Glaucoma after penetrating keratoplasty and keratoprosthesis

PURPOSE

To compare visual and glaucoma outcomes in patients with known glaucoma after a penetrating keratoplasty (PKP) or a Boston Keratoprosthesis Type 1 (KPro) as a second corneal replacement procedure.

DESIGN

Retrospective interventional case series.

PARTICIPANTS

Charts of 141 eyes that underwent either a PKP or KPro at the Centre hospitalier de l'Université de Montréal after one failed PKP from 2008 to 2020 were reviewed. Forty-six eyes with preoperative glaucoma were included.

METHODS

Data collected included demographics, indication for the initial surgery, best corrected visual acuity (BCVA), concurrent ocular disorders, number of glaucoma medications, need for glaucoma surgery, cup-to-disc ratios (CDRs), mean RNFL thickness, and visual field (VF) characteristics. Primary outcomes were glaucoma progression trends. Secondary outcomes were visual outcomes and need for additional procedures.

RESULTS

Mean follow-up was 4.7 years for the PKP and 7.3 for the KPro group (P<0.007). 30.6% of PKP compared to 70.5% of KPro patients were diagnosed with glaucoma preoperatively. Glaucoma worsened similarly in both groups; this is based on an analysis of the number of glaucoma medications, CDR, need for glaucoma surgery, and characteristic VF changes. Patients in the PKP group required significantly more regrafts than patients in the KPro group (31.8 vs. 8.3%; P=0.045).

CONCLUSIONS

A preoperative diagnosis of glaucoma does not preclude KPro implantation. In glaucomatous eyes, the disease progressed similarly in both groups. Since both procedures increase the risk of worsening glaucoma, close follow-up is recommended. KPro may decrease the need for further corneal transplantation surgery.

Effectiveness of breast cancer screening interventions in improving screening rates and preventive activities in Muslim refugee and immigrant women: A systematic review and meta-analysis

PURPOSE

To systematically assess the effectiveness of breast cancer (BC) interventions in improving breast self-examination (BSE), clinical breast examination (CBE), mammogram screening rates, and preventive activities in Muslim refugee and immigrant women.

DESIGN

Guided by the Health Belief Model, a mixed method systematic review and meta-analysis was performed using a sequential design.

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA), the Critical Appraisal Skill Program Checklists, and the Joanna Briggs Institute (JBI) methodology for systematic review and meta-analysis. A systematic search of English-language peer-reviewed articles was undertaken in multiple health and social sciences databases from January 1, 2015, to March 31, 2022. Randomized clinical trials and quasi-experimental studies focused on the uptake of BSE, CBE, and mammograms were selected.

RESULTS

Fourteen articles were included in the review. Most of the studies relied on quasi-experimental designs and were carried out in the United States of America. The qualitative analysis of BC screening interventions generated three themes: (1) education, (2) access-focused, and (3) cultural and faith-based. The meta-analysis included three randomized control trials and two quasi-experimental studies. The meta-analysis demonstrates the effectiveness of community-led cultural and faith-based interventions in facilitating the completion of CBE and mammography screening. Education on BC and patient navigator interventions are more effectively used in conjunction than standalone interventions, yet community-based cultural and faith-based interventions are the most effective.

CONCLUSION

This systematic and meta-analysis review provides evidence on the effectiveness of access-focused and cultural and faith-based interventions in improving BC screening in Muslim refugee and immigrant women. Future research should focus on designing and measuring the effectiveness of cultural and faith-based interventions to increase Muslim refugee and immigrant women's BC screening knowledge and practices.

CLINICAL RELEVANCE

This systematic and meta-analysis review demonstrates the need to explore Muslim refugee and immigrant women's cultural contexts for developing culturally sensitive BC screening interventions. Knowledge and practice of BC and religiosity intersect with financial, geographic, and linguistic barriers to decrease participation in screening and preventive activities in Muslim refugee and immigrant women.

Integrative review of the needs and challenges of indigenous palliative care in rural and remote settings

AIMS

To appraise and synthesize the empirical literature on the needs and challenges of Indigenous peoples' accessibility to palliative care in rural and remote settings.

DESIGN

Whittemore and Knafl's updated approach to integrative reviews, PRISMA guidelines and CASP (2020) checklists for narrative analysis were followed.

DATA SOURCES

A systematic search of the published empirical literature from 1 January 2015 to 31 December 2021 was undertaken in five databases.

REVIEW METHODS

Twenty-four studies met the research question and the inclusion criteria.

RESULTS

Four themes describe the findings: Respect of Indigenous cultural beliefs on death and dying, connection to the land, needs for culturally responsive care and presence of institutional and systemic barriers. These themes indicate a pressing need to increase the accessibility and utilization of palliative care. Most of the studies were qualitative and conducted by teams of Indigenous and non-Indigenous researchers.

CONCLUSION

Integrating Indigenous knowledge and providing culturally responsive palliative care are steps towards achieving the decolonization of palliative care and responding to Indigenous people's needs of palliative care services. Institutional and systemic racism affect Indigenous peoples' access and delivery of palliative services in Canada and globally.

IMPACT

The review highlights the need for establishing partnerships and building local capacity with Indigenous communities to develop and implement culturally responsive palliative care programmes in remote locations.

Barriers and Facilitators Influencing Arab Muslim Immigrant and Refugee Women's Breast Cancer Screening: A Narrative Review

Introduction:

This narrative review identifies barriers and facilitators influencing breast cancer screening among Arab Muslim immigrants and refugees. Low participation rates create health inequities in breast cancer screening among this population.

Method:

A systematic search of peer-reviewed empirical articles was performed. PRISMA, CASP, and MMAT checklists were used to appraise the studies.

Results:

Results include 3 themes: individual, health care system and health providers, and cultural factors.

Discussion:

Lack of fluency in the new country’s language, lack of knowledge, and poor exposure to breast cancer screening may contribute to the Arab Muslim women’s vulnerability to undiagnosed or delayed breast cancer diagnosis.

