Chemokines and chemokine receptors in the pathogenesis of multiple sclerosis

In recent years we have seen growing evidence for the role of chemokines in the pathogenesis of several infectious and non-infectious inflammatory CNS disease states, including Multiple Sclerosis (MS) and its animal model, experimental allergic encephalomyelitis (EAE). An increase in proinflammatory chemokines has been associated with demyelinating lesions and clinical neurological dysfunction in patients with MS; these chemokines could be potential targets for MS therapy. Besides a clearly defined role in mediating leukocyte migration, these and other chemokines may act as immunoregulatory molecules in the driving to Th1/Th2 responses, switch of cytokine profiles, and the induction of tolerance. Since chemokine receptors have now been identified on macrophages, microglia, astrocytes, and endothelial cells as well as neurons in the CNS, chemokine/receptor interactions may mediate functional responses in a variety of CNS cell types during the course of inflammatory disease states. Therefore, clarification of the roles of chemokines and their receptors in the pathogenesis of EAE and MS will be useful in establishing immunotherapeutic strategies for these neurological autoimmune disorders.

Using problem-based learning to redesign nursing administration masters programs

Problem-based learning (PBL) is offered as an appropriate pedagogy to prepare nurse managers for the uncertainties of future administrative practice. It is a student-centered, experiential learning strategy aimed at developing clinical reasoning, structuring knowledge in real-life contexts, motivating learning, and developing self-learning skills. Health professions and business schools report positive feedback from their stakeholders after adopting this new learning paradigm.

Left superior vena cava connection to unroofed coronary sinus associated with positional cyanosis: successful transcatheter treatment using Gianturco-Grifka vascular occlusion device

A persistent left superior vena cava connection to an unroofed coronary sinus is a rare cardiac anomaly that is associated with a variable degree of cyanosis. We report an infant with this condition and the unusual feature of cyanosis dependent on head position. When the patient's head was rotated to the left, he developed severe stenosis of the left internal jugular vein, enlarged cervical collateral veins that connected to the right superior vena cava and had an oxygen saturation 95%. When the patient's head was rotated to the right, the left internal jugular vein was widely patent and systemic oxygen saturation decreased to 87%. There was no right ventricular volume overload. Temporary occlusion of the left superior vena cava documented tolerable proximal venous pressure. Cyanosis was relieved by transcatheter closure of the left superior vena cava with a Gianturco-Grifka vascular occlusion device. Cathet. Cardiovasc. Intervent. 48:369-373, 1999.

Hospital consolidation. Applying stakeholder analysis to merger life-cycle

Nearly three of every five hospitals in the United States have been involved in some form of consolidation during the past 5 years. Within this turbulent hospital merger environment, nurse executives are confronted with organizational, professional, and personal decisions. Stakeholder analysis is offered as one strategy to facilitate effectiveness throughout the hospitals' merger life-cycle.

Leaflet development, induction time, and medium influence somatic embryogenesis in peanut (Arachis hypogaea L.)

Factors affecting somatic embryogenesis in peanut (Arachis hypogaea L.) using leaflet explants of seedlings obtained from aseptically germinated embryo axes were evaluated. Somatic embryogenesis was influenced by developmental stage, leaflet size, induction medium, and time on induction medium. Leaflets that were 5-7 mm long had a greater embryogenic response than smaller or larger leaflets. Percent embryogenesis and mean number of embryos were related to the developmental stage of germinating seedlings. A greater response was obtained if leaflets were folded and closely appressed. Preselection of leaflets increased percent embryogenesis from 21% up to 67%. As leaflets unfolded, embryogenesis decreased; open leaflets lost the potential for embryogenesis. The optimal induction conditions were a 7-day incubation period on Murashige and Skoog medium with 136 μM 2,4-dichlorophenoxyacetic acid and 0.93 μM kinetin. Somatic embryos germinated to form plants that exhibited a normal morphology.

Acute stroke patients comparing outcomes with and without case management

Stroke represents a major human and economic challenge to society. The literature suggests that interdisciplinary clinical pathways maximize stroke patient outcomes, whether care is delivered in a designated stroke unit or in a general medical service. In this article, the authors describe the case management model implemented at Columbus Regional Hospital, a 325-bed rural referral hospital in southeastern Indiana. A retrospective chart review compared 23 patients with non-hemorrhagic strokes using two different models of care delivery: unit-based nursing case management and standard nursing care. Differences in outcomes are reported in relation to interdisciplinary utilization, timeliness of referrals, patient education, discharge dispositions, home safety assessments, next-site-of-care communications, length of hospital stay, and patient satisfaction.

