The experience of hope for survivors of acute myocardial infarction (AMI): a qualitative research study

This qualitative study was undertaken to explore the relevance and meaning of the experience of hope for survivors of acute myocardial infarction (AMI). Depth interviews were conducted with eight survivors (n = 8) of AMI at four weeks following discharge from hospital. Analysis of transcribed interviews revealed three distinct narrative themes. These were holding on to human connectedness, finding and harnessing the 'will' to live, and, having faith in the primacy of a higher power. Study findings are discussed in relation to the literature. Findings of the study assist in building knowledge and understanding of the complex phenomenon of hope. Implications for nursing practice and research are drawn from study findings.

Graded compression ultrasonography in the assessment of the "tough decision" acute abdomen in childhood

The diagnosis of acute appendicitis in childhood is frequently difficult. In some situations the need to operate is clear, but in others the decisions may be much "tougher" because the clinical findings are equivocal. This is a retrospective study of a consecutive series of 253 children presenting with "acute abdominal pain? appendicitis" who had graded compression ultrasonography (GCUS) because the clinical scenario did not warrant immediate laparotomy. This represents 30% of all cases seen in the study period. The aim of the study was to examine the role of GCUS and a clinical scoring system (the Alvarado score) in patients in whom the diagnosis is uncertain.

The experiences of female spouses of survivors of acute myocardial infarction: a pilot study of Lebanese-born women in south-western Sydney, Australia

Lebanese migrants form a significant proportion of the population in southwestern Sydney (SWS), and in New South Wales, Australia. This pilot study was undertaken in south-western Sydney, a rapidly expanding and socioeconomically disadvantaged region, to explore the experiences of English speaking women of Lebanese origin whose spouses had recently experienced an acute myocardial infarction (AMI). Semi-structured interviews were conducted with seven Lebanese-born women at 2- and 4-week intervals, following the discharge of their husbands from hospital. Qualitative analysis of narrative text revealed four distinct themes. These were: struggle to resolve distress; intensive monitoring of the AMI survivor; searching for avenues of support; and reflecting on the future. Study findings are discussed in relation to the literature. Implications for nursing practice and research are drawn from study findings.

Effect of oscillatory high hydrostatic pressure treatments on Byssochlamys nivea ascospores suspended in fruit juice concentrates

The effect of continuous (689 MPa with holding times of 5, 15 or 25 min) and oscillatory (one, three or five cycles at 689 MPa with holding times of 1 s) high hydrostatic pressure treatments on the viability of Byssochlamys nivea ascospores suspended in apple and cranberry juice concentrates adjusted by dilution to water activities (aw) of 0.98 and 0.94 was evaluated at 21 and 60 degrees C. Inactivation of the initial spore inocula was achieved after three or five cycles of oscillatory pressurization at 60 degrees C when the aw was 0.98 in both fruit juices. With aw 0.94, the initial inocula were reduced by less than 1 log-cycle after five pressure cycles. Inactivation was not observed within 25 min with continuous pressurization at 60 degrees C. In treatments at 21 degrees C, no effect on spore viability was observed with continuous or oscillatory treatments.

High hydrostatic pressure come-up time and yeast viability

The effects of the come-up time at selected pressures (50 to 689 MPa) on Saccharomyces cerevisiae and Zygosaccharomyces bailii viability were evaluated at 21 degrees C. For Z. bailii the effects of the water activity (a(w)) of the suspension media and the stage of the growth cycle were also investigated. Pressure come-up times exerted an important effect on the yeast survival fraction, decreasing counts as pressure increased. An increased sensitivity to pressure treatments was observed with yeast cells from the exponential growth phase. Lethality increased as a(w) of the suspension media increased. For an a(w) of 0.98 and cells from the stationary growth phase, pressure treatments at less than 200 MPa had no effect on Z. bailii viability; however, no survivors (< 10 CFU/ml) were observed in treatments applied only for the time needed to reach pressures greater than 517 MPa. Yeast survivor curves showed an excellent fit (r > 0.996) when described by a phenomenological model based on the Fermi equation, S(P) = 1/¿1 + exp[(P - Pc)/k]¿, where S(P) is the survival fraction, P is the pressure, Pc is a critical pressure corresponding to 50% survival, and k is a constant representing the steepness of the curve.

