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The Cloutterbuck Minimum Data Matrix (CMDM) is an effective model to prepare nursing students for practice in the 21st century. Use of the CMDM challenges students to think critically, reflect on the changes occurring in the structure and financing of the health care system, and consider the 'big picture view' of health and the many factors that impinge on it, all within the context of an increasingly diverse and independent consumer population. This article describes how the CMDM was used to guide the selection and organization of content and teaching-learning strategies for a senior-level community health nursing course in a baccalaureate program. The CMDM provided direction for the curriculum, nature and sequence of the content, practicum settings, student requirements, and teaching-learning strategies for the course. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although nurses depend heavily on informal family caregivers to provide care to clients and to be involved in care planning and decision-making, no nursing theories that include the client, the caregiver, and the nurse were available to guide collaborative care planning and decision-making. AIM: The purpose of this paper is to describe the construction and initial testing of the theory of collaborative decision-making in nursing practice for a triad. The theory represents an extension of Kim's theory of collaborative decision-making in nursing practice. Kim's theory was developed to describe and explain collaborative decision-making in a dyad (client and nurse). The inclusion of a third person (family caregiver) in the theory required the addition of concepts about the caregiver, coalition formation, and nurse and caregiver outcomes. The expansion of Kim's dyadic theory to a triadic theory was achieved by means of a modified version of the theory derivation process described by Walker and Avant. CONCLUSIONS: The theory of collaborative decision-making in nursing practice for a triad can be used to guide further research and clinical practice. The theory provides a framework for researchers who are interested in studying the effects of collaboration regarding decision-making among nurses, family caregivers, and clients. The initial testing of the new theory in home health care nursing revealed variety in the nature of the client-caregiver-nurse relationships, the many processes used by the nurses in proceeding with the home visits, a multitude of decisions considered and different collaborative, noncollaborative, and coalition-forming interactions. The limited evidence of the empirical adequacy of the theory precludes development of definitive guidelines for clinical practice at this time. More studies are required before clinical practice guidelines can be developed. [ABSTRACT FROM AUTHOR]

Melanoma in-transit metastases (ITMs) can sometimes be difficult to manage by surgical excision due to their number, size or location. Treatment by intralesional injection of PV-10, a 10% solution of rose bengal, has been reported to be a simple, safe and effective alternative, but more outcome data are required to confirm its value in the management of ITMs. Two hundred and twenty-six melanoma ITMs in 48 patients were treated with intralesional PV-10 supplied under a special-access scheme. By 8 weeks a complete response in all injected ITMs was achieved in 22 patients (46%) and a partial response in 19 patients (40%). Of 19 patients who had uninjected metastases, 3 (16%) had a response in these. The most common adverse event was transient localised pain in injected tumours. New ITMs developed in 25 patients within 8 weeks, and later in another 8 patients. Repeat injection cycles were given to 21 patients: 13 of these received repeat injection into partially responding or nonresponding tumours, 5 had new ITMs, as well as partially-responding lesions injected, and 3 received injection into new ITMs only. Twenty-two patients received subsequent systemic therapy. At 1 year 37 of the 48 patients were alive, 28 with melanoma, and at 2 years 27 were alive, and 19 with melanoma. Injection of PV-10 was simple and safe and resulted in tumour involution in most patients and sometimes in noninjected tumours. However, many patients developed new lesions; these were treated by further PV-10 injections or with alternative therapies., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To determine the potential for delafloxacin to select for resistant mutants in methicillin-resistant Staphylococcus aureus (MRSA), including isolates with existing mutations in the quinolone resistance determining region (QRDR)., Methods: Susceptibility testing by broth microdilution was performed on 30 MRSA clinical isolates. For four of these isolates, the presence or absence of mutations in the QRDR was characterized. Resistance selection was performed on these four isolates by spreading cells on drug-containing agar plates followed by incubation for 48 h. Resistance frequencies and mutant prevention concentrations (MPCs) were calculated for each; PCR amplification and sequencing were performed using standard methods to characterize mutations in the QRDR. Growth rate analysis was performed and relative fitness was determined., Results: Delafloxacin demonstrated potent in vitro activity against this set of MRSA isolates, with MICs of 0.008-1 mg/L and an MIC(50) and MIC(90) of 0.03 and 0.5 mg/L, respectively. Spontaneous delafloxacin resistance frequencies for the MRSA strains were 2 × 10(-9) to <9.5 × 10(-11). Delafloxacin MPCs were one to four times the MIC for any isolate, lower than those of comparator quinolones. Some delafloxacin-selected mutants showed a fitness cost when co-cultured with the parent strain., Conclusions: Delafloxacin demonstrates excellent antibacterial potency and exhibits a low probability for the selection of resistant mutants in MRSA. Although mutants can be selected at low frequencies in vitro from quinolone-resistant isolates, delafloxacin MICs and MPCs remain low and a fitness cost can be observed. Consequently delafloxacin warrants further investigation for the potential treatment of drug-resistant MRSA infections.

