An aggregation of juvenile Youngina from the Beaufort Group, Karoo Basin, South Africa

Main articleAn assemblage of five fully-articulated juvenile skeletons of Youngina has been recovered from the Late Permian strata of the south-western Karoo Basin. These 12-cm-long skeletons are not only the first articulated juveniles of this taxon, but also the oldest yet found in the Karoo Basin. They are preserved in overbank mudrocks of the Hoedemaker Member (Beaufort Group, Adelaide Subgroup) on the farm Leeukloof 43 in the Beaufort West district. Although they are estimated to be some three million years older than previously described Youngina, these specimens show no significant skeletal differences. The high degree of articulation and the spatial arrangement of these skeletons in a dish-shaped hollow is compelling evidence for them having huddled together within an underground burrow. Taphonomic analysis of associated fossils indicates that this was probably a mechanism to reduce water loss during drought on the ancient Karoo floodplains .Non

Computer-based clinical decision support for general practitioners.

A GP makes many decisions within every consultation. A computer-based clinical decision support system (CDSS) is software designed to support this decision making. It matches individual patient characteristics to a computerized clinical knowledge base and then provides patient-specific assessments or recommendations to the clinician to support a decision that can relate to diagnosis, investigation, prognosis or treatment. CDSSs offers the potential to translate the most up to date and robust evidence into practice. An example would include a GP being prompted to use a clinical prediction rule for pharyngitis (such as the Centor score) through a CDSS integrated into the electronic health record, after typing the word ‘sore throat’, with suggested management options then being delivered to the GP.</p

The Mental Health Agency Research Network (MHARN): Developing a statewide network for knowledge sharing, technical assistance & collaborative research

The Mental Health Agency Research Network (MHARN) is a developing network for sharing knowledge and research collaboration between the UMMS Dept. of Psychiatry and other academics, DMH personnel, community providers, consumers and family members. Its mission is to close the gap between science and service in mental health services in Massachusetts by improving implementation of evidence based practices to benefit consumers. The MHARN provides a structure and mechanism for the Center for Mental Health Services Research (CMHSR) to better engage with DMH staff and community agencies around the state. As experience and research on science-to-service has demonstrated that dissemination of information about research findings is not sufficient to bring about changes in practice and benefits to consumers, the MHARN will incorporate principles and practices of the emerging science of implementation research

Do practitioners and friends support patients with coronary heart disease in lifestyle change? a qualitative study.

BACKGROUND: Healthy lifestyles help to prevent coronary heart disease (CHD) but outcomes from secondary prevention interventions which support lifestyle change have been disappointing. This study is a novel, in-depth exploration of patient factors affecting lifestyle behaviour change within an intervention designed to improve secondary prevention for patients with CHD in primary care using personalised tailored support. We aimed to explore patients\u27 perceptions of factors affecting lifestyle change within a trial of this intervention (the SPHERE Study), using semi-structured, one-to-one interviews, with patients in general practice. METHODS: Interviews (45) were conducted in purposively selected general practices (15) which had participated in the SPHERE Study. Individuals, with CHD, were selected to include those who succeeded in improving physical activity levels and dietary fibre intake and those who did not. We explored motivations, barriers to lifestyle change and information utilised by patients. Data collection and analysis, using a thematic framework and the constant comparative method, were iterative, continuing until data saturation was achieved. RESULTS: We identified novel barriers to lifestyle change: such disincentives included strong negative influences of social networks, linked to cultural norms which encouraged consumption of \u27delicious\u27 but unhealthy food and discouraged engagement in physical activity. Findings illustrated how personalised support within an ongoing trusted patient-professional relationship was valued. Previously known barriers and facilitators relating to support, beliefs and information were confirmed. CONCLUSIONS: Intervention development in supporting lifestyle change in secondary prevention needs to more effectively address patients\u27 difficulties in overcoming negative social influences and maintaining interest in living healthily

Tryptophan 207 is Crucial to the Unique Properties of the Human Voltage-gated Proton Channel, hHV1