Evaluation of Four Pea ( Pisum sativum ) Cultivars in PE-2 Medium for the MPN Enumeration of Anaerobic Spore-Forming Organisms

Untreated 'Alaska' seed peas have traditionally been used to prepare PE-2 medium, a medium used to recover anaerobic bacteria. Three cultivars of seed peas, 'Columbian', 'Yellow', and 'Scotch' were compared to the cultivar 'Alaska' peas in PE-2 for recovery of Clostridium butyricum ATCC 860, Clostridium sporogenes ATCC 7955/NCA 3679, and Thermoanerobacterium thermosaccharolyticum ATCC 25773 determined by using the most probable number (MPN) technique. Organisms were grown in cooked meat medium (CMM) and enumerated by the three-tube MPN method in PE-2 media incubated at 37°C for 48 h. Recovery of C. butyricum and T. thermosaccharolyticum grown in homogenates of commercial cream-style corn and vegetable beef soup were also evaluated. Similar recovery of organisms from stock cultures or from foodstuffs were observed in PE-2 prepared with three of the pea cultivars ('Alaska', 'Columbian', and 'Yellow'). While the 'Scotch' cultivar PE-2 medium yielded recoveries comparable to PE-2 prepared with the other pea cultivars, turbid tubes were occasionally observed from which viable microorganisms could not be recovered. This cultivar is therefore not recommended due to the probability of yielding false positives in the MPN technique.

Thromboembolic risks of left atrial thrombus detected by transesophageal echocardiogram

Patients with left atrial thrombus are considered at high risk for thromboembolic events. The actual prognosis of these patients and the features most predictive of future events are unclear. We performed transesophageal echocardiograms in 2,894 patients over a 6 1/2-year period; 94 (age 69 +/- 11 years, 59 men, 83 in atrial fibrillation) were found to have left atrial thrombus. The thrombi were considered mobile in 45 patients and 33 patients had thrombus with a maximum dimension > or = 1.5 cm. Seven of the 94 patients with prosthetic valves were excluded from follow-up analysis. Over a follow-up period of 25.3 +/- 19.2 months, 17 patients had suffered a stroke or embolic event (event rate 10.4% per year) and 27 had died (mortality 15.8% per year). Cox proportional hazard regression analysis identified a maximum thrombus dimension > or = 1.5 cm (RR 19, p = 0.002), history of thromboembolism (RR 4.2, p = 0.038), and mobile thrombus (RR 5.3, p = 0.02) as predictors of subsequent thromboembolism. Moderate or severe left ventricular dysfunction was the only significant predictor of death (RR 2.9, p = 0.04). Gender, age, warfarin therapy at follow-up, atrial fibrillation, location (cavity vs appendage) of thrombus, and spontaneous echocardiographic contrast were not significant. Aggressive antithrombotic therapy may be indicated in these high-risk patients.

Isolation and identification of antimicrobial furocoumarins from parsley

Photoactive furocoumarins extracted from four varieties of fresh and freeze-dried parsley leaves inhibited a DNA repair-deficient Escherichia coli in a photobiological assay. Using media-modified assays, the human pathogens E. coli O157:H7 and Listeria monocytogenes, the spoilage microorganism Erwinia carotovora, and Listeria innocua were also inhibited. Pseudomonas fragi was not inhibited. Minimum concentrations of Forest Green parsley powder in agar which showed inhibition ranged from 0.12% to 8.0% depending on the microorganism. Ultraviolet light (UV) at 365 nm for 60 min used to photoactivate the furocoumarins in the bioassay had little effect on L. monocytogenes and L. innocua. A slight UV inhibitory effect was detected with E. carotovora. Furocoumarins, psoralen, 8-methoxypsoralen (8-MOP), 5-methoxypsoralen (5-MOP), oxypeucedanin and isopimpinellin were identified using gas chromatography-mass spectrometry. Psoralen, 8-MOP, and 5-MOP were quantified. A difference in relative furocoumarin concentration (weight of furocoumarin per weight of dry parsley leaves) for all varieties of parsley was revealed. The concentration of 5-MOP was significantly greater than 8-MOP (P < 0.05), but not significantly greater than psoralen. Psoralen and 8-MOP were not significantly different in concentration.

