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This article focuses on comparative studies of sebaceous gland ultrastructure. Cattle sebum is apparently formed by lipogenesis and secretion from living cells as well as from degenerating cells, the end-product of a holocrine process. Scrutiny of the mode of sebum synthesis and secretion has been hindered by the lack of an accurate method of determining the rate of secretion, as opposed to excretion, from the gland. A potential chemical marker for study of bovine sebum triglyceride synthesis and output has emerged from the discovery that these triglycerides contain significantly more linoleic acid than those of other bovine tissues; they are unique to the sebaceous gland.

Interspecialty referrals are an essential part of most inpatient stays. With over 130 referrals occurring per week at the Royal Devon and Exeter Hospital, the process must be efficient and safe. The current paper-based 'white card' system was felt to be inefficient, and a Trust incident highlighted patient safety concerns. Questionnaires reinforced the need for improvement, with concerns such as a lack of referral traceability and delays in the referral delivery due to workload. The aims of the project were to improve patient safety and junior doctor efficiency in the referral process. Through appreciative enquiry and the PDSA (Plan-Do-Study-Act) model, an electronic referral system was developed, piloted within two specialties and later expanded to others with improvements made along the way based on user feedback. The system includes novel features including specialties 'acknowledging' a referral to allow referral progress to be tracked. The system stores all referrals, creating a fully auditable inpatient referral pathway. Qualitative data indicated improvement to patient safety and user experience (n=31). Timings for referrals were measured over a 6-month period; referrals became faster with the electronic system, with average time from decision to refer to referral submission improving from 2.1 hours to 1.9 hours, with a noted statistically significant improvement in timings on a statistical process control chart. An unexpected benefit was that patients were also reviewed faster by specialties. Measuring these changes presented a significant challenge due to the complexity of the referral process, and this was a big limitation. Overall, the re-design of a paper-based referral system into an electronic system has been proven to be more efficient and felt to be safer for patients. This is a sustainable change which is being rolled out Trust-wide. We hope that the reporting of this project will help others considering reviewing their inpatient referral pathways., Competing Interests: Competing interests: None declared.

Objective: To compare the efficacy and cost-effectiveness of different induction protocols involving gonadotropins with intrauterine insemination (IUI)., Study Design: We performed a retrospective chart review of 648 IUI cycles. Some patients had gonadotropin injections alone before human chorionic gonadotropin (hCG) and IUI (human menopausal gonadotropin protocol); others were given oral medications, then gonadotropins before hCG and IUI (combination protocol). Outcomes included pregnancy rates, multiple birth rates, endometrial thickness, number of ovarian follicles, injection days, ampules of gonadotropins and cost., Results: The combination protocol was more cost-effective. In first cycles, pregnancy rates, multiple birth rates, number of large follicles produced and cancellation rates were similar. The combination group had fewer days of injections and fewer ampules used. When all cycles were analyzed, the multiple birth rate was lower in the combination group. Comparing the different oral medications in the combination protocols, letrozole yielded higher pregnancy rates than tamoxifen or clomiphene. Multiple birth rates were similar for all oral medications., Conclusion: Combination protocols are less costly and equally effective, with potentially fewer multiple births than with gonadotropins alone. Letrozole may be more effective than clomiphene and tamoxifen in a combination protocol.

Extracellular matrix (ECM) turnover is regulated by matrix metalloproteinases (MMPs) and plays an important role in cardiac remodeling. Previous studies from our lab demonstrated an increase in gelatinolytic-MMP-2 and -9 activities in endocardial tissue from ischemic cardiomyopathic (ICM) and idiopathic dilated cardiomyopathic (DCM) hearts. The signaling mechanism responsible for the left ventricular (LV) remodeling, however, is unclear. Administration of cardiac specific inhibitor of metalloproteinase (CIMP) prevented the activation of MMP-2 and -9 in ailing to failing myocardium. Activation of MMP-2 and -9 leads to induction of proteinase activated receptor-1 (PAR-1). We hypothesize that the early induction of MMP-9 is a key regulator for modulating intracellular signaling through activation of PAR and various downstream events which are implicated in development of cardiac fibrosis in an extracellular receptor mediated kinase-1 (ERK-1) and focal adhesion kinase (FAK) dependent manner. To test this hypothesis, explanted human heart tissues from ICM and DCM patients were obtained at the time of orthotopic cardiac transplants. Quantitative analysis of MMP-2 and -9 gelatinolytic activities was made by real-time quantitative zymography. Gel phosphorylation staining for PAR-1 showed a significant increase in ICM hearts. Western blot and RT-PCR analysis and in-situ labeling, showed significant increased expression of PAR-1, ERK-1and FAK in ICM and DCM. These observations suggest that the enhanced expression and potentially increased activity of LV myocardial MMP-9 triggers the signal cascade instigating cardiac remodeling. This early mechanism for the initiation of LV remodeling appears to have a role in end-stage human heart failure.

