Follicular Lymphoma Tregs Have a Distinct Transcription Profile Impacting Their Migration and Retention in the Malignant Lymph Node

We have previously shown that regulatory T cells (Tregs) infiltrating follicular lymphoma lymph nodes are quantitatively and qualitatively different than those infiltrating normal and reactive nodes. To gain insight into how such Treg populations differ, we performed RNA sequence (RNAseq) analyses on flow sorted Tregs from all three sources. We identify several molecules that could contribute to the observed increased suppressive capacity of follicular lymphoma nodal tregs, including upregulation of CTLA-4, IL-10, and GITR, all confirmed by protein expression. In addition, we identify, and confirm functionally, a novel mechanism by which Tregs target to and accumulate within a human tumor microenvironment, through the down regulation of S1PR1, SELL (L-selectin) and CCR7, potentially resulting in greater lymph node retention. In addition we identify and confirm functionally the upregulation of the chemokine receptor CXCR5 as well as the secretion of the chemokines CXCL13 and IL-16 demonstrating the unique ability of the follicular derived Tregs to localize and accumulate within not only the malignant lymph node, but also localize and accumulate within the malignant B cell follicle itself. Such findings offer significant new insights into how follicular lymphoma nodal Tregs may contribute to the biology of follicular lymphoma and identify several novel therapeutic targets.

Dietary Digital Diaries: Documenting Adolescents' Obesogenic Environment

Obesogenic built environments may contribute to excessive eating and obesity. Twenty-three 12- to 17-year-old low-income African American adolescents created digital diaries by photographing their lunchtime food environment in a summer academic program. Digitally depicted foods were classified as appearing on the platescape (student's or others' plate) or the tablescape (food buffet). Height, weight, BMI percentile, and waist-to-hip ratio were calculated at baseline and week 4. Adolescents digitally depicted high caloric, high fat foods on the platescape and tablescape, particularly adolescents with a higher waist-to-hip ratio. Weight gain during the 4-week program was significantly predicted by the number of calories and the amount of fat content depicted on the student's plates. Digital diaries, then, can document adolescents' perspectives of their food environments that promote their overconsumption of high caloric and high fat foods that contribute to weight gain and put them at risk for obesity.

Uropod elongation is a common final step in leukocyte extravasation through inflamed vessels

Uropod elongation occurs during leukocyte extravasation.

The efficient trafficking of immune cells into peripheral nonlymphoid tissues is key to enact their protective functions. Despite considerable advances in our understanding of cell migration in secondary lymphoid organs, real-time leukocyte recruitment into inflamed tissues is not well characterized. The conventional multistep paradigm of leukocyte extravasation depends on CD18 integrin–mediated events such as rapid arrest and crawling on the surface of the endothelium and transmigration through the endothelial layer. Using enhanced three-dimensional detection of fluorescent CD18 fusion proteins in a newly developed knockin mouse, we report that extravasating leukocytes (neutrophils, monocytes, and T cells) show delayed uropod detachment and become extremely elongated before complete transmigration across the endothelium. Additionally, these cells deposit CD18⁺ microparticles at the subendothelial layer before retracting the stretched uropod. Experiments with knockout mice and blocking antibodies reveal that the uropod elongation and microparticle formation are the result of LFA-1–mediated adhesion and VLA-3–mediated cell migration through the vascular basement membrane. These findings suggest that uropod elongation is a final step in the leukocyte extravasation cascade, which may be important for precise regulation of leukocyte recruitment into inflamed tissues.

Digital expression among urban, low-income African American adolescents

Digital production is a means through which African American adolescents communicate and express their experiences with peers. This study examined the content and the form of the digital productions of 24 urban, low-income African American adolescents who attended a summer academic program. The content of student digital productions focused on academic experiences and friendships. Their production styles revealed that youth used perceptually salient production features, such as rapid scene changes and loud rap music. The results suggest that when placed in a supportive, academic environment and provided with digital production resources, students who traditionally face barriers due to cultural and economic inequalities digitally express to their peers an interest in academics and positive peer relationships, and that these youth communicate their experiences through a shared production style that reflects their broader cultural experiences.

Molecular battles between plant and pathogenic bacteria in the phyllosphere

The phyllosphere, i.e., the aerial parts of the plant, provides one of the most important niches for microbial colonization. This niche supports the survival and, often, proliferation of microbes such as fungi and bacteria with diverse lifestyles including epiphytes, saprophytes, and pathogens. Although most microbes may complete the life cycle on the leaf surface, pathogens must enter the leaf and multiply aggressively in the leaf interior. Natural surface openings, such as stomata, are important entry sites for bacteria. Stomata are known for their vital role in water transpiration and gas exchange between the plant and the environment that is essential for plant growth. Recent studies have shown that stomata can also play an active role in limiting bacterial invasion of both human and plant pathogenic bacteria as part of the plant innate immune system. As counter-defense, plant pathogens such as Pseudomonas syringae pv tomato (Pst) DC3000 use the virulence factor coronatine to suppress stomate-based defense. A novel and crucial early battleground in host-pathogen interaction in the phyllosphere has been discovered with broad implications in the study of bacterial pathogenesis, host immunity, and molecular ecology of bacterial diseases.