An integrative review of Indigenous informal caregiving in the context of dementia care

AIMS

To appraise the empirical literature on the needs of Indigenous informal caregivers caring for people living with dementia in Indigenous communities.

DESIGN

Whittemore and Knafl's updated approach to integrative reviews, PRISMA guidelines, and CASP checklists for narrative analysis were followed.

DATA SOURCES

A systematic search of published empirical literature from January 2010 to August 2020 was undertaken in six databases.

REVIEW METHODS

Fifty-one studies met the research question and the inclusion criteria.

RESULTS

Five themes describe the findings: Decolonizing Western perspectives on dementia, the centrality of cultural safety, caregivers' experiences, pre-dementia community education and family and community-centred care emerged from the thematic analysis. Most of the studies used quantitative methodologies, and few studies were conducted using community-based approaches.

CONCLUSION

This review shows that Indigenous caregiving represents an emerging field in nursing and health sciences in a context of a global crisis. Researchers need to focus on Indigenous values and voices to adapt care and support informal caregivers. Our review emphasizes that working with Indigenous communities will likely translate into new care delivery models, policies and practices to support Indigenous informal caregivers and address the specific social determinants impacting caregivers' roles and tasks.

IMPACT

This review highlights the necessity of having community and family-based discussions on enhancing the delivery of dementia care for Indigenous peoples in Canada and worldwide. Decolonizing Western perspectives of dementia translate into culturally safe approaches that aim to integrate Indigenous cultural perspectives of holism, reciprocity, wisdom, respect of older people and relationality into nursing practice. The support of Indigenous informal caregivers requires future studies to address the stigmatizing Western views of dementia.

A qualitative examination of othering processes within international nursing placements

BACKGROUND

International placements represent a popular choice to develop cultural competency and safety in nursing. The question as to whether study abroad programs enable the development of cultural competency and safety skills or provide exotic travel experiences needs further clarifications.

OBJECTIVE

The study explores the usefulness of international placements in developing cultural safety among undergraduate nursing students.

DESIGN

An exploratory qualitative design was used to answer these research questions: 1) How do undergraduate students make sense of their study abroad experiences? And 2) How international placements facilitate the acquisition of cultural safety and consciousness-raising about racial and social privileges?

PARTICIPANTS

A sample of 7 participants who completed a 4th-year community and acute care stages in Global South countries were recruited.

METHODS

A postcolonial feminist theoretical approach was used to guide the study.

DATA COLLECTION

Semi-structured interviews explored participants' perceptions of cultural differences, ways of adapting to cultural diversity, and the benefits and challenges of their global experiences. Thematic content analysis was used to analyze the data.

RESULTS

Thematic analysis revealed three themes: 1) Self-knowledge, 2) othering, and 3) consciousness of neocolonialism.

DISCUSSION

Results raise some concerns about the usefulness of international stages in developing cultural competency and cultural safety in undergraduate nursing students. Results indicate that international placements can be useful to raise consciousness about racial and social privileges. Yet, international placements involve some risks to the receiving Global South countries. This study unmasks Othering's processes, where participants reproduce harmful neocolonial relations.

CONCLUSIONS

International placements involve cultural risks that translate into Othering processes where Global South nurses and students are represented as powerless. Postcolonial feminist theories are relevant to study international placements as they enable the critical examination of race, gender, and social class and how they play out in international placements in Global South countries.

A philosophical analysis of anti-intellectualism in nursing: Newman's view of a university education

Canadian and international nursing educators are increasingly concerned with the quality of university nursing education. Contemporary nursing education is fraught by a growing anti-intellectualism coupled with the dominance of neoliberalism and corporate university business culture. Amid these challenges, nursing schools must prepare nurses to provide care in an era compounded by social and health inequities. The purpose of this paper was to explore the philosophical and contextual factors influencing anti-intellectualism in nursing education. We use John Henry Newman's view of the purpose of a university education as a heuristic perspective to examine anti-intellectualism in nursing. We contend that the ideological worship of technological advances, a culture of consumerism, quality improvement and risk management, the primacy of doing over thinking, competency-based curricula and business models rooted in neoliberal financial policies reinforce anti-intellectualism in nursing. Anti-intellectualism is a complex issue to address within the corporate university culture. We propose multiple strategies at the disciplinary, university and sociopolitical levels to decrease anti-intellectualism. Counteracting anti-intellectualism requires critical thinking, praxis and emancipation. Nurses should critically examine this anti-intellectual trend as it limits the advancement of the discipline and marginalizes its contributions within the academy. If nurses do not address this challenge, the survival of nursing as an academic discipline may be jeopardized.

Examination of Breast Cancer Screening Knowledge, Attitudes, and Beliefs among Syrian Refugee Women in a Western Canadian Province

Background

Women living in the Arab world present low breast cancer screening rates, delayed diagnosis, and higher mortality rates.

Purpose

To further explore the Muslim Syrian refugee women’s breast self-examination (BSE), utilization of clinical breast examination (CBE) and mammography.

Methods

A cross-sectional descriptive exploratory study design was used. The sample consisted of 75 refugee women. Data were collected using Champion’s Health Belief Model Scale, the Cancer Stigma Scale, and the Arab Culture-Specific Barriers to Breast Cancer Questionnaire. Descriptive, Pearson correlation and logistic regression analyses were used to analyze the data.

Results

A minority of women had BSE (32%), CBE (12%) and mammograms (6.7%) anytime during their lifetime. Women’s breast cancer screening (BCS) knowledge ranked at a medium level (M = 10.57, SD = 0.40). Low knowledge score, BSE information, policy opposition, responsibility, barriers to BSE, and seriousness were found to be statistically significant in women’s BSE practice. BSE benefits and religious beliefs significantly predict CBE Age, education, knowledge, responsibility, susceptibility, social barriers, and religious beliefs were statistically significant in women’s mammography use (p < .01).