How to avoid complications during percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) has advantages over open gastrostomy, and is an accepted technique for children. However, a number of technical problems may be encountered during insertion. This report identifies those problems and proposes precautions that can be taken to reduce their likelihood. Recognized major complications include esophageal injury, colonic perforation, wound infection, gastric erosion by the gastrostomy tube, and later symptomatic gastroesophageal reflux requiring correction by fundoplication.

Technique and complications of percutaneous endoscopic gastrostomy in children

Percutaneous endoscopic gastrostomy (PEG) is now a well-established technique in children. In this study of 63 children (mean age 7.8 years, youngest 2.4 months), technical problems associated with insertion of the gastrostomy tube, and complications related to the procedure, were analysed. Complications included wound infection, oesophageal injury (probably sustained during extraction of the guide wire) and symptomatic gastro-oesophageal reflux (GOR) occurring after PEG insertion. Many of these complications can be avoided or reduced in likelihood by refinements to the technique of insertion.

Comparison of EDTA and Apo-Lactoferrin with Lysozyme on the Growth of Foodborne Pathogenic and Spoilage Bacteria

Combinations of ethylenediaminetetraacetic acid (EDTA) or apo-lactoferrin (Apo-Lf) and lysozyme were evaluated for their antimicrobial effectiveness in ultra-high temperature pasteurized milk against Pseudomonas fluorescens , Salmonella typhimurium , Escherichia coli O157:H7, and Listeria monocytogenes . Neither P. fluorescens nor S. typhimurium growth was influenced by EDTA, Apo-Lf or lysozyme alone or in combinations. Escherichia coli O157:H7 was inhibited by EDTA alone, but no increase in antimicrobial effectiveness was noted in the presence of lysozyme. In contrast, EDTA and lysozyme had a significant interactive antimicrobial effect against L. monocytogenes . Apo-Lf, at concentrations up to 2.5 mg/ml, displayed similar inhibition patterns with lysozyme against the E. coli O157:H7 and L. monocytogenes however, the magnitude of inhibition was much less and of little practical significance. When evaluated over time, EDTA (1.5-2.5 mg/ml)-lysozyme (150 μg/ml) slowed growth of E. coli and was bactericidal to L monocytogenes . Apo-lactoferrin (15 mg/ml)-lysozyme (150 μg/ml) had little practical effect on E. coli growth but did slow growth of L. monocytogenes .

Survival of Selected Pathogenic Bacteria in White Pickled Cheese Made With Lactic Acid Bacteria or Antimicrobials

Effect of lactic acid bacteria starter culture, nisin, hydrogen peroxide, or potassium sorbate on Listeria monocytogenes , Staphylococcus aureus , and Salmonella typhimurium in white pickled cheese made from pasteurized milk with 4% salt and preserved in 4% brine solution at 4°C for 60 d was studied. The starter culture inhibited all three pathogens while antimicrobials did not. Beyond day 50 in curd and day 30 in brine solution, L. monocytogenes was not detected by direct plating in cheese with added starter culture. S. aureus was not detected after day 30 in curd and day 20 in brine solution in the same cheese. S. typhimurium was not detected after day 30 in cheese curd and was not detected in brine solution at any time with lactic acid bacteria starter culture added. The pH of brine solution of starter treatment dropped below 4.7 in all experiments, while antimicrobial treatments all had a pH >5.5.

Chemical Composition of and Listeria monocytogenes Survival in White Pickled Cheese

White pickled cheese was made from pasteurized milk with 8% salt and preserved in the whey at 4°C. About 5.0 log₁₀ CFU/ml cells of Listeria monocytogenes were inoculated into milk, and the survival of the pathogen was studied during the storage period. The chemical composition of the cheese was also determined. L. monocytogenes were not inhibited by 8% salt, but lactic acid bacteria were unable to grow and produce acid to inhibit L. monocytogenes . During ripening, the pH never decreased below 6.0. While fat, protein, total solids, and ash contents decreased in curd during ripening, the acidity and salt did not change. In cheese whey, fat, protein, acidity, and salt showed a slight increase, while total solids and ash contents were unchanged.

