Long-term serum creatinine values after radical nephrectomy

Both pre- and postnephrectomy levels of serum creatinine were measured in 52 consecutive patients who underwent radical nephrectomy for localized renal cell carcinoma between 1971 and 1976. At the time of follow-up, 17 patients were alive and 35 had died, 14 of renal cell carcinoma and 21 of other causes. Follow-up lasted a minimum of 115.5 months (mean 151.1 months, median 141.1, range 115.5-211.3 months) for 16 of the 17 patients who were alive. In this group only 2 patients had elevations in the serum creatinine level above 1.6 mg/dL-1.9 mg/dL and 2.4 mg/dL, respectively. The patient whose value was 2.4 mg/dL was a diabetic who required insulin. No serious renal failure, renal disease, or tumors in the contralateral kidney occurred among the total group of 52 patients. These data indicate that renal function remains adequate in patients who have a normal contralateral kidney and are treated by radical nephrectomy.     

Oxygen supply and limiting oxygen pressures in an insect larva

Larvae of the moth, Carpocapsa saltitans, demonstrate a diurnal activity pattern of rhythmic twitching which, under conditions of controlled light and temperature, is characterized by a predictable frequency and regularity. The twitching activity is shown to be sensitive to the partial pressure of environmental oxygen, and it ceases altogether at a particular PO2 called 'critical'. Use is made of the 'critical' PO2 in normobaric and hypobaric conditions to deduce the roles of diffusion and convection in the larval oxygen transport mechanisms; and also as a value for the total decrement of PO2 from ambient air to mitochondria, in order to evaluate predicted values based on calculations of resistance to oxygen flow. For this latter study 'porosity' of the larva and the seed pod in which it is normally housed was inferred from measured rates of water vapor loss, and oxygen uptake rates of the larvae were measured by the manometric technique of Warburg. Applying these data to a model system the conclusion was reached that almost the total resistance to oxygen flow is at the spiracle.     

A reassignment of (-)-mycothiazole and the isolation of a related diol

A reinvestigation of the thiazole constituents from Cacospongia mycofijiensis, collected in Vanuatu, yielded known mycothiazole (3) plus a new derivative, mycothiazole-4,19-diol (6). The E stereochemistry at Delta14,15 of 3 has been revised to Z and the structural features of 6 are elucidated. These compounds, which presumably arise by the action of a polyketide-nonribosomal peptide synthetase (PKS/NRPS) hybrid, possess cytotoxic properties that need further exploration.     

Getting over the rainbow: one community hospital's vision

Nursing faces a challenging future due to both a projected nursing shortage and changing needs of patients. This will require greater flexibility, an increased knowledge base, and a strengthening of our caring foundations through more evidence-based practices. A nursing taxonomy needs to be determined so that we can support the research of nursing effectiveness through the use of technology. Institutions will need to increase their investments in continuing education, nursing research, and technology to enable more efficient and effective nursing practice. New relationships will need to be forged and new roles designed to maximize the profession's contributions to patient care. Questions that have been asked for decades regarding differentiated nursing practice and entry level into practice will need to be answered. This article describes a large suburban hospital's strategic initiatives that have been designed to meet the nursing challenges of the 21st century.     

Evaluating psychological insight in a clinical sample using the Shedler-Westen assessment procedure

Using the Shedler-Westen Assessment Procedure (SWAP)-200 Q-Sort items in a large clinical sample of outpatients (N = 105), we developed the SWAP insight scale. The rationale, psychometric properties, and convergent validity of this insight scale are reported. Through factor analysis, six of the SWAP-200 items were identified as psychometrically optimal in the assessment of insight (presence or absence) with an alpha coefficient of 0.78. We examined the construct validity of this SWAP insight scale using independent clinical videotape ratings of the Capacity for Dynamic Process Scale, specifically the items "appears introspective" and "manifests insight." We also examined the relationship between the SWAP insight scale using independent clinical videotape ratings of the Social Cognition and Object Relations Scale-Global Ratings, specifically ratings of "complexity of representations" and "social causality." The results demonstrated significant positive correlation between the SWAP insight scale and all five of these criterion measures. Partial correlations demonstrated that, even when the effects of global psychiatric severity are controlled for, the SWAP insight scale maintains a significant relationship with independent clinical videotape ratings of patients manifesting insight during sessions. Future research directions and clinical implications of the SWAP insight scale are discussed.