The role of symptom appraisal, concealment and social support in optimizing dyadic mental health in heart failure

Objectives: Heart failure patients and their family care partners experience poor mental health, yet the majority of the research focuses on patients and care partners separately. Guided by the Theory of Dyadic Illness Management, the purpose of the current study was to identify distinct patterns of dyadic mental health in heart failure and identify the individual, dyadic and familial factors associated with group membership.Method: Fifty nine heart failure community-dwelling patients and their spouse care partners were recruited from an outpatient heart failure clinic. Mental health was operationalized by depressive symptoms, measured with the Patient Health Questionnaire-9 (PHQ-9) measure of depression. Distinct groups of dyadic mental health were determined by categorizing depression scores within dyads.Results: Three groups of dyadic mental health were identified: an optimal dyadic mental health group (31%), a poor dyadic mental health group (32%) and an incongruent dyadic mental health group (37%). Patient age, patient fatigue, patient concealment, incongruent dyadic appraisal of pain interference and social/familial support were significantly associated with group membership.Conclusion: Findings underscore the salience of a dyadic approach to health and the clinical relevance of identifying patterns of dyadic mental health so we may determine those most in need of intervention.

Development of Rapid Response Capabilities in a Large COVID-19 Alternate Care Site Using Failure Modes and Effect Analysis with In Situ Simulation

Preparedness measures for the anticipated surge of coronavirus disease 2019 (COVID-19) cases within eastern Massachusetts included the establishment of alternate care sites (field hospitals). Boston Hope hospital was set up within the Boston Convention and Exhibition Center to provide low-acuity care for COVID-19 patients and to support local healthcare systems. However, early recognition of the need to provide higher levels of care, or critical care for the potential deterioration of patients recovering from COVID-19, prompted the development of a hybrid acute care-intensive care unit. We describe our experience of implementing rapid response capabilities of this innovative ad hoc unit. Combining quality improvement tools for hazards detection and testing through in situ simulation successfully identified several operational hurdles. Through rapid continuous analysis and iterative change, we implemented appropriate mitigation strategies and established rapid response and rescue capabilities. This study provides a framework for future planning of high-acuity services within a unique field hospital setting.

Pandemic Care Through Collaboration: Lessons From a COVID-19 Field Hospital

During the surge of Coronavirus Disease 2019 (COVID-19) infections in March and April 2020, many skilled-nursing facilities in the Boston area closed to COVID-19 post-acute admissions because of infection control concerns and staffing shortages. Local government and health care leaders collaborated to establish a 1000-bed field hospital for patients with COVID-19, with 500 respite beds for the undomiciled and 500 post-acute care (PAC) beds within 9 days. The PAC hospital provided care for 394 patients over 7 weeks, from April 10 to June 2, 2020. In this report, we describe our implementation strategy, including organization structure, admissions criteria, and clinical services. Partnership with government, military, and local health care organizations was essential for logistical and medical support. In addition, dynamic workflows necessitated clear communication pathways, clinical operations expertise, and highly adaptable staff.

Chromoplectic TPM3-ALK rearrangement in a patient with inflammatory myofibroblastic tumor who responded to ceritinib after progression on crizotinib

Ceritinib resulted in a significant, durable response of a metastatic inflammatory myofibroblastic tumor (IMT) after failure of crizotinib. A chromoplectic TPM3–ALK rearrangement involving many known oncogenes was found in the residual IMT. Ceritinib may be useful for patients with IMT after failure of crizotinib, and chromoplexy may have a role in the oncogenesis or treatment resistance of IMTs.

Background

Inflammatory myofibroblastic tumors (IMTs) are rare sarcomas that can occur at any age. Surgical resection is the primary treatment for patients with localized disease; however, these tumors frequently recur. Less commonly, patients with IMTs develop or present with metastatic disease. There is no standard of care for these patients and traditional cytotoxic therapy is largely ineffective. Most IMTs are associated with oncogenic ALK, ROS1 or PDGFRβ fusions and may benefit from targeted therapy.

