MSHAKE. A tool for measuring staff knowledge related to geriatric mental health.

This article describes the development of a knowledge-screening instrument used with staff caring for elderly patients with neuropsychiatric disability. A 25-item tool, referred to as the Mary Starke Harper Aging Knowledge Exam (MSHAKE), was developed to verify knowledge competencies of 171 employees at a geropsychiatric center in the Southeastern United States. The MSHAKE assesses basic geriatric mental health knowledge in an educationally diverse health care work force. A variety of descriptive and inferential statistics provide preliminary evidence supporting the use of the MSHAKE as an effective measure of staff members' essential knowledge of aging and neuropsychiatric disorders. This tool has practical application in the clinical setting as part of a competency verification system or in-service evaluation.

Anionic amino acid transporter expression in late gestation rodent yolk sac.

The yolk sac plays an important role in fetal nutrition. Transport of amino acids by the rodent visceral yolk sac has been shown previously. We have demonstrated the presence of several amino acid transport proteins capable of the Na(+)-dependent transport of anionic amino acids within late gestation mouse visceral yolk sac and uterine epithelium. We speculate that these proteins may be involved in the efflux of glutamate from the fetal to the maternal circulations.

Placental anionic and cationic amino acid transporter expression in growth hormone overexpressing and null IGF-II or null IGF-I receptor mice.

The role of growth hormone (GH), insulin-like growth factor (IGF)-II and the IGF-I receptor (IGF-Ir) in the regulation of the in vivo expression of Na(+)-coupled anionic [System X-AG; GLAST1 (EAAT1), GLT1 (EAAT2), EAAC1 (EAAT3), EAAT4; where the human homologues of amino acid transport proteins first cloned in the rat are given in parentheses] and Na(+)-independent cationic (System y(+);CAT1) amino acid transport proteins was evaluated by comparing transporter expression in day 17 placentae of mice that overexpressed bovine GH (GH+) or that carried null gene mutations for IGF-II or IGF-Ir. Northern analysis revealed no apparent difference in the mRNA content of GLAST1 (EAAT1), EAAC1 (EAAT3), or EAAT4, in homogenates of GH+ placentae, but levels of GLT1 (EAAT2) and CAT1 mRNA were increased. Immunoblot analysis revealed that whole-placental steady-state GLAST1 (EAAT1), EAAC1 (EAAT3), and EAAT4 protein levels were not affected by GH+, whereas GLT1 (EAAT2) levels were increased. Immunohistochemical analysis showed that the cell-specific expression of the anionic and CAT1 transporters was not affected by overexpression of GH. Similar analyses of null IGF-II placentae demonstrated increases in GLAST1 (EAAT1), EAAT4 and CAT1 mRNAs. Parallel immunoblot analysis demonstrated decreased expression of GLT1 (EAAT2), GLAST1 (EAAT1) and EAAC1 (EAAT3) protein, but an increased expression of EAAT4. In null IGF-II and IGF-Ir placentae, however, GLT1 (EAAT2) and EAAC1 (EAAT3) protein content was decreased in junctional zone cells, whereas CAT1 content was increased in junctional and labyrinth zone cells. These data indicate that an excess level of GH stimulates GLT1 (EAAT2) expression and that a normal level of IGF-II is required for typical expression of GLT1 (EAAT2), GLAST1 (EAAT1) and EAAC1 (EAAT3), but that IGF-II downregulates the expression of EAAT4 and CAT1.

The serendipity of faculty practice: strategies for success.

The contemporary social issues impacting healthcare coupled with the increasing demands for academic units to generate income have contributed to the emergence of faculty practice as an integral component of the nurse educator's role. As a result, faculty are encouraged increasingly to assume entrepreneurial joint appointments with the service industry. For nurse educators who engage in faculty practice, serendipity occurs when they immerse themselves in situations and emerge from the experience making unexpected discoveries. The author shares practical recommendations and strategies resulting from a successful 9-month faculty practice.

Activity and protein localization of multiple glutamate transporters in gestation day 14 vs. day 20 rat placenta.

