Spiritual relationships: a concept analysis

Spiritual relationships are connections to self or soul, to others, to a higher power, or to nature. All relationships have the potential to be spiritual. The depth or intimacy of the relationship is directly related to human being's individual personal knowledge of self or soul-searching. Grounded theory and phenomenological research studies validate that spiritual relationships play an important role in one's spirituality. Theoretical and operational definitions, attributes, and several cases (e.g., model, related, contrary, and metaphorical) of spiritual relationships are discussed. Attributes and consequences are identified.

The expression of insulin-like growth factor (IGF) and IGF-binding protein (IGFBP) genes in the human placenta and membranes: evidence for IGF-IGFBP interactions at the feto-maternal interface

The placenta synthesizes insulin-like growth factors (IGFs) and their binding proteins (IGFBPs), which are believed to regulate its growth and development in an autocrine/paracrine manner. To delineate the cellular sites of expression of IGP and IGFBP messenger ribonucleic acids (mRNAs) in human placenta throughout pregnancy, we used in situ hybridization histochemistry with 35S-labeled IGF and IGFBP complementary RNA probes on human placentas and fetal membranes of gestational ages 6 weeks to term (40 weeks). In placental regions where trophoblasts (fetal) or decidua (maternal) coexist (e.g. basal plate), the identity was delineated by their cytokeratin or vimentin immunoreactivity, respectively. Except for IGF-II, mRNAs encoding peptides of the IGF system were expressed in a similar spatial pattern and relative abundance throughout gestation. Both IGF mRNAs showed similar tissue distribution, but the IGF-II mRNA was more abundant than IGF-I mRNA at all gestational ages. IGF-II mRNA was expressed in the chorionic mesoderm of placental villi and chorionic plate in moderate abundance, and it decreased with gestation. It was also expressed in the trophoblasts of the cytotrophoblastic shell and Langhan's layer of placental villi only in the first trimester, suggesting an autocrine role for IGF-II in early cytotrophoblastic proliferation and/or differentiation. IGF-II mRNA was expressed most abundantly in the columns of intermediate trophoblasts in the anchoring villi and chorionic and basal plates. A gradient of IGF-II mRNA abundance was observed in the trophoblasts of the cytotrophoblastic column, with greater IGF-II mRNA levels in those at the invading front, suggesting a role for IGF-II in trophoblastic invasion. In the fetal membranes, IGF-II mRNA was identified in the amnion and chorion laeve. IGF-I receptor mRNA was expressed in low abundance in all cell types of the placenta. All six IGFBP mRNAs were identified in variable abundance in the decidualized stromal cells of the maternal decidua basalis and parietalis, with IGFBP-1 mRNA being expressed in the greatest abundance. The spatial pattern of expression of each IGFBP mRNA also differed among decidual cells, with IGFBP-1, IGFBP-2, IGFBP-4, and IGFBP-6 mRNAs being expressed in most cells, whereas IGFBP-3 and IGFBP-5 mRNAs were expressed in only some cells. IGFBP-1 mRNA was expressed initially in the epithelium of endometrial glands and in a population of decidualized stromal cells in early gestation, and subsequently in the majority of decidualized stromal cells. IGFBP-3 mRNA was expressed in both the decidua and certain intermediate trophoblasts of the basal plate and anchoring villi of placenta and in amnion and chorion laeve of fetal membranes. IGFBP-4 and IGFBP-5 mRNA were expressed additionally in low abundance in the chorionic mesoderm. IGFBP-6 was expressed in greater abundance in the decidua parietalis than in decidua basalis, although the general level of expression was low. The spatial pattern and relative abundance of expression of IGFBP mRNAs suggest IGFBP-1 to be the predominant IGFBP synthesized by the maternal decidual cells, interacting with the IGF-II that synthesizes fetal intermediate trophoblasts. Presumably, IGF-II and IGFBPs are used for cell to cell communication between fetal trophoblasts and maternal decidual cells at the feto-maternal interface for placental development and/or function.

Stunned myocardium: theoretical mechanisms of injury

Stunned myocardium may occur after an episode of prolonged or transient ischemia. This phenomenon can occur in a variety of patient groups including medical, surgical, neurologic, and cardiac patients. In the stunned myocardium, myocardial contractility is temporarily depressed, causing symptoms similar to those of cardiogenic shock. When critical care nurses are familiar with the clinical characteristics and risk factors of stunned myocardium, they can start the appropriate interventions and left ventricular function returns to normal within days with no residual hypokinesis. Critical care nurses play a key role in assisting surgeons and other noncardiac physicians in the diagnosis and care of the patient with stunned myocardium.