Homophobic attitudes and AIDS risk behavior of adolescents

Adolescents in the United States are increasingly knowledgeable about acquired immunodeficiency syndrome (AIDS), yet they are notoriously resistant to behavioral changes that would reduce their personal risk, such as practicing abstinence, using condoms, or careful selection of sexual partners. For the present study, we asked 80 heterosexual adolescents about their sexual behavior and intentions to avoid risky behavior, in conjunction with assessing their knowledge and attitudes concerning AIDS and AIDS-related issues. The results suggest that many adolescents do not feel vulnerable to AIDS because they still see AIDS as a Gay disease. Those who are most prejudiced against Gays are, on average, five times more willing to engage in indiscriminant sex as are the least prejudiced group; among males, this effect is even greater. In addition, highly prejudiced adolescents are twice as willing to have sex without using a condom. This study indicates the importance of dealing with homophobic attitudes in the context of AIDS education.

Influence of Altered Fatty Acid Composition on Resistance of Listeria monocytogenes to Antimicrobials

The sensitivity of Listeria monocytogenes Scott A and ATCC 19114 to antimicrobial compounds was altered when bacterial membrane lipid composition was modified by growth in the presence of added fatty acids. Analysis of cellular fatty acid composition by gas-liquid chromatography indicated that L. monocytogenes Scott A cells contained 0.97, 2.32, 0.81, and 0.72% (relative) of C14:0, C16:0, C18:0, and C18:l, respectively. In the presence of exogenously supplied C14:0, C16:0, C18:0, and C18:l, the percentages increased to 14.03, 30.92, 16.30, and 27.90%. Average MICs for L. monocytogenes Scott A and ATCC 19114 to sodium chloride, tertiary butylhydroquinone, methyl paraben, and propyl paraben were 10.0%, 81, 1406, and 544 μg/ml, respectively. Growing either strain in the presence of 50 μg/ml of either exogenously added C14:0 or C18:0 fatty acids increased their resistance to the four antimicrobial compounds. However, growth in the presence of C18:1 led to increased sensitivity to the antimicrobial agents. The results indicate that the susceptibility of L. monocytogenes to antimicrobial agents is related to the lipid composition of the cell membrane. Consequently, food preservation processes which alter fatty acid composition of L. monocytogenes could result in changes in antimicrobial susceptibility.

Lymphocyte production of gamma-interferon as a test for non-tuberculous mycobacterial lymphadenitis in childhood

Infection with Mycobacterium avium, M. intracellulare and M. scrofulaceum (MAIS) organisms in normal children may result in cervical lymphadenopathy. There is a poor response to anti-tuberculous therapy and surgical excision of infected nodes is necessary. The diagnosis therefore requires consideration in children with cervical lymphadenopathy. A simple in vitro assay is described which may be useful for diagnosis prior to excision. Whole blood is cultured with M. avium purified protein derivative. After 24 h the plasma is removed and the concentration of gamma interferon (IFN-gamma) quantified by a radioimmunometric assay. In a prospective study of 38 children with neck lesions, 16 showed MAIS organisms isolated from cultures of excised tissue. The level of IFN-gamma produced by peripheral blood lymphocytes from children in the MAIS group was significantly greater when compared with children having operations for neck lesions that were not due to MAIS organisms (P < 0.001).

Psychological morbidity in the first year after breast surgery

In this prospective study, the psychological morbidity associated with the treatment of breast cancer was assessed. The study population comprised all patients referred to one centre with a recently diagnosed breast lump, who were to undergo surgery. Psychological morbidity was assessed preoperatively and at 6 and 12 months postoperatively by modified Rotterdam Symptom Checklist. Three hundred and twenty patients completed all three questionnaires: 93 women undergoing mastectomy, 73 women having conservation therapy for breast cancer and 156 women having biopsy for benign breast disease. Patients with a breast malignancy smaller than 4 cm in diameter were treated by lumpectomy and radiotherapy, anti-oestrogen therapy or chemotherapy alone or in combination. Psychological morbidity among patients with malignant disease was significantly greater than that seen in the group with benign disease. Among cancer patients, a significant decrease in anxiety and depression occurred during the year following surgery. The study failed to demonstrate any psychological advantage associated with breast conservation.

