The nurse-patient relationship: a consideration of its discursive context

This paper is a theoretical exploration of the discursive context that shapes the nurse-patient relationship. It represents a feminist poststructural consideration of the broader institutional and social context that influences the dynamics of that relationship. The characteristics of that relationship can be regarded as performances of subjectivity shaped by managerial, medical and nursing discourses. Both nurse and patient signify particular discursively constituted meanings to each other which shape the relationship. It is proposed that the discourses which inform how each should respond to the other encourage the utilization of disciplinary tactics by the nurse which relay to the patient what is expected of him/her. An effect of these disciplinary procedures is to rein in the caring potential of nursing practices. However, nursing's relationship with women's work and the social history of caring may provide it with a discursive context that recognizes the social significance of this work.

Psychiatric diagnosis: some implications for mental health nursing care

Psychiatric diagnosis: some implications for mental health nursing care This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.

Constructing normality: a discourse analysis of the DSM-IV

The purpose of this research was to explore how the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 1994, (American Psychiatric Association, 1994) defines mental disorder and the theoretical assumptions upon which this is based. The analysis examines how the current definition has been constructed and what the criteria for specific mental disorders suggest about what is regarded as normal. The method employed for the research was a critical discourse analysis. This critical approach to research is primarily concerned with analysis of the use of language and the reproduction of dominant belief systems in discourse. It involves systematic and repeated readings of the DSM-IV (1994) to examine what evidence was employed by the text to substantiate its definition of mental disorder and how in the process some assumptions are made about what constitutes normality. This study challenges a central assumption in the DSM-IV's (1994) definition: that it is a pattern or syndrome 'that occurs in an individual'. The proposal that it occurs in an individual implies that it is a consequence of faulty individual functioning. This effectively excludes the social and cultural context in which experiences occur and ignores the role of discourse in shaping subjectivity and social relations. This study proposes that the definition and criteria for mental disorder are based on assumptions about normal behaviour that relate to productivity, unity, moderation and rationality. The influence of this authoritative image of normality pervades many areas of social life and pathologies experiences that could be regarded as responses to life events.

Hospital services for patients with acute stroke in Ireland: the Volunteer Stroke Scheme survey of consultant opinion

A national postal survey of hospital based consultants with responsibility for acute care of stroke admissions was performed in November, December 1998. Of 162 survey forms, 140 (86.4%) were returned representing consultants working in all 38 acute general hospitals (total 10,067 hospital beds) of whom 135 indicated that stroke patients were admitted under their care. Patients were admitted under 11 different subspeciality groups to various medical and surgical wards. Only 18.5% of consultants worked in hospitals where there was a physician/neurologist with specific responsibility for stroke, whilst only 19.5% were aware of a policy in their hospital for implementation of minimum standards of care for stroke patients or a recent audit of stroke care (9%). A substantial number of hospitals in certain health board areas have no access to a consultant led rehabilitation unit within their own health board area whilst 18/38 hospitals have no on-site CT brain scanning. Despite the proven value of organised hospital stroke care, this survey documents major deficiencies in this country. We suggest that each health board would review its services to include in each hospital a consultant physician with special responsibility for co-ordination and development of appropriately staffed and funded stroke services.

Mad talk: attending to the language of distress

This paper will examine how the narrative of one woman, Madeleine, can be constructed as symptomatic of the diagnosis of schizophrenia, and how it can also be read from other perspectives, particularly a poststructural feminist one. The readings are presented as possibilities for understanding the woman's experiences and the implications of this for mental health nursing practice. A poststructural feminist reading acknowledges the gendered experiences of subjectivity and how those experiences are constructed in language. The purpose of this paper is to identify for mental health nursing practice an approach which recognizes the figurative and literal characteristics of language in order to provide nursing care which positions the individual's experience of mental distress as central. This requires an acknowledgement of Madeleine's path into mental distress rather than simply a categorization of what is observed in a clinical setting. Intervention may need to include a range of strategies: medical and nonmedical, psychotherapeutic and social, physical and environmental. It may also require the provision of sanctuary and security whilst these options are explored.