Conclusions

Participants’ breast cancer screening practices were low. Health beliefs, Arab culture and stigma about cancer affected women’s BCS practices. Faith-based interventions may improve knowledge and practices.

Racialization in nursing: Rediscovering Antonio Gramsci's concepts of hegemony and subalternity

Although Gramsci's notions of hegemony and subalternity may seem outdated in this 21^st century, a critical examination of the literature shows that these concepts apply in this global pandemic and political context. Racialization is a form of structural violence. In this paper, I also explore Gramsci's' notion of engaged intellectuals to support the idea of social and political activism in nursing. Nurse scholars call for the decolonization of the discipline. Gramsci's philosophical approach to hegemony can be extended to racialization in nursing. Gramsci's notions of civil society and state can help nurses to see the structures that create racism in nursing and society.

An integrative review of empirical literature on indigenous cognitive impairment and dementia

AIMS

To synthesize research findings about Indigenous perspectives on cognitive impairment and dementia.

DESIGN

Whittemore and Knafl's updated approach to integrative review and PRISMA guidelines for narrative analysis was followed.

DATA SOURCES

A systematic search of the published literature from 2010-June 2020 was undertaken in four databases and complemented by supplementary searches.

REVIEW METHODS

Thirty-four studies met the research question and inclusion criteria.

RESULTS

Four themes describe the findings. Most of the studies were conducted by non-Indigenous researchers and may reflect Western perspectives on dementia rather than Indigenous views. A majority of the studies report epidemiological data or the testing of clinical tools.

CONCLUSION

The review indicates a dearth of knowledge about Indigenous perspectives on ageing and understanding of cognitive impairment and dementia. Researchers need to draw on Indigenous traditional knowledge, culture, and traditions through a meaningful engagement with Indigenous communities and Elders to indigenize and decolonize dementia care.

IMPACT

This integrative review highlights the need for community-led discussions and community engagement around Indigenous perspectives, needs, and understandings of ageing, cognitive impairment, and dementia care.

Exploring food security among recently resettled Syrian refugees: results from a qualitative study in two Canadian cities

Purpose

This study aims to provide a qualitative in-depth account of the status and experience of food insecurity for Syrian refugee households in Toronto and Saskatoon, Canada. The study considers the range of geographic, socio-economic, cultural and gendered components shaping and determining the barriers and management of food insecurity.

Design/methodology/approach

The study included 54 semi-structured interviews with refugee families in Toronto and Saskatoon who resettled in Canada after November 2015. In addition, 15 semi-structured in-person or telephone interviews were conducted with settlement and support agencies to measure their capacity to respond to issues of food insecurity for Syrian refugees.

Findings

Syrian refugees reported experiencing food insecurity as part of the broader resettlement journey, including in the transitional phase of refuge and in each settlement context in Canada. Income status in Canada was reported as a key barrier to food security. Low-income barriers to food security were experienced and shaped by factors including food affordability, physical access and availability and the extent of familial or other support networks including sponsorship relationships. Participants also reported how managing food insecurity contributed to the intensification of gender expectations.

Originality/value

The analysis reveals food insecurity as both an income and non-income based concern for refugees during the process of resettlement. The study also highlights the importance of considering variations between primary barriers to food security identified by Syrian families and key informants as critical to the development of strategies designed to mitigate the impacts of resettlement on food security.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

[Validation of a questionnaire on health literacy among Francophones in situation of linguistic minority]

OBJECTIVE

This study was designed to develop and test the qualitative validity of a French questionnaire. The questionnaire explored the mechanisms by which Francophone in situation of linguistic minority mobilize their social capital and cultural assets in terms of health literacy.

METHODS

We used evidence derived from a previous qualitative study in which we elaborated the characteristics of social capital and cultural assets. Drawing on models of social capital and self-determination of language behaviour in Francophone in situation of linguistic minority, 21 items were developed and assessed to confirm content validity. For this purpose, cognitive interviews were conducted with 92 natural experts. These cognitive interviews tested the linguistic and content validity of the instrument. Consultations with research professionals were also conducted to increase content validity.

RESULTS

Parsimony and simplicity were tested by application of the Flesch test. The results demonstrate that 19 questions (93%) corresponded to the general public, relatively simple, and everyday use categories. Natural experts confirmed the readability and simplicity of the questionnaire.

CONCLUSION

This study addressed a lack of simple and readable questionnaire for collecting data among Francophone in situation of linguistic minority. The findings underscore the lack of evidence related to the familiar construction of health literacy among members of this population.

Granulations denses anormales dans les thrombocytes humains

On sait que les granulations denses des thrombocytes humains peuvent présenter, dans certains cas, des aspects inhabituels: granulations denses en bâtonnet, granulations denses géantes et granulations denses en “oeil-de-boeuf”. L’étude systématique au microscope électronique de thrombocytes de sujets sains et de 30 patients atteints de thrombopathies diverses a permis d’analyser la fréquence de l’apparition de cette altération, mais n’a pas montré que la présence de granulations denses anormales caractérise un type de thrombopathie déterminé. Par contre, l’analyse des réactions de ces organites tant normaux qu’anormaux vis-à- vis de certains “contrastants électroniques”, ainsi que l’étude ultrastructurelle de la thrombocytopoïèse chez l’animal de laboratoire, ont permis d’émettre quelques hypothèses sur leur genèse et leur signification. Enfin, les auteurs discutent des rapports qui peuvent exister entre déficience du facteur thrombocytaire 3 et altérations des granulations denses.

Sur la présence de graisses neutres dans les thrombocytes humains normaux et pathologiques

La microscopie électronique a montré, dans les thrombocytes humains, la présence de gouttelettes lipidiques. Dans les plaquettes normales, le pourcentage de coupes présentant cette caractéristique ultrastructurelle est très faible; cette observation concorde avec les résultats des analyses biochimiques et cytochimiques. Par contre, dans les thrombopathies (surtout congénitales), leur proportion est significativement augmentée. Nous pouvons donc considérer que la mise en évidence d’une stéatose thrombocytaire notable est un des critères valables du diagnostic d’un état pathologique des thrombocytes.