Helicobacter pylori infection in children

Helicobacter pylori was sought prospectively by culture of antral biopsy, histology and serology (IgG and IgA) in 440 consecutive endoscopies on children to determine the prevalence, clinical presentation and histological features of H. pylori infection in our population. Twenty-eight patients had H. pylori (8% overall). The mean age of infected patients was significantly higher than that of non-infected patients (P less than 0.0001). No patient under 5 years of age had H. pylori isolated. Overall, there was no significant difference in clinical presentation between those with and those without H. pylori infection, but 23% of patients 5 and 26 years of age who presented with abdominal pain as the indication for their endoscopy had H. pylori isolated. Macroscopic changes ranged from no abnormality to frank ulceration, but the typical antral mamilliform changes were 100% predictive of infection. Fifty-eight per cent of patients with duodenal ulcers, but only 17% with gastric ulcers had H. pylori infection. Histological gastritis was present in 144 patients (including all H. pylori positive patients). None of the patients with another definable cause for gastritis had H. pylori isolated. In conclusion, H. pylori is an important cause of primary gastritis in our population, occurring in children over 5 years of age. Culture of an antral biopsy should be performed in children over this age undergoing endoscopy for the investigation of abdominal pain and, more particularly, in those with peptic ulceration.

Growth after gut resection for Crohn's disease

Seventeen children underwent 19 bowel resections as part of their management of Crohn's disease. Thirteen children had evidence of retardation of linear growth preoperatively, of whom 12 exhibited catch up growth, crossing at least one centile band, after resection. Seven of the 12 showed early signs of puberty at the time of resection and one child was regarded as being fully pubertal. All children were symptomatic before their surgery; at one year 11 were asymptomatic and three others were substantially improved. Surgical resection of localised Crohn's disease, followed by adequate nutritional support has lead to catch up growth and a prolonged symptom free period in most of our patients and this was not limited by their age or stage of puberty.

Influence of Bovine Lactoferrin on the Growth of Listeria monocytogenes

The influence of bovine lactoferrin (LF) and Apo-LF on growth of Listeria monocytogenes in Ultra-High Temperature (UHT) 2% fat milk was determined. The effect of LF was dependent upon both the degree of iron saturation and concentration. Before iron removal, LF was found to be approximately 52% saturated with iron; and at 23 and 46 mg/ml LF, minimal growth inhibition of L. monocytogenes was observed. Following dialysis, Apo-LF iron saturation was reduced to approximately 18%. At 15 and 30 mg/ml Apo-LF, a bacteriostatic effect against L. monocytogenes was observed. Inhibition of growth associated with Apo-LF was abolished when ferric ammonium citrate was added to saturate the iron binding sites of the Apo-LF.

Pancreatic beta cell proliferation in rabbits demonstrated by bromodeoxyuridine labeling

The purpose of the present study was to quantify beta cell proliferation in rabbits that had undergone subtotal beta cell ablation by labeling cell nuclei undergoing DNA synthesis with bromodeoxyuridine (BUdR). Ten New Zealand white rabbits were compared with five sham-operated controls. The beta cells in the head of the pancreas were destroyed by intravenous alloxan (200 mg/kg) while the tail of the pancreas was temporarily isolated from the systemic circulation by vascular occlusion clamps. On day 7, BUdR (70 mg/kg) was infused prior to killing to label newly synthesised DNA. Immunoperoxidase staining with anti-insulin sera and an anti-islet cell monoclonal antibody confirmed the absence of insulin-producing cells in the head of the pancreas. Beta cell proliferation within the islets of the tail of the pancreas was suggested by the appearance of cells undergoing mitosis and confirmed by BUdR labeling of cell nuclei detected with anti-BUdR monoclonal antibody. The mitotic index was significantly increased compared to control rabbits (p = 0.0235, Mann-Whitney U nonparametric test). This study demonstrates that the BUdR labeling can be used to document beta cell proliferation in vivo in the rabbit model after subtotal beta cell ablation.