GBV-C/HGV coinfection in HIV-1-positive men: frequent detection of viral RNA in blood plasma but absence from seminal fluid plasma

Sequential paired samples of blood and seminal fluid were obtained from a cohort of 54 HIV-1-infected homosexual males. The prevalence of GBV-C/HGV RNA in the cell-free fractions of some of these patients was determined using reverse-transcription polymerase chain reaction (RT-PCR). To assess the effects of HIV-1 and HCV infection upon GBV-C/HGV RNA status, blood CD4 cell counts, HCV RNA status, and HIV-1 proviral DNA and viral RNA titres were also determined. GBV-C/HGV RNA was detected in 8/30 (27%) of the blood plasma samples obtained at the start of the study, and was present at a frequency of 14/64 (22%) in all the blood plasma samples tested. By contrast, GBV-C/HGV RNA was not detected in the 26 seminal fluid samples obtained at the start of the study, including 8 samples obtained from patients for which GBV-C/HGV RNA was detected in the corresponding blood sample. Of the samples tested for the presence of both GBV-C/HGV and HCV RNA, there was no evidence of coinfection. Although GBV-C/HGV RNA detection rates were significantly higher in individuals with blood CD4 cell counts greater than 200 cells per microlitre, there were no significant differences in the median blood CD4 cell counts or HIV-1 proviral DNA or viral RNA titres observed between the GBV-C/HGV-positive and -negative individuals. The failure to detect GBV-C/HGV RNA in seminal fluid samples obtained from this cohort would suggest that further studies need to be carried out to determine the roles of sexual transmission and of seminal fluid in GBV-C/HGV infection.

Developing advanced mental health nursing practice: a process of change

In the current economic climate of restructuring and rationalization it is important for mental health nurses to define their realm of expertise in order to demonstrate professional accountability and to validate their position in relation to unqualified but cheaper caregivers. If mental health nurses are to act in the best interests of patients and the community, they need to challenge current trends in health-care delivery that are preoccupied with economic efficiency and lack of consideration of broader social issues. To substantiate mental health nursing practice and defend against the undermining of clinical expertise by policies and service delivery that advances economic interests, mental health nurses need to corroborate their claims to expertise by articulating a patient-centred rationale for their practice. The ideas presented in this paper have evolved through the development of two postgraduate programmes for advanced mental health nursing practice--one in Australia at Griffith University and the other in New Zealand at the Department of Psychological Medicine, Christchurch School of Medicine.

The power of the word: some post-structural considerations of qualitative approaches in nursing research

This paper takes a post-structural position to discuss some issues related to the use of qualitative research methodologies in nursing research. Two fundamental assumptions which underpin qualitative approaches are explored in relation to how subjectivity is constructed in the process of data collection. These assumptions reveal an ideological position which proposes that reality can be apprehended by capturing the individual's point of view (subjectivity) and that qualitative researchers can directly represent this lived experience in language (linguistic representation). Post-structural approaches challenge these assumptions which are often an uncritically accepted part of the common sense world and therefore taken to be natural. It proposes that these views of subjectivity and language are not natural but rather cultural. There is a recognition of the wider sociopolitical and historical context in which nursing research takes place and a displacement of normative constructions of subjectivity. It provides nursing with the possibility of challenging existing power structures which determine the individual's experiences of health and illness.

Bacteraemia in the adult intensive care unit of a teaching hospital in Nottingham, UK, 1985-1996

