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Compliance with safety features on smart pumps with drug libraries is a challenge for health care systems. Noncompliance and workarounds heighten the risk for adverse drug events and subsequent costs of patient care. This quality improvement project describes a pump champion innovation implemented over a 6-month period. There was a significant increase in nurses' compliance to drug library software in smart pumps and a decrease in severe harms averted.

Diabetes prone biobreeding rats display several abnormalities in T cell numbers, T cell function and T cell surface phenotype which are associated with the onset of spontaneous disease. One of the most pronounced abnormalities in these animals is a marked T cell lymphopenia which is evident in both CD4+ and CD8+ peripheral T cell subsets. To gain a better understanding as to the nature of T cell responses in these animals, we have utilized RT-PCR to analyze the cytokine mRNA profiles of mitogen activated peripheral T cells derived from lymphopenic and non-lymphopenic animals. Our results suggest that inheritance of the lymphopenia gene, Lyp, is associated with a unique cytokine profile most similar to that previously described for mouse medullary thymocytes. In addition, cell surface staining of peripheral T cells from diabetes prone animals revealed a high frequency of Thyl+ cells, which is characteristic of both thymocytes and recent thymic emigrants. Following thymectomy, T cell responsiveness to a number of different stimuli is greatly reduced on a cell for cell basis as is the absolute number of surviving T cells. Taken collectively, our results suggest that the majority of the peripheral T cell pool in these diabetic prone rats consists of short lived, recent thymic emigrants which most likely also contain the effector cells required for initiation of diabetes.

The most common cause of renal allograft failure, after the first year posttransplant, is chronic rejection (CR). The impact on allograft loss of CR has remained constant despite the improvements in immunosuppression that have occurred. This process is characterized by a gradual decline in graft function over months to years. Proliferation of vascular smooth muscle cells and fibrosis of the large arteries are the main pathologic characteristics of CR. The clinical course varies widely among patients, from stable function for years to graft failure within several months. The precipitating factors of CR may be many and are unknown. Chronic rejection is likely to be, at least in part, immune mediated. A history of acute rejection episodes correlates strongly with the development of CR. No method has been clearly shown to prevent or treat CR.

Phenylephrine pivalate has been assumed to be a prodrug devoid of important intrinsic activity because of its structural similarity to dipivefrin (dipivaly epinephrine). However, unlike dipivefrin, the pharmacologic activity of phenylephrine pivalate was not prevented by prior administration of echothiophate iodide. Rabbits pretreated bilaterally with 0.25% echothiophate for two and seven days had similar mydriasis, both in quantity and duration, after receiving 10% phenylephrine hydrochloride to one eye and 1% phenylephrine pivalate to the other eye. This as consistent with the hypothesis that the phenylephrine pivalate molecule has important alpha-adrenergic activity regardless of whether it is converted to phenylephrine.