Increased plasma and ventricular fluid interleukin-6 levels in patients with head injury

The cytokine interleukin-6 (IL-6) plays a major role in initiating the acute phase response, especially in the production of acute phase reactants such as C-reactive protein. The objectives of this study were to determine whether plasma or ventricular fluid IL-6 levels were elevated at time of admission after head injury and whether plasma IL-6 levels related temporally to clinical improvement of levels of acute phase reactants. Thirty patients with Glasgow Coma Scale (GCS) scores of 3 through 10 were observed for 15 days after head injury. Peak elevation of plasma IL-6 occurred on admission (85 +/- 12 U/ml; normal level is less than 2 U/ml) and then decreased during the hospital course to a level of 29 +/- 4 U/ml on day 15. Plasma IL-6 levels decreased significantly faster in patients with admission peak 24-hour GCS scores of 8 through 10 compared with patients with GCS score less than 8 (p less than 0.01). Patients had markedly elevated and variable ventricular fluid IL-6 levels on admission (mean 3880 +/- 2022 U/ml; normal, less than 2 U/ml). A temporal relationship was found between plasma IL-6 levels and multiple acute phase reactants thought to be mediated by IL-6. We conclude that plasma and ventricular fluid levels of IL-6 are elevated after head injury and that plasma IL-6 level is temporally related to acute phase reactants and clinical improvement. We suggest that IL-6 may play an etiologic role in many of the metabolic or nutritional sequelae of head injury.     

Preparing preceptors through online education.

Preceptor education is vital to the success of healthcare institutions. Preceptors' roles are complex and require up-to-the-minute programs reflecting crucial mentoring responsibilities for orientees in multifaceted working environments. Finding the time to properly educate preceptors while maintaining quality bedside care is a challenge for staff development educators during the nursing shortage. Offering a preceptor education program online can assist preceptors in the adoption of role changes in a timely manner. The outcome can provide excellent, competent, caring preceptors. In this article, the course content and intended outcomes of online preceptor preparation programs are discussed. The role of the staff development educator in assessing, planning, implementing, and evaluating online preceptor programs is also discussed.     

Antimicrobial activity of aridicins, novel glycopeptide antibiotics with high and prolonged levels in blood.

Three new glycopeptide antibiotics, aridicins A, B, and C, produced by Kibdelosporangium aridum have a spectrum of antimicrobial activity in vitro which is similar to that of vancomycin. The antimicrobial activities of these glycopeptides against clinical bacterial isolates were compared with those of vancomycin and other related glycopeptide antibiotics in vitro by agar dilution and microtiter broth dilution tests and in vivo in mouse protection studies. In vitro they were somewhat less effective than vancomycin against strains of Staphylococcus aureus and less active against coagulase-negative Staphylococcus spp. However, they were more active than vancomycin against strains of Streptococcus faecalis and markedly superior to vancomycin and other glycopeptide antibiotics against strains of Clostridium difficile. In experimental infections, aridicin A was effective against strains of S. aureus, S. epidermidis, Streptococcus faecalis, and Streptococcus pyogenes, although its 50% effective doses were higher than those of vancomycin when administered after infection. After subcutaneous administration, aridicin A had a higher peak level in serum and a longer half-life than vancomycin or teicoplanin. The aridicins were markedly superior to vancomycin when administered prior to infection in mouse protection tests, indicating long-acting potential.     

Understanding macrographia in children with autism spectrum disorders

It has been consistently reported that children with autism spectrum disorders (ASD) show considerable handwriting difficulties, specifically relating to accurate and consistent letter formation, and maintaining appropriate letter size. The aim of this study was to investigate the underlying factors that contribute to these difficulties, specifically relating to motor control. We examined the integrity of fundamental handwriting movements and contributions of neuromotor noise in 26 children with ASD aged 8–13 years (IQ > 75), and 17 typically developing controls. Children wrote a series of four cursive letter l's using a graphics tablet and stylus. Children with ASD had significantly larger stroke height and width, more variable movement trajectory, and higher movement velocities. The absolute level of neuromotor noise in the velocity profiles, as measured by power spectral density analysis, was significantly higher in children with ASD; relatively higher neuromotor noise was found in bands >3 Hz. Our findings suggest that significant instability of fundamental handwriting movements, in combination with atypical biomechanical strategies, contribute to larger and less consistent handwriting in children with ASD.     

Functional neuroimaging studies of bipolar disorder: Examining the wide clinical spectrum in the search for disease endophenotypes

Bipolar disorder (BP) is among the top ten most disabling illnesses worldwide. This review includes findings from recent studies employing functional neuroimaging to examine functional abnormalities in neural systems underlying core domains of the psychopathology in BP: emotion processing, emotion regulation and executive control, and common comorbid features of BP, that are relevant to the wide spectrum of BP rather than focused on the more traditional BPI subtype, and that may facilitate future identification of diagnostically-relevant biomarkers of the disorder. In addition, an emerging number of studies are reviewed that demonstrate the use of neuroimaging to elucidate biomarkers whose identification may help to (1) identify at-risk individuals who will subsequently develop the illness to facilitate early intervention, (2) identify targets for treatment and markers of treatment response. The use of newer neuroimaging techniques and potential confounds of psychotropic medication upon neuroimaging findings in BP are also examined. These approaches will help to improve diagnosis and the mental well-being of all individuals with BP.     

Nursing intensity. Going beyond patient classification.

Two patient classification systems, Medicus and GRASP, were compared to the Patient Intensity for Nursing Index (PINI). Approximately 50% of the variability in both classification systems was not accounted for by PINI items. The patterns of correlation between PINI items and GRASP and Medicus scores indicated that these two classification systems do not measure nursing resource use in the same way. Nurse administrators should be aware that estimates of nursing care costs will vary depending on the patient classification system used to measure nursing intensity.     

The influence of aspirin on gastrointestinal microbleeding in dogs with gastric ulcers.

Fecal blood volume was determined daily in 11 dogs with single gastric ulcers. Beginning 11 days after production of the ulcers and dogs received, in crossover fashion, 2 placebo or ordinary 325-mg aspirin tablets orally twice daily during two 7-day treatment periods separated and followed by 5-day periods of no treatment. Mean daily fecal blood volumes of 0.52 and 3.25 ml were observed during periods of treatment with placebo and aspirin, respectively. However, in 7 previous studies in this laboratory a total of 24 normal dogs have received 7-day courses of treatment with 650 mg ordinary aspirin twice daily on 105 occasions; during these 105 treatment periods fecal blood volume averaged 2.90 ml/day. Thus, it is concluded that the effect of ordinary aspirin in dogs with gastric ulcers is essentially the same as the effect in normal dogs, and that there is no tendency for dogs with gastric ulcers to bleed massively in response to aspirin.