Patient and methods

We sought to understand the genomic abnormalities of a patient who presented for management of metastatic IMT after progression of disease on crizotinib and a significant and durable partial response to the more potent ALK inhibitor ceritinib.

Results

The residual IMT was resected based on the recommendations of a multidisciplinary tumor sarcoma tumor board and analyzed by whole-genome mate pair sequencing. Analysis of the residual, resected tumor identified a chromoplectic TPM3–ALK rearrangement that involved many other known oncogenes and was confirmed by rtPCR.

Conclusions

In our analysis of the treatment-resistant, residual IMT, we identified a complex pattern of genetic rearrangements consistent with chromoplexy. Although it is difficult to know for certain if these chromoplectic rearrangements preceded treatment, their presence suggests that chromoplexy has a role in the oncogenesis of IMTs. Furthermore, this patient's remarkable response suggests that ceritinib should be considered as an option after progression on crizotinib for patients with metastatic or unresectable IMT and ALK mutations.

Napping in college students and its relationship with nighttime sleep

Abstract.

OBJECTIVE

To examine the habit of napping and its relationship with nighttime sleep in college students.

PARTICIPANTS

Four hundred and forty undergraduate students who responded to an anonymous online survey in April 2010.

METHODS

Three questions were asked to determine the frequency, length, and timing of napping during the past month. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

The PSQI score significantly differed among self-reported nap-frequency (p=.047) and nap-length (p=.017) groups, with those who napped more than 3 times per week and those who napped more than 2 hours having the poorest sleep quality. Students who napped between 6 and 9 pm had shorter sleep on school nights compared with students in other nap-timing groups (p=.002).

CONCLUSIONS

College students who are self-reported frequent, long, and late nappers may have a higher risk of poor nighttime sleep quality and more severe sleep deprivation.

Activation of TAK1 by MYD88 L265P drives malignant B-cell Growth in non-Hodgkin lymphoma

Massively parallel sequencing analyses have revealed a common mutation within the MYD88 gene (MYD88_L265P) occurring at high frequencies in many non-Hodgkin lymphomas (NHLs) including the rare lymphoplasmacytic lymphoma, Waldenström's macroglobulinemia (WM). Using whole-exome sequencing, Sanger sequencing and allele-specific PCR, we validate the initial studies and detect the MYD88_L265P mutation in the tumor genome of 97% of WM patients analyzed (n=39). Due to the high frequency of MYD88 mutation in WM and other NHL, and its known effects on malignant B-cell survival, therapeutic targeting of MYD88 signaling pathways may be clinically useful. However, we are lacking a thorough characterization of the role of intermediary signaling proteins on the biology of MYD88_L265P-expressing B cells. We report here that MYD88_L265P signaling is constitutively active in both WM and diffuse large B-cell lymphoma cells leading to heightened MYD88_L265P, IRAK and TRAF6 oligomerization and NF-κB activation. Furthermore, we have identified the signaling protein, TAK1, to be an essential mediator of MYD88_L265P-driven signaling, cellular proliferation and cytokine secretion in malignant B cells. Our studies highlight the biological significance of MYD88_L265P in NHL and reveal TAK1 inhibition to be a potential therapeutic strategy for the treatment of WM and other diseases characterized by MYD88_L265P.

