Medicines and breastfeeding.
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Attitude of Health Personnel↗
Biomedical subjects
J M Shepherd
Publications and source records attributed to J M Shepherd.
Novel carbazole degradation genes of Sphingomonas CB3: sequence analysis, transcription, and molecular ecology.
The degradation of aromatic compounds by bacteria is dependent upon specific catabolic operons. The unique car locus isolated from Sphingomonas CB3 encodes the first four enzymes involved in the catabolism of the azaarene carbazole. These include a class II three-component dioxygenase enzyme system, a dihydrodiol dehydrogenase, an extradiol (meta-cleavage) dioxygenase, and a hydrolase. Homology of deduced amino acid sequences is closer to corresponding biphenyl catabolic genes than to previously characterised carbazole degradation genes. Gene arrangement is also identical to that found in some bph loci. The car genes are transcribed when carbazole is utilised as a sole carbon source, and although biphenyl does not serve as a growth substrate for Sphingomonas CB3 it is able to act as a non-metabolisable inducer of the car locus. Ecologically the car genes were detected in polycyclic aromatic hydrocarbon (PAH) contaminated soil associated with a former town gas site.
Amino Acid Sequence↗
Adjuvant VHF therapy in locally recurrent and primary unresectable rectal cancer.
In a prospective randomized study, 434 mHz microwave therapy combined with external beam radiotherapy (VHF + RT) was compared with standard external beam radiotherapy (RT) in controlling locally recurrent or unresectable primary adenocarcinoma of the rectum. Independent assessors documented quality of life scores, performance status, toxicities, local response to treatment, and systemic disease progression before treatment and after treatment and every 8 weeks thereafter. Of 75 patients randomized, 73 were eligible for inclusion in the study. Forty-three of these patients had local pelvic tumour recurrence only and 21 also had distant metastases. In addition, nine patients had primary inoperable carcinomas, two of whom also had metastases. Thirty-seven patients were randomized to RT and 36 to VHF + RT. The median dose of radiation in the VHF+RT arm was 4275 cGy with a median fraction size of 150 cGy and median duration of therapy of 48.5 days versus 4500 cGy in the RT-only arm with a median fraction size of 180 cGy and median duration of therapy of 38 days. These doses are unlikely to be significantly different in biological effect. No significant difference between the two groups was observed in extent and duration of local control, measures of toxicity or quality of life scores. Additionally, survival and cumulative incidence of pelvic site of first progression did not differ significantly between the groups. We conclude that VHF microwave therapy in conjunction with radiotherapy produces no therapeutic advantage over conventional radiation therapy alone in the treatment of locally recurrent rectal carcinoma.
Adenocarcinoma↗
Removal of false-positive reactions from plasma in an enzyme immunoassay for bovine interferon-gamma.
A monoclonal antibody-based sandwich enzyme immunoassay (EIA) for bovine interferon-gamma (IFN-gamma) has been developed and can be used in conjunction with a whole blood culture system to diagnose tuberculosis in cattle. During its development, normal bovine plasma samples were tested to establish background levels of circulatory IFN-gamma. Of 191 samples tested, 81 (42.4%) were positive (OD > 0.1) when tested undiluted in intact monoclonal antibody (IgG1)-coated wells compared to only 8 (4.2%) in F(ab')2-coated wells, which suggested non-specific interference in the EIA rather than circulatory IFN-gamma. Reactivity of all remaining samples was removed by diluting plasmas 1/2 with 1% casein-PBS-0.05% Tween 20 supplemented with an optimum amount (5%) of normal mouse serum (NMS). Serum pools derived from BALB/c, DBA/2, C3H/HeJ, CBA/CaH and Swiss, but not C57BL/6J, mice were found to inhibit equally the reactions of five strong false-positive bovine plasma samples but had no effect on the titre of IFN-gamma in the sample. Sera from other species tested were less effective. This suggests that the interfering factors possess a high degree of specificity, since the immunoglobulin heavy chain of IgG1 produced by all these five strains of mice are allotypically identical and different to IgG1 produced by C57BL/6J mice. The use of F(ab')2 antibody fragments to coat plate wells and sample diluent containing 5% NMS has resulted in an EIA for bovine IFN-gamma that is virtually free from false-positive reactions, has a high degree of reproducibility and a sample detection limit equivalent to approximately 80 pg/ml recombinant bovine IFN-gamma.
