A Comparative Analysis of Teaching and Evaluation Methods in Nurse Practitioner Education Programs in Australia, Canada, Finland, Norway, the Netherlands and USA.

A scoping review of published literature and dialogue with international nurse practitioner educators and researchers revealed the education of nurse practitioner students varied within and between countries. This lack of cohesiveness hinders nurse practitioner role development and practice nationally and internationally. A rapid review of grey literature was conducted on nurse practitioner education standards in six countries (Australia, Canada, Finland, Norway, the Netherlands, and USA). Data were extracted from graduate level nurse practitioner education programs' websites from each country (n = 24). Extracted data were verified for accuracy and completeness with a nurse practitioner educator from each program. Data were analyzed using content analysis. Variations in nurse practitioner education within and between countries were explored by comparing admission criteria, curricular content, clinical requirements, teaching methods, and assignment and evaluative methods. The findings will help inform education programs and further research about nurse practitioner education internationally.

The rectified second law of thermodynamics.

Equilibrium thermodynamics is combined with Jarzynski's irreversible work theorem to quantify the excess entropy produced by irreversible processes. The resulting rectified form of the second law parallels the first law, in the sense that it facilitates the experimental measurement of excess entropy changes resulting from irreversible work and heat exchanges, just as the first law quantifies energy changes produced by either reversible or irreversible work and heat exchanges. The general form of the rectified second law is further applied to a broad class of quasi-static irreverisble (QSI) processes, for which all of the thermodynamic functions of both the system and surroundings remain continuously well-defined, thus facilitating excess entropy measurements by integrating exact differential functions along QSI paths. The results are illustrated by calculating the mechanical and thermal excess entropy produced by the irreversible unfolding of an RNA molecule.

Omega incision face-lift approach and SMAS rotation advancement flap in parotidectomy for prevention of contour deficiency and conspicuous scars affecting the neck.

To overcome the disadvantages after the surgical removal of tumours of the parotid gland, especially the depressed facial deformity and conspicuous cervical scar formation subsequent to parotid surgery, we have concentrated on omega face-lift incision in combination with an SMAS rotation advancement flap for the last several years using a lazy omega incision. Nine patients (3 male and 6 female) ranging in age from 43 to 68 years (mean age: 56.3 years) fulfilled the selection criterion of having a clinically benign discrete parotid lump with a benign preoperative fine needle cytology result. Parotidectomy was performed using the modified omega face-lift incision in conjunction with the rotation advancement SMAS flap. All patients underwent follow-up every 3 months in the first year. During the follow-up, the patients were specifically asked about their satisfaction with the post-operative appearance and whether they would consent to the operation again. The vascularized SMAS rotation advancement flap is clinically simple to perform and provides satisfactory cosmetic and functional results in patients undergoing conservative parotidectomy. There are no drawbacks in the use of modified face-lift incision to remove tumours of the parotid gland.

Human follicular fluids contain tissue macrophages.

Tissue cells obtained from the follicular fluids of women undergoing in vitro fertilization and embryo transfer were found to contain interleukin-1 beta mRNA by Northern analysis. Since macrophages are known to produce interleukin-1 beta, we examined the follicular fluids of 20 women undergoing in vitro fertilization as well as tissue sections of normal human ovary for the presence of macrophages and monocytes. Although granulosa-luteal cells predominate in follicular fluid, we found that resident macrophages and monocytes comprise 5-15% of human follicular tissue cells. In addition, we observed that macrophages are present in the human ovarian follicle as well as in the corpus luteum.

Flow cytometric analysis of deoxyribonucleic acid in human granulosa cells as a function of chronological age and ovulation induction regimen.

We examined whether the proliferative index of granulosa cells as determined by flow cytometry varied with a women's age or ovulation induction regimen that included leuprolide acetate (LA). This prospective cohort study included three groups of patients undergoing assisted reproductive technologies. Group I consisted of 9 women age less than or equal to 30 yr, who received LA plus human menopausal gonadotropin (hMG). Group II included 9 women age more than or equal to 40 yr, who received LA plus hMG. Group III consisted of 6 women age less than or equal to 30 yr who received hMG alone. A total of 79 preovulatory follicles containing greater than 10(4) granulosa cells were obtained from these 24 women and examined by flow cytometry. Group I was compared to group II to match for ovulation induction regimen and to examine proliferative index as a function of age. Group I was compared to group III to match for age and to examine proliferative index as a function of ovulation induction regimen. Outcome measures included proliferative index of granulosa cells as a function of age, ovulation induction regimen, ampules of hMG, estradiol on day of hCG, and serum FSH. Group I demonstrated a greater proliferative index than group II: 23.4% +/- 1.4 vs. 18.4% +/- 0.96 (P less than 0.01). Group I had a greater proliferative index than group III: 23.4% +/- 1.4 vs. 11.9 +/- 0.61 (P less than 0.001). Although both age and the presence of LA appeared to affect the PI, multiple linear regression demonstrated that only the addition of LA and not age, per se, had an independent effect upon granulosa cells undergoing proliferation (P less than 0.0005). We conclude that LA followed by hMG leads to an increase in the percentage of granulosa cells undergoing proliferation when compared to ovulation induction regimens that include hMG alone. Chronological age does not appear to have a significant independent influence upon the proliferative index.