Selective activation of a parietofrontal circuit during implicitly imagined prehension

It is generally held that motor imagery is the internal simulation of movements involving one's own body in the absence of overt execution. Consistent with this hypothesis, results from numerous functional neuroimaging studies indicate that motor imagery activates a large variety of motor-related brain regions. However, it is unclear precisely which of these areas are involved in motor imagery per se as opposed to other planning processes that do not involve movement simulation. In an attempt to resolve this issue, we employed event-related fMRI to separate activations related to hand preparation-a task component that does not demand imagining movements-from grip selection-a component previously shown to require the internal simulation of reaching movements. Our results show that in contrast to preparation of overt actions, preparation of either hand for covert movement simulation activates a large network of motor-related areas located primarily within the left cerebral and right cerebellar hemispheres. By contrast, imagined grip selection activates a distinct parietofrontal circuit that includes the bilateral dorsal premotor cortex, contralateral intraparietal sulcus, and right superior parietal lobule. Because these areas are highly consistent with the frontoparietal reach circuit identified in monkeys, we conclude that motor imagery involves action-specific motor representations computed in parietofrontal circuits.

Seeing two sides at once: effects of viewpoint and object structure on recognizing three-dimensional objects

Five experiments demonstrated that adults can identify certain novel views of 3-dimensional model objects on the basis of knowledge of a single perspective. Geometrically irregular contour (wire) and surface (clay) objects and geometrically regular surface (pipe) objects were accurately recognized when rotated 180 degrees about the vertical (y) axis. However, recognition accuracy was poor for all types of objects when rotated around the y-axis by 90 degrees. Likewise, more subtle rotations in depth (i.e., 30 degrees and 60 degrees) induced decreases in recognition of both contour and surface objects. These results suggest that accurate recognition of objects rotated in depth by 180 degrees may be achieved through use of information in objects' 2-dimensional bounding contours, the shapes of which remain invariant over flips in depth. Consistent with this interpretation, a final study showed that even slight rotations away from 180 degrees cause precipitous drops in recognition accuracy.

Within grasp but out of reach: evidence for a double dissociation between imagined hand and arm movements in the left cerebral hemisphere

What roles are played by the cerebral hemispheres in planning object-oriented reaching and grasping movements? In an attempt to address this question, we compared the abilities of the left and right hemispheres of commissurotomy patient J.W. to imagine hand manipulation (i.e., grasp) or arm transportation (i.e., reach) movements. A graphically rendered manipulandum (dowel) was briefly presented to the left (LVF) or right (RVF) visual fields in a variety of different orientations. In the grasp selection task (experiment 1), J.W. was required to determine which side of a dowel his thumb would be on if he were to engage the stimulus in a power grip using either his dominant (right) or non-dominant hand. In the reach selection task (experiment 3), J.W. judged which end his elbow would be on if he treated the dowel as an armrest for his dominant or non-dominant forearm. No actual movements were allowed in either task. Movements selected in the imagery tasks were compared with those chosen during actual motor control under comparable circumstances. These comparisons revealed a left hemisphere advantage for representing grasping movements involving the right hand, and reaching movements involving the left arm. The right hemisphere, by contrast, displayed moderate accuracy when representing grasping movements with the left hand, but appeared incapable of imagining reaching movements with either arm. The double dissociation between imagery for hand and arm movements in the left cerebral hemispere is consistent with the hypothesis that grasping and reaching components of prehension involve dissociable planning mechanisms.

Imagining the impossible: intact motor representations in hemiplegics

Motor imagery is known to involve brain regions vital to the performance of motor skills including primary motor cortex. The present results show that, following cerebral vascular accidents (CVAs) affecting a variety of these regions, many adults with left or right upper-limb paralysis (i.e. hemiparesis/hemiplegia) retain the ability to accurately represent prehensile movements involving the impaired limb. This suggests that during the acute phase of recovery many CVA patients can use motor imagery to activate partially damaged motor networks; a process that may facilitate functional reorganization. This ability was, however, compromised in cases with right posterior parietal or left frontal lesions. This pattern is consistent with the hypothesis that imagined prehension, like actual reaching and grasping, involves a network of highly interconnected areas distributed throughout parietal and frontal cortices.

Parallel format: making life easier for the reader

Use parallel style to show the similarity between items in a series. When headings, bullet lists, and sentence phrases that relate to each other are written in a similar style, the reader can understand the information faster than when they are written in different styles.