Three phenotypes of glucosephosphate isomerase in sheep: improved staining recipe

Contrary to results published recently, we observe three, rather than two, phenotypes for the enzyme glucosephosphate isomerase (EC 5.3.1.9) from sheep. The phenotypic electrophoretic patterns conform to the patterns observed for this dimeric enzyme in other species. Genotype frequencies in a flock of Southdowns do not deviate significantly from those predicted under the assumption of the Hardy-Weinberg equilibrium. A remarkable observation is that the electrophoretically distinct phenotypes of GPI are largely or entirely obliterated by the addition of 1-10 mmol/l MgCl2 to the electrophoretic buffers. Modification of the usual staining recipe for GPI result in greater resolution and shorter staining times.

The use of genetic relationships among cattle breeds in the formulation of rational breeding policies: a re-examination of the example of the South Devon and the Gelbvieh

It has been claimed that the origin of the South Devon breed of cattle is 'unknown' and that biochemical polymorphisms '. . . indicate that Gelbvieh and South Devon had a common ancestry on the Continent and are distinct from other British breeds such as Hereford, Angus and Jersey' (Kidd et al., 1974). In fact, historical records indicate that the South Devon evolved largely from native Devon cattle and is a close relative of other English Lowland breeds such as the North Devon and Hereford. Information about crosses from other breeds makes no mention of the Gelbvieh but emphasises the contribution of Channel Island breeds, especially the Guernsey. Data for biochemical polymorphisms in the relevant breeds show agreement with the historical information and with the biogeography of the breeds involved.

Chemical classification of cattle. 1. Breed groups

From approximately 1000 papers with data on protein polymorphism in some 216 breeds of cattle, 10 polymorphic proteins were compared in means and variances of gene frequencies (arcsin p 1/2) for ten well-recognized breed groups for 196 of the breeds. The polymorphic proteins were alpha-lactalbumin, beta-lactoglobulin, caseins (alpha s1, beta and chi), serum albumin, transferrin, haemoglobin, amylase I and carbonic anhydrase II. The breed groups were North European, Pied Lowland, European Red brachyceros, Channel Island brachyceros, Upland brachyceros, primigenius-brachyceros mixed, primigenius, Indian Zebu, African Humped (with Zebu admixture), and African Humped (Sanga). The coherence within groups and the differences between groups are often impressive. Only carbonic anhydrase II fails to differentiate at least some of the major breed groups. In some cases paradoxical distributions of rare genetic variants can be explained by a more detailed inspection of breed history. The chemical data support the morphological and geographical divisions of cattle into major breed groups. There are three distinct but related brachyceros groups; for some polymorphisms the two Channel Island breeds, the Jersey and the Guernsey, are quite divergent. Although some authorities have considered the Pied Lowland as primigenius, it is a very distinct breed group.

Chemical classification of cattle. 2. Phylogenetic tree and specific status of the Zebu

Phylogenetic trees for the ten major breed groups of cattle were constructed by Farris's (1972) maximum parsimony method, or Fitch & Margoliash's (1967) method, which averages ou the deviation over the entire assemblage. Both techniques yield essentially identical trees. The phylogenetic tree for the ten major cattle breed groups can be superimposed on a map of Europe and western Asia, the root of the tree being close to the 'fertile crescent' in Asia Minor, believed to be a primary centre of bovine domestication. For some but not all protein variants there is a cline of gene frequencies as one proceeds from the British Isles and northwest Europe towards southeast Europe and Asia Minor, with the most extreme gene frequencies in the Zebu breeds of India. It is not clear to what extent the observed clines are primary or secondary, i.e., consequent to the initial migrations of cattle towards the end of the Pleistocene or consequent to the many migrations of man with his domesticated cattle. Such clines as exist are not in themselves sufficient to prove either selection versus genetic drift or to establish taxonomic ranking. Contrary to some suggestions in the literature, the biochemical evidence supports Linnaeus's original conclusions: Bos taurus and Bos indicus are distinct species.

Mitochondrial complex III-generated oxidants activate ASK1 and JNK to induce alveolar epithelial cell death following exposure to particulate matter air pollution

