The role of electrical signals in murine corneal wound re-epithelialization

Ion flow from intact tissue into epithelial wound sites results in lateral electric currents that may represent a major driver of wound healing cell migration. Use of applied electric fields (EF) to promote wound healing is the basis of Medicare-approved electric stimulation therapy. This study investigated the roles for EFs in wound re-epithelialization, using the Pax6(+/-) mouse model of the human ocular surface abnormality aniridic keratopathy (in which wound healing and corneal epithelial cell migration are disrupted). Both wild-type (WT) and Pax6(+/-) corneal epithelial cells showed increased migration speeds in response to applied EFs in vitro. However, only Pax6(+/+) cells demonstrated consistent directional galvanotaxis towards the cathode, with activation of pSrc signaling, polarized to the leading edges of cells. In vivo, the epithelial wound site normally represents a cathode, but 43% of Pax6(+/-) corneas exhibited reversed endogenous wound-induced currents (the wound was an anode). These corneas healed at the same rate as WT. Surprisingly, epithelial migration did not correlate with direction or magnitude of endogenous currents for WT or mutant corneas. Furthermore, during healing in vivo, no polarization of pSrc was observed. We found little evidence that Src-dependent mechanisms of cell migration, observed in response to applied EFs in vitro, normally exist in vivo. It is concluded that endogenous EFs do not drive long-term directionality of sustained healing migration in this mouse corneal epithelial model. Ion flow from wounds may nevertheless represent an important component of wound signaling initiation.

A feminist exploration of Traveller women's experiences of maternity care in the Republic of Ireland

OBJECTIVE

to explore Traveller women's experiences of maternity care so that their needs might be identified and perceptions of helpful responses elicited.

DESIGN

feminist research methodology using unstructured non-directive interviews.

SETTING

community setting in the Republic of Ireland.

PARTICIPANTS

snowball sample of 13 Traveller women aged 19-42 years. Each had experienced between two and eight pregnancies.

FINDINGS

a fluid concept of culture affected Traveller women's expectations and negotiation of maternity care. The essential nature of familism, socialisation and religious beliefs, and the particular emphasis placed upon peer support, reflected cohesive and supportive aspects of culture. The concept of 'possessive individualism' was portrayed as conflicting with contraceptive use, the uptake of preventive care and women's reporting of mental-health problems. Majority norm expectations of breast feeding, husband participation and 'rooming in' were culturally unacceptable. Political and structural factors, such as the direct discriminatory barriers created by general practitioner services, indirect discrimination arising from dysfunctional communication and control of information, poor housing and lack of public transport were the basic causes of inequity of access to care.

IMPLICATIONS FOR PRACTICE

midwives are challenged to respond sensitively to cultural preferences, meet informational needs and act as political advocates in efforts to improve maternity care experiences for Traveller women.

Vestibular Rehabilitation in Individuals with Inner-Ear Dysfunction: A Pilot Study

A randomised control prospective study was carried out examining patient outcomes after performing a 10-week vestibular home exercise programme. Thirty-two adults with vestibular dysfunction who reported vestibular symptoms negatively affecting daily life were enrolled. Test subjects were provided with an individualised vestibular rehabilitation programme designed by a physiotherapist. Control subjects received a set of strength and endurance exercises only. All subjects performed their exercises 3 times a day for 10 weeks. Subjective and objective patient measures were collected at 0, 6, 10 and 26 weeks. Results showed that both groups improved after beginning exercise, and that test subjects significantly benefited compared to the controls. These benefits were long term and measurable 6 months later. This study provides evidence that individualised vestibular exercises promote better outcomes for patients with vestibular dysfunction.

Fatal autochthonous eosinophilic meningitis in a Jamaican child caused by Angiostrongylus cantonensis

A fatal case of infection with Angiostrongylus cantonensis is reported in a 14-month-old Jamaican boy. Although infection with Angiostrongylus was not considered initially, sections of multiple worms were observed in the brain and lungs at autopsy and confirmed the infection. This is the first reported fatality due to this infection in the Western Hemisphere, and follows shortly after an outbreak of eosinophilic meningitis among a group of travelers to Jamaica. The source of infection in this case could not be determined.