Research can be a challenging subject for nursing students at all levels. Although a research course was a prerequisite for admittance to our masters of science in nursing program at Viterbo University, faculty found that students had varying levels of expertise with the content as well as differing attitudes toward research in practice. To initiate "research thinking" early in the program, 2 faculty members integrated research concepts across 2 of the core courses, one being the nursing research course. Both quantitative and qualitative methods were taught using didactic and experiential methods over 2 semesters. Through the combined activities in the 2 courses, many skills and a new appreciation for nursing research were instilled.

A common question asked about abused women is, "Why don't they leave?" This qualitative study explored the experiences of 15 African American and 15 Anglo American women who had terminated abusive relationships. The constant comparative method of analysis of audiotaped interviews revealed a 3-phase process of leaving: being in, getting out, and going on. Participants endured abuse until they could relinquish the fantasy of a happy relationship. Differences in relationship power and public response to abuse distinguished the experiences of Anglo and African American participants. Findings support the notion of leaving as a social process with similarities across both groups. However, critical differences in responses suggest that leaving is a culture-bound experience.

A novel abnormality of intramural coronary arteries has been recently described in allograft cardiac biopsies. Three-dimensional (3-D) models of these abnormal arteries have now been constructed from serial histological sections of diagnostic post-transplant endomyocardial biopsies. These revealed that there was an interlacing meshwork of longitudinal smooth muscle bundles in abnormal arteries. In addition, the lumen and external surface of these arteries were irregular. This contrasted with reconstructions of normal control arteries in the same sections, which were smooth and straight. This elucidation of an unusual abnormality suggests that 3-D reconstruction of arteries in forceps biopsies may be a useful technique.

Healthcare reform has affected all aspects of the healthcare system including nursing education. According to Nursing's Agenda for Health Care Reform, a major focus of future care will be in the community. Critical thinking skills are needed to practice effectively in this domain. Critical thinking has been identified by the NLN as an outcome criteria for baccalaureate education. The following community health project was designed to develop this outcome skill of critical thinking.

This article gives a brief description of the history of perioperative education, as well as an overview of the theories of teaching and learning. It discusses general principles of learning, factors facilitating learning, and factors hindering learning. Learning needs and interventions for special populations such as the pediatric patient, the elderly patient, and the ethnic patient are also identified and briefly discussed.

The 1,25-dihydroxyvitamin D3 receptor becomes phosphorylated upon treatment with 1,25-dihydroxyvitamin D3. We have investigated the role of phosphorylation in the transcriptional activity induced by 1,25-dihydroxyvitamin D3 through its receptor. An active 1,25-dihydroxyvitamin D3-dependent transcription system was reconstituted in CV-1 cells by co-transfection of plasmids containing the rat 1,25-(OH)2D3 receptor DNA and a functional vitamin D response element (DRE) in a reporter gene construct. Treatment of these transiently transfected CV-1 cells with modulators of protein kinase A (8-Br-cAMP, PKIA and H-9) and phosphatases (Okadaic acid) resulted in mimicking or abolishing the transcriptional activity of 1,25-dihydroxyvitamin D3 in a receptor-dependent fashion. These modulators directly altered 1,25-dihydroxyvitamin D3 receptor phosphorylation. Therefore, the present results strongly suggest that phosphorylation plays a central role in the transcriptional activity of the 1,25-dihydroxyvitamin D3 receptor.

Domestic violence is a major health issue. Research on this problem is just in its infancy. It remains a problem because there has been widespread acceptance of violence in our culture as a means of solving and dealing with problems. Women have been the targets. Waites admonishes health professionals to stop using the concept of masochism as an explanation for abusive behavior. She asks instead for us to look at female motivation in terms of the actual choices that are available and the realistic consequences of these choices. Perhaps only then will health professionals become able to break the cycle of violence and intervene in a way that stops the woman from becoming another homicide statistic.

