Implementation of the CNS role in Vancouver, British Columbia, Canada

The CNS as an advanced practitioner contributes significantly to the provision of comprehensive patient care services. Development and implementation of the CNS role are complex processes. This study was designed to describe the experience of practicing CNSs in various health care agencies in the Lower Mainland (the geographic region of British Columbia, Canada, comprising Vancouver and adjacent communities). Major themes emphasize the complex interplay of role ambiguity, organizational structure, and administrative support in facilitating and/or impeding the CNS role implementation process.

Adult interaction style effects on the language sampling and transcription process with children who have development disabilities

A determination was made of whether an empirically derived interaction style improves the usefulness of the language sampling and transcription in 17 children with developmental disabilities in Brown's (1973) Stages I and II. Whether the interaction style affected the diversity and complexity of the language the children produced during the samples was also examined. All subjects experienced two 20-minute interaction sessions that differed according to whether topic-continuing wh-questions were used. Results indicated that, regardless of order of exposure to the styles, children talked more often and produced proportionally more transcribable utterances. In addition, they produced a larger sample of productive vocabulary in the style using topic-continuing wh-questions. There were no style effects on vocabulary diversity or length of utterance. The importance of using interaction styles that maximize the information available from language samples of young children with disabilities was discussed.

Central melatonin binding sites in rainbow trout (Onchorhynchus mykiss)

A combination of in vitro autoradiography and membrane homogenate receptor assays has been used to localize and characterized 2-[125I]iodomelatonin binding sites in the brain of the rainbow trout (Onchorhynchus mykiss). Specific 2-[125I]iodomelatonin binding, defined as that displaced by 1 microM melatonin, increased linearly with increasing protein concentration in membrane homogenates of whole trout brain. Specific binding was both time and temperature dependent and reversible in the presence of 1 microM melatonin. Binding was saturable at between 100-150 pM 2-[125I]iodomelatonin and Scatchard analysis of saturation isotherms revealed a dissociation constant (Kd) of 15.00 +/- 0.95 pM and a maximum receptor number (Bmax) of 42.35 +/- 2.70 fm/mg protein (n = 16). Addition of 10(-4) M GTP gamma S (an analogue of guanosine triphosphate) to saturation isotherms apparently reduced the Bmax by 75% on average with no apparent change in the affinity of the binding. Scatchard analysis of saturation isotherms generated from whole brain membrane homogenates of trout kept on long days (15 hr light:9 hr dark) and killed either during the midlight or middark phase showed no significant differences in either the Kd or the Bmax of 2-[125I]iodomelatonin binding, although a robust rhythm in melatonin concentration was confirmed in these fish. Displacement of 2-[125I]iodomelatonin binding with increasing concentrations of competing ligands gave an order of potency of 2-iodomelatonin > melatonin >> 5-HT. Localization of specific central 2-[125I]iodomelatonin binding in the rainbow trout showed high levels of binding associated with neuronal areas involved in the processing of visual signals, particularly the optic tectum and nucleus rotundus.(ABSTRACT TRUNCATED AT 250 WORDS)

British home and community care: research-based critiques and the challenge of the new policy

The policy of the British central government is among the most coherent and pervasive of those in countries at the leading edge of reform. One perspective is its attempt to match resources to needs. Starting from a summary of the official statement of the logic of the policy and the way in which it reflected policy critiques of the previous decade in Section 1, Section 2 reviews the propositions of the arguments of the mid-1980s in the light of results of research on the nature and causes of patterns of resources, needs and outcomes and their interrelationships, particularly the results of a stream of 'production of welfare' studies focused on who gets what resources and with what effects. Evidence shows that applying some of the assumptions of the new policy dramatically changes the basis for judging the degree to which a cost-effective targeting of resources to needs could in principle be accomplished within the then level of public funding of the services. It shows a higher degree of consistency of allocations than some of the criticisms had implied, but the evidence did not allow a rejection of the proposition that allocations were biased against some kinds of potential beneficiary. Discussing the proposition that community-based services had a low impact on the probabilities of unwanted and inappropriate admission to institutions for long-term care, the evidence shows that low proportions of recipients were subsequently admitted; that as a consequence of assumptions and processes which have been extensively researched, the cost of care in the community approached cost of care in institutions for too few persons for the resources to have been most effectively used to make admission unnecessary, so that resources have not been focused on those for whom the impact is greatest; that generally, providing more rather than less service tended to have a small impact on the probability of admission to institutions. Section 3 discusses what changes in the relations between resources needs and outcomes will be necessary, and what the results of evaluated new models suggest about how to achieve them, discussing the improvement of targeting and increasing the impact of resources on outcomes in the context of the logic and results of care management experiments in the U.K., the U.S.A. and elsewhere, concluding that there is a need to adopt longer time horizons in the implementation of the new policy.

