Small-parts real-time sonography: a new "water path"

A new commercially available gel material was used as a convenient and inexpensive water path. It enabled conventional real-time equipment with 3.5- or 5-MHz transducers to yield satisfactory results during superficial and small-parts examinations.     

"To care for him who shall have borne the battle and for his widow and his orphan" (Abraham Lincoln): the Department of Veterans Affairs polytrauma system of care

Sigford BJ. “To care for him who shall have borne the battle and for his widow and his orphan” (Abraham Lincoln): the Department of Veterans Affairs Polytrauma System of Care.The initiation of combat in Iraq and Afghanistan has resulted in a new cohort of active-duty service members and veterans seeking rehabilitation care through the U.S. Department of Veterans Affairs (VA). Service members injured in combat most often sustain multiple injuries (polytrauma) and require a unique service delivery model to meet their needs. The VA recognized this need and responded with the development of the Polytrauma System of Care (PSC). This national system of care balances access and expertise to provide specialized life-long care to the combat injured. The PSC is comprised of: 4 specialized regional rehabilitation centers that are accredited in brain injury by the Commission on Accreditation of Rehabilitation Facilities; 21 specialized outpatient and subacute rehabilitation programs; designated polytrauma teams at smaller, more remote VA facilities; and a point of contact at all other VA facilities. In addition, the PSC has developed a proactive case-management model, a specialized telehealth network, guidelines for long-term follow-up, and services for those individuals who are unable to return home. The following commentary and articles provide additional detail on this new and unique system of care.     

Hemoglobin Abraham Lincoln, β32 (B14) Leucine → Proline AN UNSTABLE VARIANT PRODUCING SEVERE HEMOLYTIC DISEASE

An unstable hemoglobin variant was identified in a Negro woman with hemolytic anemia since infancy. A splenectomy had been performed when the patient was a child. The anemia was accompanied by erythrocyte inclusion bodies and excretion of darkly pigmented urine. Neither parent of the proposita demonstrated any hematologic abnormality, and it appeared that this hemoglobin variant arose as a new mutation. Erythrocyte survival in the patient was greatly reduced: the erythrocyte t(1/2) using radiochromium as a tag was 2.4 days, and a reticulocyte survival study performed after labeling the cells with L-[(14)C]leucine indicated a t(1/2) of 7.2 days. When stroma-free hemolysates were heated at 50 degrees C, 16-20% of the hemoglobin precipitated. The thermolability was prevented by the addition of hemin, carbon monoxide, or dithionite, suggesting an abnormality of heme binding. An increased rate of methemoglobin formation was also observed after incubation of erythrocytes at 37 degrees C. The abnormal hemoglobin could not be separated from hemoglobin A by electrophoresis or chromatography, but it was possible to isolate the variant beta-chain by precipitation with p-hydroxymercuribenzoate. Purification of the beta-chain by column chromatography followed by peptide mapping and amino acid analysis demonstrated a substitution of proline for beta32 leucine. It appears likely that a major effect of this substitution is a disruption of the normal orientation of the adjacent leucine residue at beta31 to impair heme stabilization.     

Marking a path to transplant tolerance

Long-term allograft survival requires lifelong immunosuppression, which comes with serious side effects. Inducing immune tolerance to the transplant would enable immunosuppression withdrawal and revolutionize the quality of life of transplant recipients. In this issue of the JCI, Martínez-Llordella et al. identify a profile of biomarkers that predict tolerance in liver transplant recipients (see the related article beginning on page 2845). These findings translate into a new means for prospectively selecting liver transplant patients who would benefit from immunosuppression withdrawal and ultimately may guide development of tolerogenic therapies that allow for allograft acceptance without the use of long-term immunosuppression.     

Collaborative path planning for a robotic wheelchair

Generating a path to guide a wheelchair's motion faces two challenges. First, the path is located in the human environment and that is usually unstructured and dynamic. Thus, it is difficult to generate a reliable map and plan paths on it by artificial intelligence. Second, the wheelchair, whose task is to carry a human user, should move on a smooth and comfortable path adapted to the user's intentions. To meet these challenges, we propose that the human operator and the robot interact to create and gradually improve a guide path. This paper introduces design tools to enable an intuitive interaction, and reports experiments performed with healthy subjects in order to investigate this collaborative path learning strategy. We analyzed features of the optimal paths and user evaluation in representative conditions. This was complemented by a questionnaire filled out by the subjects after the experiments. The results demonstrate the effectiveness of this approach, and show the utility and complementarity of the tools to design ergonomic guide paths.     

Nursing as a sign of hope and contradiction in the land of the children of Abraham

Israel, the Gaza Strip, and the West Bank share a small land area and the birthplace of three of the world's great monotheistic religions: Judaism, Christianity, and Islam. It is a land of paradoxes: ancient and modern, religious and secular. Nursing in this unique geographic and historical place struggles with many of the same issues and challenges facing nursing in other modern countries, but it also shines with dramatic episodes of nursing's ability to be a sign of hope and contradiction.