The Cloutterbuck Minimum Data Matrix (CMDM) is an effective model to prepare nursing students for practice in the 21st century. Use of the CMDM challenges students to think critically, reflect on the changes occurring in the structure and financing of the health care system, and consider the "big picture view" of health and the many factors that impinge on it, all within the context of an increasingly diverse and independent consumer population. This article describes how the CMDM was used to guide the selection and organization of content and teaching-learning strategies for a senior-level community health nursing course in a baccalaureate program. The CMDM provided direction for the curriculum, nature and sequence of the content, practicum settings, student requirements, and teaching-learning strategies for the course.

Bioassay-guided fractionation of the MeOH extract of Acacia tenuifolia using the engineered yeast strains 1138, 1140, 1353, and Sc7 as the bioassay tool resulted in the isolation of the three new saponins 3, 5, and 6 and the three known saponins 1, 2, and 4. The structures of the new compounds were established on the basis of HRMS, 1D and 2D NMR spectral data on the intact saponins, and GC-MS analyses of the sugars. Compounds 1,2 and 5,6 showed cytotoxicity against mammalian cell lines.

Bioassay-guided fractionation of a methanol extract of Albizia subdimidiata using the engineered yeast strains 1138, 1140, 1353, and Sc7 of Saccharomyces cerevisiae as the bioassay tool resulted in the isolation of the two active saponins 1 and 2; one of these, albiziatrioside A (1), is described for the first time. The structures of 1 and 2 were established on the basis of HRMS, 1D and 2D NMR spectral data, and GC--MS analysis of the sugar units. Both isolated compounds showed significant cytotoxicity against the A2780 cell line.

Purpose: To determine the roles of laparoscopic abdominal exploration (LE) and diagnostic peritoneal lavage (DPL) in the evaluation of abdominal stab wounds, we prospectively compared LE with mandatory celiotomy (MC) in 76 patients having anterior abdominal stab wounds penetrating the fascia over a 22-month period., Patients and Methods: Twenty-two patients underwent emergency celiotomy. The remaining patients were subjected to DPL and assigned to treatment by either celiotomy or initial LE with subsequent conversion to open exploration at the discretion of the attending surgeon., Results: Laparotomy was avoided in 55% of the 31 patients undergoing initial laparoscopy, and this group demonstrated a significant decrease in the incidence of nontherapeutic celiotomy, from 19% to 57% (P < 0.05), as well as decreased length of hospital stay (4 +/- 0.6 v 5.9 +/- 0.4 days; P < 0.05), and total hospital cost ($6119 +/- 756 v $8312 +/- 627; P < 0.05). There were no missed intraabdominal injuries or morbidity from laparoscopy identified in follow-up. The DPL (N = 36) was positive in 11 of the 12 patients with injury requiring surgical repair and was negative in 16 of the 25 patients not requiring repair. The sensitivity and specificity of DPL were 0.91 and 0.64 compared with 1.0 and 0.74 for laparoscopy., Conclusions: An algorithm to evaluate stable patients with anterior abdominal stab wounds and minimize overall costs of care, incidence of nontherapeutic celiotomy, and rate of missed injuries is suggested consisting of DPL followed by observation in patients with negative DPL and by laparoscopy in patients with positive DPL. Wounds to the thoracoabdominal region may be best evaluated by initial LE, as diaphragmatic wounds may result in a false-negative DPL.