Part of the “signature sequence” that defines the voltage-gated proton channel (HV1) is a tryptophan residue adjacent to the second Arg in the S4 transmembrane helix: RxWRxxR, which is perfectly conserved in all high confidence HV1 genes. Replacing Trp207 in human HV1 (hHV1) with Ala, Ser, or Phe facilitated gating, accelerating channel opening by 100-fold, and closing by 30-fold. Mutant channels opened at more negative voltages than wild-type (WT) channels, indicating that in WT channels, Trp favors a closed state. The Arrhenius activation energy, Ea, for channel opening decreased to 22 kcal/mol from 30–38 kcal/mol for WT, confirming that Trp207 establishes the major energy barrier between closed and open hHV1. Cation–π interaction between Trp207 and Arg211 evidently latches the channel closed. Trp207 mutants lost proton selectivity at pHo \u3e8.0. Finally, gating that depends on the transmembrane pH gradient (ΔpH-dependent gating), a universal feature of HV1 that is essential to its biological functions, was compromised. In the WT hHV1, ΔpH-dependent gating is shown to saturate above pHi or pHo 8, consistent with a single pH sensor with alternating access to internal and external solutions. However, saturation occurred independently of ΔpH, indicating the existence of distinct internal and external pH sensors. In Trp207 mutants, ΔpH-dependent gating saturated at lower pHo but not at lower pHi. That Trp207 mutation selectively alters pHo sensing further supports the existence of distinct internal and external pH sensors. Analogous mutations in HV1 from the unicellular species Karlodinium veneficum and Emiliania huxleyi produced generally similar consequences. Saturation of ΔpH-dependent gating occurred at the same pHo and pHi in HV1 of all three species, suggesting that the same or similar group(s) is involved in pH sensing. Therefore, Trp enables four characteristic properties: slow channel opening, highly temperature-dependent gating kinetics, proton selectivity, and ΔpH-dependent gating

Systematic Review of the Effect of Diet and Exercise Lifestyle Interventions in the Secondary Prevention of Coronary Heart Disease

The effectiveness of lifestyle interventions within secondary prevention of coronary heart disease (CHD) remains unclear. This systematic review aimed to determine their effectiveness and included randomized controlled trials of lifestyle interventions, in primary care or community settings, with a minimum follow-up of three months, published since 1990. 21 trials with 10,799 patients were included; the interventions were multifactorial (10), educational (4), psychological (3), dietary (1), organisational (2), and exercise (1). The overall results for modifiable risk factors suggested improvements in dietary and exercise outcomes but no overall effect on smoking outcomes. In trials that examined mortality and morbidity, significant benefits were reported for total mortality (in 4 of 6 trials; overall risk ratio (RR) 0.75 (95% confidence intervals (CI) 0.65, 0.87)), cardiovascular mortality (3 of 8 trials; overall RR 0.63 (95% CI 0.47, 0.84)), and nonfatal cardiac events (5 of 9 trials; overall RR 0.68 (95% CI 0.55, 0.84)). The heterogeneity between trials and generally poor quality of trials make any concrete conclusions difficult. However, the beneficial effects observed in this review are encouraging and should stimulate further research

How much does smoking cessation cut CHD risk?

Patients with coronary heart disease (CHD) who refrain from smoking over a 2-year follow-up period decrease their relative risk (RR) for morbidity and mortality by about one third (strength of recommendation [SOR]: A, meta-analysis of 20 cohort studies). People who maintain abstinence after coronary artery bypass surgery are more likely to avoid angina, repeat revascularization, significant physical impairment, and CHD-related hospital admissions than patients who continue to smoke (SOR: A, 4 cohort studies with 1- to 20-year follow-up)