Bacteraemia is an important cause of morbidity and mortality in the intensive care unit. In this study the distribution of organisms causing bacteraemic episodes in patients in the adult intensive care unit of a large teaching hospital was determined. Particular emphasis was placed on the type of organisms isolated from community- and hospital-acquired bacteraemia, the suspected source of infection, the possible risk factors associated with bacteraemia, and outcome. The incidence of bacteraemia and fungaemia increased from 17.7 per 1000 admissions in 1985 to 80.3 in 1996. A total of 315 episodes of bacteraemia and fungaemia were documented over a 12-year period, of which 18% were considered community-acquired and 82% hospital-acquired. Gram-positive and gram-negative bacteria accounted for 46.9% and 31.5% of the episodes, respectively. Polymicrobial infection accounted for 17.8% and fungi for 3.8% of the episodes. Staphylococcus aureus (22.5%), Staphylococcus epidermidis (7.6%), and Streptococcus pneumoniae (7.9%) were the predominant gram-positive bacteria implicated, whereas Escherichia coli (6%), Enterobacter cloacae (7%), Klebsiella aerogenes (3.8%), Pseudomonas aeruginosa (5.1%), and Acinetobacter spp. (3.8%) were the predominant gram-negative bacteria isolated. The two most common sources of infection were the respiratory tract (39.7%) and an intravascular line (24.5%), but in 8.9% of episodes the focus of infection remained unknown. Bacteraemic patients stayed in the unit for a longer period (12 days) than did non-bacteraemic patients (3 days). The overall mortality related to bacteraemia and candidaemia was 44.4%. Surveillance of bacteraemia in the intensive care unit is important in detecting major changes in aetiology, e.g., the increasing incidence of gram-positive bacteraemia, the emergence of methicillin-resistant Staphylococcus aureus in 1995, and the emergence of Enterobacter cloacae. It is of value in determining empirical antimicrobial therapy to treat presumed infection pending a microbiological diagnosis and in directing the development of guidelines for infection prevention, e.g., guidelines for central venous catheter care.

Surveillance of an adult intensive care unit for long-term persistence of a multi-resistant strain of Acinetobacter baumannii

Sporadic infections with Acinetobacter spp., punctuated with prolonged outbreaks of infection involving larger numbers of patients and a particular epidemic strain of Acinetobacter baumannii, have occurred in the adult intensive care unit (ICU) of Nottingham University Hospital since 1985. The aim of this study was to screen patients admitted to the ICU for three or more days during a non-outbreak period in 1994-1995 and to use DNA fingerprinting techniques to compare any isolates of Acinetobacter spp. with isolates obtained from the same ICU during the previous ten years. In the present study, almost 20% of the ICU patients screened during 1994-1995 became colonized with Acinetobacter spp. The commonest species isolated from patients was Acinetobacter baumannii; five different strains were identified by random amplified polymorphic DNA fingerprinting, including the epidemic strain responsible for outbreaks of infection in 1985-1986 and 1992-1993. Environmental sampling yielded Acinetobacter spp. from one or more samples on four occasions; Acinetobacter radioresistens was the commonest species isolated, and Acinetobacter baumannii (not the epidemic strain) was isolated on only one occasion from the environment. The long-term persistence of a potentially epidemic strain in the ICU, even during a non-outbreak period, indicates a need for continued vigilance. Consequently, periodic patient and environmental surveillance, combined with typing of isolates, is recommended for ICUs where significant outbreaks of Acinetobacter infection have occurred in the past.

Becoming a registered nurse

This paper describes research carried out with clinical agencies and former students to ascertain the effectiveness of curriculum design within the third year of a problem-based Bachelor of Nursing programme. It shows that where holistic care, time management, prioritization of care, working as a team member, and sophisticated clinical reasoning were introduced as deliberate strategies in students' learning, the transition to the workplace was more successful.

An analysis of the sociopolitical context of mental health nursing practice

This paper will explore the delivery of mental health nursing care within a neo-liberal model of mental health care delivery in New Zealand. Mental health nursing as a socially constructed activity occurs within a particular political context, which determines its role and function. This environment determines the nature of the nurse-patient relationship which is integral to the role of mental health nurses. Critical analysis of the New Zealand Government's neo-liberal health policies will be conducted to explore their effect on mental health care delivery and the nurse-patient relationship. Some of the ideologies and values maintained by current dominant discourses within nursing and the State are discussed. To establish therapeutic partnerships with service-users, mental health nurses are urged to critically analyse their practice and the context in which it occurs.

