External examiners: roles and issues

This paper is based on an analysis of the role of external examiners and a discussion of the various aspects of the role. Fifteen facets of the role have been identified and each facet is discussed with reference to the relevant literature. Among the issues discussed are the powers of external examiners in the decision making process; their role as the custodians of standards; and the significance of their reports. The discussion spans four levels of academic awards including diploma, bachelor's degree, master's degree and doctoral degree and deals with matters of principle as well as the mass of written and other material which external examiners are faced with. Some strengths and weaknesses of the external examining system have been identified and finally a question is raised about its future.

A journal club as a teaching and learning strategy in nurse teacher education

An account of the operation of a journal club in a Postgraduate Certificate in Education course for teachers of nursing is reported here. The paper is based on three issues: the background to journal clubs, the process involved in the operation of the club concerned, and the expected outcomes. The origins of journal clubs and the reading habits of nurses are considered in the background section through a review of some of the relevant literature. The negotiation involved, the frequency of meetings and the ethos in which they were conducted are discussed in the section on the processes involved. In the final section, both the tangible and personal outcomes are discussed and the conclusion reached is that a journal club is a worthwhile educational activity.

Pain clinic attenders: an audit

An audit of the first 135 referrals to a new Multidisciplinary Pain Clinic was conducted. Demographic data, pain experience and pain effects were recorded. Chronic Non-Malignant Pain was the diagnosis found most frequently. In that group, the mean duration of pain was seven years, the mean number of surgical operations was 1.95 and the mean number of medications being consumed at the time of presentation 3.5. Impaired occupational, social and recreational functioning was noted. Twice as many women were affected as men and all educational and socio-economic groups were represented. Patient profiles were similar to data published on chronic pain patients attending the Mayo Clinic, Minnesota, USA.

Characterization of two different glycosylated domains from the insoluble mucin complex of rat small intestine

The highly glycosylated domains of rat small intestinal mucins were isolated after reduction and trypsin digestion and separated into two populations (A and B) by gel chromatography. The molecular mass values were 650 and 335 kDa, respectively, and the relative yields suggest that the two glycopeptides occur in equimolar proportions. Electron microscopy revealed linear structures with weight average lengths of 230 nm (A) and 110 nm (B) corresponding to a mass/unit length of about 3 kDa/nm. The protein cores (17-19%) contain large amounts of threonine (over 40%), serine (17-24%), and proline (18-19%). Carbohydrate and sulfate account for approximately 80 and 0.5%, respectively, and gas chromatography-mass spectrometry showed that the patterns of neutral and sialic acid-containing glycans are very similar in the two glycopeptides. Both contain a significant amount (7-10 mol %) of single GalNAc residues, the average oligosaccharide is about 4 sugar residues long, and the largest species observed are heptasaccharides. The major neutral and sialic acid-containing oligosaccharides are Fuc1-2Gal1-3GalNAcol and GlcNAc1-6(NeuGc2-Gal1-3)GalNAcol, respectively. Sialic acid is present as both N-acetyl- and N-glycoloyl-neuraminic acid. Repeated extractions of the tissue with guanidinium chloride left approximately 80% of the mucus glycoproteins as an insoluble glycoprotein complex whereas exposure to dithiothreitol or high speed homogenization accomplished complete solubilization. The "subunits" obtained after reduction with dithiothreitol are larger than glycopeptides A and B, and fragments corresponding in size to the latter are obtained after cleavage with trypsin. Most of the mucins from rat small intestine thus occurs as an insoluble glycoprotein complex composed of subunits joined with disulfide bonds. The subunits contain two highly glycosylated regions with different lengths substituted with very similar oligosaccharides.