Scabies may cause severe problems in immunocompromised persons. Three case histories are presented which illustrate these problems in people with advanced AIDS. Recommendations for treatment and management are made, with a comment about the need for a high level of suspicion about any atypical rash in an immunocompromised patient.

Previous research has documented an association between overall Type A behavior and marital dissatisfaction. The present study examines the nature of this relationship when a two dimensional approach to Type A behavior is adopted, and impatience-irritability and achievement striving are assessed separately. Subjects were 134 medical practitioners and specialists and their wives in South Africa. As predicted, husbands' impatience-irritability was associated with their own and their wives' marital dissatisfaction. However, neither their achievement striving nor global Type A behavior correlated with their own or their wives' marital dissatisfaction. The results are discussed in terms of the need for isolating the specific component of Type A behavior that is associated with marital dissatisfaction.

Between September 1985 and June 1988, 6923 people (4550 men and 2373 women) were tested for HIV-1 antibodies at a sexually transmitted disease clinic, London, UK. Of the 6923 individuals tested, 558 (8%) were seropositive, of whom 523 (94%) were men and 35 (6%) women. Of the seropositives, 84% were homosexual or bisexual men, 5% were intravenous drug users, 4% were heterosexual contacts of HIV seropositives, 4% had multiple risk factors, 2% were heterosexual contacts of central African partners and 1% were heterosexuals with no other risk factors. This prevalence pattern conforms to that observed in other industrialized nations. For the women, heterosexual intercourse with an HIV-infected partner, intravenous drug use and heterosexual contact with a partner from central Africa were the main risk factors for infection. The important risk factors among the men were heterosexual contact with an HIV-seropositive partner, being homosexual or bisexual, intravenous drug use and heterosexual contact with a resident from central Africa. heterosexual and homosexual transmission were implicated as the main routes for viral spread in this British population.

A case of T-cell chronic lymphocytic leukaemia (T-CLL) with an unusual mature membrane phenotype: E+, CD3+, CD4+, CD8-, M1+, Leu-15+, Fc gamma+, is described. The cells were large granular lymphocytes with slight immature features. Functionally these cells lacked helper, suppressor and NK activity but possessed normal levels of K activity. These findings demonstrate several features not previously described in T-CLL: the coexpression of the antigens detected by T4, M1 and Leu-15 the presence of Fc gamma receptors on CD4+ lymphocytes and the lack of NK activity in M1+, Fc gamma+ cells. This study broadens the known heterogeneity of T-CLL and suggests the existence of a hitherto unrecognized normal T-lymphocyte subset with the same functional and phenotypic characteristics as in the case described here.

An electrical control unit is described which permits analogue signals from most sources to be made compatible with, and optimise the use of, an A/D converter. This circuitry enables the signal to be offset, relative to the electrical zero, and to be reset to zero using a push button. Extension of this unit has enabled mechanical movement, such as rotation of a shaft, to be measured. In order to make the most efficient use of the A/D converter the gain of the output can be varied.

Burnout is costly to the employees who experience it, their employers, and their patients. Individuals who leave nursing waste their education; those who stay pay a psychological price. The organization loses talent and gains poor performance from its employees. Patients lose quality care. As a health professional, listen to your body and mind, become aware of the danger signals, and acknowledge your feelings. Burnout, if diagnosed, can be diminished through careful planning, intervention, and evaluation of your personal and professional life.

Three-dimensional reconstructions and ultrastructural evidence on the sebaceous glands of man and domestic animals indicate that sebum is produced from a column of developing and degenerating cell populations derived from peripheral progenitor cells at the base of the lobe in a manner analogous to hair growth. The remainder of the peripheral cells apparently have no direct involvement with sebocyte production; those towards the neck of the gland contribute keratin to the secretory product.

A semi-automatic system has been developed for measuring the migration of leucocytes within a micropore filter. The distance in micrometers is displayed digitally or analysed on-line by a digital computer. These improvements have resulted in considerable saving in time, permitting the full potential of the micropore method to be utilised. To illustrate this technique we report results from experiments to measure dose-response relationships of leucocytes to casein and the variation in response to Staphylococcus aureus and casein of cells from normal human subjects.