We have previously reported that airborne particulate matter air pollution (PM) activates the intrinsic apoptotic pathway in alveolar epithelial cells through a pathway that requires the mitochondrial generation of reactive oxygen species (ROS) and the activation of p53. We sought to examine the source of mitochondrial oxidant production and the molecular links between ROS generation and the activation of p53 in response to PM exposure. Using a mitochondrially targeted ratiometric sensor (Ro-GFP) in cells lacking mitochondrial DNA (rho0 cells) and cells stably expressing a small hairpin RNA directed against the Rieske iron-sulfur protein, we show that site III of the mitochondrial electron transport chain is primarily responsible for fine PM (PM2.5)-induced oxidant production. In alveolar epithelial cells, the overexpression of SOD1 prevented the PM2.5-induced ROS generation from the mitochondria and prevented cell death. Infection of mice with an adenovirus encoding SOD1 prevented the PM2.5-induced death of alveolar epithelial cells and the associated increase in alveolar-capillary permeability. Treatment with PM2.5 resulted in the ROS-mediated activation of the oxidant-sensitive kinase ASK1 and its downstream kinase JNK. Murine embryonic fibroblasts from ASK1 knock-out mice, alveolar epithelial cells transfected with dominant negative constructs against ASK1, and pharmacologic inhibition of JNK with SP600125 (25 microM) prevented the PM2.5-induced phosphorylation of p53 and cell death. We conclude that particulate matter air pollution induces the generation of ROS primarily from site III of the mitochondrial electron transport chain and that these ROS activate the intrinsic apoptotic pathway through ASK1, JNK, and p53.

Stretch-induced activation of AMP kinase in the lung requires dystroglycan

Lung cells are exposed to cyclic stretch during normal respiration and during positive pressure mechanical ventilation administered to support gas exchange. Dystroglycan is a ubiquitously expressed matrix receptor that is required for normal basement membrane formation during embryogenesis and for maintaining the function of skeletal muscle myocytes and neurons where it links cells to matrix. We previously reported that equibiaxial stretch of primary alveolar epithelial cells activated the MAP kinase pathway ERK1/2 through a mechanism that required an interaction between dystroglycan and matrix. We determined whether this mechanism of mechanotransduction activates other signaling cascades in lung epithelium. Exposure of rat epithelial alveolar type II cells (AEC) to cyclic mechanical stretch resulted in activation of 5' AMP-activated protein kinase (AMPK). This response was not affected by pretreatment of AEC with the ERK inhibitor PD98059 but was inhibited by knockdown in dystroglycan expression. Moreover, production of reactive oxygen species was enhanced in mechanically stimulated AEC in which dystroglycan was knocked down. This enhancement was reversed by treatment of AEC with an AMPK activator. Activation of AMPK was also observed in lung homogenates from mice after 15 minutes of noninjurious mechanical ventilation. Furthermore, knockdown of dystroglycan in the lungs of mice using an adenovirus encoding a dystroglycan shRNA prevented the stretch-induced activation of AMPK. These results suggest that exposure to cyclic stretch activates the metabolic sensing pathway AMPK in the lung epithelium and supports a novel role for dystroglycan in this mechanotransduction.

Distance measurements in the borderline region of applicability of CW EPR and DEER: a model study on a homologous series of spin-labelled peptides

Inter-spin distances between 1 nm and 4.5 nm are measured by continuous wave (CW) and pulsed electron paramagnetic resonance (EPR) methods for a series of nitroxide-spin-labelled peptides. The upper distance limit for measuring dipolar coupling by the broadening of the CW spectrum and the lower distance limit for the present optimally-adjusted double electron electron resonance (DEER) set-up are determined and found to be both around 1.6-1.9 nm. The methods for determining distances and corresponding distributions from CW spectral line broadening are reviewed and further developed. Also, the work shows that a correction factor is required for the analysis of inter-spin distances below approximately 2 nm for DEER measurements and this is calculated using the density matrix formalism.

Ambient particulate matter accelerates coagulation via an IL-6-dependent pathway

The mechanisms by which exposure to particulate matter increases the risk of cardiovascular events are not known. Recent human and animal data suggest that particulate matter may induce alterations in hemostatic factors. In this study we determined the mechanisms by which particulate matter might accelerate thrombosis. We found that mice treated with a dose of well characterized particulate matter of less than 10 microM in diameter exhibited a shortened bleeding time, decreased prothrombin and partial thromboplastin times (decreased plasma clotting times), increased levels of fibrinogen, and increased activity of factor II, VIII, and X. This prothrombotic tendency was associated with increased generation of intravascular thrombin, an acceleration of arterial thrombosis, and an increase in bronchoalveolar fluid concentration of the prothrombotic cytokine IL-6. Knockout mice lacking IL-6 were protected against particulate matter-induced intravascular thrombin formation and the acceleration of arterial thrombosis. Depletion of macrophages by the intratracheal administration of liposomal clodronate attenuated particulate matter-induced IL-6 production and the resultant prothrombotic tendency. Our findings suggest that exposure to particulate matter triggers IL-6 production by alveolar macrophages, resulting in reduced clotting times, intravascular thrombin formation, and accelerated arterial thrombosis. These results provide a potential mechanism linking ambient particulate matter exposure and thrombotic events.