Objective: Colloids are used clinically to minimize edema yet may have detrimental consequences on glomerular filtration. The purpose of this study is to assess the renal and hormonal effects of colloid supplementation in the fluid resuscitation of burn victims., Design: Analytic cohort study., Material and Methods: Immediately following their 24 hour post-burn fluid resuscitation with Ringer's lactate, six burn patients (% total body surface area burn 30-57%) were given primed, continuous infusions of inulin and p-aminohippuric acid for 6 hours. Albumin (25% solution, 3 mL/kg/h) was given for the final 4 hours of study., Measurements and Main Results: Albumin infusion increased plasma volume by 37%; however, glomerular filtration rate decreased by 32% (p < 0.05). There was no significant change in urine output, sodium excretion, or effective renal plasma flow. Plasma volume expansion with albumin normalized elevated basal levels of aldosterone and plasma renin activity., Conclusions: These findings illustrate that despite substantially increasing plasma volume, colloid infusions reduce glomerular filtration and may limit any associated diuresis. Furthermore, this study demonstrates that hormonal regulation of blood volume remains intact after moderate burn injury.

Acute abdominal compartment syndrome has recently been shown to raise intracranial pressure (ICP). This may increase the risk of ischemic neuronal damage by decreasing cerebral perfusion pressure. We report the successful management of a patient with severe multisystem injury in whom abdominal decompression dramatically reduced high ICP unresponsive to medical measures.

Objectives: To quantitate duplex Doppler measurements of splanchnic perfusion to determine if these measurements are reproducible in euvolemic humans and if such measurements are sensitive to mild degrees of systemic hypovolemia., Design: Prospective, nonrandomized, controlled trial., Setting: Clinical research center., Participants: Seven fasting, healthy male and female volunteers, ranging in age from 25 to 37 yrs and weighing 60 to 90 kg., Interventions: Pulse, blood pressure, hematocrit, and duplex Doppler measurements of the peak systolic velocity and time averaged velocity of the subdiaphragmatic aorta, celiac artery, and superior mesenteric artery were obtained at four time points. Time points I and II were on separate days before hemorrhage and consisted of routine blood donation of 450 mL. Time point III was immediately after blood donation. Time point IV was 24 hrs after donation. Estimated blood flow was calculated from time averaged velocity (estimated blood flow = 60[vessel cross-sectional area][time averaged velocity])., Measurements and Main Results: Vital signs and hematocrit remained without significant change at all time points. Peak systolic velocity, time averaged velocity, and estimated blood flow were also unchanged between measurements at time points I and II. However, after a mean reduction of 9.1% of total blood volume, duplex ultrasound detected significant decreases of 14.5% in celiac artery and superior mesenteric artery peak systolic velocity, as well as 15.1%, 17.3%, and 20.2% decreases in aorta, celiac artery and superior mesenteric artery time averaged velocity and estimated blood flow, respectively (all values p < .05 vs. baseline, Duncan's multiple range test). All measured variables returned to baseline 24 hrs after hemorrhage., Conclusions: Noninvasive duplex Doppler measurements of splanchnic peak systolic velocity, time averaged velocity, and estimated blood flow are reproducible and sensitive to small changes in intravascular volume. These data suggest a potential clinical role for duplex imaging in the treatment of critically ill patients to guide therapy to optimize splanchnic perfusion.

We have developed a new method of continuously measuring the angle between a pulsed Doppler blood flowmeter ultrasonic beam and the flow axis for precise blood flow velocity measurements. The transducer employed in the flowmeter system design is formed by two LZT 10 MHz crystals held in a lightweight polystyrene shell. Recessed internal cavities in the shell hold one 10 MHz crystal at a 45 degree angle for blood flow velocity measurement and the other crystal at a 90 degree angle for beam angle detection. The angle and Doppler frequency are supplied to a digital signal processor to precisely calculate instantaneous flow velocity. This automatic angle correction system is designed for applications where the transducer-flow angle is subject to change. Typical use examples are half-cylinder flow transducers that do not encircle the artery and external, hand-held, transcutaneous transducers.