L’aspect submicroscopique des gouttelettes lipidiques intrathrombocytaires permet de penser qu’elles sont constituées vraisemblablement de graisses neutres très riches en acides gras non saturés. Cette hypothèse est appuyée par des études cytochimiques récentes au microscope électronique des constituants lipidiques.

Nos observations montrent que la genèse des gouttelettes lipidiques n’est vraisemblablement pas liée à une lipophanérose, ni à une phagocytose de chylomicrons. Par contre, la diminution du taux de glycogène dans les plaquettes présentant une stéatose, nous permet de supposer que les gouttelettes lipidiques peuvent être considérées comme l’indice d’un trouble du métabolisme plaquettaire.

Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses' practice

AIMS AND OBJECTIVE

To draw on the findings of a grounded theory study aimed at exploring how power is exercised in nurse-manager relationships in the hospital setting, this paper examines the empirical and pragmatic adequacy of grounded theory as a methodology to advance the concept of empowerment in the area of nursing leadership and management.

BACKGROUND

The evidence on staff nurse empowerment has highlighted the magnitude of individual and organisational outcomes, but has not fully explicated the micro-level processes underlying how power is exercised, shared or created within the nurse-manager relationship. Although grounded theory is a widely adopted nursing research methodology, it remains less used in nursing leadership because of the dominance of quantitative approaches to research. Grounded theory methodology provides the empirical and pragmatic relevance to inform nursing practice and policy. Grounded theory is a relevant qualitative approach to use in leadership research as it provides a fine and detailed analysis of the process underlying complexity and bureaucracy.

DESIGN

Discursive paper.

METHOD

A critical examination of the empirical and pragmatic relevance of grounded theory by (Corbin & Strauss, , ) as a method for analysing and solving problems in nurses' practice is provided.

CONCLUSIONS

This paper provides evidence to support the empirical and pragmatic adequacy of grounded theory methodology. Although the application of the ontological, epistemological and methodological assumptions of grounded theory is challenging, this methodology is useful to address real-life problems in nursing practice by developing theoretical explanations of nurse empowerment, or lack thereof, in the workplace.

RELEVANCE TO CLINICAL PRACTICE

Grounded theory represents a relevant methodology to inform nursing leadership research. Grounded theory is anchored in the reality of practice. The strength of grounded theory is to provide results that can be readily applied to clinical practice and policy as they arise from problems that affect practice and that are meaningful to nurses.

A Critical Perspective on Relations between Staff Nurses and their Nurse Manager: Advancing Nurse Empowerment Theory

This study considers empowerment in nurse-manager relations by examining how conflict is handled on both sides and how the critical social perspective has influenced these relations. The authors use inductive analysis of empirical data to explain how (1) nursing work is organized, structured, and circumscribed by centrally determined policies and practices that downplay nurses' professional judgement about patient care; (2) power is held over nurses in their relationship with their manager; and (3) nurses' response to power is to engage in strategies of resistance. The authors illustrate how power influences relations between staff nurses and managers and provide a critical analysis of the strategies of resistance that result in personal, relational, and critical empowerment among staff nurses. Through resistance, staff nurses engage in alternative discourses to counteract the prevailing neoliberal organizational and managerial discourses of efficiency and cost-effectiveness.

Refugees’ resettlement in a Canadian mid-sized Prairie city: examining experiences of multiple forced migrations

Purpose

– The purpose of this paper is to discuss the experiences of multiple forced migrations and resettlement among two refugee families in a mid-sized Canadian city.

Design/methodology/approach

– Case studies are located within the contingencies of the participants’ lives and the meanings they provide to the events. A postcolonial feminist perspective guided the data analysis to explore the micro-level of individual experiences that unfold within a raced, gendered, and classed reality. Open-ended interviews, participant observation, and field notes were used to collect participants’ perspectives. Data were collected until saturation occurred.

Findings

– An in-depth analysis of these two case studies revealed that lack of choice and lack of access to health and social services affect health through constant revival of traumatic past experiences prior to arrival to Canada. Three themes emerged from the data analysis: first, shared experiences of forced migrations; second, the past and present: construction of new identities; and third, resettlement challenges and opportunities. These themes overlap and intersect to shape the experiences of double forced migration.

Research limitations/implications

– This research has limitations related to the sample size but provides data on a topic that deserves more attention in the field of immigrant and health studies. The authors argue that health and social professionals must resist “finalizing” refugees into disempowered identities that undermine human agency.

Originality/value

– Research on resettlement experiences after forced migration is a burgeoning field in refugee studies. The originality lies in drawing on Bahktin to develop practical implications to guide health and social practice in this area marked by racialization and fundamentalism.

Putting the world as classroom: an application of the inequalities imagination model in nursing and health education

This article focuses on the description of an educational initiative, the Interdisciplinary Population Health Project (IPHP) conducted in the academic year of 2006-2007 with a group of nursing and health care students. Inspired by population health, community development, critical pedagogy, and the inequalities imagination model, students participated in diverse educational activities to become immersed in the everyday life of an underserved urban neighborhood. A sample of convenience composed of 158 students was recruited from 4 health disciplines in a Western Canadian university. Data were collected using a modified version of the Parsell and Bligh's Readiness of Health Care Students for Interprofessional Learning Scale. A one group pretest-posttest design was used to assess the outcomes of the IPHP. Paired t tests and one-way analyses of variance were used to compare the responses of students from different academic programs to determine if there were differences across disciplines. Findings suggest that students' readiness to work in interprofessional teams did not significantly change over the course of their participation in the IPHP. However, the inequalities imagination model may be useful to enhance the quality and the effectiveness of fieldwork learning activities as a means of educating culturally and socially conscious nurses and other health care professionals of the future.

