Influence of selective T-lymphocyte depletion on the lung pathology of gnotobiotic calves and the distribution of different T-lymphocyte subsets following challenge with bovine respiratory syncytial virus

The depletion of CD8+ T-lymphocytes with a murine monoclonal antibody (mAb) specific for the CD8 molecule delayed the ability of three gnotobiotic calves to clear bovine respiratory syncytial virus (BRSV) from their lungs within 10 days after an experimental challenge with the virus. This protracted infection was associated with an enhanced pneumonic consolidation score (21.6 per cent) compared with seven control calves (7.4 per cent) and a histological lesion of active respiratory epithelial hypertrophy. Three gnotobiotic calves depleted of the CD4+ subpopulation with the appropriate mAb also had enhanced macroscopic lesions (16.6 per cent) but the histological lesion was less active. The depletion of the gamma/delta TCR+ WC1+ subpopulation had no apparent effect on the macroscopic or microscopic pulmonary lesions. Although the depletion of the CD8+ or the CD4+ subpopulations enhanced the pulmonary lesions, no clinical signs of respiratory disease were detected. Immunoperoxidase labelling and image analysis of the lymphocyte subpopulations in lung tissue revealed an increase in the number of CD8+ T cells after the infection of non-depleted, control calves, especially in the lamina propria of the large bronchioles. Calves depleted of individual lymphocyte subsets and infected with BRSV showed no compensatory increase in the remaining subpopulations and no lymphoreticular hyperplasia.

Primary cytotoxic T-cell responses to bovine respiratory syncytial virus in calves

Bovine respiratory syncytial virus (RSV) is a major cause of respiratory disease in young calves. Recent studies in calves, in which different T-cell subsets were depleted, have shown that CD8+ T cells play a central role in recovery from RSV infection. The present study demonstrates that RSV-specific, major histocompatibility complex-restricted cytotoxic T cells appear in the peripheral blood of gnotobiotic calves 7-10 days after infection with bovine RSV and were also detected in the lungs 10 days after infection. The cytotoxic T lymphocytes (CTL) recognized antigenically distinct strains of bovine RSV. There was no correlation between either the level of CTL activity in the lung or the development of CTL in the peripheral blood and the extent of pneumonic consolidation. The demonstration of CD8+ CTL in the lungs at a time when bovine RSV has been cleared confirms the importance of these cells in recovery from infection.

The eosinophil and its role in asthma

1. The eosinophil is part of the host defence mechanism to parasitic infection, but is also a key cell in many inflammatory disorders. 2. Eosinophils synthesise a range of pro-inflammatory and cytotoxic mediators, such as basic proteins, hydrolytic enzymes, lipid mediators, cytokines, oxygen metabolites and neuropeptides. 3. Eosinophils are recruited to the lung during episodes of asthma. They migrate from the blood vessels into the tissue via a series of interactions between their surface adhesion molecules and endothelial cells or the extracellular matrix. 4. Activation and prolonged survival of eosinophils occurs upon exposure to mediators released from other tissue resident leukocytes, including eosinophils themselves, and from respiratory tract epithelial cells. Release of eosinophilic mediators causes tissue damage and persistent inflammation of the lung. 5. Currently the most effective therapy for asthma lies with anti-inflammatory drugs, of which the main choices are inhaled corticosteroids or cromolyn sodium and nedocromil sodium.

Newcastle satisfaction with nursing scales: an instrument for quality assessments of nursing care

OBJECTIVES

To test the validity and reliability of scales for measuring patients' experiences of and satisfaction with nursing care; to test the ability of the scales to detect differences between hospitals and wards; and to investigate whether place of completion, hospital, or home influences response.

DESIGN

Sample survey.

SETTING

20 wards in five hospitals in the north east of England.

PATIENTS

2078 patients in general medical and surgical wards.

MAIN MEASURES

Experiences of and satisfaction with nursing care.