Altered glycosylation of the MUC-1 protein core contributes to the colon carcinoma-associated increase of mucin-bound sialyl-Lewis(x) expression

The mucin carbohydrate epitope sialyl-Le(x), detected with the monoclonal antibody AM-3, is strongly overexpressed in > 90% of human colon carcinomas. We show here that in colon carcinoma one of the mucin cores bearing the sialyl-Le(x) group is MUC-1, whereas sialyl-Le(x) present in normal colon is not detectable on MUC-1. The amounts of MUC-1 core detectable with the monoclonal antibody BC3 in extracts of tumor tissue are 60-180% of those in normal tissue. Two other carbohydrate epitopes located on MUC-1 in mucins from normal and tumor tissue have also been characterized. In contrast to sialyl-Le(x), their expression on MUC-1 is variable and does not correlate with the malignant transformation of colonic mucosa. The transfer of the sialyl-Le(x) group onto the MUC-1 core contributes to the colon carcinoma-associated overexpression of the sialyl-Le(x) epitope.

Issues in the supervision of postgraduate research students in nursing

Some general points are made in this paper about the nature of postgraduate research degrees, and the process which results in a thesis is set out. These are followed by considering the degrees in a nursing context and also in relation to the social sciences. Next the aims of postgraduate research degree programmes are considered. Approaches to the matching of students are set out. Among those discussed are mentoring, collegiality, classification and framing, and the use of workshops. In the conclusion, some desired outcomes of the supervisory process are suggested.

Comparative evaluation of image segmentation methods for volume quantitation in SPECT

A wide variety of image segmentation techniques have been proposed for the measurement of organ or lesion volumes in SPECT images. Evaluation of the relative performance of the various methods is difficult due to wide variations in system response characteristics, size, shape, and contrast of the imaged objects, and image acquisition and processing techniques. Selected image segmentation methods for volume quantitation in SPECT were applied to a set of simulated SPECT images containing objects ranging in volume from 1.8 to 113.1 cc. The specific segmentation methods included: (1) operator drawn regions of interest, (2) count-based methods, (3) three levels of fixed thresholds, (4) an adaptive threshold (GLH method), (5) a two-dimensional (2-D) edge detection method, and (6) a three-dimensional (3-D) edge detection method. In general, the 3-D edge detection method required minimal operator intervention while providing the most accurate and consistent estimates of object volume across changes in object contrast and size.

Increased number of accessible sugar epitopes defined with monoclonal antibody AM-3 on colonic mucins is associated with malignant transformation of colonic mucosa

Monoclonal antibody AM-3 detects a mucin sugar epitope (AM-3 epitope) the expression of which increases in the course of human colon carcinogenesis parallel to the gradual morphological alterations (so called adenoma-carcinoma sequence). In the present report the AM-3-positive mucin has been purified from human normal and carcinomatous colonic tissue. About 300-fold enrichment of the epitope per protein from both sources was achieved after ultracentrifugation, gel filtration on Sepharose CL-6B and isopyknic gradient centrifugation. Slot-blot and enzyme-linked immunosorbent assays of the purified preparation indicated not only different amounts of the mucins but also a consistent qualitative difference between the molecules from both sources. The qualitative difference could be obliterated by a partial removal of the AM-3 epitope from the tumor-derived mucin with neuraminidase. The visualization of the molecules by rotary shadowing indicated that the mucins from both sources have similar length distribution, 80% of the molecules being 100-600 nm long. The reaction with AM-3 antibody followed by rotary shadowing showed that in the purified preparations more than 95% of the tumor-derived molecules and 74% of the normal colon tissue-derived molecules carried the epitope. The tumor-derived mucins bound, on the average, 34 +/- 15 (SD) antibodies/1000 nm of the protein core while the mucin from normal colon tissue carried 12 +/- 11 antibodies/1000 nm of the protein core. These data indicate that the increased expression of AM-3 epitopes during malignant transformation of the human colon is due to accumulation of AM-3-positive mucin as well as a higher number of accessible AM-3 epitopes on this mucin.