The development of a comprehensive stroke programme in the acute hospital

Stroke is the third leading cause of death and an important cause of hospital admissions and long term disability. The incidence of stroke is estimated at 200 per 100,000 of the population, Dublin has approximately 2,400 new strokes per annum. In 1989 a comprehensive stroke programme was introduced in St Vincent's Hospital. The aim was to provide patients with a coordinated approach to rehabilitation. A study of the programme was conducted in 1993 by detailed chart review. 129 patients with a clinical diagnosis of stroke were referred to the programme during a 12 month period. 27.13% were under age 65 and 72.87% were over 65 years, 18% died and 44.2% were discharged home, independently mobile. The study findings suggest that the comprehensive stroke programme in St Vincent's Hospital represents a feasible model of care in the acute general hospital setting.

Clinical features and antibiotic treatment of septic arthritis and osteomyelitis due to Yersinia enterocolitica

Yersinia enterocolitica bone and joint infections are rare. Over a period of 7 months four patients with deep-seated skeletal infections due to Y. enterocolitica were seen at the University Hospital, Nottingham. Sites of infection included the knee (one patient) the hip (one) and the spine (two). None of the patients had major underlying disease or risk factors for developing invasive Y. enterocolitica infection. The organisms were sensitive to the second- and third-generation cephalosporins, gentamicin and fluoroquinolones. A literature search covering the period 1970-1994 revealed 20 other cases of skeletal infections due to Y. enterocolitica; there was no uniformity in the choice of antimicrobial agent for treating these infections. Oral ciprofloxacin was used as the principal antimicrobial agent in the patients described here and therapeutic success was achieved in three of these patients. Ciprofloxacin should be considered as first line therapy for invasive infections due to Y enterocolitica.

A plan for action to reduce hospital-acquired infection

Surveillance is recognised as an essential component of the prevention and control of infection in hospitals. The second National Prevalence Survey in 1993-94 showed a mean hospital-acquired infection prevalence rate of 9%. The Nosocomial Infection National Surveillance Scheme is being developed in England to measure the incidence of nosocomial infection; similar schemes are being developed elsewhere in the UK. Surveillance aims to reduce the risk of nosocomial infection by highlighting areas where changes need to be made, measuring the effects of change and leading to the development of guidelines for good practice.

Cutting up: signifying the unspeakable

This article uses a feminist framework to explore women's self-injurious behaviour in response to abuse. It deals specifically with 'cutting up' as a response to physical or sexual abuse. The position pursued regards the body as an inscriptive surface that provides an interface between subject/object and explores how women may lack a means by which to signify to others what their experience means to them. The language available to women does not always provide an adequate means of self-expression. This inadequacy of language often leaves women with no option but the use of non-verbal corporeal inscription. It is proposed in this paper that 'cutting up' is a means of establishing a sense of self while perpetuating a sense of the body as a site for abuse. Discursive constructions of femininity and mental illness perpetuate both the abuse and what is being signified by the act of 'cutting up'. It is argued that this framework for understanding self-injurious behaviours will provide the mental health nurse with an approach to nursing interventions that acknowledges the woman's needs, while at the same time offering the opportunity to signify distress in a manner that does not perpetuate the body's role as an object of abuse.

Establishing a therapeutic milieu with adolescents

Adolescents with acute psychiatric illness need an environment that emphasizes containment, structure, support, involvement and validation. Within such an environment therapeutic relations based on collaboration can be developed. However, these relations require nursing actions that facilitate adolescents' acceptance of containment, their ability to form attachments and development of achievement. The proposed collaborative approach for nursing care positions the adolescent as an active participant in the treatment process. The collaborative approach encourages a sense of responsibility for self and enhances the adolescent's skills to cope with situations and relations that pose difficulties through the development of self-awareness and problem-solving abilities.