The intrinsic apoptotic pathway is required for lipopolysaccharide-induced lung endothelial cell death

LPS has been implicated in the pathogenesis of endothelial cell death associated with Gram-negative bacterial sepsis. The binding of LPS to the TLR-4 on the surface of endothelial cells initiates the formation of a death-inducing signaling complex at the cell surface. The subsequent signaling pathways that result in apoptotic cell death remain unclear and may differ among endothelial cells in different organs. We sought to determine whether LPS and cycloheximide-induced cell death in human lung microvascular endothelial cells (HmVECs) was dependent upon activation of the intrinsic apoptotic pathway and the generation of reactive oxygen species. We found that cells overexpressing the anti-apoptotic protein Bcl-X(L) were resistant to LPS and cycloheximide-induced death and that the proapoptotic Bcl-2 protein Bid was cleaved following treatment with LPS. The importance of Bid was confirmed by protection of Bid-deficient (bid(-/-)) mice from LPS-induced lung injury. Neither HmVECs treated with the combined superoxide dismutase/catalase mimetic EUK-134 nor HmVECs depleted of mitochondrial DNA (rho(0) cells) were protected against LPS and cycloheximide-induced death. We conclude that LPS and cycloheximide-induced death in HmVECs requires the intrinsic cell death pathway, but not the generation of reactive oxygen species.

Empowerment among Latina nurses in Mexico, New York and Indiana

BACKGROUND

Increasing empowerment among nurses may help retain nurses and increase the international workforce. There are very few cross-national studies of nurse empowerment reported in the professional literature.

AIM

To conduct a cross-national exploratory study testing a theoretical model of nurse empowerment.

DESIGN

Descriptive survey of three convenience samples of graduate Latina nurses in Monterrey, Mexico, New York City and Indiana.

METHODS

Data were collected using self-administered questionnaires. The Klakovich Reciprocal Empowerment Scale (RES) was translated into Mexican-Spanish using a translation back-translation technique. Variables for the study included empowerment, years of experience, job satisfaction and intent to stay. Frequency distributions and descriptive statistics were used to analyse the data.

FINDINGS

Empowerment involves reciprocity between the leader and follower, a common vision and synergy about the work, and a sense of ownership in the work site. Mexican nurses scored significantly higher on synergy than Latina nurses in New York and Indiana. Empowerment is related to job satisfaction, age and years of employment.

CONCLUSIONS

Results indicate the usefulness of the RES instrument for Latina nurses and the need for further research with larger samples. Cross-national research provides culturally sensitive information. Such research partnerships facilitate modelling the importance of nursing research to graduate nurses and students.

Proapoptotic Bid is required for pulmonary fibrosis

The molecular mechanisms of pulmonary fibrosis are poorly understood. Previous reports indicate that activation of TGF-beta1 is essential for the development of pulmonary fibrosis. Here, we report that the proapoptotic Bcl-2 family member Bid is required for the development of pulmonary fibrosis after the intratracheal instillation of bleomycin. Mice lacking Bid exhibited significantly less pulmonary fibrosis in response to bleomycin compared with WT mice. The attenuation in pulmonary fibrosis was observed despite similar levels of inflammation, lung injury, and active TGF-beta1 in bronchoalveolar lavage fluid 5 days after the administration of bleomycin in mice lacking Bid and in WT controls. Bleomycin induced similar levels cell death in vitro in alveolar epithelial cells isolated from WT and bid(-/-) mice. By contrast, alveolar epithelial cells from bid(-/-) mice were resistant to TGF-beta1-induced cell death. These results indicate that Bcl-2 family members are critical regulators for the development of pulmonary fibrosis downstream of TGF-beta1 activation.

Acetylation regulates the differentiation-specific functions of the retinoblastoma protein

The retinoblastoma tumor-suppressor protein (pRb) is known to induce growth arrest and cellular differentiation. The molecular determinants of pRb function include protein-protein interactions and post-translational modifications such as phosphorylation. Recently, the co-activator p300 was found to acetylate pRb. The biological significance of pRb acetylation, however, remains unclear. In the present study, we provide evidence that pRb undergoes acetylation upon cellular differentiation, including skeletal myogenesis. In addition to p300, the p300-Associated Factor (P/CAF) can mediate pRb acetylation as pRb interacts directly with the acetyltransferase domain of P/CAF in vitro and can associate with P/CAF in differentiated cells. Significantly, by using a C terminal acetylation-impaired mutant of pRb, we reveal that acetylation does not affect pRb-dependent growth arrest or the repression of E2F transcriptional activity. Instead, acetylation is required for pRb-mediated terminal cell cycle exit and the induction of late myogenic gene expression. Based on these results, we propose that acetylation regulates the differentiation-specific function(s) of pRb.

Hospital conversion foundations. Issues in creation, operation, and evaluation

A major healthcare transformation in the United States is the conversion of nonprofit hospitals to for-profit entities, and the creation of hospital conversion foundations for the nonprofit charitable assets, which now exceeds $9 billion. Because less than 21% of the 525 hospitals converting from nonprofit to for-profit ownership have established a hospital conversion foundation, the public's monetary losses are considerable. This article examines some of the key legal and organizational issues related to hospital conversion foundations including factors related to establishing fair value of the converting hospital, foundation mission, use of conversion revenue, governance, and evaluation.

