Emergency admissions. Over the threshold.

Analysis of emergency admissions to six hospitals over three weeks in winter found marked differences in the severity of cases. Some admissions could have been avoided if more investigations had been available on an outpatient basis. Where community services are easily accessible and available seven days a week, those admitted to hospital are likely to be more severely ill. British guidelines are needed on medical admissions.

Using research in community nursing.

The concept of evidence-based medicine has received considerable attention, but the distinctive nature of evidence within community nursing has not been fully explored. This study examines the nature of evidence within community nursing and the factors influencing use of evidence. Although much of the literature has concentrated on individuals as sites of resistance to evidence-based change, the findings of this study suggest that organisational and cultural factors represent more significant obstacles.

Phenotypic heterogeneity of spontaneous lymphomas of CWD mice.

Animals of the inbred mouse strain, CWD, express endogenous murine leukemia viruses early in life and have a high incidence of spontaneous neoplasms. We found that approximately one half of these animals died of malignant lymphoma by the age of 16 months. Splenic enlargement was seen in all mice, but thymic involvement was unusual. One half of the CWD tumors were diffuse lymphoblastic or immunoblastic lymphomas while the remainder were large cell, small cell, or mixed cell lymphomas. Analysis of DNAs from 12 tumors for immunoglobulin and T-cell receptor gene rearrangements revealed that all six of the lymphoblastic and immunoblastic lymphomas were of T-cell origin, as was one tumor of small cleaved cells. Four of the others were clonal B-cell lymphomas and one was of uncertain lineage. Assays of a limited number of tumors for the expression of the Thy 1.2 and IgM molecules confirmed the diversity in the cellular phenotype. The results indicate that CWD mice develop primarily splenic lymphomas with an unusual degree of heterogeneity in the tumor cell phenotypes as compared with the thymic lymphomas found in other high leukemia strains. The CWD strain is a useful new model for studies of retroviral leukemogenesis and the relationship between the histopathology and immunophenotype of malignant lymphomas.

Mechanism of selection of class II recombinant murine leukemia viruses in the highly leukemic strain CWD.

The development of spontaneous lymphomas in CWD mice is associated with the expression of endogenous ecotropic murine leukemia viruses (MuLV) and the formation of recombinant viruses. However, the pattern of substitution of nonecotropic sequences within the envelope genes of the CWD class II recombinant viruses differs from that seen in class I recombinant MuLVs of AKR, C58, and HRS mice. To determine how CWD host genes might influence the envelope gene structure of the recombinant viruses, we characterized the responses of these mice to two different types of exogenous MuLVs. Neonatal mice injected the HRS class I recombinant PTV-1 became infected and developed T-cell lymphomas more rapidly than controls did. The inoculation of CWD mice with the leukemogenic AKR ecotropic virus SL3-3 led to the formation of recombinant MuLVs with a novel genetic structure and class II-like envelope genes, although SL3-3 generates class I recombinants in other strains. These results suggest that the absence of class I recombinant MuLVs in CWD mice is not related to the restriction of the replication or oncogenicity of class I viruses or to the absence of an appropriate ecotropic virus that can generate class I recombinants. More likely, the genes of CWD mice that direct the formation or selection of class II recombinant viruses affect the process of recombination between the ecotropic and nonecotropic envelope gene sequences.

Evaluation of the NASA/JSC blood pressure screening clinic.

This study evaluated the NASA/Johnson Space Center's blood pressure screening program, which was designed to identify the proportion of NASA employees who were hypertensive and to identify self-report variables related to elevated pressures. In 1978, a random sample of 3892 employees was selected from over 2,100 NASA employees. Twenty-eight percent were classified as hypertensive by the criterion of systolic pressure of 140 or above or diastolic pressure of 90 or greater. Approximately 16% of all employees had a history of hypertension; the remaining 12% of the identified hypertensives were unaware of their potential health problem. Multivariate analysis showed that elevated systolic pressures were more prevalent in the older, heavier employees. Of hypertensives under treatment, about 74% were under poor control as judged from blood pressures randomly taken at their place of employment. These results demonstrated the effectiveness of screening for unsuspecting hypertensives in industry.