Web sites for midwives.

With increasingly more useful information becoming available on the World Wide Web and with the Internet becoming accessible to everyone, an organized and annotated review of sites beneficial to midwives is an important tool. In addition to being useful to midwifery professionals, this listing will be helpful to nursing and midwifery educators and students, to pregnant women and their families, and to the reference librarian providing assistance to these individuals. This article provides individuals interested in midwifery with the ability to choose from evaluated Web sites.

Exploring a fourth dimension: spirituality as a resource for the couple therapist.

This article explores ways in which the therapist's own spirituality can serve as a resource in couple therapy. Spirituality is defined as subjective engagement with a fourth, transcendent dimension of human experience. This engagement enhances human life and evokes corresponding behavior. Spiritually based therapy may be influenced by three assumptions: that God or a Divine Being exists, that human-kind yearns innately for connection with this Being, and that this Being is interested in humans and acts upon and within their relationships to promote beneficial change. In therapy these assumptions affect how the therapist listens and responds throughout sessions. The authors incorporate a case example illustrating the application of this fourth dimension in couple therapy.

Remaking health care in America.

Academic medical centers, vulnerable populations, rural health. Each represents the fragmentation of the current health care delivery system. Not surprisingly, the challenge of achieving cost-effective integrated delivery raises complex issues for each. These issues are explored in Remaking Health Care in America, based on research by Stephen Shortell, Ph.D., and his colleagues at Northwestern University, in partnership with KPMG's National Health Care & Life Sciences practice and 11 integrated health care systems. Hospitals & Health Networks presents an exclusive preview of the book.

Implementing organized delivery systems: an integration scorecard.

Organized vertically integrated health systems are in a key position to play a major role in present health care reform efforts. To demonstrate a competitive advantage in the new health care environment, however, integration efforts must be successful. Based on a national study of nine organized delivery systems, this article develops measures of three types of integration that occur in vertically integrated health systems--functional, physician-system, and clinical. These measures can be used as a "scorecard" to assess progress toward achieving integration objectives.

Effects of altered dietary iron intake in Mycobacterium paratuberculosis-infected dairy cattle: sequential observations on growth, iron and copper metabolism and development of paratuberculosis.

Twenty calves were orally inoculated with Mycobacterium paratuberculosis at six weeks old. At six months old, 10 of these, plus four uninfected controls were maintained on limited dietary copper and supplemented iron intake for a further 27 months. During this time all these animals, together with a further four untreated controls, were bred before being killed and examined for evidence of paratuberculosis. Despite significant reduction in weight gain, attributable to both iron supplementation and infection, no significant difference was found in the numbers of iron-supplemented and unsupplemented animals that developed clinical signs nor in the extent and severity of intestinal lesions between groups. Accumulation of iron in paratuberculosis lesions was not affected by iron supplementation but was positively correlated with the frequency of shedding of M paratuberculosis in faeces (P less than 0.05). Dietary iron supplementation alone resulted in serum hyperferraemia, hepatic siderosis and slight hypocuprosis, whereas, in infected animals, this resulted in marked hypocuprosis and anaemia within groups (P less than 0.05). Infection alone resulted in serum hypoferraemia and intestinal and hepatic siderosis which was positively correlated with the severity of infection within groups (P less than 0.05). Susceptibility to paratuberculosis may result from failure ultimately to limit monokine-mediated iron sequestration in intestinal tissue.

Studies into immunisation of cattle against interdigital necrobacillosis.

Calves were immunised with fractions of Fusobacterium necrophorum incorporated in mineral oil adjuvant and then each foot was experimentally exposed to interdigital necrobacillosis (foot abscess) by subcutaneous injection of homologous organisms through the interdigital skin. The number of cells from an 18 h liquid culture that might be expected to cause 50% of the feet of control calves to develop marked swellings following subcutaneous injection was shown to be approximately 2.2 X 10(8) cells. Immunity was shown to be associated with antigens that were located in the supernatant of the culture, and which may be identical with or closely associated with the exotoxins.