, and qualitative analysis was guided by concepts of the framework of systemic organization. Common family characteristics were lack of togetherness, nonexistent or peripheral role of fathers, and underused or overused controlling power with victimization of the weakest. Regenerative strengths were seen in some families. Family integration of addicts seemed more difficult than anticipated by the subjects and demanded major changes in family processes.