Using individual and group reflection in and on assessment as a tool for effective learning

This paper outlines the background to the current United Kingdom educational scene for post-registration nurse education, highlighting the influence of the English National Board (ENB) framework and higher award. The study reported was undertaken with the help of two student cohorts who were registered consecutively on a 6 month ENB course at diploma level. Formal reflection using both individual written and group discussion was introduced focusing on the two summative course assessments. This kind of formal reflection was seen as a learning strategy to influence positively students' educational outcomes and professional practice via six key factors: (a) academic self-concept; (b) task awareness; (c) views of knowledge; (d) the influence of knowledge on behaviour; (e) writing as a learning activity; and (f) generating knowledge by reflecting in and on assessment with discussion. The findings, reported under the six factor-headings, fully support the use of reflection in this way for these purposes.

Placement of an implantable venous access device for use in maintenance ECT

Achieving intravenous (i.v.) access prior to electroconvulsive therapy (ECT) can be painful and time consuming. It may contribute to premature discontinuation of therapy. The authors report a novel method of ensuring i.v. access in a patient receiving maintenance ECT who developed an aversion to needle sticks. A Port-A-Cath P.A.S. vascular access catheter, placed in her left forearm, has been used for > 30 treatments without complication.

Behavioral, structural and neurochemical asymmetries in the avian brain: a model system for studying visual development and processing

The emphasis of this review is on the visual systems and lateralized visually guided behavior in several avian species. Lateral asymmetry is known to be present in the tectofugal visual projections to the forebrain of the pigeon and in the thalamofugal visual projections to the forebrain of the chicken. These structural asymmetries are discussed in the context of the behavioral and neurochemical asymmetries. While recognizing the need to investigate the organization of both of the visual pathways within one avian species; this review reasons inductively that the lateralized organization of the two visual pathways leads to binocular input to the right hemisphere via the thalamofugal visual system and to the left hemisphere via the tectofugal visual system. For each system, input to the other hemisphere is primarily monocular. This specialization of the hemispheres for visual processing has predictable effects on behavior. The role of asymmetrical light stimulation of the eyes of the embryo in determining the lateralizations in the visual pathways and some behaviors is discussed, as are other lateralizations generated or altered by imprinting and passive avoidance learning.

Evolving cooperation: the role of individual recognition

To evaluate the role of individual recognition in the evolution of cooperation, we formulated and analyzed genetic algorithm model (EvCo) for playing the Iterated Prisoner's Dilemma (IPD) game. Strategies compete against each other during each generation, and successful strategies contribute more of their attributes to the next generation. Each strategy is encoded on a 'chromosome' that plays the IPD, responding to the sequences of most recent responses by the interacting individuals (chromosomes). The analysis reported in this paper considered different memory capabilities (one to five previous interactions), pairing continuities (pairs of individuals remain together for about one, two, five, or 1000 consecutive interactions), and types of individual recognition (recognition capability was maximal, nil, or allowed to evolve between these limits). Analysis of the results focused on the frequency of mutual cooperation in pairwise interactions (a good indicator of overall success in the IPD) and on the extent to which previous responses by the focal individual and its partner were associated with the partner's identity (individual recognition). Results indicated that a fixed, substantial amount of individual recognition could maintain high levels of mutual cooperation even at low pairing continuities, and a significant but limited capability for individual recognition evolved under selection. Recognition generally increased mutual cooperation more when the recent responses of individuals other than the current partner were ignored. Titrating recognition memory under selection using a fitness cost suggested that memory of the partner's previous responses was more valuable than memory of the focal's previous responses. The dynamics produced to date by EvCo are a step toward understanding the evolution of social networks, for which additional benefits associated with group interactions must be incorporated.

Leptomeningeal dissemination of malignant glioma simulating cerebral vasculitis. Case report with angiographic and pathological studies

BACKGROUND

The complex clinical and radiological picture of leptomeningeal spread of tumor is well recognized as a problem of systemic cancer but is less frequent in primary cerebral glioma, particularly as a presenting picture. While brain ischemia and infarction may occur in patients with subarachnoid tumor, the mechanism for these complications remains unclear. Angiographic and pathological demonstrations of direct vascular involvement by disseminated glioma are particularly sparse. We report a patient presenting with multiple infarctlike lesions with postmortem evidence of direct vascular involvement by glioma.