Clinical and epidemiological features of an outbreak of acinetobacter infection in an intensive therapy unit

Sporadic examples of infection with multi-resistant Acinetobacter spp. have occurred in Nottingham hospitals since at least 1977, punctuated by more prolonged outbreaks involving larger numbers of patients, particularly those confined to the intensive therapy unit (ITU) with severe underlying disease. In the most recent outbreak, 11 patients were infected with multi-resistant Acinetobacter strains and 26 patients were colonised. Four of the infected patients died directly or indirectly from infection with multi-resistant Acinetobacter spp., either while in the ITU or after discharge to a general ward. The mean interval from admission to the first isolation of a multi-resistant Acinetobacter strain was 6.7 and 12.1 days in the infected and colonised groups, respectively. Multi-resistant Acinetobacter strains were isolated most frequently from the respiratory tract, and eight patients had probable or suspected pneumonia caused by a multi-resistant Acinetobacter sp. All infected patients were treated with imipenem, with or without an aminoglycoside, except one patient who died before a diagnosis of acinetobacter infection was confirmed. Multi-resistant Acinetobacter spp. were isolated from various environmental sites in the ITU, and patient and environmental isolates were found to be related closely by biotyping, antibiograms, pulsed-field gel electrophoresis of chromosomal fingerprints and ribotyping. The outbreak was controlled ultimately by transfer of infected or colonised patients to an isolation cubicle, cohort nursing, emphasis on the importance of hand washing before and after patient contact and when handling case notes, and the use of disposable aprons and gowns during patient contact.(ABSTRACT TRUNCATED AT 250 WORDS)

Problem-based learning: a model for graduate transition in nursing

This article is a discussion paper related to the use of problem-based learning to assist in the professional role socialization that occurs during the transition from student to graduate nurse. Through the use of a preceptorship program which incorporates the principles of problem-based learning this transition can be a positive experience for both the graduate and the health care setting. It encourages the graduate to develop independent problem-solving skills in order to make clinical judgements and develop and evaluate action plans with a client-centred focus. The graduate would be encouraged to critically evaluate and challenge ready-made principles and norms to develop creative approaches to care which are sensitive to the client's physical, psychological, social and spiritual needs. As a model of preceptorship it provides the graduate with the opportunity to explore clinical situations within a framework of critical reflection and problem resolution.

What events precede violent incidents in psychiatric hospitals?

BACKGROUND

The study aimed to identify, classify and measure the relative frequency of events preceding violent incidents in psychiatric hospitals.

METHOD

Possible antecedents for 1000 incidents in three associated psychiatric hospitals over 13 months were investigated with an 'untoward incident database'.

RESULTS

From eyewitness accounts, 921 incidents (92%) could be related to one of 15 categories of antecedent involving characteristics of the patient, or of the hospital regime, or interactions with other individuals. Overall, the most common antecedents involved patients who were generally agitated or disturbed (286), restrictions on patients associated with the routine hospital regime (192) or provocation by other patients, relatives or visitors (175). Incidents arising from staff members initiating contact with patients were very rare (7). Twenty-one patients were involved in 10 or more incidents, including 19 (90%) who were detained under the Mental Health Act. These patients were more likely to commit assaults after certain antecedents (self-harm, absconding or arson) which were serious incidents in themselves.

CONCLUSIONS

Staff training on specific safety issues will be needed under the new Management of Health and Safety at Work Regulations.

Effects of anions on the binding of the cAMP receptor protein to the lactose promoter

The DNA binding affinities of several gene-regulatory proteins, restriction endonucleases and the Escherichia coli RNA polymerase have previously been found to be dependent on the nature of the dominant buffer anion. To discover whether the E. coli cAMP receptor protein (CAP) exhibits a similar dependency, we measured its affinity for its primary lactose promoter binding site (lac site 1) in buffers in which the principal anion was chloride, phosphate, sulfate, acetate, or glutamate. We found that the affinity of CAP for lac site 1 is affected only slightly by changes in the dominant buffer anion. The binding of cAMP is similarly insensitive to buffer anion type, indicating that specific protein-anion interactions, if they occur, must be similar for the free and cAMP-bound forms of the protein. The effect of anion substitution on the ability of acrylamide to quench the intrinsic fluorescence of tryptophanyl residues of CAP is also small, suggesting that changes in buffer anion composition have minimal effect on the conformation of tryptophan-proximal regions of CAP. This conclusion is extended by the finding that anion substitution has a relatively small effect on the urea-concentration dependence of CAP denaturation. Taken together, these results support the notion that neither CAP nor CAP.cAMP nor the CAP.cAMP complex with lac promoter DNA interact selectively with anions present in the surrounding buffer. A possible role for this anion-insensitivity in the in vivo function of CAP is suggested.