Concentrative absorption of glutamate by the developing placenta is critical for proper fetal development. The expression of GLAST1, GLT1, EAAC1, and EAAT4, known to be capable of D-aspartate-inhibitable and Na(+)-coupled glutamate transport (system X-AG), was evaluated in day 14 vs. day 20 rat chorioallantoic placenta. Steady-state mRNA levels were greater at day 20 for all transporters. Immunohistochemistry determined that the expression of GLAST1, GLT1, and EAAC1 was greater throughout the day 20 placenta and was asymmetric with respect to cellular localization. EAAT4 protein was not detected. System X-AG activity was responsible for most of the Na(+)-dependent glutamate uptake and was greater in day 20 than in day 14 apical and basal membrane subdomains of the labyrinth syncytiotrophoblast. Greater quantities of EAAC1 and GLAST1 protein were identified on day 20, and quantities were greater in basal than in apical membranes. GLT1 expression, unchanged in apical membranes, was decreased in basal membranes. These data correlate transporter mRNA and protein content with transport activity and demonstrate an increasing capacity for glutamate absorption by the developing placenta.

Nurse case managers' opinions of their role.

Delphi and focus group methods were used to identify nurse case managers' (NCMs') opinions regarding their professional role. This study convened 15 NCMs from a regional medical center in the southeastern United States. Findings present the highest-rated items influencing the NCM role, as well as a definition and model depicting the role's essential elements. In study questionnaires, participants were asked to identify and subsequently rate items in seven categories. The overall highest-rated item was the personal attribute of critical thinking and prioritizing. The second highest-rated response was the critical function of coordinating a multidisciplinary plan of care. Interdisciplinary support and participative decision making were consistently ranked as important organizational factors. In the category of impact on health care outcomes, identifying patient needs and services was highly rated. Participants suggested that NCM assignments should be based on clinical knowledge and expertise, with a focus on prevention. Practice implications, based on the findings, are emphasized.

Demonstration of system y+L activity on the basal plasma membrane surface of rat placenta and developmentally regulated expression of 4F2HC mRNA.

Na(+)-independent cationic amino acid transport in the rat placenta occurs by leucine-sensitive and leucine-insensitive pathways. The ontogeny of these transport mechanisms within the rat placenta has been described recently. To assign the leucine-inhibitable portion of uptake definitively the uptake of [3H]arginine was studied in the presence of both BCH (to inhibit system Bo,+) and varied concentrations of leucine. Uptake of arginine into basal-enriched membrane vesicles derived from rat placenta was, in the presence of sodium, inhibited by micromolar concentrations of leucine, consistent with assignment of this activity to system y+L. In contrast, the majority of arginine uptake into apical-enriched membrane vesicles was leucine insensitive. Messenger RNA derived from rat placenta at days 14, 16, 18 and 20 of gestation was hybridized with full-length rat cDNA probes against NBAT and 4F2HC (thought to encode proteins associated with system bo,+ and y+L activities, respectively). No NBAT mRNA was detected, whereas 4F2HC mRNA was present at all gestational stages, increasing 12-fold over the last third of gestation. It is concluded that system y+L is present in the basal plasma membrane of the rat placenta syncytium and is subject to developmental regulation by a mechanism that alters the steady content of 4F2HC mRNA.

Transplantation in children. A longitudinal assessment of mothers' stress, coping, and perceptions of family functioning.

This study examined the parenting stress, coping resources, and family functioning among 27 mothers of children undergoing bone marrow, liver, kidney, and heart transplantation. The mothers completed a comprehensive battery of psychological instruments at the pretransplant stage and at 1- and 6-month posttransplant stages. Increased parenting stress, financial strain, caregiver burden, and family stress were reported following transplantation and persisted for several months. The mothers reported using coping strategies characterized by attempts to maintain family integration and to understand the child's medical situation. Development and evaluation of intervention programs to enhance parents' ability to cope with stress and maintain family stability are warranted.

Glutamine transport in human and rat placenta.

Glutamine plays an important role in fetal nutrition. This study explored the transport of [3H]glutamine into apical and basal predominant membrane vesicles derived from rat and human placenta. Na+-dependent glutamine transport was present in both apical and basal predominant vesicles derived from 20- and, to a lesser degree, 14-day gestation rat placenta. Amino-acid transport systems A, ASC-like, B(o,+) (in apical membrane vesicles) and, perhaps, y+L were involved in Na+-dependent glutamine transport. Na+-dependent glutamine uptake into human placental microvillus and basolateral membrane vesicles also occurred via several distinct transport activities. Glutamine transport via system N was not detected in either rat or human placental preparations. Na+-dependent glutamine transport in the rat was more pronounced in basal as compared to apical membrane vesicles. Conversely, in the human preparations, activity was significantly higher in microvillus as compared to basolateral membrane vesicles. It is concluded that Na+-dependent glutamine transport occurs through a variety of transport agencies in both the rat and human placenta. Transport varies with ontogeny and between species.