CASE DESCRIPTION

A 54-year-old woman presenting with seizures, headache, and changes in mental status was found to have vascular narrowing in cerebral blood vessels and ischemic lesions on neuroimaging studies of the brain, interpreted as cerebral vasculitis. A brain biopsy showed leptomeningeal glioma. Postmortem examination demonstrated a glioblastoma arising around the right sylvian fissure with extensive subarachnoid dissemination of tumor. The leptomeningeal tumor caused vascular narrowing by encasement, direct vascular wall invasion, and thrombosis and was associated with underlying infarctlike foci of parenchymal necrosis.

CONCLUSIONS

This case demonstrates an unusual presentation of glioblastoma clinically and radiographically mimicking cerebral vasculitis, and it illustrates a variety of mechanisms for tumor-produced vascular compromise.

Diarrhea caused by a Cyanobacterium-like organism

Seven cases of watery diarrhea of explosive onset, three of them ending within two weeks, are discussed. The cause of diarrhea is believed to be the presence of an organism called Cyanobacteriumlike organism. These are non-refractile, spherical bodies, 8-9 micrometers in diameter, which take on a faint to deep pink color after modified kinyoun acid-fast staining. Risk factors such as travel to and from warm regions, and water as a possible source of infection are briefly discussed.

Nursing care that patients value

The delivery of nursing care should be based on meeting patients' individual needs. This article presents the findings of a small-scale study which explored the feelings that people express regarding the care they would like and receive from nurses.

Mortality in a migrating Mennonite church congregation

Preston's two-census method of demographic estimation is applied to three pairs of reconstructed censuses from the records of a migrating Mennonite church congregation covering the period 1780-1890. The three pairs of censuses correspond to three periods (1780-1790, 1850-1860, and 1880-1890) and to stays in three settings (Prussia, Russia, and Kansas, respectively). The Mennonites' stay in Prussia was a period of hardship. In Russia they expanded their economic base and developed new farming methods, dramatically increasing their productivity. The Mennonites took these skills to Kansas, where they continued to be successful. The increase in life expectancy at age 5 corroborates this picture. The Prussian period exhibits the shortest life expectancy for both sexes. After the move to Russia, life expectancy increased for both sexes and continued to increase with the move to Kansas. The model also provides limited evidence for fertility depression following the move to Kansas.

The accuracy of video imaging in orthognathic surgery

Video imaging is an important emerging technology in planning orthognathic surgery and educating patients about the esthetic effects of treatment. The presurgical cephalograms of 56 patients, 41 with mandibular advancement alone and 15 with mandibular advancement plus genioplasty, were digitized, and the computer-generated soft tissue "line drawing" predictions were compared with the actual posttreatment cephalograms. Video images of the patients' presurgical lateral view were obtained, and two experienced clinicians compared the computer generated video image predictions with the actual posttreatment profile. Video images judged very good or excellent were considered acceptable for treatment planning; 60% to 83% met this criterion, depending on the profile area viewed. The percentage of acceptable images in the lower lip, labiomental fold, and chin area decreased with the addition of a genioplasty. The predicted and actual posttreatment soft tissue line drawings were quite similar for all areas except for the lower lip region, where statistically significant differences were noted, with the predicted lower lip more retrusive and thinner than the actual contours. For the lower lip and chin, a 2 mm or more discrepancy was observed in 20% of the patients. In all cases, the actual image was judged more esthetic than the predicted image, allaying fears of unrealistically optimistic computer generated predictions.

Changes in fertility relative to starting, stopping, and spacing behaviors in a migrating Mennonite community, 1775-1889

Fertility change over time in a migrating Mennonite church congregation is reconstructed through genealogies developed from church registries of vital events during 1725-1924. The congregation was located in Prussia from 1725-1821, in Russia from 1822-1874, and in Kansas, U.S.A., from 1875-1924. Age-specific marital fertility rates were relatively low and usually peaked for women aged 25-29. Total fertility rates ranged from 1.19 to 5.29. These relatively low figures for a natural fertility population may partly reflect underreporting of births and deaths of infants, but it also reflects the heterogeneity in fertility evident for this population. Some women had many children while others were having either few or none. This pattern changed twice. Fertility was lowest during residence late in Prussia and early in Russia, peaked during residence late in Russia, and has decreased slightly for women born in the United States.