Differentiated nursing practice: assessing the state-of-the-science

The authors present their findings following an exhaustive literature review of research on differentiated nursing practice (DNP) that used a number of tools to measure various aspects of DNP that are applicable across the health care delivery continuum. Issues related to DNP include: optimal nursing care, matching patient needs with nurse competencies, effective use of nursing resources, equitable compensation, career satisfaction, loyalty to employers, and enhanced prestige of the nursing profession. One 1992 Massachusetts study of a three-role oncology unit project (including patient care manager, clinical nurse, and patient care technician), showed positive change in five criteria including: standards of nursing care, actual care hours, average labor costs, job satisfaction and patient satisfaction. A 1990 Arizona study that included unit assistants concluded that DNP supported a decline in the use of supplemental staff and staff overtime which led to cost savings, and increases in the actual hours of care and nurse satisfaction.

Organizational effectiveness: toward an integrated model for schools of nursing

Assessing the quality of academic institutions involves much more than the opinions of peers or experts. Examination of the organizational effectiveness of schools of nursing has been neglected. Current emphasis on assessing educational outcomes has diverted attention from the construct, organizational effectiveness, and more comprehensive theory-driven approaches to evaluation. This review of the organizational effectiveness literature focuses on the major assessment models: goal attainment, human relations, open systems, internal processes, culture, and life cycle. Attention is given to the influence of organizational maturation on an integrated model of organizational effectiveness. Selected macrolevel studies of schools of nursing are examined, and an agenda for nursing research is proposed.

Quality assurance procedure on a Huestis Styro-former--stay on the cutting edge

A review of variations in block positions on port film vs. simulator film at The Nashua Regional Cancer Center, Nashua, NH, prompted the development of a method of measuring the accuracy of hot wire cut molds vs. a "test" film. The procedure is done at a minimum of once a year, or when accuracy of the block cuts are suspect. This simple test insures a high degree of confidence that the resulting cut molds are appropriate for the clinical situation and the need to recut blocks as a result of an out-of-tolerance Huestis Styro-former is kept to a minimum.

Improvements in rooting regenerated safflower (Carthamus tinctorius L.) shoots

A continuing obstacle for regenerating safflower (Carthamus tinctorius L.) plants from cultured explants or callus has been a reliable method for rooting shoots. For shoots directly regenerated from primary explants, 76% of shoots rooted after a 7-d exposure to 10 mg/1 indole-3-butyric acid. Auxin source, concentration or exposure time did not greatly affect root formation or morphology, but strongly affected callus production. Shoots infected with Agrobacterium rhizogenes produced massive numbers of fibrous roots, but shoots did not elongate or survive transfer to soil. Shoot hyperhydricity symptoms were reduced by including 1 g/1 activated charcoal in rooting media. The optimal protocol for inducing root formation consisted of a 7-d exposure to 10 mg/l indole-3-butyric acid in root induction media, followed by incubation in media containing 15 g/l sucrose and 1 g/1 activated charcoal for 21 d.

Directors of Continuing Nursing Education: A National Survey of Educational Needs

Advancing technology and healthcare reform necessitate continuing nursing education to maintain competence. This study assesses the knowledge and skills needed to function as a director of continuing nursing education in a variety of settings, estimates the supply of qualified applicants for vacant director positions, and identifies essential academic needs of someone preparing for the director's position.

When to begin a doctoral programme in nursing

The future of the nursing profession is strengthened by the expansion of nursing science and its integration with nursing practice, the hallmarks of doctoral education. Launching a doctoral programme in nursing is a monumental venture into the main stream of higher education; consequently, the readiness to begin such an effort must be carefully assessed.

High frequency somatic embryogenesis in peanut (Arachis hypogaea L.) using mature, dry seed

Peanut (Arachis hypogaea L.) somatic embryos were produced from the embryo axes of mature, dry seeds of cultivar GK-7. Percent embryogenic explants ranged from 88-100% using 10-40 mg/1 of 2,4-D in the induction medium. Neither 2,4-D concentration nor photoperiod during the induction period had a large effect on percent embryogenesis, mean number of embryos per explant, or embryo morphology. However, embryos obtained from cultures grown in the dark were easier to remove from the explant than those under a 16-h photoperiod. Somatic embryos developed on the epicotyl portion of the embryo axis, primarily on the young, expanding leaves. A survey of 14 genotypes indicated that genotype had a large influence on embryogenic capacity, with all genotypes being embryogenic to some extent. The ability to recover somatic embryos from axes of harvested, stored seeds represents significant advantages for the establishment of peanut embryogenic cultures, including the use of simple sterilization procedures and a constant source of explant tissue.

