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Recent changes in nurse education have led to a desire in nurse educators to promote meaningful learning rather than rote learning of facts. A major metacognitive learning strategy that appears to promote this is concept mapping. However, many nurse educators appear to be unaware of this strategy's existence, or of the research evidence available that supports the claim of promoting meaningful learning. This paper sets out to address these issues. It explores the nature of a concept map, the research on concept mapping and meaningful learning and possible reasons why its use has not been noticeable in nurse education. By addressing these issues it is hoped that more nurse educators will attempt to use concept mapping in the promotion of meaningful learning.

Hundreds of millions of passengers travel on U.S. airliners annually. These large numbers, together with the close proximity required onboard, raise a concern about microbiologic disease transmission in cabin air. Previous air quality surveys generally concentrated on environmental tobacco smoke and particulate matter. They largely ignored the microorganisms also present. We sampled the microbiologic climate of 45 domestic and international flights. We also sampled common locations in a major southwestern city. The concentration of microorganisms in airline cabin air is much lower than in ordinary city locations. We conclude that the small number of microorganisms found in U.S. airliner cabin environments does not contribute to the risk of disease transmission among passengers.

Insulin-like growth factor-binding proteins (IGFBPs) in sera from non-pregnant and pregnant women, and from the umbilical cord at the time of delivery, were separated by gel filtration chromatography. The binding characteristics of the 150 and 40 kDa binding proteins were examined by Scatchard analysis. In serum from pregnant women, the affinity of the 150 kDa binding proteins (IGFBP-3) decreased as pregnancy progressed, with an apparent increase in the maximum binding capacity. In contrast, the affinity of the 40 kDa binding proteins showed a slight increase. In umbilical cord serum, the binding affinity of both the 150 and 40 kDa binding proteins was similar, whereas the binding capacity was two-fold higher in the 40 kDa than in the 150 kDa group. Both maternal and umbilical cord serum (artery and vein) contained unoccupied IGFBPs. Following acid treatment, there was an increase in binding of 125I-IGF-I to umbilical cord serum but a decrease in that to maternal serum. These changes in the characteristics of the binding proteins in the pregnancy sera are probably due to partial degradation of the 150 kDa binding proteins by proteases. The present data confirm that IGFBP-3 is the main binding protein for IGFs during pregnancy, although its affinity is decreased. In fetal circulation, the 40 kDa binding proteins appear to be the major IGFBP with a high affinity and high capacity.

Objective: To study some of the metabolic effects of oral gestrinone on plasma lipoprotein risk markers for cardiovascular disease and on bone density, a risk marker for osteoporosis., Design: Randomized double-blind study., Setting: All patients were referred to Gynaecology Clinic of Royal Free Hospital Medical School., Patients: Twenty premenopausal women with laparoscopically confirmed endometriosis., Interventions: Subjects were randomized in a double-blind fashion to receive either 1.25 mg or 2.5 mg gestrinone two times per week for 6 months., Main Outcome Measure: Laparoscopy was performed before treatment, and clinical responses were determined by second laparoscopy after 6 months. Plasma lipid and bone density measurements during and after therapy were compared with baseline., Result: Median total endometriosis scores decreased from 7.5 to 1.0 in the 1.25-mg group and from 7.0 to 0 in the 2.5-mg group. There were no significant between-group differences in endometriosis scores. At both doses, bone density in the spine and the proximal femur was conserved, but plasma concentrations of low-density lipoproteins rose by 13% and those of high-density lipoproteins fell by 40%., Conclusions: Reducing the dose of gestrinone to 1.25 mg appeared to maintain the therapeutic effectiveness of this treatment but was still associated with potentially unfavorable effects on lipids and lipoproteins.

The finding of primary or metastatic carcinoma in an episiotomy scar is a rare event; we report three cases. The first patient presented with an abnormal cervical smear and was found to have a primary squamous cell carcinoma of the vulva in an old, healed episiotomy scar. A second patient, diagnosed as having cervical carcinoma 6 months postpartum, was found to have a metastatic deposit in the episiotomy scar during the staging of her disease. The third patient developed adenocarcinoma metastatic from an endocervical primary in an episiotomy scar that presented as a small nodule at the introitus. These cases exemplify the need for careful inspection and biopsy of any nodular lesions in episiotomy scars as part of the initial assessment and follow-up of patients with premalignant or malignant lesions of the lower genital tract.

It is all too often assumed, by both healthcare professionals and many elderly people themselves, that incontinence is an inevitable part of old age. Careful assessment and treatment, the provision of suitable aids and the restoration of self-esteem can help many elderly people to achieve full continence control.

Monitoring of the influence of cardiopulmonary bypass (CPB) on hematologic parameters is relevant to an improved understanding of the pathophysiology produced, as well as for the development of improved methods. The selection of suitable parameters is highly important. In this study, both contact phase activation and leukocyte response have been studied. Contact activation was determined by a novel assay for the measurement of Factor XII activity (FXIIA), and leukocyte response was measured by the release of granulocyte elastase. Five patients undergoing elective coronary artery surgery using a bubble oxygenator and pulsatile perfusion were studied. A notable feature of this study was the gradual increase of FXIIA during the study period, with granulocyte elastase levels following a similar pattern. Both FXIIA and granulocyte elastase are appropriate parameters for monitoring CPB, and could be useful in studying alternative bypass procedures and antithrombotic agents.

To assess the possible role of virus infections in spontaneous abortion we undertook a prospective study of three groups of patients: women who had a spontaneous abortion; women seen in the antenatal booking clinic; and those undergoing therapeutic termination of pregnancy. Venous blood was taken for antibody detection, cervical swabs for virus isolation, and in the cases of spontaneous and therapeutic abortion products of conception were sent for virus culture. The infectious agents studied were influenza A and B, adenovirus, respiratory syncytial virus, measles, psittacosis, Varicella zoster, and mumps virus. Statistical analysis revealed that women in the spontaneous abortion group has a higher incidence of antibodies against respiratory syncytial virus (P less than 0.01), and mumps virus (P less than 0.01). Among women seropositive for each virus, higher titres were found only for respiratory syncytial virus (P less than 0.05) in cases rather than controls. These results could be explained if viruses such as respiratory syncytial virus caused abortion or if women having a spontaneous abortion mount exaggerated immune responses to fetal and viral infections, and the former altered immune response is associated with spontaneous abortion.

Domiciliary fetal monitoring via a telephone link has been in clinical use at the Royal Free Hospital for 2 years, during which time 858 traces of 134 patients who were moderately at risk have been transmitted to the hospital. All recognized abnormal heart rate patterns were detected during the study period. In seven patients obstetric intervention took place on the basis of the domiciliary fetal monitoring recording and subsequent hospital monitoring. There were no intrauterine or neonatal deaths, and there was no overall increase in obstetric operative intervention. There appeared to be a significant reduction in the inconvenience suffered by the patient and her family, compared with conventional monitoring. Fetal heart recordings performed solely by the patient were of a high quality and reduced the demand on midwifery resources. To allow this only 3 hours of midwifery time daily was required and no additional demands on obstetric staff were made. It is anticipated that domiciliary fetal monitoring, performed by patients, will become an essential and established service throughout the United Kingdom (and probably Europe) as the principal means of monitoring fetal well-being.