A Milky Way-like barred spiral galaxy at a redshift of 3

The majority of massive disk galaxies in the local Universe show a stellar barred structure in their central regions, including our Milky Way1,2. Bars are supposed to develop in dynamically cold stellar disks at low redshift, as the strong gas turbulence typical of disk galaxies at high redshift suppresses or delays bar formation3,4. Moreover, simulations predict bars to be almost absent beyond z = 1.5 in the progenitors of Milky Way-like galaxies5,6. Here we report observations of ceers-2112, a barred spiral galaxy at redshift zphot ≈ 3, which was already mature when the Universe was only 2 Gyr old. The stellar mass (M★ = 3.9 × 109 M⊙) and barred morphology mean that ceers-2112 can be considered a progenitor of the Milky Way7-9, in terms of both structure and mass-assembly history in the first 2 Gyr of the Universe, and was the closest in mass in the first 4 Gyr. We infer that baryons in galaxies could have already dominated over dark matter at z ≈ 3, that high-redshift bars could form in approximately 400 Myr and that dynamically cold stellar disks could have been in place by redshift z = 4-5 (more than 12 Gyrs ago)10,11.

Compact hohlraum configuration with parallel planar-wire-array x-ray sources at the 1.7-MA Zebra generator

A compact Z-pinch x-ray hohlraum design with parallel-driven x-ray sources is experimentally demonstrated in a configuration with a central target and tailored shine shields at a 1.7-MA Zebra generator. Driving in parallel two magnetically decoupled compact double-planar-wire Z pinches has demonstrated the generation of synchronized x-ray bursts that correlated well in time with x-ray emission from a central reemission target. Good agreement between simulated and measured hohlraum radiation temperature of the central target is shown. The advantages of compact hohlraum design applications for multi-MA facilities are discussed.

Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) can play a major role in the management of acute pain in the peri-operative period. However, there are conflicting views on whether NSAIDs are associated with adverse renal effects.

OBJECTIVES

The primary objective of this review was to determine the effects of NSAIDs on postoperative renal function in adults with normal preoperative renal function.

SEARCH STRATEGY

Electronic searches for relevant randomised and quasi-randomised controlled trials in Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were performed. Attempts were also made to identify trials from citation lists of relevant trials, review articles and clinical practice guidelines. Handsearching of conference abstracts published in major anaesthetic journals was also performed. (Search date: 7 February 2003)

SELECTION CRITERIA

The inclusion criteria were randomised or quasi-randomised comparisons of individual NSAIDs with either each other or placebo for treatment of postoperative pain, with relevant postoperative renal outcome measures, in adult surgical patients with normal renal function.

DATA COLLECTION AND ANALYSIS

The data was extracted independently by two reviewers. The primary outcome measure was creatinine clearance within the first two days after surgery. Secondary outcome measures included serum creatinine, urine volume, urinary sodium level, urinary potassium level, fractional excretion of sodium, fractional excretion of potassium, need for dialysis and need for diuretic or dopamine treatment for renal insufficiency. Weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes were estimated.

MAIN RESULTS

Nineteen trials ( n = 1204) fulfilled the selection criteria for this review. NSAIDs reduced creatinine clearance by 16 ml/min (95%CI 5 to 28) and potassium output by 38 mmol/day (95%CI 19 to 56) on the first day after surgery compared to placebo. There was no significant difference in serum creatinine on the first day (0 umol/L, 95%CI -5 to 4) compared to placebo. No significant reduction in urine volume during the early postoperative period was found. There was no significant difference in serum creatinine in the early postoperative period between patients receiving diclofenace and ketorolac (or indomethacin). No cases of postoperative renal failure requiring dialysis were described. The trials were homogeneous for the primary outcome.

REVIEWERS' CONCLUSIONS

NSAIDs caused a clinically unimportant transient reduction in renal function in the early postoperative period in patients with normal preoperative renal function. NSAIDs should not be withheld from adults with normal preoperative renal function because of concerns about postoperative renal impairment.

Effects of nonsteroidal anti-inflammatory drugs on post-operative renal function in normal adults

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) can play a major role in the management of acute pain in the peri-operative period. However, there there are conflicting views on whether NSAIDs are associated with adverse renal effects.

OBJECTIVES

The primary objective of this review was to determine the effects of NSAIDs on post-operative renal function in adults with normal pre-operative renal function.