32P following negative second-look laparotomy for epithelial ovarian cancer

PURPOSE

Peritoneal seeding remains a prominent failure pattern in patients with invasive epithelial ovarian cancer, even following a pathologically negative second-look laparotomy (2LL). In an attempt to decrease the risk of peritoneal recurrence, we have treated patients with no clinical or histopathologic evidence of disease at 2LL with 15 mCi of chromic phosphate suspension intraperitoneally (32P).

METHODS

Between 1973-1987, 69 patients with stages I-III invasive epithelial ovarian cancer in complete clinical remission were found to have no evidence of disease at 2LL. Fifty-one patients received intraperitoneal 32P. Thirty-five patients, otherwise eligible for 32P, did not receive it primarily due to other treatment protocols, peritoneal adhesions, or the recommendation that no further therapy be given following a negative 2LL. Patients in both groups were comparable with regard to stage, histology, grade, median age, residual disease following initial surgery, and chemotherapeutic regimen. The median follow-up for uncensored patients is 58 months (minimum, 18 months).

RESULTS

The 5-year actuarial disease-free survival rate from the date of 2LL was 86% for those receiving 32P and 67% for those not receiving 32P (P = 0.05). The corresponding 5-year overall survival rates were 90 and 78%, again favoring patients treated with 32P.

COMPLICATIONS

There were minimal acute side effects from 32P. Late adverse effects were similar in the two groups. Bowel complications were seen in 3 of 51 patients receiving 32P and 1 of 18 patients not receiving 32P.

CONCLUSIONS

We have found intraperitoneal 32P administration immediately after 2LL to be a safe and well-tolerated therapy. Our data suggest that 32P confers a survival advantage to patients with a pathologically negative 2LL. These findings suggest a continued role for second-look laparotomy with the use of 32P in selected patients.

Analysis of state and local hospital employed RN labor markets

Analysis and knowledge of state and local RN labor markets can facilitate nurse retention and recruitment by allowing nurse administrators to better predict market changes and maintain a stable RN workforce.

Expression of gelatinase A and TIMP-2 mRNAs in desmoplastic fibroblasts in both mammary carcinomas and basal cell carcinomas of the skin

AIMS

To compare the localisation of mRNAs for the basement membrane degrading enzyme gelatinase A (72 kilodalton type IV collagenase) and its inhibitor TIMP-2 in carcinomas of the breast and basal cell carcinomas of the skin which have little or no ability to metastasize.

METHODS

In situ hybridisation was performed on formalin fixed, paraffin wax embedded blocks using 35S-labelled riboprobes on 16 mammary carcinomas, three fibroadenomas, and a benign phyllodes tumour, and on 15 basal cell carcinomas of the skin (BCC).

RESULTS

Labelling for both mRNAs was detectable in 14 of 16 mammary carcinomas and in 13 of 15 BCC, most often over organising desmoplastic fibroblasts in the stroma around invasive epithelial aggregates. Some sparse labelling was seen over malignant epithelial cells in six of the mammary carcinomas but not in the BCC. Some expression of gelatinase A mRNA was also seen in fibroblasts of breast lobules adjacent to the mammary carcinomas and around engulfed adnexal elements in the BCC, but not in unaffected breast tissues, fibroadenomas, the phyllodes tumour or unaffected skin.

CONCLUSIONS

Maximal expression of gelatinase A and TIMP-2 mRNAs occurs in malignant neoplasms as part of the host response to the presence of established neoplastic cells rather than as an initial response to invasion. The degree to which this is present suggests this may be a highly relevant mechanism modulating tumour differentiation, growth and progression, possibly entailing uptake via specific receptors on the tumour cell surface.

Hyperplastic polyps: a cell lineage which both synthesizes and secretes trefoil-peptides and has phenotypic similarity with the ulcer-associated cell lineage

Hyperplastic polyps are common benign lesions of uncertain histogenesis, which occur in the colon in populations at risk for colorectal carcinoma. They contain neutral/MUC1 gene-related mucin which in turn is closely associated with the trefoil-peptide pS2, a major component of the ulcer-associated cell lineage, previously termed pseudopyloric metaplasia. We have examined 17 hyperplastic polyps for expression of the trefoil-peptides pS2 and human spasmolytic polypeptide by in situ hybridization and immunohistochemistry, as well as by using antisera to epidermal growth factor/urogastrone and its receptor and to epitopes of the product of the MUC1 gene to characterize any further similarity between these lesions and the ulcer-associated cell lineage and thus help elucidate the nature of the lesions. Our investigations show both human spasmolytic polypeptide and pS2 messenger RNA within the polyps, whereas only pS2 peptide could be demonstrated immunohistochemically. Epidermal growth factor/urogastrone, its receptor, and antisera to the MUC1 gene also showed widespread staining of these polyps. We suggest that hyperplastic polyps are formed of a lineage that both synthesizes and secretes trefoil-peptides and the MUC1 mucin and that hyperplastic polyps may be related to the phenotypically similar ulceration-associated cell lineage.