Conceptions of the nursing process amongst nurse teachers and clinical nurses

This is a report of an empirical study whose aim was to investigate the conceptual nature of the nursing-process approach to the delivery of nursing care. The report includes a selective review of the literature on the subject to determine how the nursing-process approach is characterized by people who write about it. Details of the grounded theory research methodology used are outlined. So are the hierarchically focused interviews used to collect the data. Details of the data analysis are also given, including the use of a cluster analysis technique. In the results section, areas of concordance between conceptions of the nursing-process approach as they appear in the literature and those held by the interviews have been identified. Areas where conceptions are at variance with those in the literature have also been identified.

Investigating change in a nursing context

This paper focuses on 'why', 'what' and 'how' issues as they relate to the investigation of change in a nursing context. The why issues revolve around the need for change, and evolutionary and revolutionary change are discussed. Next the what issues are discussed and some variables involved in the change process are identified, and the role of change agents is outlined. Change strategies such as the power-coercive, the rational-empirical and the normative-re-education are discussed. Finally, the potential of action research in the context of bringing about change is advanced.

The use of cyclosporin A in adult nephrotic syndrome: nine cases and literature review

Nine adult patients with resistant nephrotic syndrome were treated with cyclosporin A (CyA). All had failed to respond to high dose corticosteroids with or without cyclophosphamide. Three patients had minimal change disease, 3 had focal sclerosing glomerulosclerosis (FSGS), 2 had mesangiocapillary GN, and one had membranous nephropathy. The mean age of the patients was 26.4 years (range 16 to 39 years). CyA was given orally twice daily at a mean dose of 6.7 mg/kg/24 hours (range 6-10 mg/kg/24 hours). Four patients achieved full remission, two patients went into partial remission and three failed to respond. Two patients developed clinical nephrotoxicity, which reversed on dose reduction or cessation of CyA. All 3 patients with minimal change disease who responded subsequently relapsed after stopping CyA, but remitted rapidly on reintroduction of the drug. We suggest that the mode of action of CyA in nephrotic syndrome may be related to intra-renal vasoconstriction in addition to its direct immunosuppressive effect. In this limited series, we found that CyA can be an effective therapy for otherwise refractory nephrotic syndrome, although relapse on withdrawal of CyA may well be a significant clinical problem.

Importance of magnesium chloride repletion after myocardial infarction

Data pertinent to the role of magnesium deficits in coronary artery disease and myocardial infarction are reviewed. Results of clinical, laboratory and epidemiologic studies indicate an association between magnesium deficiency and a poor prognostic outcome in patients who have had myocardial infarction. It therefore appears to be a reasonable prophylactic measure to monitor closely magnesium status in patients with coronary heart disease and other patients at risk of acute myocardial infarction, and to supplement with magnesium chloride when clinically necessary. In addition, recent studies provide supportive evidence that supplementation of magnesium chloride may reduce the incidence of fatal and nonfatal arrhythmias after an infarct.

Reinforcement of bone cement using metal meshes

Following on from previous work reported in this journal, a practical system has been developed for in situ fibre reinforcement of bone cement in the hip joint prosthesis. A fibre preform is inserted during the operation, surrounding the metal stem of the prosthesis, forming a composite with the cement. Tests performed on full-scale models of the joint show improvements in fatigue life by more than an order of magnitude when a preform of metal fibres is used; this significantly delays the onset of cement cracking and stem loosening. Initial results reported previously suggest that other fibre materials such as carbon may give even greater improvements. Clinical trials have begun, using a form of the metal mesh.

Fibre reinforcement of bone cement

Polymethylmethacrylate bone cement is used in many orthopaedic applications, including the replacement of hip joints. Fatigue in the cement is a common cause of prosthesis failure, and reinforcement using carbon or other fibres has been attempted as a means of strengthening the material. A new method of reinforcement using a woven preform of carbon or metal fibres is proposed, and shown to confer superior properties in static and fatigue tests. Flexural specimens and compression-loaded models are used in order to infer the behaviour of the actual prosthesis. The initial results reported here are encouraging and prompt more detailed investigation.