RESULTS

75% of patients approached to complete the questionnaires did so. Construct validity and internal consistency were both satisfactory. Both the experience and satisfaction scales were found to detect differences between randomly selected wards and hospitals. A sample of patients (102) were sent a further questionnaire to complete at home. 73% returned this; no significant differences were found in either experience or satisfaction scores between questionnaires given in hospital or at home.

CONCLUSION

Scales to measure patients' experiences of and satisfaction with nursing in acute care have been developed and found to be valid, reliable, and able to detect differences between hospitals and wards. Questionnaires can be given before patients leave hospital or at home without affecting scores, but those given at home have a lower response rate.

Measuring patients' satisfaction with nursing: 1990-1994

Assessing patients' satisfaction with the care they receive is assuming greater importance in the new-style National Health Service. This paper reviews recent developments in the measurement of patients' satisfaction with nursing, including new approaches and taking into account increased interest in users' opinions. Studies published since 1990 generally demonstrate lack of clarity with regard to the purpose and intent of the study, as well as a lack of conceptual rigour and methodological investment. However, several new approaches were found upon which future nursing research could build.

Effects of integrin clustering on human lung mast cells and basophils

The interaction of cells with the extracellular matrix can alter cell responses and is regulated by integrins on the cell surface. We used monoclonal antibodies to the VLA-4 integrins CD29 and CD49d followed by an F(ab')2 fragment of rabbit anti-mouse immunoglobulin G1 to crosslink integrins on the surface of human lung mast cells and basophils. Crosslinking either CD29 or CD49d caused a significant histamine release (HR) from the basophils of most asthmatic donors (10 of 14 for CD49d and 7 of 10 for CD29) (HR = 21 +/- 5%, n = 10, P < 0.005 for CD29 and HR = 19 +/- 4%, n = 14, P < 0.01 for CD49d) yet failed to initiate HR from the basophils of non-atopic and atopic donors (HR was 1 +/- 0.5% for CD29 and 1 +/- 0.5% for CD49d, n = 10, P = NS). Crosslinking either CD29 or CD49d also failed to initiate histamine release from human lung mast cells (HR was 1 +/- 1% for CD29 and 2 +/- 1% for CD49d). The basophils of asthmatic donors responded to 100 and 30 micrograms/ml tissue fibronectin (HR = 12 +/- 2% and 10 +/- 3% for 100 and 30 micrograms/ml fibronectin, respectively, n = 18, P < 0.05), whereas basophils of nonasthmatic patients again failed to degranulate (HR was 0 +/- 0.4% and 1 +/- 0.6%, respectively, n = 11, P = NS). In contrast to the basophil, crosslinking of either CD29 or CD49d failed to initiate histamine release in human lung mast cells (HR = 1 +/- 1% for CD29 and 2 +/- 1%, n = 15). Human lung mast cells were also unresponsive to tissue fibronectin (100 and 30 micrograms/ml) (HR = 1 +/- 1%, n = 5). The tyrosine kinase inhibitor, genistein, significantly reduced CD29- and CD49d-induced HR (inhibition = 83 +/- 7% for CD29 and 77 +/- 6% for CD49d, n > or = 5, P < 0.05). A second tyrosine kinase inhibitor, piceatannol, also significantly reduced both CD29- and CD49d-induced HR (inhibition was 62 +/- 19% for CD29 and 56 +/- 14% for CD49d, n = 7, P < or = 0.05). Integrin crosslinking also affected the response to a second, immunoglobulin E (IgE)-dependent stimulus. Both CD29 and CD49d clustering significantly inhibited anti-IgE-induced histamine release from the human basophil. Inhibition was 30 +/- 5%, n = 18, P < or = 0.001 for CD29 versus 40 +/- 6% for CD49d. In summary, we have shown that crosslinking the beta 1 integrins using either monoclonal antibodies or tissue fibronectin can initiate mediator release from the basophils of asthmatic patients by a mechanism which appears to be tyrosine kinase-mediated. In addition, clustering of integrins modulates the response to a second IgE-dependent signal.