Use of grade membership analysis to profile the practice styles of individual physicians in the management of acute low back pain

The objective of this study was to investigate Grade of Membership analysis (GoM) as a means of profiling the practice styles of individual physicians. GoM uses maximum likelihood techniques to estimate occurrences of management items that define unique practice styles. It also provides statistical estimates (grade of membership coefficients) of how well each individual physician's practice fits the identified styles. Data sources were responses to a mailed survey asking 814 physicians to select from predetermined management options in three scenarios depicting patients with acute low back pain. Four distinct types of practice style were identified: watchful waiting; investigative; guideline based; and physiotherapy focused. Most physicians were characterized by high grades of membership in the two profiles that most closely matched existing guidelines for the management of acute low back pain. GoM successfully identified characteristic practice styles, and the GoM coefficients obtained provided descriptions of individual management approaches. GoM is data driven and less subject to judgment than opinion-based measures of performance. It has several potential applications in identifying physicians for whom some form of intervention would be beneficial.

Thinking ahead: the case for motor imagery in prospective judgements of prehension

How similar are judgements concerning how we expect to perform an action, to how we actually behave? The veracity of such prospective action judgements, and the mechanisms by which they are computed, was explored in a series of tasks that involved either grasping (MC conditions) or thinking about grasping (PJ conditions) a dowel presented in various orientations. PJs concerning limits of comfortable hand supination and pronation when turning a dowel in the picture plane were highly consistent with values obtained during actual hand rotation (Exp. 1). The same was true for judgements regarding the level of awkwardness involved in adopting a prescribed grip (e.g. overhand with right hand) for dowels in various picture plane orientations (Exp. 2). When allowed to select the most natural grip (overhand versus underhand) or hand (left versus right) for engaging dowels in these orientations, subjects preferred virtually identical responses in both PJ and MC conditions. In both instances, they consistently chose the least awkward response options. As would be expected for actual movements, PJs involving awkward hand postures had longer response times (RTs), and were less accurate. Likewise, latencies for both grip and hand judgements tended to increase as a function of the angular distance between the current positions of subjects' hands, and the orientation of the chosen posture. Together, these findings are consistent with a the hypothesis that PJs involve mentally simulated actions, or motor imagery. These results suggest that motor imagery does not depend on the existence of a completed premotor plan (Jeannerod, 1994), but may instead be involved in the planning process itself. A provisional model for the involvement of imagery in motor planning is outlined, as are a set of criteria for evaluating claims of the involvement of motor imagery in problem solving.

The proofing challenge: finding hidden errors

Page proofs are deceptive. The beautiful fonts, printout and lay-out of page proofs can be deceptive, because there are usually some errors still lurking. Most nursing journals send page proofs to authors, but most authors are not experienced at proofing final pages for publication, so errors can sneak through. This article provides tips on proofing final pages so that those pesky, final errors can be corrected before printing.

Coping with census fluctuations

Census fluctuations are the latest challenge for nurse managers, recruiters, and human resource professionals. How health care facilities deal with this problem affects retention and recruitment.

A preliminary analysis of medical futility decisionmaking: law and professional attitudes

Judicial decisions reviewed in this article indicate that courts have taken two disparate approaches to disputes over futility of treatment. To explore whether a consensus on medical futility is developing among hospitals, the authors conducted a nationwide survey of health care professionals at hospitals. Respondents assigned importance ratings to factors used in recent futility decisions made at their institutions. The resulting importance ratings showed significant variation by characteristics of the institution (comparing respondents from for-profit, not-for-profit, and government hospitals) and by profession of the respondent (comparing physicians and nurses). The respondents' judgments endorsed three distinct strategies for making futility decisions (i.e., emphasis on the patient's decision preferences, providing for the patient and family, and adhering to objective medical and social norms).