SEARCH STRATEGY

Electronic searches for relevant randomised and quasi-randomised controlled trials in Cochrane Controlled Trials Register, MEDLINE and EMBASE were performed. Attempts were also made to identify trials from citation lists of relevant trials, review articles and clinical practice guidelines. Hand-searching of conference abstracts published in major anaesthetic journals was also performed.

SELECTION CRITERIA

The inclusion criteria were randomised or quasi-randomised comparisons of individual NSAIDs with either each other or placebo for treatment of post-operative pain, with relevant post-operative renal outcome measures, in adult surgical patients with normal renal function.

DATA COLLECTION AND ANALYSIS

Of the 14 trials that fulfilled the selection criteria for this review, eight trials were relevant with sufficient data for meta-analysis. The data was extracted independently by two reviewers. The primary outcome measure was creatinine clearance within the first two days after surgery. Secondary outcome measures included serum creatinine, urine volume, urinary sodium level, urinary potassium level, fractional excretion of sodium, fractional excretion of potassium, need for dialysis and need for diuretic or dopamine treatment for renal insufficiency. Weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes were estimated.

MAIN RESULTS

As a group, NSAIDs reduced creatinine clearance by 18ml/min (95%CI: 6 to 31) and potassium output by 38mmol/day (95%CI: 19 to 56) on the first day after surgery compared to placebo. Serum creatinine clearance increased on the second day after surgery by 15umol/L (95%CI: 2 to 28) compared to placebo. No significant reduction in urine volume during the early post-operative period was found. There was no significant difference in serum creatinine in the early post-operative period between patients receiving ketorolac and diclofenac in one trial. No cases of post-operative renal failure requiring dialysis were described.

REVIEWER'S CONCLUSIONS

NSAIDs caused a clinically unimportant transient reduction in renal function in the early post-operative period in patients with normal pre-operative renal function. NSAIDs should not be withheld from adults with normal pre-operative renal function because of concerns about post-operative renal impairment.

Prenatal sonographic detection of congenital hepatic cyst in third trimester after normal second-trimester sonographic examination

A solitary unilocular hepatic cyst (SUHC) is a rare prenatal or neonatal finding. There are few reports of the prenatal detection of SUHC, and the progression of SUHC in utero is unknown. We present a proven case of SUHC in a fetus detected on a 34-week ultrasound examination following a normal 19-week examination. The cyst was inseparable from the liver and caused some flattening of the liver edge. Prenatal detection of an SUHC inseparable from the liver and appearing in the late second or third trimester should suggest a congenital hepatic cyst.

Perceptions of pediatric chief residents on minority house staff recruitment and retention in large pediatric residency programs

This study examined methods of recruiting and retaining minority house staff at US residency training programs. A 28-item questionnaire was mailed to pediatric chief residents at 78 US training programs with more than 35 residents. The response rate was 74%. Programs were characterized by patient populations served, number of ethnic/racial minority house staff and faculty, and the presence of minority house staff support systems within the institution. In this largely urban sample, minority recruitment and retention was reported as an explicit priority by 40% of pediatric chief residents. The majority (71%) reported that their house staff recruitment committees had no explicitly defined recruitment goals regarding minority house staff. Seventy-seven percent reported that within their departments, recruitment efforts toward minorities were no different than for nonminorities. Overall, few minority house staff and minority faculty were identified in the responding institutions. The most frequently reported intra-institutional support systems for minority house staff included individual pairing with faculty advisors from the same minority group (29%), an affirmative-action office located at the institution (8%), and the existence of a minority faculty support group (4%). These results indicate that pediatric chief residents may not be fully aware of the specific challenges related to the recruitment and retention of minority physicians, and most house staff recruitment committees do not have explicit goals in this regard.

Ethical decision making in nephrology nursing for end-of-life care: a responsibility and opportunity

This article describes the ethical significance of working with ESRD patients with a focus on end-of-life decision making. The ethical aspects of patient advocacy are explored and suggestions are offered for helping patients make ethically sound and caring end-of-life decisions. A model for ethical decision making is outlined, along with guidance from the ANA Code of Ethics and suggestions from the ANA Position Statements on Care and Comfort in Dying Patients, Euthanasia, and Assisted Suicide.