Does the amount of endurance exercise in combination with weight training and a very-low-energy diet affect resting metabolic rate and body composition?

Effects of large (LA; 400 min/wk) and moderate (MA; 200 min/wk) amounts of endurance exercise in combination with weight training (3 d/wk) were compared with the effects of no exercise (C) in 23 obese females after a 12-wk, 3360-kJ/d very-low-energy diet (VLED). The LA group lost 6.5 kg more weight, mainly as fat (6.4 kg), than the C group (P < 0.05). No measurable differences were found among groups for decreases in resting metabolic rate (-729 to -1233 kJ/d; NS) or fat-free mass (-2.9 to -3.9 kg; NS). No improvements in aerobic capacity were achieved with the addition of exercise to a VLED (-0.079 to -0.037 L/min; NS). Strength indexes were improved (+16 to +5 kg; P < 0.05) or maintained with exercise (-3 kg; NS) whereas a loss (-9.3 kg; P < 0.05) or maintenance (+4.5 kg; NS) was found for VLED alone. Large amounts of endurance exercise in combination with weight training added to a VLED appear to improve weight and fat loss compared with a VLED alone.

P-glycoprotein expression and multidrug resistance in adrenocortical carcinoma.

BACKGROUND: The response of adrenocortical carcinoma (ACC) to adjuvant chemotherapy has been disappointing with no significant impact on survival. The normal adrenal cortex has very high levels of P-glycoprotein, an energy-dependent efflux pump of a variety of structurally unrelated chemotherapeutic agents. P-glycoprotein has been implicated as a cause of multidrug resistance in a variety of neoplasms. The purpose of this study was to evaluate P-glycoprotein expression in ACC. METHODS: Eleven patients with ACC had paraffin-embedded tumor evaluated for P-glycoprotein expression. These were analyzed by immunohistochemistry assay with a battery of four anti-P-glycoprotein antibodies (MRK-16, JSB-1, UIC-2, MDR). RESULTS: All eleven cases showed intense, predominantly membrane immunoreactivity for P-glycoprotein. In 10 of the cases, most tumor cells were immunoreactive with at least three antibodies, and six of 11 cases were positive for all four antibodies. In this small series no correlation existed between P-glycoprotein expression and tumor grade, stage of disease, or survival. CONCLUSIONS: All 11 cases of ACC studied showed P-glycoprotein expression, which was similar to the normal adrenal cortex. This possible mechanism of multidrug resistance may help explain the significant chemoresistance seen in ACC.

Impact of community volunteers on immunization rates of children younger than 2 years.

OBJECTIVE: To assess the effectiveness of a volunteer-driven outreach program on immunization rates in children younger than 2 years. DESIGN: Randomized controlled trial. SETTING: Pediatric ambulatory clinics in New York, NY. PATIENTS: A total of 163 children were randomly assigned to receive services from the volunteer-driven outreach program or to serve as control subjects. All children were (1) younger than 2 years, (2) no-shows for a scheduled appointment in the pediatric clinic, and (3) due or overdue for a vaccine. INTERVENTION: Immunization outreach, tracking, and follow-up were provided by community volunteers throughout follow-up (mean, 6.5 months). Control children were notified of immunization status at enrollment but received no further contact until the conclusion of follow-up (mean, 6.4 months). MAIN OUTCOME MEASURE: Immunization status 6 months after enrollment. RESULTS: Significantly more intervention children were up-to-date with their vaccination series than controls (75% vs. 54%; P = .03). Children in the control group were 2.8 times more likely to be late for a vaccine than intervention children (odds ratio = 2.8; P = .02). In addition, an immunization delay of longer than 30 days at enrollment was a significant predictor of final immunization delay (odds ratio = 2.6; P = .02). CONCLUSIONS: This volunteer-driven program significantly improved immunization rates among intervention children compared with controls. Results confirm previous findings that indicate an increased risk of an incomplete immunization series by 2 years of age among children who fall behind early in their primary vaccination series. However, control children were almost 3 times more likely to be late (for > or =1 vaccines) than intervention children, regardless of whether an earlier immunization delay was present.