Role of T-lymphocyte subsets in recovery from respiratory syncytial virus infection in calves

The role of T-cell subsets in respiratory syncytial virus (RSV) infection was investigated by using monoclonal antibodies (MAbs) to selectively deplete gnotobiotic calves of CD4+, CD8+, or WC1+ gamma delta T-cell receptor+ lymphocytes. Injection of these MAbs produced specific reductions of the target cell populations in the circulation and tissues. Ten days after RSV infection, immunoglobulin M (IgM), IgG1, and IgA antibodies were detected in sera and lung washings from control calves. Depletion of CD8+ T cells had no effect on either the serum or local antibody responses to RSV, whereas depletion of CD4+ T cells suppressed the antibody responses in two of three calves. The IgM and IgA responses were significantly increased in the lung washings of calves from which WC1+ T cells were depleted. Depletion of CD4+ or WC1+ T cells caused no significant delay in virus clearance, although an increase in the extent of pneumonic consolidation was observed in anti-CD4-treated calves. Nasopharyngeal excretion of RSV was prolonged in calves depleted of CD8+ T cells, and virus was isolated in high titers from lung washings of these animals 10 days after infection, whereas virus had been cleared from lung washings of all other animals. The delayed virus clearance was associated with an increase in the severity of pneumonic consolidation in three of four of the calves from which CD8+ T cells were depleted. This study shows that CD8+ T cells play a dominant role in the recovery of calves from RSV infection.

Obtaining patients' views of nursing care to inform the development of a patient satisfaction scale

Patient satisfaction is increasingly being measured as an indication of the effectiveness of nursing care. At present, however, there are no validated UK scales available specifically addressed to nursing. The aim of the present study was to develop a sensitive, valid and reliable measure of patient satisfaction. This paper describes the first phase of the study, the development of a multidimensional concept of satisfaction from the patients' perspective. Using qualitative methods, patients were interviewed both in hospital and following discharge. Eleven main concepts were identified: nurses' manner, attentiveness, availability, reassurance, individual treatment, openness/informality, information, professionalism, ward organization, nurses' knowledge and ward environment. Beginning with customer-defined values has provided the starting point for the development of a scale to measure patients' satisfaction with nursing using concepts important to patients, rather than hospital personnel or research teams.

Regulation of integrin-dependent release in human lung mast cells and basophils

The interaction of cells with surfaces or components of the extracellular matrix alters cell responses and is regulated by integrins on the cell surface. We have used monoclonal antibodies to CD29 and CD49d followed by an F(ab)2 fragment of rabbit anti-mouse IgG1 to cross-link the integrins on the surface of human lung mast cells and basophils. We found that cross-linking either CD29 or CD49d failed to initiate mediator release from the basophils of non-atopic and atopic donors [histamine release (HR) = 1 +/- 0.5% for CD29 and 1 +/- 0.5% for CD49d, n = 10, NS]. In contrast we found that clustering CD29 caused significant HR from the basophils of asthmatic donors (HR = 21 +/- 5%, n = 10, p < 0.005). Clustering of CD49d also caused significant degranulation in the same donors (HR = 9 +/- 3%, n = 10, p < 0.11). Incubating the basophils of these asthmatic donors with a synthetic RGD peptide significantly reduced CD29- and CD49d-induced histamine release. CS-1 peptide was also found to inhibit CD29-induced histamine release but had no significant effect on CD49d-induced histamine release. The tyrosine kinase inhibitors, genistein and piceatannol, completely ablated CD29- and CD49d-induced degranulation. In summary, we have shown that cross-linking integrins can initiate mediator release from the basophils of asthmatic patients and that this appears to involve recognition of RGD and activation of tyrosine kinase.

The effectiveness of nursing: a review

This paper describes the findings of a literature review of the effectiveness of nursing. Three journals were selected in which this type of study was most likely to be published. A diversity of attempts to measure nursing effectiveness with various types of patient was found. Generally, however, there was a lack of rigour in study design and sample sizes were too small to be able to draw conclusions. No studies were found which undertook a cost-effectiveness analysis of nursing interventions. Suggestions for the way forward in measuring nursing effectiveness are given, together with questions to be addressed by nursing research.

