Tri-trophic effects of transgenic insect-resistant tobacco expressing a protease inhibitor or a biotin-binding protein on adults of the predatory carabid beetle Ctenognathus novaezelandiae.

Tri-trophic impacts on adult predatory carabid beetles, Ctenognathus novaezelandiae, of insect-resistant transgenic tobacco plants expressing a serine protease inhibitor, bovine spleen trypsin inhibitor (BSTI), or a biotin-binding protein, avidin, were investigated. Both proteins could potentially affect this beetle, since avidin is known to be insecticidal to many beetle species and C. novaezelandiae midguts were shown to contain high levels of trypsin, a protease powerfully inhibited by bovine pancreatic trypsin inhibitor (a BSTI homologue) in vitro. Newly emerged field-collected adult C. novaezelandiae were fed exclusively for 280 days on Spodoptera litura larvae raised either on non-transgenic control, transgenic avidin (55 ppm) or transgenic BSTI (68 ppm) tobacco. Despite this long-term exclusive diet, there was no treatment effect on survival or fecundity and only minor and transient effects on beetles were observed. Data pooled across time and genders showed control-prey-fed beetles weighed 3% more than BSTI-prey-fed beetles and avidin-prey-fed beetles consumed 3-4% fewer prey than control- or BSTI-prey-fed individuals. Females in all treatments gained more mass and survived longer than males. Low exposure to the proteins because of dilution and deactivation within the prey is the most likely explanation for the lack of tri-trophic effects observed. Aditionally, the presence of a digestive chymotrypsin only partially inhibited by BSTI may provide an alternative path for proteolysis.

Evaluation of the Sysmex NE-8000. Automated hematology analyzer in a high-volume outpatient laboratory.

An evaluation of SYSMEX NE-8000 (Toa Medical Electronics Co., Ltd., Kobe, Japan) hematology analyzer, including its automated five-part white blood cell (WBC) differential count, was performed in a high-volume outpatient laboratory. Precision, mixing studies, stability, carry-over, and linearity were all within the limits stated by the manufacturer. Evaluation of the five-part WBC differential revealed excellent correlation with manual differential neutrophil and lymphocyte counts. Monocyte, eosinophil, and basophil data were acceptable given the known poor precision of 200 cell manual WBC differential counts when low percentages of individual cell types are present. Overall, flagging for morphologic abnormalities displayed a sensitivity of 87% and a specificity of 97%. The combination of the flagging system with the visual record provided by the NE-8000 WBC histogram represents an effective tool for separating normal from abnormal specimens, and allows considerable selectivity in the performance of follow-up manual WBC differential counts.

The lack of clinical utility of white blood cell differential counts and blood morphology in elderly individuals with normal hematology profiles.

An investigation of 462 patients aged older than 65 years with normal hematology profiles revealed 105 individuals with unsuspected abnormalities in the white blood cell differential count, peripheral blood film, or platelet count. In only 8 patients would this information have resulted in additional patient testing or other changes in management. The availability of instrumentation providing an automated platelet count would have decreased the number of patients experiencing a change in management to 5. In no instance did physicians believe that an individual patient's clinical outcome would have been altered by a knowledge of the unexpected abnormalities or the anticipated management changes. In an ambulatory adult population with normal hematology profiles, there is limited clinical value in pursuing further studies, such as a white blood cell differential count or an examination of the red blood cell morphology.

Evaluation of the Cell-Dyn 1600 in an outpatient laboratory.

An evaluation of the Cell-Dyn 1600 hematology analyzer (Sequoia-Turner Corporation; Mountain View, CA) was performed in an outpatient laboratory in British Columbia, Canada, to assess the analytic performance and the ease of use of the instrument. The Cell-Dyn 1600 is a three-part differential, 18-analyte instrument that requires only 30 muL of whole blood for complete analysis. It is a compact instrument with an impressive data-management package that is remarkably easy to use. The correlation study was performed using a Coulter S880 (Coulter Electronics, Hialeah, Florida) and manual differentials. Precision, carry-over, and linearity values for the Cell-Dyn provided results well within manufacturer's specifications. The two instruments correlated well as did the granulocyte and lymphocyte population comparisons. The mid-cell correlation was consistent with other studies assessing three-part differentials. Overall the Cell-Dyn 1600 is a good choice for any small or medium-sized laboratory.