Evidence of a functional alpha7-neuronal nicotinic receptor subtype located on motoneurons of the dorsal motor nucleus of the vagus

In vitro autoradiography using 125I-alpha-bungarotoxin (alpha-BGTx) and anti-alpha7 immunohistochemistry were performed on the dorsal motor nucleus of the vagus (DMV) of sham and chronically vagotomized rats to determine whether the alpha7-nicotinic acetylcholine receptor (nAChR) is located postsynaptically on DMV neurons whose axons contribute to the vagus nerve. Intense bilateral 125I-alpha-BGTx binding and anti-alpha7 immunostaining were observed in coronal brain sections containing the DMV of sham-vagotomized animals. Unilateral cervical vagotomy resulted in ipsilateral losses of 125I-alpha-BGTx binding and anti-alpha7 immunostaining from the DMV. Simultaneous staining of rat brainstem sections with anti-alpha7 and anti-choline acetyltransferase (ChAT) antibodies (to identify cholinergic DMV neurons that project into the vagus nerve) revealed that every DMV neuron that was stained for ChAT showed alpha7-staining as well. In vagotomized animals, no ChAT-positive neurons expressing alpha7-nAChRs remained in the ipsilateral DMV. We conclude that the alpha7-nAChR subtype is located postsynaptically on DMV neurons. To test whether the alpha7-nAChR is similar to the alpha7-homomeric nAChR, experiments were performed in anesthetized rats, and compounds were microinjected into the DMV while monitoring intragastric pressure (IGP). alpha-BGTx and strychnine antagonized nicotine-induced increases in IGP; no antagonism was observed with methyllycaconitine, a compound known to block the homomeric alpha7-nAChR subtype. Recovery from alpha-BGTx-induced antagonism of the nicotine response was observed. We conclude that there is a nAChR containing the alpha7-subunit in the DMV that is different from the homomeric alpha7-nAChR subtype.

Pulmonary artery trauma due to balloon dilation: recognition, avoidance and management

OBJECTIVES

We reviewed the management and outcome of patients experiencing pulmonary artery (PA) trauma during balloon dilation (BD).

BACKGROUND

Balloon dilation of the PA is important in the management of peripheral pulmonary stenosis. Successful BD requires a controlled tear of the PA; excessive tearing can produce complications ranging from pseudoaneurysms to rupture and death. The incidence and optimum management for such complications are unreported.

METHODS

All records of patients who underwent branch PA dilation between June 1984 and October 1997 were reviewed; those with a significant complication were analyzed.

RESULTS

Of 1,286 catheterizations in 782 patients, PA trauma (excluding isolated pulmonary edema and PA aneurysms) was identified in 29 catheterizations in 26 patients. Tears occurred distal to the area of stenosis in most cases (62%). Intensive medical management, with and without catheter directed therapy, was employed. The damaged PA was successfully coil embolized in five patients, four of whom survived; temporary balloon occlusion did not prevent death in two patients. There were six deaths from pulmonary hemorrhage. A case control analysis demonstrated that PA trauma was significantly associated with pulmonary hypertension.

CONCLUSIONS

Pulmonary artery trauma associated with BD occurs mostly distal to the site of narrowing, is associated with underlying pulmonary hypertension and is frequently (5/12 or 42%) fatal in those with unconfined tears. Intensive management strategies as well as attention to distal balloon position may reduce incidence and mortality. Coil occlusion of the damaged PA appears to be a valuable strategy to prevent fatal hemorrhage.

Problem-based learning for nursing: integrating lessons from other disciplines with nursing experiences

Problem-based learning (PBL) is a philosophy and teaching method that structures knowledge in clinical contexts, strengthens motivation to learn, develops clinical reasoning skills, and enhances self-directed and life-long learning. During the past 30 years, PBL has been implemented in schools of medicine worldwide, including 100 of the 126 schools in the United States. This article reviews the international PBL literature and focuses on the key aspects of this paradigm in educating health professionals: recent history and worldwide diffusion, basic characteristics and rationale, typical case presentation, student and tutor roles, and data-based outcomes. Conclusions from selected meta-analytic studies of assessment are described and discussed. The potential of PBL for nursing education is examined. Key implementation issues are identified, including the challenge to persuade faculty to move from efficient teaching to effective learning.

Hospital ownership, performance, and outcomes: assessing the state-of-the-science

OBJECTIVE

This study 1) identified the research evidence; 2) assessed the state-of-the-science surrounding hospital ownership, performance, and outcomes in acute care hospitals in the United States; and 3) identified measurable components of hospital performance and outcomes for the organization, patient, and community.

BACKGROUND

As the size of the nonprofit sector decreases and the size of the for-profit sector increases, hospital ownership warrants examination. Most research has focused on either ownership and performance or ownership and outcomes, rather than the potential interaction of all three variables.

METHODS

A comprehensive, computerized search of the healthcare research literature yielded 69 data-based references published between 1985 and 1999. Coding sheets were developed to abstract the articles. Analysis involved synthesizing the research evidence for each of the three major variables and their components.