Differential expression of clusterin in inducible models of apoptosis

Apoptosis (programmed cell death) and necrosis can be readily distinguished morphologically and biochemically. The most striking biochemical change observed in apoptotic cells is the cleavage of the genomic DNA into discrete nucleosome sized fragments, producing a laddering pattern when the DNA is examined electrophoretically. It has recently been shown that RNA and protein products of the testosterone-repressed prostate message-2 gene are induced, coordinate with the onset of cell death. This gene has been isolated from a variety of species and tissues, it is highly conserved, and collectively referred to as clusterin. We have examined a number of inducible leucocyte models of apoptosis, including glucocorticoid and calcium ionophore induced thymocyte death, 'aged' neutrophils and cytotoxic T cells, and found that in these situations that cell death is not associated with up-regulation of clusterin gene expression. The finding that clusterin is not expressed in all cells undergoing apoptosis would suggest that this molecule is not critical to the mechanism of cell death. It does, however, provide the first example of a readily detectable marker which is differentially expressed in cells undergoing apoptosis and adds further weight to the argument that apoptosis is not a uniform phenomena, but is dependent on the nature of the cells involved and the means of induction.

Stromal expression of 72 kda type IV collagenase (MMP-2) and TIMP-2 mRNAs in colorectal neoplasia

We undertook an in situ hybridization study to localize the mRNAs for the 72 kda type IV collagenase (MMP-2) and its specific inhibitor (TIMP-2) in 12 colorectal carcinomas, 3 adenomas, and 4 uninvolved resection margins to see how their distributions correlated with that of the reported distribution of MMP-2 protein. Labeling for MMP-2 and TIMP-2 mRNAs was detectable in 10 of 12 carcinomas and in 2 of 3 adenomas. Unexpectedly, we found much stronger signals for MMP-2 and TIMP-2 mRNAs within the mesenchymal cells in the desmoplastic stroma, of endothelial and/or (myo)fibroblastic nature, rather than in tumor epithelial cells in which localization of MMP-2 was anticipated. Our data indicate that stromal cells may have the ability to synthesize a metalloproteinase that degrades basement membrane, and may together with the neoplastic epithelial cells participate actively in the tissue remodeling and disruption of the basement membrane integrity which is characteristic of invasive tumors.

Estradiol induces proliferation of peroxisome-like microbodies and the production of 3-hydroxy fatty acid diesters, the female pheromones, in the uropygial glands of male and female mallards

During the mating season the female mallards produce sex pheromones, diesters of 3-hydroxy fatty acids, in their uropygial glands. Subcellular fractionation by sucrose and Nycodenz density gradient centrifugations and electron microscopic examination of the fractions showed that diesters of 3-hydroxy acids and the enzymes that catalyze the formation and esterification of the 3-hydroxy fatty acids are located in the catalase-containing fractions, probably peroxisomes, whereas monoester synthesizing activities are located in the endoplasmic reticulum. Fatty acyl-CoA reductase that would provide fatty alcohol needed for the synthesis of monoester and diester waxes was found both in the peroxisomal and endoplasmic reticulum fraction. Upon daily intramuscular injection of estradiol into the females in the nonmating season, the short chain monoester waxes of the uropygial glands were replaced by long chain monoester waxes, and subsequently the monoester waxes were replaced by diester waxes. Injection of thyroxine with estradiol hastened the induction of the compositional changes including diester synthesis. Similar changes, including the synthesis of the female pheromones, were induced in the uropygial glands by the hormone treatment of males that do not normally produce diesters at any time during their life cycle. The structure and composition of the diesters induced by hormone treatment of both males and females were identical to those of the female pheromones produced during their mating season. Electron microscopic examination of diaminobenzidine-treated glands showed that peroxisomes proliferated in the gland of the females in the mating season and in the estradiol-treated males that produce the diesters.