Effect of adult continuing wh-questions on conversational participation in children with developmental disabilities

Children with developmental disabilities often converse less frequently than their developmentally matched peers. This low conversational participation can cause problems for the children's future language and discourse development. The purpose of this experimental study was to test the hypothesis that adult topic-continuing wh-questions would elicit topic continuations in children with relatively low language ability, but not in children with relatively high language ability. Twenty-three children with developmental delays interacted with an adult who conducted two play sessions. In each session, the adult used a different interaction style. The two styles differed in the adult's use of topic-continuing wh-questions. Results indicate that adult use of topic-continuing wh-questions supported the use of child continuations in children at all language levels. The type of continuations (single word versus multiword) that were elicited depended on the language level of the children. Clinical implications are discussed.

Levels of matrix metalloproteases in bladder cancer correlate with tumor grade and invasion

We have used quantitative zymography to measure levels of the type IV collagenases matrix metalloproteinase (MMP)-9 and MMP-2 in 42 biopsies of transitional cell carcinoma and in 7 biopsies of normal bladder. Mean levels of MMP-9 were significantly higher in tumor compared with normal samples (P = 0.08). Levels of MMP-9 and active MMP-2 increased with tumor grade (test for trend, P = 0.002 and P = 0.05, respectively). Levels of MMP-9 and activated MMP-2 were also higher in invasive tumors than in superficial ones (P = 0.001 and P = 0.008, respectively). In situ hybridization studies showed that the mRNAs for both MMP-2 and MMP-9 were located chiefly in the stroma rather than epithelial tumor cells and were concentrated at the interface between the two tissues.

Restoration of occupational capacity in post-cardiac patients

Employees returning to work after injury and illness have typically been offered an 'all or nothing' approach to rehabilitation. Dr Bruce Davies questions this attitude and argues for improved policies to facilitate a more effective return to work for post-cardiac patients.

Survey of nursing research programs in children's hospitals

Available published literature describing successfully implemented research programs is relatively limited, particularly within children's hospitals. In order to determine the status of research program development within children's hospitals, a mailed survey was sent to 108 free-standing children's hospitals in the United States and Canada. The questionnaire was comprised of questions pertaining to five general sections: (a) institutional demographics; (b) organizational structure for research; (c) research activities; (d) relationship to other agency research; and (e) demographic characteristics of the individual completing the survey. Findings indicated that nursing research within children's hospitals is in an early development state, but that it is recognized as a necessary and credible component of nursing. Differences were noted between the groups of hospitals with the most research activity and those with no research activity. Hospitals were in various stages of research development, a sequential process characterized by a sequential pattern comprised of two phases.

Activity of type IV collagenases in benign and malignant breast disease

Using zymography and computer assisted image analysis, we have measured the levels of type IV collagenases in biopsies from normal breast, and benign and malignant breast disease. The 92 kDa form was present in three of 11 cases of normal/benign disease, three of nine grade I tumours, four of 12 grade II tumours, but 11 of 11 grade III tumours. Mean levels were higher in grade III tumours (P < 0.0001). When the levels of 72 kDa collagenase and its active 62 kDa form were considered together, there was no difference between the benign and malignant cases (P = 0.55), but the amount of active enzyme, considered as a proportion of the 62 + 72 kDa forms, was significantly higher in malignant disease (P = 0.003). There was also a trend towards a higher proportion of active enzyme with increasing tumour grade (P < 0.0001). In situ hybridisation and immunohistochemistry studies showed that that mRNA and protein for the 92 kDa enzyme was primarily found in the tumour stroma. mRNA for the 72 kDa enzyme was also found in stromal areas. This study demonstrates a clear relationship between production of Type IV collagenases and malignant breast disease. Inhibitors of these enzymes may be of value in preventing metastatic disease.

A synthetic matrix metalloproteinase inhibitor decreases tumor burden and prolongs survival of mice bearing human ovarian carcinoma xenografts

We have examined the effect of a synthetic low-molecular-weight matrix metalloproteinase inhibitor, [4-(N-hydroxyamino)-2R-isobutyl-3S- (thiopen-2-ylthiomethyl)-succinyl]-L-phenylalanine-N-meth yla mide (BB-94), on human ovarian carcinoma xenografts growing in nude mice. The xenografts grew as thick intraperitoneal mucinous ascites containing free-floating tumor cell clumps. The ascites increased in volume, causing death approximately 3 weeks after introduction. Treatment with BB-94 caused resolution of ascitic disease. Tumor burden was dramatically reduced, and survival increased 5-6-fold. The increase in survival was dose dependent. The effects observed with BB-94 appeared to be due to its matrix metalloproteinase inhibiting effects, inasmuch as its inactive diastereoisomer had no effect on tumor biology. Following treatment with BB-94, free-floating clumps of tumor cells became surrounded by a capsule of host cells. These clumps of tumor cells typically formed one small (approximately 8 mm) avascular tumor of bright white appearance loosely attached to fat in the peritoneum. Tumor cells within these capsules often appeared to be necrotic. Gel substrate analysis demonstrated that activated Mr 92,000 type IV collagenase was present in the xenografts. We propose that inhibition of this enzyme causes the transition of ascites to solid tumors, concomitantly slowing tumor cell growth and allowing the development of tumor stroma.

