Understanding dementia is vital in all health care staff

As the Australian population continues to age, health care staff will come into contact with and care for increasing numbers of people with dementia. A basic understanding of dementia is important to the quality of these interactions. This article summarises recently published research on levels of knowledge of Alzheimer’s disease among health care staff in an Australian regional health district (Smyth, Fielding, Beattie, Gardiner, Moyle, Franklin, Hines & MacAndrew, 2013).

Putting vital stains in context

While vital staining remains a cornerstone in the diagnosis of ocular disease and contact lens complications, there are many misconceptions regarding the properties of commonly used dyes by eye-care practitioners and what is and what is not corneal staining after instillation of sodium fluorescein. Similarly, the proper use and diagnostic utility of rose Bengal and lissamine green B, the other two ophthalmic dyes commonly used for assessing ocular complications, have similarly remained unclear. Due to the limitations of vital stains for definitive diagnosis, concomitant signs and symptoms in addition to a complete patient history are required. Over the past decade, there have been many reports of a type of corneal staining—often referred to as solution-induced corneal staining (SICS)—that is observed with the use of multipurpose solutions in combination with soft lenses, more specifically silicone hydrogel lenses. Some authors believe that SICS is a sign of lens/solution incompatibility; however, new research shows that SICS may be neither a measure of lens/solution biocompatibility nor ‘true’ corneal staining, as that observed in pathological situations. A large component of SICS may be a benign phenomenon, known as preservative-associated transient hyperfluorescence (PATH). There is a lack of correlated signs and/or symptoms with SICS/PATH. Several properties of SICS/PATH, such as appearance and duration, differentiate it from pathological corneal staining. This paper reviews the properties of vital stains, their use and limitations in assessment of the ocular surface, the aetiology of corneal staining, characteristics of SICS/PATH that differentiate it from pathological corneal staining and what the SICS/PATH phenomenon means for contact lens-wearing patients.

Response to re : putting vital stains in context

A response to: "Re: Putting vital stains in context" by Eric Papas & Lyndon Jones, published in the same issue of this journal. "There has been considerable discussion in recent times about the origins of solution-induced corneal staining (SICS) and I welcome this opportunity to further clarify some points raised in my paper1 in relation to certain issues highlighted by Drs Papas and Jones.2 Part of the difficulty in understanding these phenomena relates to the imprecise terminology used. For example, Drs Papas and Jones state ‘. . . SICS..."

Response to re : putting vital stains in context

A response to "Re: Putting vital stains in context" by Charles W McMonnies, published in the same issue of this journal. "I thank Professor McMonnies for his thoughtful comments,1 which rightly forcemeto more directly address the clinical ramifications of solution-induced corneal staining (SICS). I concur with his observation that determining whether the staining can be attributed to preservative-associated transient hyperfluorescence (PATH) or true pathology can be difficult in a typical clinical situation, perhaps requiring two visits in a single day. There is no easy answer to this dilemma..."

Vital role of journalism underlined

Book Review of 'Tragedy at Pike River Mine: How and why 29 men died', by Rebecca Macie. Wellington: AWA Press, 2013, 224 pp. ISBN 9781877551901

The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: A cross sectional study