Stunned myocardium: theoretical mechanisms of injury

Stunned myocardium may occur after an episode of prolonged or transient ischemia. This phenomenon can occur in a variety of patient groups including medical, surgical, neurologic, and cardiac patients. In the stunned myocardium, myocardial contractility is temporarily depressed, causing symptoms similar to those of cardiogenic shock. When critical care nurses are familiar with the clinical characteristics and risk factors of stunned myocardium, they can start the appropriate interventions and left ventricular function returns to normal within days with no residual hypokinesis. Critical care nurses play a key role in assisting surgeons and other noncardiac physicians in the diagnosis and care of the patient with stunned myocardium.

Carotid duplex scanning: patterns of referral and outcome

OBJECTIVE

Review of the results of carotid Duplex scanning.

DESIGN

Retrospective review of new referrals for carotid Duplex scanning to a regional vascular laboratory.

MATERIALS

1041 referrals made over an 18 month period.

METHODS

Referrals were reviewed for scan quality, diagnostic category and outcome of scanning.

RESULTS

The overall detection rate of ipsilateral stenoses > 70% and occlusions was 13.5%; the detection rate of surgically significant carotid lesions (70-99%) was only 8%. Analysis by diagnostic category revealed a significantly greater detection rate for carotid lesions > 70% in patients presenting with amaurosis fugax (24%) in comparison to those with TIAs (9.5%, p = 0.0005) or following a stroke (13%, p = 0.01). Patients referred with asymptomatic bruits or prior to cardiac surgery showed a positive scan rate of 30%. Sixty-seven carotid endarterectomies have resulted from scans performed in this period.

CONCLUSION

The overall rate of detection for surgically relevant lesions is low, but in comparison to a similar audit conducted in 1992, the absolute number of carotid lesions > 70% has risen by 60%. An 8% detection rate for surgically relevant lesions may be valuable in projecting the need for carotid endarterectomy arising from a given number of Duplex scans.

Visualization of sphere packs using a dataflow toolkit

We describe the construction of a simple application for the visualization of sphere packs, with applications to molecular graphics. Our development environment is IRIS Explorer, one of the new generation of so-called dataflow toolkits. We emphasize particularly the way in which working in such an environment facilitates the design and construction process, paying special attention to tools which aid the importing of data into the application, the design of the user interface, and the extension or modification of existing tools. Some examples of the use of the application in the field of molecular modeling are presented.

Working together to meet the needs of multiple-birth families

Health visitors have an important role in providing postnatal support to multiple-birth parents, write Jill Walton et al. Here they describe how a series of joint parent/professional seminars helped raise awareness among health visitors of the special needs of multiple-birth parents for services and support, and the importance of developing closer links with voluntary and self-help groups at local and national level.

Artifactually elevated basal uterine tonus resulting from measurement of hydrostatic pressure by transducer-tipped intrauterine catheters

Accurate measurements of uterine activity are a valuable adjunct in the management of parturition. Recently transducer-tipped intrauterine pressure catheters (IUPC) have been advocated because of their accurate recording of uterine contraction pressures. We hypothesized that the transducer-tipped IUPC may record elevated basal uterine pressures because of measurement of additional hydrostatic pressures within the uterus. Eight laboring patients received intrauterine placement of a transducer-tipped IUPC. Catheters were zeroed to air pressure, electronic zero was checked, and monitors were calibrated before insertion. Catheters were not rezeroed during labor. Basal resting uterine pressures were recorded at insertion and before IUPC removal. After removal, electronic zero and catheter accuracy were tested in a specially designed pressure chamber (21 and 60 mm Hg). Electronic zero averaged -3 mm Hg before insertion and after removal. Baseline uterine resting tone averaged 15 +/- 1 mm Hg in seven patients, and one patient had a measurement of 34 mm Hg. Uterine resting tone remained stable in five patients and decreased to 20 mm Hg in the one patient with elevated basal tone. Uterine resting tone increased markedly to 36 and 41 mm Hg in two patients with normal pressures on insertion, in spite of no evidence of uterine hyperstimulation. Extrauterine pressure testing recorded pressures of 23 +/- 1 and 62 +/- 1 mm Hg, respectively. Because of the measurement of the amniotic fluid column above the catheter, transducer-tipped IUPCs may artifactually elevate uterine pressure measurements and basal levels may shift during the course of labor.(ABSTRACT TRUNCATED AT 250 WORDS)