Submitting your manuscript on disk: a steep learning curve for authors and editors

Many nursing journals are switching to state-of-the-art manuscript production systems. Most of these new systems include computerized typesetting, so some journals are requesting disk submission of manuscripts. However, computer disk submission is not without difficulties. Editors and authors alike are experiencing a fairly steep learning curve before developing a system where the author's disk can work in the publisher's production system. This article describes how authors and editors can collaborate on the disk submission system for nursing publications.

Fax etiquette for nurse authors and editors

Is the facsimile (fax) machine really as great as it seems? Yes, but there is a potential for its misuse. Like all equipment, the fax machine is a tool that needs to be used wisely. This article describes the Do's and Don'ts of using the fax machine to communicate between authors and editors. Tips in this article will help authors and editors to correspond smoothly by fax and use new fax equipment options.

Mentally Simulated Reaches for Visual Objects: Effects of Stimulus Orientation and Biomechanical Constraints

Recent evidence suggests that mentally simulating an action involves many of the same neuropsychological mechanisms as overt performance. A series of experiments were conducted to evaluate whether representations involved in mentally simulated reaches are constrained by the same biomechanical factors that limit actual movements. Subjects were asked to use either the right or the left hand to acquire a dowel presented visually in one of 24 different orientations within the picture plane. In reaching studies, subjects responded by grasping the target using either an overhand or underhand grip; in the mentally simulated studies, subjects responded by vocally indicating whether they would prefer an overhand or underhand grip if they were to actually grasp the object.

Results indicate substantial correspondence between actual and mentally simulated reaching. Grip preferences in both situations are highly correlated, and reflect biomechanical constraints on rotation of the forearm. In both actual and mentally simulated tasks, subjects show clear preferences for grips that minimise perceived awkwardness. In contrast to related work, the time required to perform mentally simulated reaches for visual objects was found not to increase linearly with distance from the resting posture of the response hand.

Findings are discussed with respect to the hypothesis that actual and mentally simulated actions involve the same internal representations.

Where are clinical ladders headed?

Now that restructuring projects are under way, revision of the delivery system has expanded to related areas. One system that is being reviewed is the clinical ladder. This article discusses the future directions of clinical ladders within a restructured healthcare system.

Agenesis of cerebellum associated with arrhinencephaly

Complete cerebellar agenesis or aplasia is an extremely rare condition with few previously reported cases. We identified a 38-week gestation infant with microcephaly who had complete cerebellar agenesis associated with arrhinecephaly. There was complete lack of the efferent and afferent limbs of the cerebellum, including the nuclei of the basis pontis, the inferior olivary nuclei, ascending spinal and medullary afferents, deep cerebellar nuclei and their afferents, and the red nucleus. Although complete cerebellar agenesis is rare, cerebellar hypoplasia is more common and can be sporadic, asymmetric, or represent clinically, genetically, and pathologically diverse examples of primary cerebellar or vermian hypoplasia.

Adapting a thesis to publication style: meeting editors' expectations

Every year hundreds of thesis reports are completed by graduate students. Many of these end up on nursing journal editors' desks, only to be rejected. What characteristics of a thesis lead to rejection? How can authors develop quality research manuscripts? How can faculty teach graduate students the difference between a thesis and manuscript. This article answers these questions by providing advice from 15 critical care and research journal editors.

Teaching Nursing Delegation: Analyzing Nurse Practice Acts

Teaching delegation to nurses, especially for those nurses who have mostly practiced in primary nursing, is challenging. Many staff development and continuing education instructors are teaching delegation principles to nurses today because good delegation skills are needed to effectively implement current skill-mix and patient-focused care changes. In these courses, nurses almost always want guidelines on what they can and cannot delegate to unlicensed assistive personnel and LPN/LVNs. The best foundation for teaching what can and cannot be delegated is the nursing practice act in the state, even though analyzing state practice acts can be cumbersome. Analyzing practice acts as the basis for teaching delegation principles is a critical requirement for today's staff development/continuing educator.