Pathologic findings of experimentally induced Streptococcus uberis infection in the mammary gland of cows

Twenty-five quarters of 12 dairy cows, 3 to 8 years old, with a bacteriologic history of freedom from infection with Streptococcus uberis were inoculated via the teat canal with S uberis (23 quarters) or sterile medium (2 quarters). The cows were sent to slaughter 1, 3, or 6 days later. Acute inflammatory response involving accumulation of large numbers of polymorphonuclear, neutrophilic leukocytes (neutrophils) in the secretory acini was recognized after 24 hours in infected cows. After 6 days, the neutrophil response was still evident, but infiltration of septa by lymphocytes, septal edema, extensive vacuolation of secretory cells, focal necrosis of alveoli, small outgrowths of the secretory and ductular epithelium, and widespread hypertrophy of the ductular epithelium also were recognized. Early stages of involution and fibrosis also were evident at that stage. Streptococci were identified by immunoperoxidase labeling, free or phagocytosed, in macrophages; in the alveolar lumina, adherent to damaged secretory or ductular epithelium; in the subepithelium and septal tissue; and in lymphatic vessels and lymph nodes. The importance of the macrophage as the primary phagocytic cell is highlighted, and doubt is cast on the value of the exuberant neutrophil response by the host in defense of the gland.

A comparison of the verbal interactions of qualified nurses and nursing auxiliaries in primary, team and functional nursing wards

The purpose of this study was to compare the differential contribution to patient care of qualified nurses and nursing auxiliaries in primary, team and functional nursing wards using a measurable qualitative indicator, nurse-patient verbal interaction. Twelve qualified nurses and 12 nursing auxiliaries were chosen randomly in each organizational type. Data were collected using non-participant observation and a computerized event recorder. Regardless of staff grade, nursing staff in wards practising primary nursing gave patients more choice, general explanations about their care and, in the afternoon, spent more time seeking verbal feedback from patients about their care. Implications of these findings for the employment of nursing auxiliaries in elderly care wards are discussed.

Comparing qualified nurse and auxiliary roles

This paper describes the contribution of nursing auxiliaries (NAs) compared with qualified nurses (QNs) in terms of activities performed. It also examines how this was affected by three organisational types, namely primary, team and functional nursing. Twelve QNs and 12 NAs were chosen randomly in each organisational type. Data were collected using non-participant observation and a computerised event recorder. The most interesting findings were found across organisational type, with QNs and NAs within each type engaging in similar patterns of work. Both grades of nursing staff in primary wards spent a greater amount of time in direct patient care but less time in supplementary patient care and staff activities. Team and functional nursing staff spent more time with patients in domestic and administrative activities. The implications of these findings for the employment of NAs in care of the elderly wards are discussed.

Qualified nurse and nursing auxiliary perceptions of their work environment in primary, team and functional nursing wards

The way in which nursing work is organized has major implications for the role of different staff grades. This paper describes how qualified nurses and nursing auxiliaries perceived their work in primary, team and functional nursing wards. The Work Environment Scale was distributed to 12 qualified nurses and 12 nursing auxiliaries within each organizational mode, and a response rate of 97% was achieved. While differences were found between organizational modes, there was no difference in work perceptions between qualified nurses and nursing auxiliaries within organizational mode. It is argued that this is due to cultures existing within organizational types which transcend staff grade.

Ischaemic heart disease and consumption of hydrogenated marine oils in England and Wales

STUDY OBJECTIVE

The aim was to examine the hypothesis that hydrogenated fats, particularly those obtained from marine oils, may present a health hazard.

DESIGN

Storage fat specimens obtained at necropsy were collected from several areas in England and Wales during 1975-1978. Cases (n = 136 samples) consisted of males dying of ischaemic heart disease, male deaths from unrelated causes acting as controls (n = 95 samples). The fatty acid compositions of the specimens were determined, and analysis included those acids--16:1 trans and "higher" C-20 plus C-22 (H)--highly characteristic of partially hydrogenated marine oils.