Developing and piloting an online graduate nursing course focused on experiential learning of qualitative research methods

Despite the turmoil of a worldwide economic crisis, the health sector remains largely understaffed, and the nursing shortage represents a major issue that jeopardizes graduate nursing education. Access to education remains a challenge, particularly in rural and remote areas. This article reports the process of developing an asynchronous online qualitative research course. This online course was piloted among 16 interdisciplinary students. Participants agreed that experiential learning was useful to understand the intricacies of qualitative research. Within this constructivist approach, students were immersed in real-life experiences, which focused on the development of skills applicable to qualitative research. Based on the findings, we suggest that constructivism and the Four-Component Instructional Design (4C/ID) model (a four-part approach for fostering the development of complex skills) represent valuable ontological and pedagogical approaches that can be used in online courses. Triangulating these two approaches is also congruent with the student-centered philosophy that underpins nursing graduate programs.

Evaluation of bacterial contamination and control methods in soluble metalworking fluids

In the United States, 1.2 million workers are exposed to metalworking fluids. During operations, aerosols are produced and airborne contaminants can be inhaled. Although biocides are used to control the bacterial content of metalworking fluids, they can create health-related problems, and their efficiency remains to be proved. The objectives of this project were (1) to verify whether rigorous cleaning according to a standard protocol could reduce microbial contamination and (2) whether the use of biocides with different spectra could reduce the bacterial population. Four similar machines producing similar components were evaluated; a specific treatment was applied to each machine. The machine used as a control (1) was thoroughly cleaned prior to sampling, (2) did not undergo any major cleaning afterward, and (3) was operated without the use of any biocide. A major cleaning is a protocol described and recommended by the fluid manufacturer and was performed on the three other machines, two of which were subsequently treated with biocides weekly. Fluid samples from the four lathes were collected weekly during a 6-month period, and total bacterial and cultivable Gram-negative bacteria were analyzed for each sample. Major cleaning of the machines (120-4) did not significantly reduce the concentration of bacteria in the cutting fluids when compared with the control machine (120-3), which had not undergone major cleaning. The concentrations of total bacteria were in the 10(6) CFU/mL range for these two lathes; however, a reduction in the total number of fluid changes was observed for this machine. Bacterial flora in the cutting fluids was significantly controlled with the use of biocides. Bacteria concentrations were in the 10(3)-10(5) CFU/mL range for the lathes with the use of biocides. Since thorough cleaning is insufficient and biocides are recognized as being responsible for some worker health problems, other avenues for controlling bacterial flora in cutting fluids should be evaluated to reduce worker exposure to their bacterial contaminants.

Examining the conflation of multiculturalism, sexism, and religious fundamentalism through Taylor and Bakhtin: expanding post-colonial feminist epistemology

In this post-9/11 era marked by religious and ethnic conflicts and the rise of cultural intolerance, ambiguities arising from the conflation of multiculturalism, sexism, and religious fundamentalism jeopardize the delivery of culturally safe nursing care to non-Western populations. This new social reality requires nurses to develop a heightened awareness of health issues pertaining to racism and ethnocentrism to provide culturally safe care to non-Western immigrants or refugees. Through the lens of post-colonial feminism, this paper explores the challenge of providing culturally safe nursing care in the context of the post-9/11 in Canadian healthcare settings. A critical appraisal of the literature demonstrates that post-colonial feminism, despite some limitations, remains a valuable theoretical perspective to apply in cultural nursing research and develop culturally safe nursing practice. Post-colonial feminism offers the analytical lens to understand how health, social and cultural context, race and gender intersect to impact on non-Western populations' health. However, an uncritical application of post-colonial feminism may not serve racialized men's and women's interests because of its essentialist risk. Post-colonial feminism must expand its epistemological assumptions to integrate Taylor's concept of identity and recognition and Bakhtin's concepts of dialogism and unfinalizability to explore non-Western populations' health issues and the context of nursing practice. This would strengthen the theoretical adequacy of post-colonial feminist approaches in unveiling the process of racialization that arises from the conflation of multiculturalism, sexism, and religious fundamentalism in Western healthcare settings.

[Long-term changes in pupil size after implantation of an Artisan phakic intraocular lens for correction of high myopia]

PURPOSE

To evaluate the long-term changes in pupil size after implantation of an Artisan phakic intraocular lens for correction of high myopia.

PATIENTS AND METHODS

Fourteen myopic eyes of seven patients were included in the study. Pupil size was measured under photopic conditions, under scotopic conditions after 10 min of dark adaptation, and after topical medical mydriasis. The pupil size was measured using the eye image of the OPD scan (Nidek).

RESULTS

The mean follow-up was 46 months after surgery. The mean photopic pupil diameter was 2.94+/-0.33 mm (range, 2.54-3.6 mm). The diameter of the scotopic pupil remained less than 6.0 mm in all patients (4.68+/-0.59 mm, with maximal pupil diameter of 5.67 mm). The mean pupil diameter after pharmacological dilation was also reduced (5.39+/-1.08 mm; range, 4.19-7.59 mm), with pupil dilation more than 7 mm in only one patient.

CONCLUSION

The iris-fixated intraocular lens mechanically limited pupil dilation in our patients. The long-term reduction in pupil size after Artisan phakic intraocular lens implantation may contribute to the maintenance of the quality of vision in scotopic conditions.

[The post-colonial theoretical approach in cultural nursing research about adapting nursing care to non-Western populations]

Providing culturally competent care to non-Western populations remains a challenge in Western pluralist societies. Limitations related to the use of cultural theories to adapt nursing care have to be acknowledged. Cultural theories erase the impact of the larger social context on non-Western populations' health. Health problems arising from social inequities have to be addressed, if culturally adapted nursing interventions, are to be designed. To this end, post-colonialist theoretical approach represents a promising avenue since it is aimed at unmasking health problems intersecting with race, ethnicity, gender, and social classes. Research endeavours are directed at integrating marginalized knowledge in nursing theorization. As well, post-colonialism, from which the concept of cultural safety is derived, is a means to enhance the quality of care offered by nurses coming from dominant ethnic group to non-Western populations.