Technology and care in a bone marrow transplant unit: creating and assuaging vulnerability

The article describes the experience of technologically induced vulnerability and the inherent uncertainty of patients undergoing bone marrow transplantation. Examples of care by nurses, as perceived by patients and their family members, are offered. The relationship between the iatrogenic vulnerability and suffering of patients and the nursing response of care is explored. The claim is made that a caring response by nurses enables patients to make meaning of their choice to undergo simultaneously life-saving and life-threatening bone marrow transplantation.

Measurement of soluble transferrin receptor in serum of healthy adults

The concentration of soluble transferrin receptor (sTfR) in serum is reported to be useful in the diagnosis of iron deficiency, especially for patients with concurrent chronic disease, where routine tests of iron status are compromised by the inflammatory condition. A new diagnostic assay for sTfR is calibrated against natural plasma sTfR, thus minimizing calibration discrepancies that result from differences between the analyte and the cellular transferrin receptor used in other assays. Use of the new assay to measure sTfR concentrations in 225 healthy, hematologically normal adults provided a reference interval against which pathological samples could be compared. There was no difference in the reference intervals for men and women and no correlation of [sTfR] with the age of the subject. Black subjects had significantly higher concentrations than nonblacks, and people living at high altitude had higher concentrations than those living closer to sea level. These differences were additive.

Measurement of soluble transferrin receptor in serum of healthy adults

The concentration of soluble transferrin receptor (sTfR) in serum is reported to be useful in the diagnosis of iron deficiency, especially for patients with concurrent chronic disease, where routine tests of iron status are compromised by the inflammatory condition. A new diagnostic assay for sTfR is calibrated against natural plasma sTfR, thus minimizing calibration discrepancies that result from differences between the analyte and the cellular transferrin receptor used in other assays. Use of the new assay to measure sTfR concentrations in 225 healthy, hematologically normal adults provided a reference interval against which pathological samples could be compared. There was no difference in the reference intervals for men and women and no correlation of [sTfR] with the age of the subject. Black subjects had significantly higher concentrations than nonblacks, and people living at high altitude had higher concentrations than those living closer to sea level. These differences were additive.

Can a zero defects philosophy be applied to drug errors?

The literature reveals that errors of drug administration are a widely distributed and common occurrence. The frequency of errors and their underlying causes are discussed, and the literature is surveyed to determine reasons for mistakes and possible remedial measures. Ideas are drawn from industrial sources to describe a model of preventing mistakes at source, by making errors impossible. The ideas of Crosby and Shingo are discussed and a 'zero defects philosophy' is described and developed. This paper attempts to determine if this quality model developed and used in industry can be transferred to the health service, and concludes that it needs adaptation and cautious application. Recommendations are made for improved practices and improvements, both clinical and managerial. The author recommends a multidisciplinary review of all practices and systems to develop a radically different procedure with no drug errors as its aim. It is questioned whether this is possible in the present health service environment, as this would require sustained management commitment to both the idea and the quality system. However, the author believes that some of the principles can be applied as individual quality initiatives.

Violence: changing the paradigm in New Jersey

Physicians must assist in making violence a major statewide public health issue. The medical profession with its concern for patients has a natural interest in seeing that the victims of violence are treated effectively. Physicians must help uncover the root causes of violence.

The intersection of technology and care in the ICU

In this article the author describes the paradoxical nature of the relationship between technology and care in the ICU. Although technology enhances care by expanding the repertoire of competent nurses' responses to the patient, it simultaneously alienates nurse and patient, hence inhibiting care. This occurs when nurses and patients have different understandings of technology and when the nurse identifies with the values imposed by technology at the expense of acknowledging her own and the patient's vulnerability.

Principle-oriented ethics and the ethic of care: a creative tension

Research to date in the field of nursing ethics has overlooked the nature of the guiding moral framework in nursing practice, while focusing primarily on the moral reasoning and moral behaviors among nurses. This research depicts two moral frameworks--a principle-oriented ethic and the ethic of care--as they are experienced by practicing critical care nurses. The interdependence of these two frameworks as they inform the moral experience of the nurse is demonstrated in the analysis of a complex nurse narrative that depicts the nurse's moral struggle.