BACKGROUND: Registered nurses and midwives play an essential role in detecting patients at risk of deterioration through ongoing assessment and action in response to changing health status. Yet, evidence suggests that clinical deterioration frequently goes unnoticed in hospitalised patients. While much attention has been paid to early warning and rapid response systems, little research has examined factors related to physical assessment skills. OBJECTIVES: To determine a minimum data set of core skills used during nursing assessment of hospitalised patients and identify nurse and workplace predictors of the use of physical assessment to detect patient deterioration. DESIGN: The study used a single-centre, cross-sectional survey design. SETTING and PARTICIPANTS: The study included 434 registered nurses and midwives (Grades 5-7) involved in clinical care of patients on acute care wards, including medicine, surgery, oncology, mental health and maternity service areas, at a 929-bed tertiary referral teaching hospital in Southeast Queensland, Australia. METHODS: We conducted a hospital-wide survey of registered nurses and midwives using the 133-item Physical Assessment Skills Inventory and the 58-item Barriers to Registered Nurses’ Use of Physical Assessment scale. Median frequency for each physical assessment skill was calculated to determine core skills. To explore predictors of core skill utilisation, backward stepwise general linear modelling was conducted. Means and regression coefficients are reported with 95% confidence intervals. A p value < .05 was considered significant for all analyses. RESULTS: Core skills used by most nurses every time they worked included assessment of temperature, oxygen saturation, blood pressure, breathing effort, skin, wound and mental status. Reliance on others and technology (F = 35.77, p < .001), lack of confidence (F = 5.52, p = .02), work area (F = 3.79, p = .002), and clinical role (F = 44.24, p < .001) were significant predictors of the extent of physical assessment skill use. CONCLUSIONS: The increasing acuity of the acute care patient plausibly warrants more than vital signs assessment; however, our study confirms nurses’ physical assessment core skill set is mainly comprised of vital signs. The focus on these endpoints of deterioration as dictated by early warning and rapid response systems may divert attention from and devalue comprehensive nursing assessment that could detect subtle changes in health status earlier in the patient's hospitalisation.

Structural Integrity of the Greek Key Motif in beta gamma-Crystallins Is Vital for Central Eye Lens Transparency

Background: We highlight an unrecognized physiological role for the Greek key motif, an evolutionarily conserved super-secondary structural topology of the beta gamma-crystallins. These proteins constitute the bulk of the human eye lens, packed at very high concentrations in a compact, globular, short-range order, generating transparency. Congenital cataract (affecting 400,000 newborns yearly worldwide), associated with 54 mutations in beta gamma-crystallins, occurs in two major phenotypes nuclear cataract, which blocks the central visual axis, hampering the development of the growing eye and demanding earliest intervention, and the milder peripheral progressive cataract where surgery can wait. In order to understand this phenotypic dichotomy at the molecular level, we have studied the structural and aggregation features of representative mutations. Methods: Wild type and several representative mutant proteins were cloned, expressed and purified and their secondary and tertiary structural details, as well as structural stability, were compared in solution, using spectroscopy. Their tendencies to aggregate in vitro and in cellulo were also compared. In addition, we analyzed their structural differences by molecular modeling in silico. Results: Based on their properties, mutants are seen to fall into two classes. Mutants A36P, L45PL54P, R140X, and G165fs display lowered solubility and structural stability, expose several buried residues to the surface, aggregate in vitro and in cellulo, and disturb/distort the Greek key motif. And they are associated with nuclear cataract. In contrast, mutants P24T and R77S, associated with peripheral cataract, behave quite similar to the wild type molecule, and do not affect the Greek key topology. Conclusion: When a mutation distorts even one of the four Greek key motifs, the protein readily self-aggregates and precipitates, consistent with the phenotype of nuclear cataract, while mutations not affecting the motif display `native state aggregation', leading to peripheral cataract, thus offering a protein structural rationale for the cataract phenotypic dichotomy ``distort motif, lose central vision''.

An extended Shine-Dalgarno sequence in mRNA functionally bypasses a vital defect in initiator tRNA

Initiator tRNAs are special in their direct binding to the ribosomal P-site due to the hallmark occurrence of the three consecutive G-C base pairs (3GC pairs) in their anticodon stems. How the 3GC pairs function in this role, has remained unsolved. We show that mutations in either the mRNA or 16S rRNA leading to extended interaction between the Shine-Dalgarno (SD) and anti-SD sequences compensate for the vital need of the 3GC pairs in tRNA(fMet) for its function in Escherichia coli. In vivo, the 3GC mutant tRNA(fMet) occurred less abundantly in 70S ribosomes but normally on 30S subunits. However, the extended SD:anti-SD interaction increased its occurrence in 70S ribosomes. We propose that the 3GC pairs play a critical role in tRNA(fMet) retention in ribosome during the conformational changes that mark the transition of 30S preinitiation complex into elongation competent 70S complex. Furthermore, treating cells with kasugamycin, decreasing ribosome recycling factor (RRF) activity or increasing initiation factor 2 (IF2) levels enhanced initiation with the 3GC mutant tRNA(fMet), suggesting that the 70S mode of initiation is less dependent on the 3GC pairs in tRNA(fMet).