Group B streptococcal disease prevention practices of obstetrician-gynecologists.

OBJECTIVE: To describe group B streptococcal (GBS) disease prevention practices of obstetrician-gynecologists. METHODS: We surveyed 1019 ACOG Fellows-the 419 members of the Collaborative Ambulatory Research Network (CARN) and 600 randomly selected non-CARN Fellows. RESULTS: There were 601 eligible respondents. More than 95% in both the CARN and the non-CARN groups reported adopting one of three GBS prevention strategies. The most commonly reported strategy was a combination approach not described in the consensus guidelines. The second most common strategy was the screening-based strategy; the risk-based strategy was third. Most respondents provided GBS information to all prenatal patients, but those using a risk-based strategy and those in solo practice were less likely to do so. Less than 60% in each group used penicillin as their first choice for GBS prophylaxis. More than 20% in each group who routinely screened for GBS did not collect both vaginal and rectal cultures. Respondents rated ACOG publications as the most important influence on their GBS prevention approach. CONCLUSION: Almost all ACOG Fellows have adopted a GBS prevention strategy. The importance of providing GBS prevention information to all patients, use of penicillin, and collection of both vaginal and rectal cultures should be reinforced.

Analysis of ploidy status in progression of head and neck cancers by DNA image cytometry.

Eight cases of leukoplakia, 25 lingual cancers, 15 cancers of the floor of the oral cavity, 11 pharyngeal cancers and 14 lymph nodes with squamous cell cancer metastases were stained using the Feulgen method to evaluate the ploidy status and ploidy related parameters. All leukoplakias were euploid. Percentage of aneuploid cancers correlated with the grade of tumours. Significant differences between tumours with 3 different locations were not found. Metastatic carcinoma cells in lymph nodes had significantly more cells in S-phase as compared to primary tumours.

Loss of DNA-mismatch repair gene expression in oral melanomas.

The defect of DNA mismatch repair is postulated to be responsible for malignant transformation in many types of tumours. The main aim of this study was to evaluate the expression of DNA mismatch repair proteins in 29 cases of oral melanomas and to relate this to the ploidy status of the lesions. MLH1 expression was found in 4/29, MSH2 in 6/29, PMS2 in 2/29 and PMS1 in 0/29 cases investigated. The range of positively stained cells did not exceed 50% with MSH2, and PMS2, or 5% with MLH1. Loss of the DNA mismatch repair gene expression correlated with high aneuploidy ratio, observed in totally negative cases.

CD-44: a marker of metastases of head and neck melanomas.

Specimens of 38 melanomas of the oral cavity and facial skin and 23 lymph nodes with melanoma metastases were stained immunohistochemically for the presence of variants 5, 6, 7 and 8 of CD-44 antigen. A positive reaction was observed only for variant 7-8 in primary melanomas as well as in lymph nodes with metastases from melanoma. The CD-44 score (percentage of CD-44 positive cells chi intensity of reaction) correlated with metastatic behaviour of tumours and was greater in metastatic lymph nodes than in primary tumours.

Loss of growth arrest DNA damage genes expression in oral melanomas.

29 oral melanomas were stained immunohistochemically for the GADD34, GADD45 and GADD153. GADD34 was found in 5/29 melanomas and its expression did not exceed 21%, averaging 4.1% of melanoma cells. GADD45 was observed in 8/29 oral melanomas and cell positivity averaged 2.8%. GADD153 was found in 2/29 melanomas and the percentage of positive cells ranged between 0 and 31%, averaging 1.2%. Not one significant correlation between GADD genes in oral melanomas was found. Loss of GADD gene expression and lack of correlation between them show advanced disturbances in their cooperation, leading to a high genetic instability of oral melanoma cells.

The Göttingen quick arch-bar. A new technique of arch-bar fixation without ligature wires.

A simple and easy fixation technique is described in which a newly designed quick arch-bar is used which can be attached easily and quickly and provides consistently firm fixation even in difficult situations. No anaesthesia or sophisticated appliances are required.

The multipoint contact plate in fracture treatment of the atrophied mandible: animal study and clinical application.

