Expression of B7 co-stimulatory molecules and CD1a antigen by alveolar macrophages in allergic bronchial asthma

BACKGROUND

Lung allergen recognition that takes place in the airways of asthmatic subjects is still a controversial matter.

OBJECTIVE

We hypothesized that a rapid allergen recognition process requires the presence, at the mucosal surface, of professional APC, such as B7+ alveolar macrophages (AM) and/or CD1+ dendritic cells, which usually have a lower expression in the normal human lung.

METHODS

Studies were performed on bronchoalveolar lavage (BAL) fluid collected from 10 untreated allergic subjects and 10 adult normal volunteers. Further controls consisted of five untreated pulmonary sarcoidosis (PS) and four extrinsic allergic alveolitis (EAA) individuals. To ascertain whether T helper 2-type cytokines or allergen influence B7 and CD1 antigen expression, in vitro studies were carried out using unprimed (naive) cord blood plastic-adherent monocytes.

RESULTS

Cytofluorymetric analysis revealed that AM from asthmatics, unlike those from normal subjects or patients with PS or EAA, overexpressed B7-2, CD1a and, to a lesser extent, B7-1 surface molecules. Immunohistochemical studies confirmed the presence of CD1+ dendritic cells in the BAL fluid from asthmatic subjects. On in vitro cultured naive cord blood monocytes both purified Dermatophagoides pteronyssinus allergen and T-cell cytokines, i.e. IL-4 and granulocyte macrophage colony-stimulating factor, induced surface expression of B7-2 and CD1a receptors, whereas they had no appreciable effect on that of B7-1 membrane molecule.

CONCLUSIONS

Taken together, these findings support the proposal that airways of atopic individuals are equipped with professional APC that synergize with allergen-specific T cells for the recognition of intact allergens. When the recognition process takes place, asthmatic symptoms could develop in genetically susceptible individuals.

Identification of a polymorphic nucleotide in oxyR specific for Mycobacterium bovis

Automated sequence analysis of a 410-bp region of the axyR gene in 105 Mycobacterium tuberculosis complex isolates identified a polymorphic nucleotide that differentiated Mycobacterium bovis isolates from other complex members. All 29 M. bovis isolates sequenced had an adenine residue at nucleotide 285, whereas all 76 other complex isolates had a guanine residue. PCR-restriction fragment length polymorphism analysis of oxyR with restriction endonuclease AluI in an additional 255 complex isolates from widespread intercontinental sources confirmed and extended the unique association of adenine at position 285 with M. bovis isolates.

Satisfaction of nurse managers in long-term care

Nurse managers control quality and cost of the principal service provided by long-term care agencies. Job satisfaction was higher for long-term care nurse managers in metropolitan than in rural or suburban agencies. Findings suggest that continuing education may increase task satisfaction, as well as job knowledge of diploma-prepared nurse managers.

Factors encouraging and discouraging the use of nursing research findings

A sample of 543 members of Midwest Alliance in Nursing and Midwest Nursing Research Society were surveyed to identify factors encouraging and discouraging research utilization. Lack of time was the factor that most discouraged research utilization. A library containing research journals was available to most service (82 percent) and educator nurses (86 percent). Computer services were more available to educators (85 percent) than service nurses (68 percent). A research newsletter was ranked as more helpful than continuing education or computer networks for keeping abreast of research findings.

Negotiating nurse-patient authority in pediatric home health care

In this qualitative study, pediatric home health nurses described the solitary, ambiguous, and unprogrammed nature of home health nursing. As employees of the family, the nurses in this study found it necessary to negotiate their work tasks and working conditions with family members. In describing the meaning of their work, the nurses emphasized differences between hospital and home health nursing with regard to their authority for care decisions, methods of child discipline, parental control of care, and innovations of nursing routines and interventions. Characteristics of pediatric home nursing are identified in order for these to be communicated to prospective home care nurses, to pediatric nurse educators, and to home health managers. With knowledge of these characteristics, a new home health nurse will be better prepared to negotiate shared patient care responsibilities with the client's family.

Managing HIV-positive and AIDS risks: educational and psychosocial resource assessment

A needs assessment survey reveals many staff nurses incorrectly estimate the HIV contagion risk, inadequately follow universal precaution mandates, and are often unaware of available information and counseling resources. Nurses want current, reliable HIV-AIDS related information and counseling from credible, accessible, and readily available sources. Colleagues, families, and friends' attitudes decidedly influence nurses' capacity to cope emotionally.

Retention of Continuing Education Participants

The Midwest Alliance in Nursing (MAIN) used a multidirectional approach to recruit long-term care nurses to a three-year, federally funded continuing education (CE) program in geriatric nursing. Program staff used a project logo, frequent mailings, bimonthly telephone calls, a series of diverse educational offerings, and scattered social meetings to strengthen participants' identification with the project's purpose and activities. Nevertheless, several nurse dyads failed to complete the program, citing excessive workload and lack of agency support as principal reasons for withdrawal. Program staff concluded that, without strong and continuing support from their employer, even highly motivated nurses will not maintain commitment to an extended-time CE program.