Implementing a postcolonial feminist perspective in nursing research related to non-Western populations

In this article, I argue that implementing a postcolonial feminist perspective in nursing research transcends the limitations of modern cultural theories in exploring the health problems of non-Western populations. Providing nursing care in pluralist countries like Canada remains a challenge for nurses. First, nurses must reflect on their ethnic background and stereotypes that may impinge on the understanding of cultural differences. Second, dominant health ideologies that underpin nurses' everyday practice and the structural barriers that may constrain the utilization of public healthcare services by non-Western populations must be further examined. Postcolonial feminism is aimed at addressing health inequities stemming from social discriminative practices. I will draw on extant literature and data of an ongoing ethnography exploring the Haitian caregivers' ways of caring for ageing relatives at home to unveil how the larger social and cultural world has an impact on caregivers' everyday lives. Marginalized locations represent privileged sites from which health problems, intersecting with power, race, gender, and social classes, can be addressed. Postcolonial feminism provides the analytic lens to look at the impact of these factors in shaping health experiences. It also suggests redirecting nursing cultural research and practice to achieve social justice in the healthcare system.

Adhesion of Helicobacter pylori to polarized T84 human intestinal cell monolayers is pH dependent

Epithelial cells, which form tight polarized monolayers on porous substrates, constitute ideal model systems to study bacterial adhesion and invasion. The binding of Helicobacter pylori to the apical membrane of T84 cells, an epithelial cell line derived from a human colon carcinoma, was assessed biochemically and morphologically. Attachment was rapid, and binding remained constant over time, with a significant (P < 0.01, Mann-Whitney U test) ca. fourfold increase at pH 5.4 (76% +/- 22%) compared with pH 7.4 (18% +/- 7%). In contrast, adhesion of enteropathogenic Escherichia coli was not enhanced at pH 5.4. The transepithelial electrical resistance of the T84 cell monolayers was not affected by pH or by H. pylori. Following binding, H. pylori induced a reorganization of the brush border as reflected by actin condensation, facilitating the intimate association of the bacteria with the apical plasma membrane. H.pylori was not internalized, as shown by confocal microscopy. Some bacteria, found in deep invaginations of the apical membrane, were probably inaccessible to gentamicin, thus accounting for the observed tolerance to the antibiotic. These data provide the first evidence that an acidic environment favors Helicobacter adhesion and that binding is followed by survival of the survival of the bacteria in pockets of the apical membrane.

Distribution of albumin, alpha 1-inhibitor 3 and their respective mRNAs in periportal and perivenous rat hepatocytes isolated by the digitonin-collagenase technique

The expression of albumin and alpha 1-inhibitor 3 genes was investigated in rat cell suspensions enriched in periportal (n = 10) and perivenous (n = 10) hepatocytes obtained by the digitonin-collagenase technique. The degree of enrichment of the cell suspensions was assessed: (1) by enzymic assays for the periportal marker alanine aminotransferase and for the perivenous marker glutamine synthetase; and (2) by their content of mRNAs for the periportal marker hepatic glutaminase and for glutamine synthetase. The existence of an antegrade intra-lobular gradient for albumin and alpha 1-inhibitor 3 mRNAs was demonstrated, with periportal:perivenous ratios of 2.33 and 3.80, respectively. However, no gradient was demonstrated for the respective protein contents with corresponding ratios of 0.98 and 1.21. A certain degree of overlap existed between periportal and perivenous suspensions for their content in albumin and alpha 1-inhibitor 3 mRNAs. A morphometrical analysis of the surface of digitonin-permeabilized hepatic tissue revealed that this overlap could be explained by a variable extent of permeabilization of the mediolobular zone from one rat to another and from one lobule to another in a given animal. These results suggest that while the digitonin-collagenase technique is well suited for studies in vitro of proteins expressed in sharp intra-lobular gradients or restricted to an intra-lobular compartment, it is not completely reliable for proteins distributed in continuous moderate intra-lobular gradients, such as albumin and alpha 1-inhibitor 3.

Endothelial cell heterogeneity in the normal human liver acinus: in situ immunohistochemical demonstration

While a certain degree of structural and functional intra-lobular heterogeneity of sinusoidal endothelial cells has been observed in rodents, little information is available about the zonal characteristics of sinusoidal endothelial cells in the human liver acinus. We have therefore examined the intra-acinar distribution of a panel of endothelial markers in the normal human liver, including: (a) structural markers of continuous and sinusoidal endothelia (PECAM-1, CD-34 protein, VE-cadherin, 1F10 antigen), (b) functional markers specific for sinusoidal endothelial cells, as previously determined in the laboratory (CD4 protein, the lipopolysaccharide-binding protein receptor (CD 14), aminopeptidase N, ICAM-1, receptors II and III for the Fc fragment of immunoglobulins G), (c) endothelial cell-matrix adhesion proteins and leukocyte-endothelial cell adhesion molecules. We observed a heterogeneous distribution for: (a) the 1F10 antigen, whose distribution in the human liver acinus was restricted to vessels situated along the axis of acinar zone 1, (b) the lipopolysaccharide-binding protein receptor and the receptor III for the Fc fragment of IgG, not expressed or only barely expressed in acinar zone 1. The distribution of the other markers tested did not display significant intra-lobular variation. Our in situ results suggest the existence of a degree of zonal heterogeneity in the structural and functional characteristics of sinusoidal endothelial cells in the human liver acinus. This might contribute to the constitution of distinct microenvironments within the human liver parenchyma.