RESULTS

Hospital ownership has an impact on hospital performance in relation to system operations; costs, prices, and financial management practices; and personnel issues. Organizational outcomes are similar among hospital ownership types in relation to increasing administrative costs and overall mediocre efficiency. Organizational outcomes differ among hospital ownership types in relation to nursing staff mix and professional satisfaction. The association of hospital ownership with patient outcomes varies depending on the dimension measured. The evidence is mixed or inconclusive regarding hospital ownership and access to care, morbidity, and mortality. The association of hospital ownership and adverse events is consistently supported. Hospital ownership status has an impact on the type and magnitude of community benefits. Differences among the three hospital ownership types are minimized in a competitive market.

CONCLUSIONS

This study reinforces the position that nurse researchers need to include hospital ownership as an important structural variable in their studies of hospital-based nursing. Examining the conceptual links between ownership, performance, and outcomes requires the integration of macro-level and micro-level theory.

Chemokines and chemokine receptors in the pathogenesis of multiple sclerosis

In recent years we have seen growing evidence for the role of chemokines in the pathogenesis of several infectious and non-infectious inflammatory CNS disease states, including Multiple Sclerosis (MS) and its animal model, experimental allergic encephalomyelitis (EAE). An increase in proinflammatory chemokines has been associated with demyelinating lesions and clinical neurological dysfunction in patients with MS; these chemokines could be potential targets for MS therapy. Besides a clearly defined role in mediating leukocyte migration, these and other chemokines may act as immunoregulatory molecules in the driving to Th1/Th2 responses, switch of cytokine profiles, and the induction of tolerance. Since chemokine receptors have now been identified on macrophages, microglia, astrocytes, and endothelial cells as well as neurons in the CNS, chemokine/receptor interactions may mediate functional responses in a variety of CNS cell types during the course of inflammatory disease states. Therefore, clarification of the roles of chemokines and their receptors in the pathogenesis of EAE and MS will be useful in establishing immunotherapeutic strategies for these neurological autoimmune disorders.

Using problem-based learning to redesign nursing administration masters programs

Problem-based learning (PBL) is offered as an appropriate pedagogy to prepare nurse managers for the uncertainties of future administrative practice. It is a student-centered, experiential learning strategy aimed at developing clinical reasoning, structuring knowledge in real-life contexts, motivating learning, and developing self-learning skills. Health professions and business schools report positive feedback from their stakeholders after adopting this new learning paradigm.

Left superior vena cava connection to unroofed coronary sinus associated with positional cyanosis: successful transcatheter treatment using Gianturco-Grifka vascular occlusion device

A persistent left superior vena cava connection to an unroofed coronary sinus is a rare cardiac anomaly that is associated with a variable degree of cyanosis. We report an infant with this condition and the unusual feature of cyanosis dependent on head position. When the patient's head was rotated to the left, he developed severe stenosis of the left internal jugular vein, enlarged cervical collateral veins that connected to the right superior vena cava and had an oxygen saturation 95%. When the patient's head was rotated to the right, the left internal jugular vein was widely patent and systemic oxygen saturation decreased to 87%. There was no right ventricular volume overload. Temporary occlusion of the left superior vena cava documented tolerable proximal venous pressure. Cyanosis was relieved by transcatheter closure of the left superior vena cava with a Gianturco-Grifka vascular occlusion device. Cathet. Cardiovasc. Intervent. 48:369-373, 1999.

Hospital consolidation. Applying stakeholder analysis to merger life-cycle

Nearly three of every five hospitals in the United States have been involved in some form of consolidation during the past 5 years. Within this turbulent hospital merger environment, nurse executives are confronted with organizational, professional, and personal decisions. Stakeholder analysis is offered as one strategy to facilitate effectiveness throughout the hospitals' merger life-cycle.

Leaflet development, induction time, and medium influence somatic embryogenesis in peanut (Arachis hypogaea L.)

Factors affecting somatic embryogenesis in peanut (Arachis hypogaea L.) using leaflet explants of seedlings obtained from aseptically germinated embryo axes were evaluated. Somatic embryogenesis was influenced by developmental stage, leaflet size, induction medium, and time on induction medium. Leaflets that were 5-7 mm long had a greater embryogenic response than smaller or larger leaflets. Percent embryogenesis and mean number of embryos were related to the developmental stage of germinating seedlings. A greater response was obtained if leaflets were folded and closely appressed. Preselection of leaflets increased percent embryogenesis from 21% up to 67%. As leaflets unfolded, embryogenesis decreased; open leaflets lost the potential for embryogenesis. The optimal induction conditions were a 7-day incubation period on Murashige and Skoog medium with 136 μM 2,4-dichlorophenoxyacetic acid and 0.93 μM kinetin. Somatic embryos germinated to form plants that exhibited a normal morphology.

