Informed Consent Prior to Coronary Angiography in a Real World Scenario: What Do Patients Remember?

Background

Patients'' informed consent is legally essential before elective invasive cardiac angiography (CA) and successive intervention can be done. It is unknown to what extent patients can remember previous detailed information given by a specially trained doctor in an optimal scenario as compared to standard care.

Methodology/Principal Findings

In this prospective cohort study 150 consecutive in-patients and 50 out-patients were included before elective CA was initiated. The informed consent was provided and documented in in-patients by trained and instructed physicians the day before CA. In contrast, out-patients received standard information by different not trained physicians, who did not know about this investigation. All patients had to sign a form stating that enough information had been given and all questions had been answered sufficiently. One hour before CA an assessment of the patients'' knowledge about CA was performed using a standard point-by-point questionnaire by another independent physician. The supplied information was composed of 12 potential complications, 3 general, 4 periprocedural and 4 procedural aspects.95% of the patients felt that they had been well and sufficiently informed. Less than half of the potential complications could be remembered by the patients and more patients could remember less serious than life-threatening complications (27.9±8.8% vs. 47.1±11.0%; p<0.001). Even obvious complications like local bleeding could not be remembered by 35% of in-patients and 36% of out-patients (p = 0.87). Surprisingly, there were only a few knowledge differences between in- and out-patients.

Conclusions

The knowledge about CA of patients is vague when they give their informed consent. Even structured information given by a specially trained physician did not increase this knowledge.     

Comparing temperature sensitivity of bacterial growth in Antarctic marine water and soil

The western Antarctic Peninsula is an extreme low temperature environment that is warming rapidly due to global change. Little is known, however, on the temperature sensitivity of growth of microbial communities in Antarctic soils and in the surrounding oceanic waters. This is the first study that directly compares temperature adaptation of adjacent marine and terrestrial bacteria in a polar environment. The bacterial communities in the ocean were adapted to lower temperatures than those from nearby soil, with cardinal temperatures for growth in the ocean being the lowest so far reported for microbial communities. This was reflected in lower minimum (T_min) and optimum temperatures (T_opt) for growth in water (?17 and +20°C, respectively) than in soil (?11 and +27°C), with lower sensitivity to changes in temperature (Q₁₀; 0–10°C interval) in Antarctic water (2.7) than in soil (3.9). This is likely due to the more stable low temperature conditions of Antarctic waters than soils, and the fact that maximum in situ temperatures in water are lower than in soils, at least in summer. Importantly, the thermally stable environment of Antarctic marine water makes it feasible to create a single temperature response curve for bacterial communities. This would thus allow for calculations of temperature‐corrected growth rates, and thereby quantifying the influence of factors other than temperature on observed growth rates, as well as predicting the effects of future temperature increases on Antarctic marine bacteria.     

Growth of saprotrophic fungi and bacteria in soil

Bacterial and fungal growth rate measurements are sensitive variables to detect changes in environmental conditions. However, while considerable progress has been made in methods to assess the species composition and biomass of fungi and bacteria, information about growth rates remains surprisingly rudimentary. We review the recent history of approaches to assess bacterial and fungal growth rates, leading up to current methods, especially focusing on leucine/thymidine incorporation to estimate bacterial growth and acetate incorporation into ergosterol to estimate fungal growth. We present the underlying assumptions for these methods, compare estimates of turnover times for fungi and bacteria based on them, and discuss issues, including for example elusive conversion factors. We review what the application of fungal and bacterial growth rate methods has revealed regarding the influence of the environmental factors of temperature, moisture (including drying/rewetting), pH, as well as the influence of substrate additions, the presence of plants and toxins. We highlight experiments exploring the competitive and facilitative interaction between bacteria and fungi enabled using growth rate methods. Finally, we predict that growth methods will be an important complement to molecular approaches to elucidate fungal and bacterial ecology, and we identify methodological concerns and how they should be addressed.     

Interactions of selenium with metal ions at the cellular level

In a supplementation study in which organic selenium asl-selenomethionine was administered in low doses during 1 yr, alterations in the concentrations of metal ions in the erythrocytes and the neutrophil granulocytes were observed. In the erythrocytes, altered concentrations of zinc were parallel with selenium. The concentrations of magnesium, calcium, manganese, copper, and sulfur were not significantly altered. However, altered concentrations of iron and zinc were observed in the neutrophils. The concentrations of magnesium, calcium, manganese, copper, and sulfur were not significantly altered. The accumulation of selenium in individual blood cells was different from that obtained with supplementation of inorganic selenium. When organic selenium was supplemented, the thrombocytes accumulated more selenium than the erythrocytes and the neutrophil granulocytes. The observations indicate that selenium interacts with metal ions at the cellular level when supplemented in low doses. The chemical form of selenium might be important in nutrition and therapy in view of the interaction and distribution pattern at the cellular level.     