Sex therapy: the successes, the failures, the future

Sexual dissatisfaction or dysfunction occurs in one fifth to one third of the adult population. Although great advances have been made in the pharmacological treatment of impotence, psychological and relationship therapy remain the mainstay of the treatment of sexual problems within relationships.

Oral estrogen retains potency as an aversion agent in eggs: implications to studies of community ecology and wildlife management

The first of two experiments with laboratory rats demonstrated that oral estrogen (17 alpha-ethinylestradiol) can remain in the albumen of eggs at room temperature for up to 8 days with undiminished capacity to produce conditioned taste aversion. The second experiment showed that estrogen remains potent in the yolk of eggs for at least 4 days. There is now greater assurance that egg prey placed into the field will induce reliable CTA among mammalian predators. Community ecologists interested in such processes as competitive release and the responses of prey populations to reduced predation upon their eggs can selectively factor predation out of field experiments without the need for physically excluding predators. Wildlife biologists interested in reducing predation upon the eggs of endangered species now have greater assurance that estrogen-treated egg baits will suppress predation in a more cost-effective manner and with less likelihood of discrimination between treated eggs and those of endangered species.

Outcome of stroke related admissions to a general hospital

In a prospective study of patients admitted to a general hospital, 43 patients with stroke were identified accounting for 3.9% of all medical admissions over a six month period. Of these, 23.2% died in hospital, whilst 46.5% were discharged to the community, and 30.3% to institutional care after a mean length of stay in hospital of 24.5 and 34 days respectively. At follow-up seven months following discharge, most patients were alive and still residing in the community or institution to which they had been discharged. The majority of survivors (57%) however, were severely handicapped, 37% of whom were resident with carers in the community. Our study emphasises the overly long stay of stroke patients in the acute hospital, and the high morbidity in survivors with consequent demand on institutional and community care services.

The i.v. nurse and the i.v. drug abuser: medical and psychosocial implications

When I.V. nurses treat I.V. drug abusers, they must be aware of the medical and psychosocial issues relevant to this group. Medical issues include the I.V. drug abuser's depleted venous access and this group's high rate of infection with HIV and other blood pathogens. Psychosocial issues relate to the various social and psychological problems associated with drug abuse. Further, when caring for these patients who are at high risk for HIV and other serious blood infections, the I.V. nurse may experience a conflict between her desire to care for the patient and her fear of contracting HIV or another infection through patient contact. Education is recommended so that I.V. nurses can reduce their risk of infection with blood-borne diseases and can better understand these patients. Also suggested are a multidisciplinary approach to treatment and referral to drug rehabilitation programs.

The size and strength of the quadriceps muscles of old and young men

The mean isometric strength of the stronger quadriceps muscles of 12 healthy men in their seventies was 39% less than that of 12 healthy men in their twenties (P less than 0.001). The cross-sectional area of the quadriceps was measured at mid-thigh, by ultrasound scanning; the older men's stronger quadriceps were 25% smaller (P less than 0.001). The ratio of the stronger quadriceps' strength to its cross-sectional area was very similar in the old men to values obtained previously for both old and young women, but averaged 19% less than in the young men (P less than 0.02). Quadriceps size and strength were correlated in the old men (r = 0.77, P = 0.03) but not in the young men (r = 0.15). The principal axis of the relationship between quadriceps size and strength in the old men was very similar to those previously reported for both old and young women. The quadriceps strength of some young men is greater than would be expected from the size of the muscle.