Acute stroke patients comparing outcomes with and without case management

Stroke represents a major human and economic challenge to society. The literature suggests that interdisciplinary clinical pathways maximize stroke patient outcomes, whether care is delivered in a designated stroke unit or in a general medical service. In this article, the authors describe the case management model implemented at Columbus Regional Hospital, a 325-bed rural referral hospital in southeastern Indiana. A retrospective chart review compared 23 patients with non-hemorrhagic strokes using two different models of care delivery: unit-based nursing case management and standard nursing care. Differences in outcomes are reported in relation to interdisciplinary utilization, timeliness of referrals, patient education, discharge dispositions, home safety assessments, next-site-of-care communications, length of hospital stay, and patient satisfaction.

Differentiated nursing practice: assessing the state-of-the-science

The authors present their findings following an exhaustive literature review of research on differentiated nursing practice (DNP) that used a number of tools to measure various aspects of DNP that are applicable across the health care delivery continuum. Issues related to DNP include: optimal nursing care, matching patient needs with nurse competencies, effective use of nursing resources, equitable compensation, career satisfaction, loyalty to employers, and enhanced prestige of the nursing profession. One 1992 Massachusetts study of a three-role oncology unit project (including patient care manager, clinical nurse, and patient care technician), showed positive change in five criteria including: standards of nursing care, actual care hours, average labor costs, job satisfaction and patient satisfaction. A 1990 Arizona study that included unit assistants concluded that DNP supported a decline in the use of supplemental staff and staff overtime which led to cost savings, and increases in the actual hours of care and nurse satisfaction.

Organizational effectiveness: toward an integrated model for schools of nursing

Assessing the quality of academic institutions involves much more than the opinions of peers or experts. Examination of the organizational effectiveness of schools of nursing has been neglected. Current emphasis on assessing educational outcomes has diverted attention from the construct, organizational effectiveness, and more comprehensive theory-driven approaches to evaluation. This review of the organizational effectiveness literature focuses on the major assessment models: goal attainment, human relations, open systems, internal processes, culture, and life cycle. Attention is given to the influence of organizational maturation on an integrated model of organizational effectiveness. Selected macrolevel studies of schools of nursing are examined, and an agenda for nursing research is proposed.

Quality assurance procedure on a Huestis Styro-former--stay on the cutting edge

A review of variations in block positions on port film vs. simulator film at The Nashua Regional Cancer Center, Nashua, NH, prompted the development of a method of measuring the accuracy of hot wire cut molds vs. a "test" film. The procedure is done at a minimum of once a year, or when accuracy of the block cuts are suspect. This simple test insures a high degree of confidence that the resulting cut molds are appropriate for the clinical situation and the need to recut blocks as a result of an out-of-tolerance Huestis Styro-former is kept to a minimum.

Improvements in rooting regenerated safflower (Carthamus tinctorius L.) shoots

A continuing obstacle for regenerating safflower (Carthamus tinctorius L.) plants from cultured explants or callus has been a reliable method for rooting shoots. For shoots directly regenerated from primary explants, 76% of shoots rooted after a 7-d exposure to 10 mg/1 indole-3-butyric acid. Auxin source, concentration or exposure time did not greatly affect root formation or morphology, but strongly affected callus production. Shoots infected with Agrobacterium rhizogenes produced massive numbers of fibrous roots, but shoots did not elongate or survive transfer to soil. Shoot hyperhydricity symptoms were reduced by including 1 g/1 activated charcoal in rooting media. The optimal protocol for inducing root formation consisted of a 7-d exposure to 10 mg/l indole-3-butyric acid in root induction media, followed by incubation in media containing 15 g/l sucrose and 1 g/1 activated charcoal for 21 d.

Directors of Continuing Nursing Education: A National Survey of Educational Needs

Advancing technology and healthcare reform necessitate continuing nursing education to maintain competence. This study assesses the knowledge and skills needed to function as a director of continuing nursing education in a variety of settings, estimates the supply of qualified applicants for vacant director positions, and identifies essential academic needs of someone preparing for the director's position.

When to begin a doctoral programme in nursing

The future of the nursing profession is strengthened by the expansion of nursing science and its integration with nursing practice, the hallmarks of doctoral education. Launching a doctoral programme in nursing is a monumental venture into the main stream of higher education; consequently, the readiness to begin such an effort must be carefully assessed.

High frequency somatic embryogenesis in peanut (Arachis hypogaea L.) using mature, dry seed

Peanut (Arachis hypogaea L.) somatic embryos were produced from the embryo axes of mature, dry seeds of cultivar GK-7. Percent embryogenic explants ranged from 88-100% using 10-40 mg/1 of 2,4-D in the induction medium. Neither 2,4-D concentration nor photoperiod during the induction period had a large effect on percent embryogenesis, mean number of embryos per explant, or embryo morphology. However, embryos obtained from cultures grown in the dark were easier to remove from the explant than those under a 16-h photoperiod. Somatic embryos developed on the epicotyl portion of the embryo axis, primarily on the young, expanding leaves. A survey of 14 genotypes indicated that genotype had a large influence on embryogenic capacity, with all genotypes being embryogenic to some extent. The ability to recover somatic embryos from axes of harvested, stored seeds represents significant advantages for the establishment of peanut embryogenic cultures, including the use of simple sterilization procedures and a constant source of explant tissue.