Giant Robber Crabs Monitored from Space: GPS-Based Telemetric Studies on Christmas Island (Indian Ocean)

We investigated the navigational capabilities of the world''s largest land-living arthropod, the giant robber crab Birgus latro (Anomura, Coenobitidae); this crab reaches 4 kg in weight and can reach an age of up to 60 years. Populations are distributed over small Indo-Pacific islands of the tropics, including Christmas Island (Indian Ocean). Although this species has served as a crustacean model to explore anatomical, physiological, and ecological aspects of terrestrial adaptations, few behavioral analyses of it exist. We used a GPS-based telemetric system to analyze movements of freely roaming robber crabs, the first large-scale study of any arthropod using GPS technology to monitor behavior. Although female robber crabs are known to migrate to the coast for breeding, no such observations have been recorded for male animals. In total, we equipped 55 male robber crabs with GPS tags, successfully recording more than 1,500 crab days of activity, and followed some individual animals for as long as three months. Besides site fidelity with short-distance excursions, our data reveal long-distance movements (several kilometers) between the coast and the inland rainforest. These movements are likely related to mating, saltwater drinking and foraging. The tracking patterns indicate that crabs form route memories. Furthermore, translocation experiments show that robber crabs are capable of homing over large distances. We discuss if the search behavior induced in these experiments suggests path integration as another important navigation strategy.     

Toward a confocal subcellular atlas of the human proteome

Information on protein localization on the subcellular level is important to map and characterize the proteome and to better understand cellular functions of proteins. Here we report on a pilot study of 466 proteins in three human cell lines aimed to allow large scale confocal microscopy analysis using protein-specific antibodies. Approximately 3000 high resolution images were generated, and more than 80% of the analyzed proteins could be classified in one or multiple subcellular compartment(s). The localizations of the proteins showed, in many cases, good agreement with the Gene Ontology localization prediction model. This is the first large scale antibody-based study to localize proteins into subcellular compartments using antibodies and confocal microscopy. The results suggest that this approach might be a valuable tool in conjunction with predictive models for protein localization.     

Identification of a tyrosinase (TYR) exon 4 deletion in albino ferrets (Mustela putorius furo)

Albinism is due to a lack of pigmentation in hair, skin and eye, and has been shown to occur in several animal species. Mutations of the tyrosinase (TYR) gene account for albinism in domestic cats, rabbits, cattle, mice and rats. In this study, we demonstrate that a TYR mutation accounts for albinism in the ferret (Mustela putorius furo). The coding sequence of the five exons of TYR was determined in genomic DNA from wild-type pigmented 'sable' coloured and albino ferrets. It was not possible to amplify TYR exon 4 in albino ferrets originating from different breeds. The deletion of exon 4 in albino ferrets was confirmed by Southern blot hybridization of genomic DNA from albino and pigmented ferrets. This is the first report of a deletion of a TYR exon in a non-human mammal.     

Fungal and bacterial growth in soil with plant materials of different C/N ratios

Fungal (acetate-in-ergosterol incorporation) and bacterial (leucine/thymidine incorporation) growth resulting from alfalfa (C/N=15) and barley straw (C/N=75) addition was studied in soil microcosms for 64 days. Nitrogen amendments were used to compensate for the C/N difference between the substrates. Fungal growth increased to a maximum after 3–7 days, at five to eight times the controls, following the addition of straw, and three to four times the controls following the addition of alfalfa. After 20–30 days, the fungal growth rate converged with the controls, resulting in a cumulative fungal growth two to three times the controls following straw addition and about 20% higher than the controls following alfalfa addition. The bacterial growth rate reached rates five times the controls following alfalfa addition and twice that of the controls following straw addition after 3–7 days. It remained elevated after 64 days. The cumulative bacterial growth was two and four times the controls following straw and alfalfa addition, respectively. A negative correlation was found between N addition and bacterial growth, while N stimulated fungal growth. Thus, the C/N ratio of the additions (substrate and extra N) could not entirely explain the different results regarding fungal and bacterial growths. Respiration was not always related to the combined growth of the microorganisms, emphasizing the requirement for a better understanding of growth efficiencies of fungi and bacteria.     

Modeling long-term compost application effects on nitrate leaching

Application of compost to agricultural soils may be beneficial for crop production by increasing soil fertility and supplying plant nutrients, however, any raise of the soil organic matter content may increase the potential for unintended groundwater contamination by nitrate leaching. In this paper, the effect of long-term compost applications on nitrate leaching, soil organic matter content, and crop production is analyzed using results of simulation scenarios for agricultural sites with loamy and sandy soils. Simulations were carried out using the Danish Nitrogen Simulation System (DAISY) which describes the nitrogen balance in a one-dimensional soil-plant-atmosphere system and considers compost type and application rate as well as management and cropping practice. Estimations of hydraulic and solute transport parameters are based on pedotransfer functions. Data from a 4.5-year period of field experiments with compost applications in northern Germany as well as from laboratory experiments with compost amended soil are used for model calibration. Simulation results suggest that: (i) with respect to nitrogen turnover the differences between compost types (i.e., non-matured and matured) are small compared to site-specific properties (i.e., soil temperature and water balance) and management practices (i.e., crop rotation) when considering a compost application period of 50 years; (ii) with respect to nitrate leaching the effect of different compost application scenarios is highly sensitive at the sand and relatively small at the loam site; and (iii) relatively high crop yields and acceptably low nitrate concentrations in the drainage water are obtained at the sand site when applying a combination of 10 t compost/ha/yr and soil- N_min adjusted mineral nitrogen additions of about 20 kg/ha/yr to a winter-grain dominated crop rotation. Further optimization may be possible by applying reduced rates of the (economically interesting) non-matured compost. This revised version was published online in June 2006 with corrections to the Cover Date. This revised version was published online in June 2006 with corrections to the Cover Date. This revised version was published online in June 2006 with corrections to the Cover Date.