Sibling bereavement: research-based guidelines for nurses

Despite the marked improvement in the treatment of childhood cancer in recent decades, there are children who die, leaving behind a legacy of grief for all who knew them, including their siblings. Nurses can play a significant role in facilitating healthy grieving for these surviving children. The results of several studies pertaining to sibling bereavement after the death of a child from cancer provide guidelines for clinicians.

A comparison of beclomethasone dipropionate and budesonide in the treatment of asthma

Several reports have claimed that beclomethasone dipropionate (BDP) and budesonide (BUD) differ with regard to therapeutic efficacy and associated adverse effects, based either upon clinical data, or upon theoretical considerations. Although long-term comparisons are lacking, the consensus of numerous studies is that these drugs are of equivalent therapeutic efficacy. Assessment of pharmacological data suggests that beclomethasone 17-monopropionate (17-BMP), the active bronchial metabolite of BDP, has a greater glucocorticoid receptor affinity than BUD and thus theoretical claims for greater efficacy of BUD based on comparison with the receptor affinity of unchanged BDP are inaccurate. Similarly, clinical experience has not revealed any significant differences between the adverse effect profiles of BDP and BUD, in terms of adrenal suppression, changes in bone metabolism and growth, or cataract formation. Critical examination reveals that those reports describing differences in efficacy or safety profile between the two drugs have study design flaws which may undermine the validity of their conclusions. Current evidence indicates that, in terms of therapeutic efficacy and safety profile, BDP and BUD are effectively indistinguishable.

Factors influencing nursing care of children who are terminally ill: a selective review

Care of the child who is dying is a complex and emotionally difficult nursing challenge. A review of the literature reveals a scarcity of information relating to the nurse's experience and indicates a predominant atheoretic approach. Obstacles to effective and humane terminal care exist at the personal, interpersonal, and social levels in the current health care system.

The structure of the human intron-containing S8 ribosomal protein gene and determination of its chromosomal location at 1p32-p34.1

The intron-containing gene encoding human ribosomal protein S8 (RPS8) has been cloned and characterized, and its chromosomal position determined. Using a PCR-based cloning strategy, we have isolated the intron-containing gene in the presence of its many processed pseudogenes and determined the DNA sequence of the entire gene and its upstream and downstream flanking regions. The human RPS8 gene is 3161 bp in length and comprises six exons. Despite lacking a consensus TATA box, primer extension analysis indicates that the start of transcription is precisely located at a C residue within an 11-bp oligopyrimidine tract. The first exon, which contains the ATG start codon, is just 27 bp in length. The DNA sequence 5' to the RPS8 gene and within the first exon and intron shows several features of a CpG island. A combination of Southern blotting, PCR, and fluorescence in situ hybridization analyses has enabled the chromosomal location of the human RPS8 gene to be determined as 1p32-p34.1.

Electrosurgery in restorative Dentistry: 2. Clinical applications

Electrosurgery techniques have been used in dentistry as an aid to soft tissue management for nearly 60 years. However, it was not until the late 1960s that the principles of electrosurgery were understood and improved equipment became available. Part 1 of the two-part series covered the theory behind using this technique. Part 2 will now discusses the clinical applications.

Electrosurgery in restorative dentistry: 1. Theory

Electrosurgery techniques have been used in dentistry as an aid to soft tissue management for nearly 60 years. However, it was not until the late 1960s that the principles of electrosurgery were understood and improved equipment became available. Part 1 of this two-part series covers the theory behind using this technique. Part 2 will discuss the clinical applications.

Chemiluminescence of human bloodstream monocytes and neutrophils: an unusual oxidant(s) generated by monocytes during the respiratory burst

Maximal rates of O2- and H2O2 production by human bloodstream monocytes activated during the respiratory burst by phorbol ester were only about 10% of those of neutrophils. Furthermore, monocytes possess only about 5% of the myeloperoxidase activity of neutrophils and so can only produce low levels of HOCl and related compounds. These combined reductions in O2- generating ability and lower myeloperoxidase levels result in low levels of luminol chemiluminescence stimulated during the respiratory burst of monocytes. However, although monocytes generate much lower levels of O2- and H2O2 than neutrophils, these cells produce comparable rates of PMA-stimulated lucigenin chemiluminescence. Hence, this assay does not accurately reflect the production of either of these two oxidants by activated phagocytes, and further lucigenin must react with some other oxidant(s) via a process which leads to photon emission. This oxidant(s) is not O2-, H2O2, .OH, 1O2 or NO, but is derived from O2- generated during the respiratory burst and is generated in greater quantities by activated monocytes compared with neutrophils. Thus, lucigenin chemiluminescence is an indirect measure of superoxide release.

Do children with developmental delays use more frequent and diverse language in verbal routines?

The current study is the first to test the hypotheses that children with developmental delays use more frequent language and more diverse vocabulary in routines than in nonroutines. The 19 child participants were in Brown's (1973) first stage of language learning. Using a novel method of measuring routines, 18 of the parents identified at least one routine in a videotaped play session with their children. Results support both hypotheses and provide descriptive information about the content of the routines displayed by the parents and children in the free-play context. The importance of replicating the findings in the context of an experimental design before concluding that "routineness" caused the children to talk more often and with more diverse vocabulary was emphasized.