Influence of photoperiod and medium formulation on peanut somatic embryogenesis

Somatic embryos were produced from peanut (Arachis hypogaea L.) immature zygotic cotyledons. Comparisons were made of the level of α-naphthaleneacetic acid during induction, nitrogen formulation of the medium, and photoperiod. Over 70% embryogenesis was obtained regardless of NAA level used. Percent embryogenesis and number of embryos were markedly lower in explants induced on NAA compared to 2,4-D. Embryo production was not greatly affected by either the use of Murashige & Skoog versus Finer & Nagasawa salts or light versus dark culture conditions. However, embryo morphology was noticeably affected by photoperiod. Embryos produced under a 16 h photoperiod were tough, woody and difficult to separate for subsequent germination and conversion. Those produced under a 0-h photoperiod were succulent and pliable.

Master's degree nursing education: state of the art

This study examines the state of the art in master's nursing education in the United States in light of projected national trends in the health care delivery system. The specific questions addressed are: What are the general characteristics of master's programs, including admission requirements and prerequisites, program requirements, major and minor areas of clinical concentration, functional role preparation, and career mobility options? What is the curricular organization, particularly with respect to required core courses? Is there a difference between master's programs in schools with a doctoral program in nursing and those with master's programs only? Is there a difference between master's programs with public support and master's programs with private support? Data were collected from 175 accredited master's programs in 1990. Study results and the projected trends derived from Nursing's Agenda for Health Care Reform, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, and Healthy America: Practitioners for 2005 provide the foundation for recommendations. Recommendations are organized around communication and curricular issues that master's nursing education needs to address as the profession approaches the 21st century.

Somatic embryogenesis and plant regeneration from leaflets of peanut, Arachis hypogaea

Somatic embryos were induced on peanut (Arachis hypogaea) leaflets from aseptically germinated embryo axes. Leaflet size influenced percent somatic embryogenesis; 5-8 mm long cut leaflets were superior to 2-3 mm long uncut leaflets. Maximum embryogenesis of 14.6% was obtained after a 15 d incubation on induction medium (modified MS with B5 vitamins, 30 g/l sucrose, 4 g/l Gel-Gro, 40 mg/l 2,4-D +0.2 mg/l kinetin) followed by transfer to a secondary medium with 5 mg/l 2,4-D+0.2 mg/l kinetin. Primary somatic embryos were fused along the axes with no distinct cotyledons, but secondary embryos had single axes with two cotyledons. Other treatments had lower percent embryogenesis, no secondary embryogenesis, and embryos with single axes with two cotyledons. Some somatic embryos converted into normal plants capable of greenhouse survival.

Genetic variation in the African rodent subfamily Otomyinae (Muridae). II. Chromosomal changes in some populations of Otomys irroratus

Chromosome-banding studies have been carried out on 31 specimens of Otomys irroratus from six localities. Light-microscope preparations of chromosomes were obtained from cultures of fibroblasts, spleen lymphocytes, peripheral blood lymphocytes, and directly from bone marrow. Karyotypic variability, both numerical and morphological, was detected in three populations. Diploid numbers ranged from 2n = 23 to 2n = 32. Intrapopulation differences were chiefly caused by variation in the number of copies in two pairs of small, biarmed, partly heterochromatic autosomes suggestive of B chromosomes. A major morphological variation in the karyotypes involved the presence of seven pairs of biarmed autosomes with totally heterochromatic short arms in the populations distributed to the west of 26 degrees 57' E. To the east of this longitude, populations of this species exhibited mostly acrocentric autosomes. G-banding patterns of these karyotypes and those of a karyotype from a previous study (Robinson and Elder, 1987) were compared. A chromosome originating from a tandem fusion, possibly leading to partial reproductive isolation, was found in one population. Possible implications of these results for mechanisms of speciation are discussed.

Interinstitutional collaboration for nursing excellence: Part 2. Testing the model

Two unrelated public institutions formed a partnership to foster excellence in professional nursing. The organizational structure was described in Part 1 (February 1989). This second article reports a 15-week pilot study conducted on seven hospital units to determine the degree to which the clinical nurse specialist can merge the multiple functions of professional nursing: practice, education, and research.

Interinstitutional collaboration for nursing excellence: Part 1, Creating the partnership

A partnership between two unrelated public institutions was formed to enhance the quality of clinical learning for students and staff, promote exemplary care to patients, and foster expansion of nursing research. The critical nucleus of the partnership is the unit-based clinical nurse specialist who performs the multiple functions of professional nursing: practice, education, and research. This two-part series describes the collaboration effort. Part 1 focuses on the organizational structure created for the partnership, and part 2 reports the findings of a 15-week pilot study conducted to test the model.