Influence of photoperiod and medium formulation on peanut somatic embryogenesis

Somatic embryos were produced from peanut (Arachis hypogaea L.) immature zygotic cotyledons. Comparisons were made of the level of α-naphthaleneacetic acid during induction, nitrogen formulation of the medium, and photoperiod. Over 70% embryogenesis was obtained regardless of NAA level used. Percent embryogenesis and number of embryos were markedly lower in explants induced on NAA compared to 2,4-D. Embryo production was not greatly affected by either the use of Murashige & Skoog versus Finer & Nagasawa salts or light versus dark culture conditions. However, embryo morphology was noticeably affected by photoperiod. Embryos produced under a 16 h photoperiod were tough, woody and difficult to separate for subsequent germination and conversion. Those produced under a 0-h photoperiod were succulent and pliable.

Master's degree nursing education: state of the art

This study examines the state of the art in master's nursing education in the United States in light of projected national trends in the health care delivery system. The specific questions addressed are: What are the general characteristics of master's programs, including admission requirements and prerequisites, program requirements, major and minor areas of clinical concentration, functional role preparation, and career mobility options? What is the curricular organization, particularly with respect to required core courses? Is there a difference between master's programs in schools with a doctoral program in nursing and those with master's programs only? Is there a difference between master's programs with public support and master's programs with private support? Data were collected from 175 accredited master's programs in 1990. Study results and the projected trends derived from Nursing's Agenda for Health Care Reform, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, and Healthy America: Practitioners for 2005 provide the foundation for recommendations. Recommendations are organized around communication and curricular issues that master's nursing education needs to address as the profession approaches the 21st century.

Somatic embryogenesis and plant regeneration from leaflets of peanut, Arachis hypogaea

Somatic embryos were induced on peanut (Arachis hypogaea) leaflets from aseptically germinated embryo axes. Leaflet size influenced percent somatic embryogenesis; 5-8 mm long cut leaflets were superior to 2-3 mm long uncut leaflets. Maximum embryogenesis of 14.6% was obtained after a 15 d incubation on induction medium (modified MS with B5 vitamins, 30 g/l sucrose, 4 g/l Gel-Gro, 40 mg/l 2,4-D +0.2 mg/l kinetin) followed by transfer to a secondary medium with 5 mg/l 2,4-D+0.2 mg/l kinetin. Primary somatic embryos were fused along the axes with no distinct cotyledons, but secondary embryos had single axes with two cotyledons. Other treatments had lower percent embryogenesis, no secondary embryogenesis, and embryos with single axes with two cotyledons. Some somatic embryos converted into normal plants capable of greenhouse survival.

Genetic variation in the African rodent subfamily Otomyinae (Muridae). II. Chromosomal changes in some populations of Otomys irroratus

Chromosome-banding studies have been carried out on 31 specimens of Otomys irroratus from six localities. Light-microscope preparations of chromosomes were obtained from cultures of fibroblasts, spleen lymphocytes, peripheral blood lymphocytes, and directly from bone marrow. Karyotypic variability, both numerical and morphological, was detected in three populations. Diploid numbers ranged from 2n = 23 to 2n = 32. Intrapopulation differences were chiefly caused by variation in the number of copies in two pairs of small, biarmed, partly heterochromatic autosomes suggestive of B chromosomes. A major morphological variation in the karyotypes involved the presence of seven pairs of biarmed autosomes with totally heterochromatic short arms in the populations distributed to the west of 26 degrees 57' E. To the east of this longitude, populations of this species exhibited mostly acrocentric autosomes. G-banding patterns of these karyotypes and those of a karyotype from a previous study (Robinson and Elder, 1987) were compared. A chromosome originating from a tandem fusion, possibly leading to partial reproductive isolation, was found in one population. Possible implications of these results for mechanisms of speciation are discussed.

Interinstitutional collaboration for nursing excellence: Part 2. Testing the model

Two unrelated public institutions formed a partnership to foster excellence in professional nursing. The organizational structure was described in Part 1 (February 1989). This second article reports a 15-week pilot study conducted on seven hospital units to determine the degree to which the clinical nurse specialist can merge the multiple functions of professional nursing: practice, education, and research.

Interinstitutional collaboration for nursing excellence: Part 1, Creating the partnership

A partnership between two unrelated public institutions was formed to enhance the quality of clinical learning for students and staff, promote exemplary care to patients, and foster expansion of nursing research. The critical nucleus of the partnership is the unit-based clinical nurse specialist who performs the multiple functions of professional nursing: practice, education, and research. This two-part series describes the collaboration effort. Part 1 focuses on the organizational structure created for the partnership, and part 2 reports the findings of a 15-week pilot study conducted to test the model.