MEASUREMENTS AND MAIN RESULTS

The case samples, which had been shown to be the richer in 16:1 trans (p less than 0.005), were now found to have a significantly higher value of the ratio 16:1 trans to H (p less than 0.002), arising from consumption of differing hydrogenated marine oil types.

CONCLUSIONS

It is concluded that the cases had consumed a greater amount (p less than 0.001) of hydrogenated marine oils of a certain type, ie, that manufactured from certain highly unsaturated raw oils. The process of partial hydrogenation results in conversion to a product containing large amounts of polyunsaturated acids (PUFA) which are no longer in the natural all-cis methylene interrupted configuration. Such isomeric PUFA may obstruct or compete with utilisation of natural PUFA. It is further concluded that the case excess did not rise from medical advice favouring margarine or from any difference in social class status, but rather from fortuitous selection of margarine brand.

Measuring patients' satisfaction with nursing care

Assessing patients' satisfaction with the care they receive is assuming greater importance and satisfaction with nursing is no exception. The kinds of study in which patient satisfaction has been used as an outcome are considered and show the range of conceptualizations and the general lack of rigour in its measurement. It is argued that research methods are often flawed by using inappropriate measures and greater care is warranted in their selection. Where appropriate measures do not exist, only then is the costly process of developing new assessments warranted. Some of the necessary steps in arriving at reliable and valid measures of patient satisfaction are discussed in the context of asking particular research questions.

Adherence and colonization by bacterial pathogens in explant cultures of bovine mammary tissue

Explant cultures of bovine mammary tissue taken from virgin heifers were used to examine adherence, colonization and cytopathogenesis of Streptococcus uberis, Streptococcus agalactiae, Streptococcus dysgalactiae, Staphylococcus aureus and Escherichia coli in the putative target tissue. None of the five bacteria was able to adhere to healthy ductular epithelium but all showed a marked tropism for exposed connective tissue. S. aureus and E. coli induced a marked cytopathic effect in ductular epithelium after 6 hours in culture but the bacteria were not in close association with the affected tissue. No evidence could be found to support the hypothesis that adherence to epithelium might be the first stage in the pathogenesis of mastitis caused by these organisms.

Issues in measuring outcomes of nursing

The upsurge in interest in measuring patient outcomes of nursing, it is argued, has been occasioned firstly by management changes and secondly by the professionalizing thrust of the nursing profession. Within this overall context, however, the objectives of individual patient outcome studies vary considerably. The current status of outcome measurement in nursing is outlined through a description of the use of different outcome measures to suit different purposes. Ascertaining whether nursing care makes a difference by using outcome measures raises methodological as well as professional issues, for example that of separating nursing from the inputs of other professional groups and incorporating individual patients' perspectives. While these challenges are complex and measuring the effectiveness of nursing in terms of patient outcomes is in its infancy, it is argued that, in this, nursing is no different from other professional groups. The paper goes on to suggest ways of moving forward in the measurement of outcomes of nursing for patients.

Effects of recombinant human alpha A interferon in gnotobiotic calves challenged with respiratory syncytial virus

The effects of recombinant human alpha A interferon were studied in gnotobiotic calves challenged with respiratory syncytial virus (RSV). Gnotobiotic calves given doses of interferon by intramuscular injection over five days showed a marked, dose-related, rise in rectal temperature and depression of circulating leucocytes. Differential counts showed decreases in both lymphocytes and neutrophils. No significant pathological differences were found between treated and untreated calves, nor could any difference be demonstrated in the pattern of RSV infection.

Outcomes of nursing care: the case of primary nursing

Using primary nursing as a 'case study', this paper reviews research literature which attempts to measure the effectiveness of a mode of nursing using outcome measures. Previous research, it is argued, is hampered by a lack of conceptualization of structure and process and inadequate research design, with consequent uncertain findings. A shift in emphasis is suggested from an evaluation of global concepts, such as primary nursing, to an identification of the features of structures and processes of nursing care which interrelate with patient and nurse outcomes. For this purpose, multivariate research design and investment in methodological research are recommended.