Nursing care costs for a DRG sub-group

This study determined the average cost of nursing care for two DRGs and evaluated how a specific nursing intervention, Phase I Cardiac Rehabilitation, impacts on these costs. A unit-based methodology to determine the cost of providing nursing care to patients who stay on more than one nursing care unit during their hospital stay will facilitate decision making by nurse administrators and clinicians to contain rising health care costs.

Learning from management videos: the producers' point of view

Desiring to use videotapes to teach nursing management and failing to find commercially available tapes on needed topics, the authors produced their own tapes on using a decision tree, negotiating a labor contract, leading a quality circle discussion, defending a budget request, conducting an evaluation conference, and leading a brainstorming session. Having identified the underlying principles for each topic, they wrote scripts for 15 minute vignettes dramatizing a nurse manager's use of each technique. They directed nursing and theater students' portrayals of the characters for each vignette. The edited videotapes of managerial interventions proved to be effective models for nurses enrolled in basic management courses. The scriptwriter, director, camera operator, and student actors all acquired an in-depth understanding of the videotaped managerial interventions through their research and prerehearsal conferences.

Marketing the home healthcare agency. Do nurses and physicians agree?

Increasingly, hospital nurse administrators are being called upon to organize and implement home care services and to market these services to physicians, patients, and family members. A survey of hospital personnel revealed that both nurses and physicians perceived themselves as the persons primarily responsible for determining the patient's need for postdischarge home care. In listing criteria for selecting a home care agency for patient referral, nurses and physicians rated service dependability and nursing care quality as the most important criteria.

Managerial interests and personal attributes of nurses

This study replicated another by Hanson and Chater (1983) that investigated the relationship between interest in management roles and personality, demographic, and career background characteristics of female nurses. For the present study, 128 sophomore, senior, and master's degree students were asked to participate and a self-selected convenience sample of 69 was obtained. Three instruments were used: The Vocational Preference Inventory (VPI), to measure personality traits; a demographic data questionnaire, to measure demographic variables; and the Strong-Campbell Interest Inventory, to measure managerial interests. The total sample of nurses exhibited an artistic-social-intellectual profile. The subhypothesis that nurses of different education levels would exhibit different personality profiles was supported. Analysis of VPI scores demonstrated a statistically significant association between higher educational levels of nurses and higher acquiescence scores, (F = 5.1729 with a significance level of 0.0082). Analysis of variance of Vocational Preference Inventory scale scores showed a statistically significant association between nurses interested in management and higher scores on the enterprising attribute (F = 5.7753 with a significance level of 0.0266). No significant difference was found between management and nonmanagement interest groups in demographic and career characteristics. The findings of this study contribute more insight and knowledge about nurses who select management and administrative roles.

Maximizing the Benefits of Management Education for Nurses

Funding from a Division of Nursing training grant supported the management education of 35 first- and middle-level nurse managers from a variety of hospitals, clinics, and home health agencies. Nurse administrators and scholars introduced nurse management approaches and techniques to the program participants in three workshops that featured lectures, group exercises, group discussions, and videotapes. Project staff provided ongoing counseling and support to participants by means of teleconferences and telephone coaching, with the result that participants applied many of their newly learned concepts and skills on the job.

The emotional and behavioral process of staff nurse turnover

Nurses who leave their jobs proceed through stages of disengagement, some of which are quite intense. Yet 88% of the nurses in this study say that an appropriate managerial intervention early in their leave-taking decision process would have halted their decision to leave. The authors describe stages of nurses' leave-taking decisions, their experiences, and their behaviors.

Impaired cognition in the critically ill elderly patient: clinical implications

Cognitive impairment is a significant health problem for the critically ill aged and warrants further investigation. Despite the lack of knowledge of all aspects of cognitive impairment, much can be undertaken to improve the care of impaired patients. Nurses must routinely, systematically, and comprehensively assess the cognitive state of each elderly patient at the time of admission and daily throughout hospitalization. On the basis of these assessments, nurses must accurately differentiate among confusion, depression, and dementia in the cognitively impaired patient. To carry out such assessments, modification of existing tools, such as the MMSE, may be necessary. Only through such assessment, however, is it possible to detect, prevent, or treat changes in cognition, and thereby prevent its sequelae.

Resource teams: their structure and use

With the current nursing shortage and changing health care climate, nursing administrators are concerned with the effective and efficient use of supplementary staffs such as internal resource teams (RTs) or float pools. This article describes a telephone survey of 20 leading hospitals nationwide, which identified organization structure, personnel use, and the main characteristics of state-of-the-art resource teams.

Effect of advance organizers on learning medical surgical nursing content by baccalaureate nursing students

The hypothesis for this study was that a verbal advance organizer would increase learning and retention of class content more in subjects with greater field independence and with higher scholastic aptitude. The sample was 43 junior baccalaureate nursing students, randomly assigned to experimental and control groups. Sophomore cumulative grade point averages were used as a measure of scholastic aptitude and Group Embedded Figures Test scores as measures of field independence. An expository organizer was presented to experimental subjects and a passage of nonorganizing historical information to control subjects at the beginning of each of six classes. Class quizzes were used to measure initial learning, and end-of-unit and final examinations were used to measure intermediate and long range retention of class content. Increased initial learning occurred with exposure to a verbal advance organizer in subjects with above average scholastic ability and below average field independence (p less than .05), but intermediate and long-term retention were not significantly higher in these subjects.