Animals↗
A novel format for a rapid sandwich EIA and its application to the identification of snake venoms.
A rapid sandwich enzyme immunoassay format is described where conjugate is lyophilised within the well in which the test reaction will occur. The format is straight forward to manufacture, has a prolonged shelf life, and eliminates one incubation and wash step from the usual test procedure. The technology has been applied to the development of a rapid assay for the identification of snake venom in clinical specimens. The resultant assay was specific and sensitive, provided rapid results and was appropriate for field use.
Immunoenzyme Techniques↗
Enigmatic trigeminal sensory neuropathy diagnosed by facial skin biopsy.
Facial paraesthesia due to perineural malignant infiltration is a well recognised complication of basal and squamous cell carcinomas of the head and neck. Perineural involvement was originally attributed to involvement of the perineural lymphatics; however subsequent studies have demonstrated conclusively that these lymphatics do not exist and that the invasion occurs along the line of least resistance. Previous studies on perineural spread of carcinomas of the head and neck have emphasised diagnostic biopsy of an involved nerve (e.g. the infraorbital, mental or major branches of the trigeminal nerve), or at times craniectomy with exploration of the gasserian ganglion. We suggest that in many cases the diagnosis can be obtained by biopsy of the anaesthetic skin alone, without recourse to more involved biopsy techniques. The following case report illustrates this point.
Biopsy↗
The relationship between clinical decision-making skills in nursing and general critical thinking abilities of senior nursing students in four types of nursing programs.
This descriptive study was undertaken to investigate the relationship between clinical decision-making skills in nursing and critical thinking abilities of senior nursing students in four types of nursing education programs: generic baccalaureate, associate, and diploma--the basic RN programs, along with the upper division baccalaureate (specifically RN completion) program. Fifty senior students from each type of program were conveniently selected. Clinical decision-making in nursing was measured by the Nursing Performance Simulation Instrument. General critical thinking abilities were determined by the Watson-Glaser Critical Thinking Appraisal. Among the basic RN programs, the higher level of general critical thinking ability was attained by generic baccalaureate seniors (mean score, 61.3) compared with the associate (50.0) and diploma (51.3) seniors. The clinical decision-making scores in nursing skills were virtually identical for the three basic programs--generic (32.2), associate (32.2), and diploma (32.3). That is, mean performance scores of the 2-year associate degree, 3-year diploma, and 4-year generic baccalaureate degree students on the Nursing Performance Simulation Instrument showed no statistically significant difference. The mean critical thinking score for the upper division baccalaureate seniors (61.1) was comparable to that of the generic baccalaureate seniors. Clinical decision-making mean score for the upper division seniors was significantly higher (38.0) than those of the other three groups. A weak though significant positive correlation (r = 0.249) between clinical decision-making and critical thinking across all four types of programs was found.
Clinical Competence↗
High-grade cerebral neuroblastoma: a case study.
The case of a 48-year-old male patient is reported in whom a primary malignant cerebral neoplasm was cured by its neurosurgical removal and by postoperative radiotherapy and chemotherapy. Initially, from the results of the examination of frozen and paraffin section, the tumour was considered to be a glioblastoma multiforme. Electronmicroscopy, immunohistochemistry and review of the light microscopy of the original biopsy sample after his death by suicide four-and-a-half years later showed the neoplasm to have been a primary cerebral neuroblastoma rather than a glioblastoma. The diagnosis of glioblastoma multiforme, which depends upon multiple non-specific microscopic findings, such as necrosis, abnormal blood vessels, anaplasia and the pleomorphism of tumour cells, often is imprecise. Our experience underlines the need for comprehensive neuropathological studies of malignant cerebral neoplasms, including transmission electronmicroscopy and immunohistochemistry. This is of particular importance in view of the dismal prognosis of glioblastoma multiforme and of the palliative, rather than curative, treatment programmes that frequently are indicated for this tumour. The value of our report is to demonstrate that a cerebral neuroblastoma, which potentially is curable, may be mistaken easily for a glioblastoma-even by competent neuropathologists.
Brain Neoplasms↗
Medulloblastoma: a clinicopathological study of 42 cases.