Towards defining the organization of nursing care in hospital wards: an empirical study

The method of organizing nursing care known as 'primary nursing' is increasingly being introduced into hospital wards on the assumption that it will have beneficial effects for both patients and staff. Operational definitions of primary nursing, essential to provide replicable research into the organization of nursing care, are, however, lacking in available research literature. This study describes the development of a questionnaire intended to identify and discriminate between three methods of organizing nursing staff and nursing work: task allocation or functional nursing, team nursing and primary nursing. The questionnaire was distributed to 36 ward sisters on 27 acute and rehabilitation care of the elderly wards. Questionnaires were returned from 17 wards, a response rate of 63%. Findings indicate that few wards meet five or more criteria for classification as a particular method of nursing organization. The findings illustrate the difficulties in matching and discriminating between wards in order to conduct research in which organizational modality is an independent variable.

Effect of vaccination on cell populations in lung washes from calves after infection with respiratory syncytial virus

The inflammatory response in the air-passages of the lungs of calves after intranasal inoculation with respiratory syncytial virus (RSV) was compared in RSV-vaccinated and control animals. Total cells recovered from lung washings remained the same; however, the fold by eight days after infection and the type of cells changed from a predominance (85 per cent) of macrophages to equal proportions of macrophages and neutrophils (45 per cent) during the course of infection. The absolute numbers of neutrophils rose by 15-fold. In contrast, when RSV-vaccinated calves were challenged, the total number of cells recovered from lung washings remained the same; however, the numbers of macrophages decreased and the numbers of neutrophils increased by fivefold. Cytological studies of the lung washings revealed no evidence of an exacerbated inflammatory response in RSV-vaccinated calves. Levels of virus replication were significantly reduced in RSV-vaccinated compared with control animals.

Experimental Pasteurella multocida pneumonia in calves

Pasteurella multocida was isolated from the lungs of calves that died on a farm in the south of England. This organism was inoculated experimentally into 13 calves by the intratracheal route: in all but two of the calves mild clinical disease resulted and at necropsy, three or four days later, pneumonic consolidation involving up to 22 per cent of the lung was observed. P multocida was isolated from all but two of the lungs. Of two calves inoculated intravenously with P multocida, one showed mild clinical disease and slight pneumonic consolidation at necropsy and the other remained normal. Control calves inoculated intratracheally and intravenously with sterile broth showed no signs of illness and no pneumonic consolidation. Histologically the lung lesions comprised a fibrinous bronchopneumonia with variable sized areas of coagulative necrosis, extensive deposition of fibrin and massive dilatation and oedema of the interlobular and pleural lymphatics. It is concluded that P multocida should receive more recognition as a primary pathogen.

Effect of a new macrolide antibiotic (tilmicosin) on pneumonia experimentally induced in calves by Mycoplasma bovis and Pasteurella haemolytica

Two gnotobiotic calves were treated once with tilmicosin (20 mg kg-1) six hours before they were infected by the intratracheal route with Mycoplasma bovis and Pasteurella haemolytica serotype 1. This treatment prevented colonisation of the lungs by P haemolytica and considerably reduced colonisation by M bovis, and the clinical scores and the extent of pneumonic consolidation, compared with two untreated gnotobiotic calves, both of which had to be killed in extremis for humanitarian reasons within 24 hours of infection. In a second experiment, 10 conventionally reared calves were similarly exposed to infection and, at the onset of clinical disease, five were treated once with tilmicosin (20 mg kg-1). Colonisation by P haemolytica and M bovis, the clinical scores and extent of pneumonic consolidation were suppressed or greatly reduced in the treated compared with the untreated calves, one of which had to be killed in extremis two days after infection. It was concluded that tilmicosin had a beneficial effect.