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The term "tactical medicine" can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years' literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making.

Background: The introduction of non-invasive ventilation outside the Intensive Care Unit (ICU) is an increasing phenomenon, motivated by the shortage of intensive care beds and growing confidence with the technique. However, although general ward nurses are responsible for carrying out the daily management of the treatment and the extra monitoring it requires, their perspective on non-invasive ventilation (NIV) has never before been studied, and as a result their training is often neglected., Methods: A questionnaire was administered to the nurses of four non-intensive wards. The questionnaire addressed several issues, including the extent of the nurses' involvement in the decision to start the treatment, their relationship with the ward physicians and the Medical Emergency Team (MET), the monitoring, incidence, and management of errors and complications, the adhesion to the prescribed ventilatory program, and the desired training., Results: Out of 115 nurses, 90 completed the questionnaire (78.3%). Of this group, 67% did not feel involved in the decision-making process, and half felt they were inadequately informed. Approximately one third reported that they did not have adequate consultations with the doctors in the ward or with the MET. Only 13% of the nurses stated that the training was adequate (0% in medical wards)., Conclusions: Nurses indicated a strong demand for training on NIV, in order to improve their involvement with the therapeutic program and for better communication with the MET and ward doctors. We conclude that active research towards understanding their point of view should be included as part of the quality control of NIV treatments outside the ICU.

Changes in the healthcare industry have created great challenges for leaders of acute-care organizations. One of the greatest challenges is ensuring a competent nursing staff to care for patients within this changing environment (Boylan & Westra, 1998). Patients are more acutely ill and have shorter lengths of stay, placing greater demands on nurses who must demonstrate competency in caring for increasingly complex patients in a continually changing healthcare environment. Competency is defined as "the knowledge, skills, ability and behaviors that a person possesses in order to perform tasks correctly and skillfully" (O'Shea, 2002, p. 175). Competency assessment involves more than a checklist and a test. Hospitals are required to assess, maintain, demonstrate, track, and improve the competence of the staff. Competency assessment is an ongoing process of initial development, maintenance of knowledge and skills, educational consultation, remediation, and redevelopment. Methods to assess competencies include competency fairs, Performance Based Development System and online programs. Certain key people should be involved in the development of competencies. The department managers can give input related to department-specific competencies. Experienced staff members can provide valuable insight into the competencies that need to be assessed. Educators should be involved for providing the input for the methods used to validate competencies. Competencies are an important part of the work world. They are a part of a continual process to help ensure that the organization provides a high-quality care to its customers and patients.

We investigated the effects of capillin, a constituent of Artemisia monosperma, on four human tumour cell lines: colon carcinoma H729, pancreatic carcinoma MIA PaCa-2, epidermoid carcinoma of the larynx HEp-2 and lung carcinoma A549. Cells were treated with capillin to examine both the anti-proliferative and pro-apoptotic effects, as well as the molecular mechanism underlying these effects. Changes in cell proliferation, membrane permeability, macromolecular synthesis, glutathione (GSH), cell cycle and programmed cell death were evaluated. Capillin (1microM-10microM) inhibited cell proliferation and decreased macromolecular synthesis simultaneously, in a dose- and time-dependent manner. Co-incubation with L-buthionine sulfoximine (L-BSO) augmented the efficacy of capillin. Capillin modulated GSH levels, accumulated cells in the S+G2/M-phase of the cell cycle and induced cell death and DNA fragmentation, as indicated by flow cytometry, fluorescence microscopy and DNA fragmentation assay. These findings suggest that capillin has cytotoxic activity and can induce apoptosis in human tumour cell lines.

Ethanolic extracts of 20 plant species, selected from the ethnobotanical literature, were analysed for their pharmacological potential as antineoplastic agents against the HEp-2 cell line. Psoralea corylifolia and E. grandidens were the most efficacious species eliciting IC50 values of 22 microg/ml and 57 microg/ml respectively. Psoralea corylifolia, additionally tested against lung carcinoma (A549) cells gave an IC50 value of 68 microg/ml. Such data would justify a search for active compounds from this species.

The opioid peptides Leu-enkephalin and Met-enkephalin are stored intraneuronally in the brain where they are thought to act as neurotransmitters and/or neuromodulators. Evidence for their release from nerve terminals has come from biochemical and pharmacological studies in vitro with brain tissue slices and synaptosomes. Enkephalins also exist in the peripheral nervous system in nerve cell bodies and axon terminals in the gastrointestinal tract, sympathetic ganglia and adrenal gland. In the adrenal gland, high levels of enkephalins are present both in axon terminals of the splanchnic nerve and in the adrenal medullary chromaffin cells where they are stored together with the catecholamines in the chromaffin granules. Stimulation of the adrenal gland in vivo or the perfused gland in vitro causes release of catecholamines and enkephalins into the adrenal vein. However, it is not clear whether the origin of the released enkephalins is the adrenal medullary chromaffin cells or the enkephalin-containing splanchnic nerve terminals that innervate the medulla. We now show that enkephalin and catecholamines are released together from primary cultures of bovine adrenal medullary chromaffin cells by nicotine in a Ca2+-dependent manner.