Clinicopathological data have been collected for 42 patients with cerebellar medulloblastoma diagnosed and treated in Western Australia between the years 1961 and 1984. Thirty-one patients were male and 12 were over 14 years of age. In 31 patients the neoplasms were localized to the midline, while in 10 they were placed laterally in the cerebellar hemispheres. The remaining patient had a diffusely spreading neoplasm in the meninges of the posterior fossa. Thirty-nine underwent surgical treatment followed by postoperative radiotherapy. Three patients died in the early postoperative period. Twenty-four patients survived for one year or longer, 15 for two or more years, 10 for five years, and five survived longer than 10 years. The survival proportions estimated by the life-table method were 66% at one year, 48% at two years and 32% at 5 and 10 years. In one patient who survived for 23 years a meningioma developed, possibly due to radiotherapy.
Adolescent↗
The multispatula: a new dimension in sampling the cervix.
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Cervix Uteri↗
Septic abortion in Wellington 1960-1979.
A retrospective analysis was made of 283 cases of septic abortion admitted to Wellington Hospital from 1960-1979. There was a substantial reduction in the annual numbers of admissions occurring at the end of the study period compared with the beginning. Morbidity as measured by hospital stay, haemorrhage and septicaemia also fell. Possible causes for the reduction are discussed.
Abortion, Septic↗
Treatment of early breast cancer.
The early follow-up of patients treated by simple mastectomy alone or simple mastectomy combined with radical radiotherapy is presented. Both groups were well matched for age, menopausal status, duration of symptoms, size of tumour, and lymph-node involvement. There was no significant difference in survival of patients in the two groups at three years, but local recurrence was significantly more frequent (28%) in the mastectomy-alone patients. Early survival was not adversely affected by radiotherapy.
Age Factors↗
Adenocarcinoma of the large bowel.
Pathological features of 656 consecutive large bowel adenocarcinomas resected at the Middlesex Hospital in the 10-year period 1951-61 have been studied, comparing right and left colon and rectum.A change in sex distribution from a majority of females in right colon cases to a small male majority in rectal cases was found. High grade and colloid tumours were more frequent in the right colon than elsewhere in the large bowel. The proportion of patients with advanced tumours was also higher in the right colon.Adenomatous polyps were found in 24·5% of resected specimens and 31 of these (19%) had more than one carcinoma.The overall corrected 5 year survival rate was 50·7% for those with right colon tumours, 66·9% for those with growths of the left colon and 56·7% for those with tumours in the rectum. The effect of Dukes stage and of histological grade on prognosis was similar in colon and rectum. Females fared better than males at all sites and had a lower operative mortality.The effect of extent of local spread on survival in Stage B cases was studied. An increasing operative mortality and a steady worsening of prognosis with increased local spread was found.
Adenocarcinoma↗
Professionalism versus general critical thinking abilities of senior nursing students in four types of nursing curricula.
This descriptive study was undertaken to investigate the relationship between professionalism and critical thinking abilities of senior nursing students in four types of nursing educational programs: generic baccalaureate, associate, and diploma--the basic registered nurse (RN) programs--along with the upper division baccalaureate, specifically RN completion, program. Fifty students from each type of program were conveniently selected during the same spring semester before graduation. Professionalism was measured by the Health Care Professional Attitude Inventory; general critical thinking abilities, by the Watson-Glaser Critical Thinking Appraisal. For individual programs, low to moderate correlations ranging from r = 0.263 (diploma) to 0.516 (upper division) were found between critical thinking and professionalism. This culminated in a significant, low positive correlation (r = 0.447) between critical thinking and professionalism across all programs. Upper division seniors showed significant low to moderate positive correlations for age with critical thinking (r = 0.487) and professionalism (r = 0.327) that were not observed in the other programs. Comparisons of professionalism scores among programs showed that upper division seniors scored highest. The measure of professionalism for seniors from 4-year generic programs was not significantly different from associate degree seniors. Diploma program seniors showed the lowest level of professionalism. When critical thinking abilities were compared, seniors from generic and upper division baccalaureate programs showed significantly higher levels than those from associate and diploma programs.
Adult↗
The issue of aging faculty in higher education.
The aging of faculty in higher education is upon us. Certain features of the trend could become problematic over the next 20 years. This issue holds particular relevance for nurse educators as they strive to establish and maintain a foothold in the collegiate milieu, simultaneously facing the impact of the aging trend and associated events. In addition to consideration of the ramifications of the aging faculty and with particular regard for nursing faculty in higher education, certain strategies may be available to allay the detrimental outcomes often associated with the issue of aging faculty in higher education.
Age Factors↗