ACID-BASE REGULATION, BRANCHIAL TRANSFERS AND RENAL OUTPUT IN A MARINE TELEOST FISH (THE LONG-HORNED SCULPIN MYOXOCEPHALUS OCTODECIMSPINOSUS) DURING EXPOSURE TO LOW SALINITIES

A number of studies have implied a linkage between acid­base and ion exchanges in both freshwater and seawater fish, although little is known about the branchial and renal acid­base transfers involved as the animals move between different salinities. To investigate the role of these transfers in a marine teleost fish as it is exposed to a dilute environment, we measured plasma acid­base values and net movements from fish to water of NH4+, HCO3- and H+ in long-horned sculpin (Myoxocephalus octodecimspinosus) placed in 100 %, 20 %, 8 % or 4 % sea water for 24­48 h. Renal excretion of H+ was also monitored in fish exposed to 4 % sea water. Sculpin proved to be somewhat euryhaline for they were able to maintain plasma ion and acid­base transfers in hypo-osmotic (20 %) sea water, but could not tolerate greater dilutions for more than several days. Plasma pH and carbon dioxide concentration (CCO2) increased in the 20 % and 8 % dilution groups, with CCO2 nearly doubling (control, 4.56 mmol l-1; 8 % group, 8.56 mmol l-1) as a result of a combined increase in the partial pressure of plasma CO2 (PCO2) and [HCO3-]. During a 44­46 h exposure, HCO3- transfers increased progressively in the most dilute water, with animals in the 8 % and 4 % groups exhibiting a net H+ loss that was smaller than that of seawater fish (control, 5.1 mmol kg-1; 8 %, 0.9 mmol kg-1; 4 %, -2.9 mmol kg-1). Animals exposed to 4 % sea water for 24 h and then returned to normal sea water had a variable plasma pH, an elevated CCO2 and a net efflux of H+ that effectively stopped (control, 0.10 mmol kg-1 h-1; 4 %, 0.02 mmol kg-1 h-1; seawater recovery, 0.20 mmol kg-1 h-1) during the low-salinity period. Renal acid excretion remained relatively constant throughout the experiment but only made up a significant portion (approximately 40 %) of the total acid transfers during the 4 % dilution period (control rate approximately 3 µmol kg-1 h-1: 3 % of branchial rate). We postulate that the increase in plasma CCO2 during exposure to low salinity may be due to mobilization of base from the intracellular bone compartment. The decrease in external salinity could induce base loss by alteration of gill ion exchanges (Na+/H+, Cl-/HCO3-) and/or changes in branchial HCO3- permeability. For the first time, we have shown that the effects of a dilute environment on acid­base transfers may be an important limitation to the survival of a euryhaline species in brackish or fresh water.

Diabetes mellitus: implications for nursing care

Like so many aspects of nursing, diabetes care has changed over the years. This article will look at the condition of diabetes mellitus and its implications for care and examine some of the relevant physiological mechanisms, also in relation to care.

Nurse-aid management of hyperthermia

Hyperthermia is a condition in which the body temperature is raised above the normal level of 37 degrees C and may exceed 43 degrees C. Temperatures of 41-42 degrees C may prove fatal. Hyperthermia may arise from external or internal causes or situations. It is important that the nurse aider recognizes situations that may give rise to hyperthermia and takes early preventive action. Hyperthermia may lead to sensors changes in functioning of the circulatory and/or neurological system.

Research and nurse aid

This article asks whether nurses make inadequate first aiders and invites nurses to fill in a questionnaire as part of a research study into nurses' knowledge of first aid and emergency care. The results will be presented in this journal in 1994.

Acute effects of mycoprotein on subsequent energy intake and appetite variables

The effect of mycoprotein, a food produced by continuous fermentation of Fusarium graminearum (Schwabe), on energy intake and appetite was investigated. Female subjects, all classified as nonrestrained eaters, participated in two 3-d study periods. Subjects weighed food consumed on the day before the study, on the day of the meal, and on the following day. Subjects were presented with an isoenergetic meal containing either mycoprotein or chicken and visual analogue scales were completed immediately premeal, postmeal, and at hourly intervals for 3 h. Energy intake was significantly reduced the day of the study (by 24%) and the next day (by 16.5%) after eating mycoprotein compared with chicken. When measured 3 h after consumption, prospective food consumption and desire to eat decreased after mycoprotein compared with chicken. Evidence is increasing that fiber can have an effect on appetite and we have demonstrated that fiber-containing mycoprotein also has this affect.