Assessment of the stroke patient using the NIH stroke scale.

The NIH scale requires no advanced expertise to complete. Any level of EMS provider can use the form if given proper orientation and training, with an in-service to explain the form and clear up any ambiguous language in it. Scenario-based practice sessions following a short class are ideal. A nurse from a hospital's stroke team would be the best person to teach the class, since he/she would be intimately familiar with the form and how to use it. The NIHSS is the ideal assessment tool to make prehospital examination of stroke patients more aggressive. Although ideal, the NIHSS should only be used when transport time allows. By no means should a stroke patient's transport be delayed to administer the scale. If conditions and time do not allow, the provider should revert back to the CPSS as an assessment tool. If transport time allows, however, the NIHSS is the proper exam to use. It is aggressive, simple to use and cases the transition of the patient from ambulance to emergency department. It also saves time for the patient by allowing the doctor to provide proper treatment more quickly. The forms are free to copy from the NIHSS and, therefore, costs are minimal to implement its use. Any solution that assists patient, physician and provider in an aggressive yet economical manner needs to be implemented. The positive aspects of the NIHSS in prehospital care span across the board and will be realized in patient care.

Isolation of a 250 million-year-old halotolerant bacterium from a primary salt crystal.

Bacteria have been found associated with a variety of ancient samples, however few studies are generally accepted due to questions about sample quality and contamination. When Cano and Borucki isolated a strain of Bacillus sphaericus from an extinct bee trapped in 25-30 million-year-old amber, careful sample selection and stringent sterilization techniques were the keys to acceptance. Here we report the isolation and growth of a previously unrecognized spore-forming bacterium (Bacillus species, designated 2-9-3) from a brine inclusion within a 250 million-year-old salt crystal from the Permian Salado Formation. Complete gene sequences of the 16S ribosomal DNA show that the organism is part of the lineage of Bacillus marismortui and Virgibacillus pantothenticus. Delicate crystal structures and sedimentary features indicate the salt has not recrystallized since formation. Samples were rejected if brine inclusions showed physical signs of possible contamination. Surfaces of salt crystal samples were sterilized with strong alkali and acid before extracting brines from inclusions. Sterilization procedures reduce the probability of contamination to less than 1 in 10(9).

Testing visual acuity in the emergency department: a simple method of correcting refractive error by using the hand-held ophthalmoscope.

The assessment of visual acuity is an important part of the emergency ophthalmologic examination. The ability to distinguish refractive error from other etiologies of decreased visual acuity is necessary to adequately evaluate visual function. A readily available source of corrective lenses can be found in the hand-held ophthalmoscope. These lenses can be used to identify and quantitate refractive errors and assist in identifying serious ocular pathology.