Dispelling myths about the new NCLEX exam

The new computerized NCLEX system is working well. Most new candidates, employers, and board of nursing representatives like the computerized adaptive testing system and the fast report of results. But, among the candidates themselves some myths have grown which cause them needless anxiety.

Setting limits on death: a view from the United States

Assisted suicide is a tragic issue, one of those for which the tools of mere logic are inadequate and in which the power of the individual case is compelling and seductive but not necessarily clarifying. Meaningful dialogue is difficult. Persuasion is limited because the resolution of the issue, on a moral level, must be founded upon fundamental notions of what it means to be human, especially in the midst of suffering or disability or at the point of death.

Monitoring professionals' intent-to-leave: anticipating the effects of restructuring on future retention

Staff who are dissatisfied with current restructuring changes are not leaving in large numbers, at least not yet. But, in some settings their intent-to-leave may be high enough that increased turnover might be next. Monitoring the intent-to-leave now can help you reduce resignations later, when patient demand increases again.

Safe discontinuation of antihypertensive therapy

We summarize herein the clinical and pathophysiological features of antihypertensive withdrawal syndrome and its risk factors, management, and prevention. Antihypertensive withdrawal syndrome occurs most frequently with beta-blocking agents and centrally acting antihypertensives such as clonidine hydrochloride. This syndrome resembles a state of sympathetic nervous system hyperactivity. In the most critical case, it can be severe and life threatening. Antihypertensive dosages, particularly for beta-blockers and clonidine, should be tapered slowly rather than discontinued abruptly.

Managed care as regulation: functional ethics for a regulated environment

Analysis in bioethics has relied primarily on the identification and application of general principles and on the examination of particular paradigmatic cases. Principalism and casuistry depend on an assumption of generalizability; that is, that learning and insights gained from an understanding of the principles or the case may be effectively applied to other similar situations. For the most part, the particular characteristics of the institutional setting have not played a central role in these approaches. It would appear, then, that what has been learned in the context of one health care setting is transferable, with some few adjustments, to another.

The institutional context does make both a practical and a substantive difference, however, and shifting ethical analyses from one context to another has sometimes proven difficult. This has been so, for example, in the context of nursing home care.

Plasma concentrations of medroxyprogesterone acetate, estradiol and estrone following oral administration of Klimaxil, Trisequence/Provera and Divina. A randomized, single-blind, triple cross-over bioavailability study in menopausal women

The absorption of estradiol and medroxyprogesterone acetate was investigated in a randomized single-blind, triple cross-over study, in 12 menopausal women, for four different HRT drugs (Klimaxil, a combination tablet containing 17 beta-estradiol 2 mg and medroxy-progesterone acetate 5 mg; Divina, a combination tablet containing 17 beta-estradiol valerate 2 mg and medroxyprogesterone acetate 10 mg; Trisequence, a triphasic preparation containing 17 beta-estradiol 2 mg in the first phase; Provera, a tablet containing medroxyprogesterone acetate 5 mg). Trisequence and Provera were ingested simultaneously. In conclusion, there was no statistically significant difference between the drugs with respect to the estradiol levels. The estrone concentration, however, differed between the different drugs. The serum concentration was higher after intake of tablets containing estradiol than after intake of tablets containing the valerate ester. There was a significant increase in the MPA levels between periods 1 and 3. Finally, Divina produced higher MPA concentrations than Klimaxil and the combination of Trisequence and Provera, although the mean AUC was not twice as high, as might have been expected.