Developmental changes in the expression of S-acyl fatty acid synthase thioesterase gene and lipid composition in the uropygial gland of mallard ducks (Anas platyrhynchos)

Developmental changes in the composition of the uropygial gland secretory lipids of the postembryonic mallard ducks (Anas platyrhynchos) were determined. During the first 3 weeks after hatching, the composition of the secretory lipids remained constant; the lipids consisted of long-chain wax esters composed of a complex mixture of n-, monomethyl, and dimethyl fatty acids esterified to n-C16 and n-C18 fatty alcohols. Afterward, as the ducks began to acquire adult feathers, short-chain wax esters composed of 2- and 4-monomethyl fatty acids began to appear with 2-methylhexanoyl and 4-methylhexanoyl as the major acyl components; esters of short-chain monomethyl fatty acids (less than or equal to C12) constituted 90% of the lipids when the ducks were 2 months old and had acquired adult plumage. The appearance of the short-chain acids in the acyl portion of the wax esters was accompanied by the appearance of S-acyl fatty acid synthase thioesterase, which can hydrolytically release short-chain acids from fatty acid synthase in the gland. Northern blot analysis showed that the gland-specific thioesterase gene transcripts began to appear in the gland only 3 weeks after hatching. The appearance of the transcripts and immunologically detectable thioesterase protein reached maximum levels 2 months after hatching, with the acquisition of the adult plumage. Thus, the developmental changes in lipid composition correlated with the changes in the level of expression of the thioesterase gene. Expression of other gland-specific genes has been previously found to begin just prior to hatching. The gland-specific thioesterase is the first case of delayed expression of a gland-specific gene.

Experience with younger siblings facilitates maternal responsiveness in pubertal Norway rats

The latency of maternal behavior (MB) onset induced by cohabitation with pups (sensitization) increases in female and male Long-Evans rats from 24 days of age (1-2 day latency) to 42 days of age (4-5 day latency). This decline in maternal responsiveness at Day 42 did not occur in 50% of rats ("responders") which lived with their dam and younger siblings (conceived during the postpartum estrus) for either 4 or 11-18 days after their birth. In contrast to cessation of suckling at about Day 25 postpartum in the absence of a 2nd litter, when a 2nd litter was born greater than Day 26 or less than Day 26 postpartum, suckling continued for a mean of 32 and 35.5 days, respectively (and up to Day 40). Also, time spent suckling during the 10 days following the birth of the 2nd litter was more than five times as great if the 2nd litter was born with little or no delay (less than Day 26). The offspring from the 1st litter spent about 80% of the diurnal observation time in proximity to the dam and younger siblings, and instances of nurturance (retrieving, crouching, licking) toward the young littermates were observed. However, the only dam-litter interaction significantly related to subsequent maternal responsiveness by 1st litter offspring was a positive relation between the prior incidence of aggression by mothers towards juveniles and sensitization latency.

Infection of Peruvian Aotus nancymai monkeys with different strains of Plasmodium falciparum, P. vivax, and P. malariae

Aotus nancymai (karyotype I) monkeys from Peru were studied for their susceptibility to infection with Plasmodium falciparum, P. vivax, and P. malariae. Three strains of P. falciparum (Santa Lucia from El Salvador, Indochina I/CDC from Thailand, and Uganda Palo Alto) were inoculated into 38 monkeys. The results indicated that this species of Aotus monkey is highly susceptible to infection. The Uganda Palo Alto and the Santa Lucia strain parasites appear to be the most useful for immunologic and chemotherapeutic studies. Five strains of P. vivax (Chesson, ONG, Vietnam Palo Alto, Salvador I, and Honduran I/CDC) were inoculated into 28 monkeys. The Vietnam Palo Alto strain produced the highest level parasitemias ranging from 23,800 to 157,000/mm3. Mosquito infections were obtained with the ONG, Chesson, and Salvador I strains. Two out of 6 attempts to transmit P. vivax via sporozoite inoculation to splenectomized monkeys were successful with prepatent periods of 39 and 57 days. Five monkeys were infected with the Uganda I/CDC strain of P. malariae. Maximum parasitemias ranged from 10 to 5,390/mm3.

Medulloblastoma in association with the Coffin-Siris syndrome

An 8-year old patient with Coffin-Siris syndrome is presented, who was found to have a medulloblastoma during the evaluation of apnea and ventilator dependency. Although several cases of Dandy Walker cysts and one case of brain-stem heterotopia have been described in this rare syndrome, this is the first report of medulloblastoma in a patient with Coffin-Siris syndrome. Possible pathogenetic mechanisms are briefly discussed.