Structural changes in the megakaryocytes of patients infected with the human immune deficiency virus (HIV-1)

Although immune mechanisms are known to be partially responsible for the thrombocytopenia of patients infected with HIV-1, an understanding of the mechanism underlying this disorder is incomplete. A casual observation that bone marrow biopsies of HIV-infected individuals seem to exhibit an unusually large number of denuded megakaryocyte nuclei (DN-MK) prompted a study comparing MK of 20 HIV-seropositive individuals with those of 10 patients with HIV-negative idiopathic thrombocytopenic purpura and 10 hematologically normal subjects. In normal marrows the number of DN-MK average 2.1 +/- 0.5 SE per 10 low power field. In patients with ITP the average number was 6.5 +/- 1.4 SEM, whereas HIV-ITP marrows had an average of 42.5 +/- 3.7 SEM. Electron microscopy of AIDS megakaryocytes exhibited ballooning of the peripheral zone to an extent not seen by us in any other myelodysplastic syndromes. These observations support the concept that the pathophysiology affecting MK/platelets in HIV-infection should not be equated with the destructive process underlying other immune thrombocytopenias.

Gilligan's different voice: a perspective for nursing

This article proposes that Carol Gilligan's ethic of care provides for nursing a paradigm for moral deliberation that demonstrates compatibility with nursing's historical and philosophical traditions of relational caring and furnishes empirical support for the value of caring as a moral activity. The appropriateness of Gilligan's theory for nursing is further illustrated by an elucidation of the similarities between Gilligan's theory and nurse theorist Jean Watson's claims that caring constitutes both a necessary and a fundamental component of nursing. It is argued that Gilligan's theory of moral deliberation more faithfully reflects the nursing experience than Kohlberg's contractual, Kantian theory, which currently dominates the nursing literature.

Covenantal relationships: grounding for the nursing ethic

This article is in reaction to recent articles in Advances In Nursing Science by Yarling and McElmurry and Bishop and Scudder, which interpret the nursing ethic as grounded in the social reform of the institution or in the role of the nurse on the health care team. It is argued here that covenantal relationships between the nurse and the patient provide a more substantial foundation for the nursing ethic. Arising from the moral principle of fidelity, this model furnishes guidance for the nurse, a link for the nursing ethic with traditional moral theory, and, most important, a grounding in the unique experience of the nurse-patient relationship.

A Study of the Comparability of External Criteria for Hierarchical Cluster Analysis

Five external criteria were used to evaluate the extent of recovery of the true structure in a hierarchical clustering solution. This was accomplished by comparing the partitions produced by the clustering algorithm with the partition that indicates the true cluster structure known to exist in the data. The five criteria examined were the Rand, the Morey and Agresti adjusted Rand, the Hubert and Arabie adjusted Rand, the Jaccard, and the Fowlkes and Mallows measures. The results of the study indicated that the Hubert and Arabie adjusted Rank index was best suited to the task of comparison across hierarchy levels. Deficiencies with the other measures are noted.

Lymphomas in men at high risk for acquired immune deficiency syndrome (AIDS). A study of 21 cases

An increased incidence of lymphoid neoplasias is associated with the states of immune deficiency, both congenital and acquired. Twenty-one cases of lymphoma in men at high risk for Acquired Immune Deficiency Syndrome (AIDS) were diagnosed in one community hospital in New York City within the last 2 years. The mean age of these patients was 39.6 years, 20 were homosexual, and 1 was an intravenous drug abuser. There were 3 Hodgkin's and 18 non-Hodgkin's lymphomas of various histologic types, but almost all of high-grade categories. The proportion of extranodal lymphomas, the involvement of the gastrointestinal tract, central nervous system, bone marrow, and myocardium were significantly higher than in the lymphomas of the general population. The phenotypes were B-cell and non-B-non-T-cell types without any T-cell lymphomas. All patients had reversed helper-suppressor T-cell ratios and all those tested had circulating HTLV-III antibodies. Seven patients have had previous lymph node biopsies performed, showing the lesions of AIDS-related lymphadenopathies that often were directly associated with lymphoma. A variety of severe opportunistic infections and Kaposi's sarcoma affected these patients. All lymphomas in this group were highly aggressive, involved multiple organs, and responded poorly to treatment, resulting in early deaths.

The effect of erythropoietin on colonial growth of erythroid precursor cells in vitro

A method is described for the colonial growth, in semi-solid medium, of erythropoietin-responsive erythroid cell precursors. The erythroid cell precursors were isolated by immune hemolysis from fetal mouse liver. Both the number of precursor cells triggered to proliferate and differentiate, and the size of the erythropoietic colonies formed, are directly dependent upon the concentration of erythropoietin included in the culture.