Effects of digitonin on the intracellular content of rat hepatocytes: implications for its use in the study of intralobular heterogeneity

Anterograde or retrograde perfusion of rat liver with digitonin selectively permeabilizes the periportal or the perivenous zone of the hepatic lobule. Digitonin perfusion is used to analyze the effluents released by permeabilized hepatocytes or, combined with collagenase perfusion, to obtain cell suspensions enriched in either periportal or perivenous hepatocytes. Despite the wide use of digitonin to study lobular heterogeneity, its affects on rat hepatocytes are not well documented. We therefore analyzed the effects of digitonin perfusion on the intracellular content of rat hepatocytes by combining electron microscopy, histoenzymology, immunohistochemistry, and in situ hybridization. At the concentration currently used for the study of lobular heterogeneity, digitonin perfusion induced a marked cytosolic clarification of permeabilized hepatocytes, while most organelles except mitochondria were well preserved. In the digitonin-altered zones, there was no histochemical detection of non-membrane-bound enzymes (lactate dehydrogenase, glutamate dehydrogenase), whereas membrane-bound enzymes (succinate dehydrogenase, beta-hydroxybutyrate dehydrogenase, NADPH dehydrogenase, glucose-6-phosphatase) were still detected. Immunohistochemistry and in situ hybridization revealed significant amounts of several plasma proteins (albumin, alpha 2-macroglobulin, alpha 1-inhibitor 3, alpha 1-acid glycoprotein) and their respective mRNAs in digitonin-permeabilized hepatocytes. The demonstration that digitonin-permeabilized hepatocytes retain many intracellular constituents shows that biochemical analysis of cellular effluents released from digitonin-permeabilized hepatocytes must be interpreted with caution and that the apparent characteristics of cell suspensions obtained by the digitonin-collagenase technique might be significantly altered by contamination with permeabilized hepatocytes from the opposite zone.

Parenchymal innervation of normal and cirrhotic human liver: a light and electron microscopic study using monoclonal antibodies against the neural cell-adhesion molecule

Hepatic innervation participates in the control of sinusoidal blood flow and in the regulation of certain metabolic functions of the liver. The study of the distribution of hepatic nerves has been hampered by the lack of adequate markers. We therefore tested the value of the neural cell-adhesion molecule (NCAM) as a probe for the study of parenchymal nerves in the normal and cirrhotic human liver. Four antibodies against various epitopes of NCAM were tested by light and electron microscopic immunohistochemistry: Leu19, ERIC-1, VC1.1, and HNK-1. Their reactivity was compared with that of antibodies against the following neural cell markers: S100 protein, neurofilaments, and neuron-specific enolase (NSE). The tissue reactivity of anti-NCAM antibodies was variable, suggesting a microheterogeneity of the NCAM molecule in the normal liver. Clones Leu19 and ERIC-1 proved to be the most sensitive of the anti-NCAM antibodies. Their sensitivity was superior to that of the antibodies directed against the other neural cell markers tested. In the normal liver, both Leu19 and ERIC-1 demonstrated a heterogeneous distribution of nerve fibers inside the hepatic lobule. Intralobular nerve fibers predominated in Zone 1. This might contribute to the constitution of distinct zonal microenvironments inside the hepatic lobule. In cirrhosis, no nerve fiber was detected inside parenchymal nodules; no nerve plexus was visible at the contact of proliferating neoductules. These alterations might contribute to the pathogenesis of the hemodynamic and metabolic disorders observed in cirrhosis.

Functional hepatocellular heterogeneity for the production of plasma proteins

It is now well established that hepatocytes are the main liver cells responsible for the synthesis of plasma proteins produced by the liver. That these cells are not specialized in the production of the different plasma proteins is also well established. Presently the point still debated is whether a functional hepatocellular heterogeneity exists for plasma protein synthesis as for many other hepatocyte functions. Several physiological and pathological situations suggest that this heterogeneity takes place in the hepatocytes of two opposite hepatic lobular zones, the periportal and centrilobular zones. However, this zonal difference, which supposes different regulatory mechanisms, must be confirmed by techniques other than the now classical immunocytochemistry or the in situ hybridization technique recently proposed for the demonstration of mRNAs in hepatocytes. Another hepatocellular heterogeneity, the intercellular heterogeneity, which can be observed in the same lobular zone, is more difficult to analyze, but shows that from hepatocyte to hepatocyte a variation exists in the synthesis of a given plasma protein.

Transfection of lipoma cells with papilloma bovine virus subgenomic fragment

Lipoma cells with consistent chromosomal aberration have been transfected with plasmids carrying papilloma bovine virus subgenomic fragment (PBV 69). The successful transformation of the cells was ascerted on the changed growth pattern of the cells in liquid medium, colony formation in soft agar and modified cell appearance in electron microscopy; transfection with PBV 69 has not been, however, sufficient to immortalize lipoma cells.

HIV infection among Quebec women giving birth to live infants

This is the first anonymous unlinked seroprevalence study in Canada to use serum samples from newborns to determine the seroprevalence rate of human immunodeficiency virus (HIV) infection among childbearing women. Of the 68,808 samples tested 42 were confirmed as positive, for an overall crude seroprevalence rate of 6.1 per 10,000 live births (95% confidence interval [CI] 4.4 to 8.3), or 1 woman in 1638. Women who lived on Montreal island had an overall rate of 17.9 per 10,000 live births (95% CI 12.2 to 25.4), or 1 woman in 559. We observed a significant association between revenue index and seroprevalence; the rates were as high as 46.4 per 10,000 live births (95% CI 18.7 to 95.3), or 1 woman in 216, for Montreal island postal code areas with revenue indexes 20% or more below the provincial median. Extrapolation of the data suggested that 56 women with HIV infection gave birth to a live infant during 1989 in Quebec. Even though attempts to generalize the data from childbearing women to women of childbearing age have an inherent conservative bias, the results of our study suggest that 988 women (95% CI 713 to 1336) aged 15 to 44 years in Quebec had HIV infection in 1989. The actual number is likely substantially higher. The need for well-designed, creative interventions to prevent further HIV transmission to women is evident. Planning for the provision of medical and psychosocial services sensitive to specific needs of women who are already infected should start immediately.