Undesired light images associated with ovoid intraocular lenses

Ovoid intraocular lenses (IOLs) accounted for approximately 35% of the lenses implanted in 1991. Despite their popularity among surgeons, patient observations and complaints suggest that ovoid lenses are associated with undesired optical images postoperatively. A pilot clinical study was carried out to test that hypothesis. A multicentered investigation of 289 cases with well-centered IOLs determined that 45% of 168 patients with ovoid lenses observed unwanted optical phenomena at some time after surgery, whereas 17% of 121 patients with round IOLs had similar complaints. Based upon the preliminary clinical study a laboratory investigation was designed to assess optical performance differences between ovoid and round IOLs. One testing system used scatterometry and a second, ray tracing analysis. Both methods determined that the truncated, thickened edge of ovoid lenses was associated with significant light scattering, possibly accounting for the extraneous light images observed by some patients. The results of the clinical and laboratory investigations suggest that undesired optical images produced by ovoid IOLs are due to lens shape rather than to the reduced dimension of the optic.

Effects of flunarizine on neurological recovery and spinal cord blood flow in experimental spinal cord ischemia in rabbits

BACKGROUND AND PURPOSE

The lipophilic calcium channel antagonist flunarizine has been demonstrated to be neuroprotective in several models of cerebral ischemia. Ischemic spinal cord injury may have a similar pathophysiology and hence may respond in a similar fashion. This study was designed to investigate the effects of pretreatment with flunarizine on systemic hemodynamics, spinal cord blood flow, and neurological recovery in a rabbit model of ischemic spinal cord injury.

METHODS

New Zealand White rabbits were anesthetized with ketamine and xylazine and instrumented for systemic blood pressure monitoring and spinal cord blood flow measurements using the microsphere method. After pretreatment with flunarizine or vehicle, ischemic spinal cord injury was created selectively in the caudal regions of the spinal cord by cross-clamping the abdominal aorta for a period of 25 minutes. Spinal cord blood flow was measured before, during, and 15 minutes after cross-clamp removal. Animals were allowed to recover and were graded neurologically at 18 and 24 hours after ischemia.

RESULTS

Flunarizine injection was associated with hypotension that was both transient and dose related. Animals pretreated with flunarizine 0.4 mg/kg had significantly improved neurological recovery scores at 18 hours after ischemia (P = .017) compared with vehicle controls. At 24 hours this effect was lessened (P = .095); however, 60% of flunarizine-treated animals retained their ability to hop, whereas all of the vehicle-treated animals were nonambulatory.

CONCLUSIONS

Flunarizine has a protective effect on neurological recovery after experimental ischemic spinal cord injury. The therapeutic window is narrow, and dosing is limited by untoward hypotension. The mechanism of protection likely involves inhibition of pathological cytosolic calcium accumulation rather than a direct effect on vascular smooth muscle.

Avoiding the "school paper style" rejection

These style aspects are developed slightly differently by each journal or book publisher, so investigate how each is handled in your target publication. Through these steps and the advice of your editor, you can develop a professional style that communicates your professional ideas as the expert you are.

Split and lift: nuclear quadrant management for phacoemulsification

A bimanual technique for handling the nuclear quadrants created during "in situ fracture" or "divide-and-conquer" phacoemulsification after capsulorhexis is described. This technique involves lifting the sharp apex of each nuclear quadrant anteriorly, permitting centralization of the quadrant for emulsification. Complications and difficulties associated with other methods of nuclear quadrant handling, such as tumbling and use of high vacuum level settings, are avoided.

Measurement of the impulsive bone motion by skin-mounted accelerometers

A measurement system was designed to investigate longitudinal wave propagation through the lower extremity generated from foot strikes. The principal goal of the design was to eliminate measurement time lag and amplitude reduction, such that the acceleration measured by Skin Mounted Accelerometer--SMA is equal to the actual acceleration of the bone measured by Bone Mounted Accelerometer--BMA. For accurate dynamic measurement, it is important that the gain and phase of the measurement system are as close as possible to a constant and zero, respectively, for the frequency range being covered. An in vitro experiment was carried out to simultaneously measure skin and bone accelerations. The obtained information was used for identification of a linear spring/damper model representing the interface between the BMA and the SMA. The present work showed that the SMA overestimated the BMA by 12 percent in the signals between 15-30 Hz.