Rapid consolidation of osseous fractures requires stable immobilization of the fragments. In the atrophied mandible, the nutrient supply should be ensured by protecting the periosseous soft tissue, i.e., the periosteum. In the conventional placement of osteosynthesis plates, however, the subimplant nutrition is restricted because of the high surface pressure between the osteosynthesis plate and bone. In order to improve the subimplant nutrient supply, we designed a new osteosynthesis plate with a "knobbed" underside enabling multipoint contact. Histomorphologic comparative studies were conducted on 16 Göttingen minipigs with an average weight of 47.5 +/- 8 kg. In each minipig, one side of the mandible was fractured and one side was left intact. One side of each mandible was plated with a six-hole dynamic multipoint contact plate and the other side with a conventional plate. The plates were applied, either epiosseous or epiperiosteal, with bicortical screws under defined torque. The results demonstrate the advantages of multipoint contact plates over the conventional ones and create the clinical basis for a "bio-logical" plate design that allows callus to grow between the knobs and therefore provide adequate nutritional and vascular supply. The plate's knobbed profile also promotes extraosseous venous drainage without impeding intraosseous fluid flow. This plate is the logical choice for rapid fracture consolidation in the high-grade atrophied mandible.

Incomplete bilateral transverse facial cleft--a previously unreported associated defect of the Kallmann's syndrome.

In 1944 Kallmann et al described sex-linked inheritance of hypogonadotropic hypogonadism with anosmia and noted the co-occurrence cleft lip, cleft palate and cranio-facial asymmetry. Since then, other clinical cases associated with various skeletal, ophthalmic, urogenital, cardiovascular and central nervous system disorders have been reported. This article presents the case of a 17-year-old girl with a bilateral incomplete facial cleft in association with the Kallmann's syndrome, a previously unreported connection. We describe the plastic surgical reconstruction of the bilateral incomplete facial cleft. The mechanism of this embryopathologic association of the Kallmann's syndrome is, we suggest, due to a developmental disturbance in the region of the median forebrain organizer and associated structures, possibly in connection with a pleiotropic genetic mechanism.

Elimination of rabies from red foxes in eastern Ontario.

The province of Ontario (Canada) reported more laboratory confirmed rabid animals than any other state or province in Canada or the USA from 1958-91, with the exception of 1960-62. More than 95% of those cases occurred in the southern 10% of Ontario (approximately 100,000 km2), the region with the highest human population density and greatest agricultural activity. Rabies posed an expensive threat to human health and significant costs to the agricultural economy. The rabies variant originated in arctic foxes: the main vector in southern Ontario was the red fox (Vulpes vulpes), with lesser involvement of the striped skunk (Mephitis mephitis). The Ontario Ministry of Natural Resources began a 5 yr experiment in 1989 to eliminate terrestrial rabies from a approximately 30,000 km2 study area in the eastern end of southern Ontario. Baits containing oral rabies vaccine were dropped annually in the study area at a density of 20 baits/km2 from 1989-95. That continued 2 yr beyond the original 5 yr plan. The experiment was successful in eliminating the arctic fox variant of rabies from the whole area. In the 1980's, an average of 235 rabid foxes per year were reported in the study area. None have been reported since 1993. Cases of fox rabies in other species also disappeared. In 1995, the last bovine and companion animal cases were reported and in 1996 the last rabid skunk occurred. Only bat variants of rabies were present until 1999, when the raccoon variant entered from New York (USA). The success of this experiment led to an expansion of the program to all of southern Ontario in 1994. Persistence of terrestrial rabies, and ease of elimination, appeared to vary geographically, and probably over time. Ecological factors which enhance or reduce the long term survival of rabies in wild foxes are poorly understood.

A school-based clinic in a preschool.

Primary health care in a school-based clinic (SBC) for preschoolers is examined. Based on personal experience, a PNP describes an actual preschool SBC. The benefits of an on-site service for this age group include periodic and accurate developmental assessments and screening procedures and improved compliance with treatments and referrals. The process of establishing an SBC is presented in terms of management, funding, and resources.

Temporomandibular joint dysfunction in children.

Despite the fact that temporomandibular joint (TMJ) dysfunction has traditionally been considered an adult disorder, there is research to document that signs and symptoms of TMJ dysfunction are prevalent in the younger population as well. Although some aspects manifest equally in both adults and children, there are unique qualities that are more relevant to pediatrics. Knowledge of the etiology, prevalence, and its clinical components may assist pediatric primary care providers in screening and caring for children with TMJ.

[An X-ray study of the incidence of asymptomatic hypertrophy of the coronoid process]. / Röntgenologische Studie zur Häufigkeit der asymptomatischen Processus-coronoideus-Vergrösserung.

Although the coronoid process is not part of the temporomandibular joint, hyperplasia of the coronoid process can effect the mandibular movement as the result of the impingement on the zygomatic arch which is demonstrated in the case of a 22-year-old man. In order to access the prevalence of the asymptomatic enlargement of the coronoid process we carried out an investigation on 2000 panoramic radiographs and found only one case of a 64-year-old man. The very rare coronoid process abnormalities demonstrated on routine plan films should best be demonstrated in computed tomography, appreciating the morphology and the deformity of the surrounding structures.