Polarized transport of the polymeric immunoglobulin receptor in transfected rabbit mammary epithelial cells

A cDNA for the rabbit low Mr polymeric immunoglobulin (poly-Ig) receptor was expressed in an immortalized rabbit mammary cell line. The intracellular routing of the receptor and its cell surface expression was analyzed in stably transfected cells grown on permeable supports. Initially the cells formed a monolayer with no transmural electrical resistance. All monolayer cells expressed the poly-Ig receptor and cytokeratin 7 filaments characteristic of luminal mammary cells but absent in myoepithelial cells. Within 7 d in culture, the cells underwent cytodifferentiation and formed a bilayer with a transepithelial electrical resistance of approximately 500 omega x cm2. Upper layer cells formed tight junctions with adjacent cells and gap junctions with basal cells. Expression of the poly-Ig receptor and cytokeratin 7 was restricted to the cells from the upper layer. The kinetics of receptor biosynthesis and processing was similar to that reported for rabbit mammary gland and rat liver. The receptor was cleaved at the apical cell surface and release of secretory component into the apical medium occurred with a half-time of approximately 2 h. Selective cell surface trypsinization combined with pulse-chase experiments served to determine at which cell surface domain newly synthesized receptor appeared first. The receptor was digested with a half-time of approximately 60 min with trypsin present in the basolateral medium and 90 min with apical trypsin. These data are consistent with selective targeting of newly synthesized receptor to the basolateral surface. The results indicate that transcytosis of the receptor from basolateral to apical membrane in the presence or the absence of its ligand requires approximately 30 min. Cleavage of the receptor by endogenous protease is not concomitant with its appearance at the apical surface, but requires additional time, thus explaining the presence of intact receptor on the apical membrane.

Distribution and processing of the polymeric immunoglobulin receptor in the rat hepatocyte: morphological and biochemical characterization of subcellular fractions

The transepithelial transport of polymeric immunoglobulins is an essential process in the mucosal immune system. Transport across the epithelial cells of mucous or exocrine glands is affected by an integral membrane glycoprotein receptor known as membrane secretory component (SCm) or as polymeric immunoglobulin receptor (pIgR). This receptor binds polymeric immunoglobulins at the basolateral cell surface and mediates their transcellular translocation and their release from the apical plasma membrane into external secretions. Release depends on cleavage of the membrane-anchoring domain of the receptor, resulting in liberation of polymeric immunoglobulin bound to the ectoplasmic domain of the receptor (secreted SC or SCs) into extracellular secretions. Using a monoclonal antibody directed against the cytoplasmic tail of the receptor and a polyclonal antibody directed against the secreted ectoplasmic domain, we have combined cell fractionation and Western blotting techniques to examine the fate of these receptor domains in the hepatocyte. In this study, we characterize biochemically and morphologically the various subcellular components separated by our fractionation scheme, and correlate this with biochemical analysis of the receptor in each fraction.

Effect of cell shape change on the function and differentiation of rabbit mammary cells in culture

We examined the role of cell shape, cytodifferentiation, and tissue topography on the induction and maintenance of functional differentiation in rabbit mammary cells grown as primary cultures on two-dimensional collagen surfaces or in three-dimensional collagen matrices. Mammary glands from mid-pregnant rabbits were dissociated into single cells, and epithelial cells were enriched by isopycnic centrifugation. Small spheroids of epithelial cells (approximately 50 cells) that formed on a rotary shaker were plated on or embedded in collagen gels. The cells were cultured for 1 d in serum-containing medium and then for up to 25 d in chemically defined medium. In some experiments, epithelial monolayers on gels were mechanically freed from the dishes on day 2 or 5. These gels retracted and formed floating collagen gels. On attached collagen gels, flat monolayers of a single cell type developed within a few days. The cells synthesized DNA until the achievement of confluence but did not accumulate milk proteins. No morphological changes were induced by prolactin (PRL). On floating gels, two cell types appeared in the absence of cell proliferation. The cells in direct contact with the medium became cuboidal and developed intracellular organelles typical of secretory cells. PRL-induced lipogenesis, resulting in large fat droplets filling the apical cytoplasm and accumulation of casein and alpha-lactalbumin in vesicles surrounding the fat droplets. We detected tranferrin in the presence or absence of PRL intracellularly in small vesicles but also in the collagen matrix in contact with the cell layer. The second cell type, rich in microfilaments and reminiscent of the myoepithelial cells, was situated between the secretory cell layer and the collagen matrix. In embedding gels, the cells formed hollow ductlike structures, which grew continuously in size. Secretory cells formed typical lumina distended by secretory products. We found few microfilament-rich cells in contact with the collagen gels. Storage and secretion of fat, caseins and alpha-lactalbumin required the presence of PRL, whereas the accumulation and vectorial discharge of transferrin was prolactin independent. There was no differentiation gradient between the tip and the cent of the outgrowth, since DNA synthesis and milk protein storage were random along the tubular structures. These results indicate that establishment of functional polarity and induction of cytodifferentiation are influenced by the nature of the interaction of the cells with the collagen structure. The morphological differentiation in turn plays an important role in the synthesis, storage, and secretion of fat and milk proteins.

Attempts to quantitate immunocytochemistry at the electron microscope level

The ability to localize intracellular macromolecules in situ by high resolution techniques has been made possible by the development of antibody labelling of thin sections obtained either from tissues embedded in an hydrophilic matrix, or by ultracryotomy or from conventional plastic embedded tissue. When particle-tagged immunological reagents are used to visualize intracellular antigens, quantitative information can be obtained by combining particle counts with morphometric estimations of compartment volume. Various detection systems have been used successfully for quantitation, which include ferritin-conjugated antibodies, biotin-avidin-ferritin complexes and, more recently, gold-protein A conjugates. Examples of the use of these techniques the localization of secretory proteins in pancreatic exocrine cells, opsin and a large membrane protein in photoreceptor cells of frog retina, and contractile proteins in skeletal muscle are given. Quantitative data obtained by morphometric analysis, both in bovine and rat pancreatic exocrine cells, are compared with values assessed by biochemical methods.