Oomycete plant pathogens use electric fields to target roots

Plant roots generate electrical currents and associated electrical fields as a consequence of electrogenic ion transport at the root surface. Here we demonstrate that the attraction of swimming zoospores of oomycete plant pathogens to plant roots is mediated in part by electrotaxis in natural root-generated electric fields. The zones of accumulation of anode- or cathode-seeking zoospores adjacent to intact and wounded root surfaces correlated with their in vitro electrotactic behavior. Manipulation of the root electrical field was reflected in changes in the pattern of zoospore accumulation and imposed focal electrical fields were capable of overriding endogenous signals at the root surface. The overall pattern of zoospore accumulation around roots was not affected by the presence of amino acids at concentrations expected within the rhizosphere, although higher concentrations induced encystment and reduced root targeting. The data suggest that electrical signals can augment or override chemical ones in mediating short-range tactic responses of oomycete zoospores at root surfaces.

Suspected child abuse: communicating with a child and her mother

The purpose of this article is to explore and examine how the value judgments of the health professionals involved affected the interaction between themselves and a mother with her injured child who presented at an accident and emergency department. The interaction is depicted by means of a classroom role-play in which the "actors" are nurses. Analysis of the interaction demonstrates clearly how the perspectives of health professionals may be enshrouded by a miasma of suspicion. Indeed, by focusing on the actions of the mother rather than the needs of the child, suspicion gained momentum and finally entered the public domain. Encouraging health professionals to listen to what the child has to say goes some way to challenging the suspicion of abuse. Nonetheless, in the role-play analyzed, the mounting suspicion so antagonized the mother that an angry confrontation with the doctor ensued, the doctor being forced to make an embarrassing apology. Yet the interaction is so irredeemably prejudiced that it remains impossible either to confirm or reject the suspicion of abuse. Analysis of the interaction attempted to unravel some of the knots in which we, as health professionals, unfailingly tie ourselves when communicating with patients-knots of suspicion, labeling, conflict, embarrassment, and power that fail to anchor the humanity of "self" or others.

Clinical analysis of families with heart, midline, and laterality defects

Disturbances of the normal asymmetric placement of organs, such as polysplenia or situs inversus, have been defined traditionally as laterality defects. However, there is compelling evidence from vertebrate models and human birth defects to hypothesize that defects of the midline, isolated congenital heart defects, and laterality defects are etiologically related. We present the clinical characteristics of three families that exhibit a variety of midline defects and isolated heart defects in addition to laterality defects. These observations suggest that the phenotypic consequences of mutations causing laterality defects include defects of the midline as well as isolated heart defects. To further explore the relationship between midline, heart, and laterality defects, it is imperative that detailed phenotyping of individuals and families with laterality defects be done and a classification system created to facilitate identification of genes causing human laterality disorders.

Nurse consultants. Room at the top

The role of nurse consultant needs to be embedded in trust culture if it is to achieve its potential. The process of defining key competencies can enhance the organisation's ownership. The post needs to be evaluated at local level.

Evaluation of the performance of diagnosis-related groups and similar casemix systems: methodological issues

With the increasing recognition and application of casemix for managing and financing healthcare resources, the evaluation of alternative versions of systems such as diagnosis-related groups (DRGs) has been afforded high priority by governments and researchers in many countries. Outside the United States, an important issue has been the perceived need to produce local versions, and to establish whether or not these perform more effectively than the US-based classifications. A discussion of casemix evaluation criteria highlights the large number of measures that may be used, the rationale and assumptions underlying each measure, and the problems in interpreting the results. A review of recent evaluation studies from a number of countries indicates that considerable emphasis has been placed on the predictive validity criterion, as measured by the R2 statistic. However, the interpretation of the findings has been affected greatly by the methods used, especially the treatment and definition of outlier cases. Furthermore, the extent to which other evaluation criteria have been addressed has varied widely. In the absence of minimum evaluation standards, it is not possible to draw clear-cut conclusions about the superiority of one version of a casemix system over another, the need for a local adaptation, or the further development of an existing version. Without the evidence provided by properly designed studies, policy-makers and managers may place undue reliance on subjective judgments and the views of the most influential, but not necessarily best informed, healthcare interest groups.

Under-coding in Australia limits the performance of DRG groupers

The Diagnosis Related Group (DRG) system is now used extensively in Australia to classify acute inpatients for many applications, including payments to hospitals. The quality of the inpatient separation data affects the performance of the DRG version, especially its predictive validity. Data from the State of Maryland, in the United States, contain more secondary diagnosis and procedure codes than Australian data. A comparison of the performance of DRG versions using data from Australia and Maryland allowed us to answer the following research question: What impact did these additional codes have on the performance of the DRGs? The best performance in predictive validity (R2) was obtained using the Maryland data no matter which DRG version was used. Casemix-adjusted code counts showed that more diagnoses were coded in Maryland. The most plausible reason for this was that conditions were not being recorded comprehensively by doctors in the medical record in Australia.