Size and strength of the quadriceps muscles of old and young women

Muscle weakness and wasting may be evaluated objectively by dynamometry and compound ultrasound imaging. We have measured the voluntary isometric strength of the quadriceps muscles of healthy women in their 70s (n = 25) and in their 20s (n = 25) and have compared it with the mid-thigh cross-sectional area of the same muscles. The two groups of women showed similar variability when strength was measured on consecutive days (coefficients of variation: 8%). The older women were 35% weaker than the young women (P less than 0.001) and their quadriceps cross-sectional area was 33% less (P less than 0.001). Quadriceps strength and cross-sectional area were correlated (r = 0.66, P less than 0.001, elderly; r = 0.53, P less than 0.01, young) and the principal axis of the relationship was closely similar for the two groups of women. There is therefore no difference in the intrinsic strength of the quadriceps muscles of healthy women in their third and eighth decades. This report also provides normative data for the objective evaluation of quadriceps weakness and/or wasting in female patients. The techniques involved are straightforward, the dynamometer is easily made, and compound ultrasound imaging is widely available.

Examination of the energetics of aging skeletal muscle using nuclear magnetic resonance

Human skeletal muscle has been studied in vivo by 31P nuclear magnetic resonance. Young adult subjects were compared with healthy elderly subjects aged 70-80 years. Intracellular pH and concentrations of adenosine triphosphate (ATP), phosphocreatine and inorganic phosphate were measured. At rest, no differences were found between the two age groups. Aerobic dynamic exercise resulted in a similar reduction of phosphocreatine in both groups while the ATP concentration did not change. The pH fall in exercise was not significantly different in the elderly and younger subjects. The time to resynthesize ATP in the recovery period as measured by the time to replete phosphocreatine was also not different in the two groups. The results suggest that the aging process does not affect the metabolic ability of human skeletal muscle to respond to exercise and that changes found in muscle of the elderly are not due to alterations in energy production.

Myocardial glycolytic and gluconeogenic enzyme activity during cardiopulmonary bypass in humans

Through a study of the activity of the regulatory enzyme of glycolysis phosphofructokinase and the regulatory enzyme of gluconeogenesis fructose-1,6-diphosphatase, myocardial metabolism has been evaluated in the human heart during cardiopulmonary bypass. Three ventricular transmural biopsy specimens were obtained at open-heart surgery before cardiopulmonary bypass was instituted and three similar specimens were taken 30 minutes after cardiopulmonary bypass was started. The enzyme assays were performed on the supernatant obtained from myocardial cells disrupted by sonication. The activity of both enzymes increased during the anoxic conditions of cardiopulmonary arrest. The increase in phosphofructokinase activity is likely due to an overall increase in glycolytic activity, but the presence and increased activity of fructose-1,6-diphosphatase was unexpected.

The significance of free blood in liquid and solid tumours

Impregnation of the vasculature with ink was used to study microvascular changes induced in rats by liquid (ascites) and solid growth of W256 and Y-P388 tumour cells. Ascites fluid produced by both tumours was heavily blood-stained; the deep red colour of solid tumour deposits was similarly due to the presence of free blood. In both types of tumour growth this free blood was due to diapedesis of erythrocytes through tips of capillary sprouts which grow when neovascularization (angiogenesis) occurs in response to any suitable (non-neoplastic or neoplastic) stimulus. Ascites growth of these tumours induced profuse sprouting from the peritoneal capillaries; this sprouting, together with the "bleeding" it caused, were inhibited by local pre-irradiation of the peritoneal vasculature with X-rays before intraperitoneal inoculation of rats with the tumours. Similar angiogenesis with bleeding did not occur following inoculation with an allogeneic tumour in rats which had been previously immunized against the tumour. LI tumour cells (tumour cells lethally irradiated in vitro to destroy their proliferative integrity, but which remain metabolically active) also induced sprouts to grow in close proximity to the implanted LI cells, but heat-killed tumour cells caused no sprouting. The nature and significance of neovascularization of tumours and their so-called "haemorrhagic" growth are discussed.