We have studied various aspects of MAP-1 and MAP-2 from neuronal as well as nonneuronal sources. MAP-1 and MAP-2 polymerized from brain were resolved into a number of subcomponents upon electrophoresis on low percentage gels. Based on peptide mappings performed under a variety of different conditions, we conclude that the three major subcomponents of MAP-1 have very similar, though not identical structures. The two major MAP-2 subcomponents might have identical structure, because their peptide maps were hardly distinguishable. The apparent microheterogeneity of high Mr MAPs is not yet understood on a molecular basis. Proteolysis during isolation or a different degree of phosphorylation, however, seems to be an unlikely cause for microheterogeneity. When localized on microtubules polymerized in vitro by electron microscopy, both MAP-1 and MAP-2 polypeptides apparently form helical arrays on the polymer's surface with periodicities of 100 nm. In the presence of taxol, MAPs form irregular and bulky extensions. Both MAPs are found to be widespread in neuronal as well as nonneuronal cells. MAP-1- and MAP-2-related polypeptides, together with other high Mr proteins, such as plectin, were associated with microtubules polymerized by taxol from extracts of a nonneuronal cultured cell line. MAP-2 from cultured cells was found to be extremely sensitive to proteolysis, in particular in the presence of free Ca-ions. MAP-1 and MAP-2 generally were found associated with typical microtubule structures such as interphase and spindle microtubules and primary cilia. A differential distribution of MAP-1 and MAP-2 was clearly evident in neural tissues, where MAP-2 was restricted to cell bodies and dendrites, whereas MAP-1 was present also in axons. Moreover, a differential distribution of MAPs and tubulin was observed in de-and regenerating peripheral nerve, and in a few occasions, also with nonneuronal cells. A quite unexpected result was the identification of a protein in the extracellular matrix of cultured fibroblast cells, which has antigenic determinants in common with MAP-1 and MAP-2 from brain. As a whole, the data presented support a concept in which a family of structurally homologous, though not identical, high Mr polypeptides constitute the crosslinking elements between microtubules and various other cellular components. The structural diversity of these polypeptides might play a role in the development and dynamic changes in the cytoskeletal architecture.

High molecular weight microtubule-associated proteins 1 and 2 (MAP-1 and MAP-2), prepared by copolymerization with tubulin, were electrophorectically separated into three and two major subcomponents, respectively, using 5% sodium dodecyl sulfate-polyacrylamide gels. By two-dimensional gel electrophoresis, all five MAP components were shown to possess a pI of around 5. Four of these proteins, MAP-1A, MAP-1C, MAP-2A, and MAP-2B, present in comparable amounts, were iodinated after electrophoretic separation and analyzed by two-dimensional peptide mapping. With both trypsin and V8 protease, almost identical patterns were obtained from MAP-2A and MAP-2B. MAP-1A and MAP-1C, too, gave similar digestion patterns, although some differences were noted. Incubation with [gamma-32P]ATP demonstrated that endogeneous protein kinase activities phosphorylated individual subcomponents at different rates. MAP-2A, the highest labeled component, was phosphorylated 2.5-fold compared to MAP-2B both in the presence and the absence of cAMP. Labeling of MAP-1 subcomponents was 4 times less than that of MAP-2A in the absence and 16 times less in the presence of cAMP. 32P-labeled MAP-2A and MAP-2B bands were indistinguishable by one-dimensional peptide mapping, as were the three MAP-1 bands. For both MAP-1 and MAP-2 subcomponents, cAMP induced phosphorylation at new molecular sites. Incubation of radiolabeled microtubule proteins with 1 mM ATP effected, upon electrophoresis, a clear shift of MAP-2A and MAP-2B bands to positions of higher apparent molecular weights, while only slightly affecting MAP-1 bands.

The major high molecular weight microtubule-associated polypeptides from hog brain (MAP-1 and MAP-2) were compared by one- and two-dimensional peptide mapping under varied conditions and by immunological techniques. Partial digestion of MAP-1 and MAP-2 with Staphylococcus aureus V8 protease and analysis in one dimension gave rise to very similar peptide maps independent of whether 125I-, 3H-, or 32P-labeled proteins were used. One-dimensional cleavage patterns of significant similarity were also obtained by partial digestion of MAP-1 and MAP-2 using trypsin or chymotrypsin. Furthermore, a pronounced similarity, although clear nonidentity, of MAP-1 and MAP-2 was also revealed after exhaustive digestion of 125I-labeled proteins with S. aureus V8 protease or trypsin followed by analysis of peptides in two dimensions. For immunological comparison, antisera were used that had been raised in rabbits using electrophoretically purified MAP-1 and MAP-2 components as immunogens. As determined by immunoprecipitation, the antiserum raised to MAP-1 was equally reactive with MAP-1 and MAP-2 components, whereas the antiserum to MAP-2 reacted primarily with MAP-2. Indicating the presence of common as well as unique antigenic determinants on MAP-1 and MAP-2, these results, therefore, were in agreement with the peptide mapping data. Implications of these results for biosynthetic mechanisms as well as differential distribution and functions of MAPs in cells are discussed.