Gastric Tube Placement in Children 1-215 Months Old

poster abstractFeeding by a nasogastric/orogastric (NG/OG) tube is preferred when the gastrointestinal system is functional and the need for assisted feeding is expected to be short-term. Preliminary studies in children show that between 21% and 44% of these tubes are placed incorrectly. When tubes are out of place, children can be seriously harmed, causing increased morbidity and occasionally death. The aims of this study were to determine the best method to predict the insertion distance for placing NG/OG tubes and to determine the best clinical methods of testing the location of NG/OG tubes once they were inserted. A randomized clinical trial was conducted. The three insertion-distance prediction methods tested were nose-ear-xiphoid (NEX); nose-ear-mid-umbilicus (NEMU); and age-related, height-based (ARHB). An abdominal radiograph was obtained immediately following tube insertion to determine the internal location of the tube tip and orifice(s). Based on data from 95 children age 1-220 months (M = 51.8, SD = 54.9, median = 33.4), both the ARHB and NEMU methods were superior to NEX in placing the tube in the stomach (p = .0064). ARHB and NEMU were not significantly different from each other. NEX was frequently too short (41.93% of tube insertions) leaving the tube tip and/or orifices in the esophagus. The three clinical methods of testing tube location were CO2 monitoring and measuring pH and bilirubin in tube aspirate. Measuring pH of tube aspirate was the superior clinical method of determining tube location. Aspirate was available for testing in 84 children (88.42%). Based on a pH cutoff of 5 (recommended by Metheny in fasting adults), the sensitivity was 26.67 (low), specificity was 80.60 (high), positive predictive value was 23.53 (low), and negative predictive value was 83.08 (high). Measuring the NEX distance is the method most commonly used by nurses in practice; therefore, based on the results of this study and studies of other researchers, a practice change to either ARHB or NEMU should improve the safety of enteral feeding in children. Because of the low sensitivity in predicting misplaced tubes using pH, the superior clinical method, obtaining an abdominal x-ray to ensure placement in the stomach at the time of tube insertion is recommended

Histidine168 is crucial for ΔpH-dependent gating of the human voltage-gated proton channel, hHV1

We recently identified a voltage-gated proton channel gene in the snail Helisoma trivolvis, HtHV1, and determined its electrophysiological properties. Consistent with early studies of proton currents in snail neurons, HtHV1 opens rapidly, but it unexpectedly exhibits uniquely defective sensitivity to intracellular pH (pHi). The H+ conductance (gH)-V relationship in the voltage-gated proton channel (HV1) from other species shifts 40 mV when either pHi or pHo (extracellular pH) is changed by 1 unit. This property, called ΔpH-dependent gating, is crucial to the functions of HV1 in many species and in numerous human tissues. The HtHV1 channel exhibits normal pHo dependence but anomalously weak pHi dependence. In this study, we show that a single point mutation in human hHV1—changing His168 to Gln168, the corresponding residue in HtHV1—compromises the pHi dependence of gating in the human channel so that it recapitulates the HtHV1 response. This location was previously identified as a contributor to the rapid gating kinetics of HV1 in Strongylocentrotus purpuratus. His168 mutation in human HV1 accelerates activation but accounts for only a fraction of the species difference. H168Q, H168S, or H168T mutants exhibit normal pHo dependence, but changing pHi shifts the gH-V relationship on average by /unit. Thus, His168 is critical to pHi sensing in hHV1. His168, located at the inner end of the pore on the S3 transmembrane helix, is the first residue identified in HV1 that significantly impairs pH sensing when mutated. Because pHo dependence remains intact, the selective erosion of pHi dependence supports the idea that there are distinct internal and external pH sensors. Although His168 may itself be a pHi sensor, the converse mutation, Q229H, does not normalize the pHi sensitivity of the HtHV1 channel. We hypothesize that the imidazole group of His168 interacts with nearby Phe165 or other parts of hHV1 to transduce pHi into shifts of voltage-dependent gating

Strategies for a Successful PhD Program: Words of Wisdom From the \u3cem\u3eWJNR\u3c/em\u3e Editorial Board

Nursing doctoral programs prepare students for research-focused careers within academic settings. The purpose of this Editorial Board Special Article is to provide PhD students and advisors with suggestions for making the most of their doctoral experience. Editorial Board members provide their individual insights on the skills and attributes students must acquire during the course of their doctoral education in order to succeed. The authors provide practical tips and advice on how to excel in a PhD program, including how to select an advisor and a dissertation committee, the importance of attending conferences to increase visibility and develop a network of colleagues, presenting and publishing research while still a student, and balancing work and personal life. Students who take full advantage of the opportunities available to them during the course of their doctoral programs will graduate well prepared to take on the multiple responsibilities of research, teaching, and leadership