Curriculum models: product versus process

At the beginning of this article there is a brief outline of the nature of the curriculum and models. This leads into a discussion of curriculum models in which 'product' and 'process' models are set out and discussed. The strengths and weaknesses of both approaches to the curriculum are outlined and issues relating to the choice of model are advanced.

Fractures of the femoral shaft treated by plating

Eighty-six fractures of the femoral shaft were treated by open reduction and plating. Seventy-seven fractures (90 per cent) were reviewed 12-72 months (average 38 months) after operation. An excellent or good result was achieved in 70 fractures (91 per cent). There was no case of deep infection. The most common complication was a fatigue fracture of the plate, which occurred in five cases. In patients over the age of 60 years, loosening of the implant was troublesome. Primary bone grafting is essential if rigid internal fixation is not obtained. Plating is an excellent method of treating fractures of the femoral shaft in patients under the age of 60 years, provided that the surgeon is technically competent and experienced in this method of treatment.

Ethical considerations in nursing practice

Some ethical implications for nursing practice are considered in relation to three issues: competence, honesty and obedience. Factors which contribute to conformity, obedience and authoritarianism are discussed, and respect for other people is suggested as a guiding principle for ethically acceptable conduct.

The attitudes of nurse tutor students to behavioural objectives: results and discussion

This small-scale empirical study provides evidence of the attitudes of a group of nurse tutor students to behavioural objectives. The questionnaire items used ranged from questions about behaviourism and the use of behavioural objectives in teaching, to a question on whether the participants would use behavioural objectives in their teaching once they had finished their course. It emerged that while there was not an uncritical acceptance of behavioural objectives, they were seen as having a place in the process of teaching and learning nursing.

The attitudes of nurse tutor students towards behavioural objectives: background and method of study

Since behavioural objectives are rooted in behaviouristic psychology there is a brief discussion of some notable behaviourists. This is followed by reference to some key characters in the behavioural objectives movement. The strengths and weaknesses of behavioural objectives are discussed with reference to the relevant literature. Behavioural objectives in nursing education are considered and the tensions which their use may give rise to are noted. Finally, details are given of how a small-scale empirical study relating to behavioural objectives was conducted.

Separation and characterization of two populations of aggregating proteoglycans from cartilage

Intermediary gel immunoelectrophoresis was used to show that purified aggregating cartilage proteoglycans from 2-year-old steers contain two distinct populations of molecules and that only one of these is immunologically related to non-aggregating cartilage proteoglycans. The two types of aggregating proteoglycans were purified by density-gradient centrifugation in 3.5M-CsCl/4M-guanidinium chloride and separated by zonal rate centrifugation in sucrose gradients. The higher-buoyant-density faster-sedimenting proteoglycan represented 43% of the proteoglycans in the extract. It had a weight-average Mr of 3.5 X 10(6), did not contain a well-defined keratan sulphate-rich region, had a quantitatively dominant chondroitin sulphate-rich region and contained 5.9% protein and 23% hexosamine. The lower-buoyant-density, more slowly sedimenting, proteoglycan represented 15% of the proteoglycans in the extract. It had a weight-average Mr of 1.3 X 10(6), contained both the keratan sulphate-rich and the chondroitin sulphate-rich regions and contained 7.3% protein and 23% hexosamine. Each of the proteoglycan preparations showed only one band on agarose/polyacrylamide-gel electrophoresis. The larger proteoglycan had a lower mobility than the smaller. The distribution of chondroitin sulphate chains along the chondroitin sulphate-rich region was similar for the two types of proteoglycans. The somewhat larger chondroitin sulphate chains of the larger proteoglycan could not alone account for the larger size of the proteoglycan. Peptide patterns after trypsin digestion of the proteoglycans showed great similarities, although the presence of a few peptides not shared by both populations indicates that the core proteins are partially different.