Practical strategies for CNS role implementation.

Methods of implementing the clinical nurse specialist (CNS) role can be approached in many ways. Providing the clinical specialist with concrete strategies to use during role implementation or expansion can aid in expediting the acceptance process for the CNS. Some authors have discussed phases the CNS encounters during role development. Time span of these phases vary greatly, dependent not only on the individual specialist, but also on the system for which they are employed. Kramer's four phases detailing the adjustment period of the newly practicing nurse may be used when discussing CNS role implementation. These four phases are: honeymoon, shock/rejection, recovery, and resolution. Practical suggestions to expedite role implementation can make progression through these phases easier and less overwhelming. Although obstacles will often be present, the CNS must then become a catalyst by using creative ideas and effective coping mechanisms to effect change and advance the role.

Visitation in the pediatric intensive care unit: controversy and compromise.

Much controversy has arisen in the last few decades regarding parental and family visitation in the intensive care setting. The greatest needs of parents while their child is in an intensive care unit include: to be near their child, to receive honest information, and to believe their child is receiving the best care possible. The barriers that exist to the implementation of open visitation mostly are staff attitudes and misconceptions of parental needs. Open visitation has been found in some studies to make the health-care providers' job easier, decrease parental anxiety, and increase a child's cooperativeness with procedures. To provide family-centered care in the pediatric intensive care unit, the family must be involved in their child's care from the day of admission. As health-care providers, the goal is to empower the family to be able to advocate and care for their child throughout and beyond the life crisis of a pediatric intensive care unit admission.

Rethinking the merger of the clinical nurse specialist and the nurse practitioner roles.

The clinical nurse specialist (CNS) and nurse practitioner (NP) have been distinct and separate advanced nursing practice roles since the 1960s. The forces of economics and health care reform have fostered an interest in merging these two advanced practice roles. Economic and regulatory advantages have been noted in the literature for both roles. What is not so evident are the possible disadvantages. Several aspects of the merger issue are explored as is the recent background of the creation of the CNS and NP roles. Problems and questions are asked to stimulate future discussions in nursing's professional associations and in education and service settings.

The imposter phenomenon in the clinical nurse specialist role.

The imposter phenomenon describes individuals who at times feel as if they are imposters in their chosen profession. Individuals experiencing the phenomenon have a deep feeling that they are fooling everyone. The title of clinical nurse specialist (CNS) in itself may foster misinterpretations and false beliefs in oneself or others. The term "specialist" implies expertise in the five subroles of the CNS (educator, consultant, research, clinician and manager). Feelings of imposture within the CNS role can precipitate or exacerbate low self-esteem and lead to ineffective role implementation. The phenomenon must be recognized in the CNS and management strategies instituted. Management strategies include peer support, CNS mentoring and self-provided positive reinforcement. Further research is essential to document the existence of the phenomenon within the CNS role and the creation of effective management strategies to prevent or alleviate it.

Identifying and caring for the child with new onset type 1 diabetes.

The parents of a child with new onset type 1 diabetes must master essential "survival skills" to return home safely with their child. It is the healthcare provider's responsibility to assure that the family has been taught necessary information to succeed at home and provide the family with access to nurses and physicians for insulin adjustment and emergencies upon discharge.

Intubation complications in the critically ill child.

The acutely ill child requiring intubation is at risk for complications at three crucial points: during the intubation procedure, in the first few hours or days after intubation, and during long-term endotracheal tube (ETT) placement. Consideration must be given to the anatomic and physiologic differences between children and adults that place children at risk for acute respiratory failure and that present difficulties in providing respiratory support. Each potential complication must be understood in terms of cause, assessment, prevention, and intervention. The method of securing the ETT can decrease tube displacement, trauma to the airway, and breakdown of the skin. Intra- and interhospital transport presents more considerations in maintaining ETT placement and physiologic stability of the patient. Prevention of intubation complications in children can reduce length of stay, decrease cost of care, minimize length of time for family separation, decrease potential disabilities and prevent death in the critically ill child who requires intubation.