El caso del cáncer avanzado del cuello uterino

Resumen: Se analiza el caso de una mujer de 42 años que padece un cáncer localmente avanzado de cuello uterino, asociado a una insuficiencia renal obstructiva, a la luz de las consideraciones éticas respecto al uso de los medios de preservación de la vida. Se discute la proporcionalidad y ordinariedad del uso de la derivación urinaria, en función de las condiciones clínicas evolutivas de estos pacientes.

Agotamiento vital en pacientes hipotiroideos antes y después del tratamiento con levotiroxina

Resumen: El objetivo de este trabajo fue comprobar la existencia de Agotamiento Vital (AV) en pacientes con Hipotiroidismo Primario (HP), si el tratamiento del HP modifica el AV, y si existe asociación entre TSH y respuesta del AV al tratamiento. Se agruparon estos teniendo en cuenta la similitud clínica entre el AV y el HP y el riesgo cardiovascular implicado. En una muestra de 31 mujeres con HP, se midió AV y TSH pre y pos tratamiento del HP. Posteriormente se estudió la relación entre el nivel TSH y la respuesta al AV. Conclusiones: La mayoría de los pacientes con HP presentaron AV, situación que se revierte luego del tratamiento del HP. Existe un grupo de pacientes en los que persiste el AV luego del tratamiento y en los cuales el valor de TSH es mayor que en los que el AV revierte.

Desarrollo de un nuevo soporte polímerico con componentes de matriz extracelular neural para su aplicación en la diferenciación "in vitro" de distintas células primarias

268 p. : il.

Soporte a la explotación de datos y gestión de una red de sensores

El seguimiento de distintas especies de animales contribuye en gran medida a su estudio y, por tanto, a su conservación y control. Los avances tecnológicos de los últimos años han facilitado las posibilidades de seguimiento con la creación de distintos dispositivos que permiten conocer los movimientos de la especie que se desea estudiar. Uno de los sistemas más utilizados consiste en la utilización de dispositivos GPS incorporados al espécimen sobre el que se realiza el seguimiento y cuya señal es recogida por satélites que se encargan de almacenar y posteriormente reenviar la información para su almacenamiento y procesamiento en el laboratorio. El principal problema de este sistema es su elevado coste. Existen alternativas que no presentan un coste tal alto, tales como el uso de módulos basados en telefonía móvil. Sin embargo, tienen limitaciones de cobertura, por lo que no es aplicable en todos los ámbitos. Este proyecto forma parte de una propuesta que ofrece realizar seguimiento de ejemplares de una especie de ave, la gaviota Patiamarilla, en Gipuzkoa mediante la utilización de una red de sensores y que tiene varias ventajas frente a las opciones presentadas anteriormente. En este proyecto en concreto se ha diseñado e implementado el módulo que permite recoger la información obtenida por el conjunto de sensores (cada ejemplar lleva incorporado un sensor que permite registrar su posición) y enviarla a un servidor centralizado para su posterior consulta y análisis. Adicionalmente, también se permite consultar el último estado registrado de cada dispositivo de seguimiento, además de contemplar la posibilidad de actualizar su software.

Familias monoparentales: satisfacción vital en madres jóvenes inmigrantes

[SPA] Conocer el bienestar psicológico subjetivo y satisfacción vital de quienes asumen la responsabilidad de las familias monoparentales mejora la acción educativa, ayudando a prevenir situaciones de riesgo y exclusión social. Este trabajo presenta el análisis de la satisfacción vital expresada por un grupo de madres jóvenes inmigrantes al frente de familias monomarentales usuarias del Programa Beregain de la Fundación Itaka-Escolapios (Bilbao). Se realizaron entrevistas individuales semiestructuradas a las madres que integran la muestra. El análisis e interpretación de datos se llevaron a cabo conforme a una metodología cualitativa, específicamente el estudio de casos. Los resultados revelaron la escasa satisfacción en ciertos ámbitos vitales relacionados con las relaciones interpersonales, el ocio, la conciliación del cuidado de sus hijos/as con la propia formación, y la imposibilidad de hacer frente a los gastos económicos sin la ayuda que reciben por parte de la fundación.