Older adults' descriptions of their role expectations of nursing.

A qualitative descriptive approach was used to identify 28 older adults' role expectations of nursing. This study describes elders' opinions, expectation and health care preferences which influence their judgments about nursing. Three categories emerged from analyzing transcripts of the audiotaped interviews. The older adults expected the nurse to be knowledgeable, caring and attentive by: demonstrating professional competence when recognizing patients' needs, as well as being concerned for the individual in the responsive delivery of services. The results of this study are congruent with descriptions of valued nursing behaviors that have been identified in previous studies. Additional findings, also corroborated by prior research, indicated that nursing roles and actions may not be accurately perceived or understood by the older consumer. Nurses therefore not only need to be vigilant in eliciting and evaluating consumer expectations but also need to be diligent in explaining their role and informing the public of their qualifications.

An expression system for mammalian amino acid transporters using a stably maintained episomal vector.

Despite its versatility and effectiveness in numerous studies, the vaccinia/HeLa cell expression model may not be optimal for the study of all transport proteins. To evaluate an alternative expression model for amino acid transport Systems ASC and X-AG, the mRNA content and transport activity encoded by human hippocampal ASCT1 cDNA and rat hippocampal EAAC1 cDNA, respectively, were measured in pDR2-cDNA-transfected human embryonic kidney 293 cells made competent by stable transfection with the Epstein-Barr neutral antigen-1 (EBNA-1) cDNA (293c18 cells) to evaluate the EBNA-1/293c18 expression system. The results show that (i) the EBNA-1/293c18 expression system results in a larger increase over background of Systems ASCT1 (6.4x) and EAAC1 (39x) transport activity than does the vaccinia/HeLa expression system (2.6x and 22x, respectively); (ii) transfection and hygromycin B selection for the pDR2 vector do not affect the endogenous transport velocities of Systems ASC, X-AG, or A; and (iii) the endogenous transport velocities of Systems ASC and X-AG in 293c18 cells were not affected by the expression of exogenous EAAC1 or ASCT1. We conclude that the EBNA-1/293c18 cell expression model represents a useful transient expression regimen to characterize mammalian amino acid transport proteins, especially for transporters that may exhibit relatively low activity in transient expression systems lacking a selection mechanism.

Perceptions of parenting stress and family relations by fathers of children evaluated for organ transplantation.

18 fathers of children evaluated for solid organ or bone marrow transplantation completed measures of parenting stress and family functioning. Comparisons with normative data indicated that these fathers reported less parenting stress, less family conflict, more concern about family finances, and more limitations in family activities. These data highlight the need for family-based assessments in pediatric transplantation.

Ontogeny of amino acid transport system A in rat placenta.

Amino acid transport System A has previously been demonstrated in apical membranes derived from rat placenta, as well as in apical and basal membranes derived from human placenta. We have studied Na(+)-dependent alpha-(methylamino)isobutyric acid (MeAIB) transport in apical and basal predominant membrane fractions prepared from 14 and 20 day gestation rat placenta. Marker enzyme recoveries did not differ significantly between age groups. Markers for intracellular organelles were also found to be comparable. Na(+)-dependent MeAIB transport was not sensitive to freezing and could be found in all membrane components tested. Kinetic parameters were studied--Km = 852 +/- 215 microM, Vmax = 718 +/- 126 pmol/5 sec/mg protein--20 day apical; Km = 748 +/- 269 microM, Vmax = 610 +/- 176 pmol/5 sec/mg protein--20 day basal-predominant; Km 614 +/- 261 microM, Vmax = 123 +/- 45 pmol/5 sec/mg protein-14 day apical. Kinetic parameters could not be determined in the 14 day gestation basal-predominant fraction because of the small amount of uptake present. We conclude that System A like activity is found in both apical and basal predominant membrane fractions derived from rat placenta, and that this activity increases over the last one third of gestation.

Mothers of children evaluated for transplantation: stress, coping resources, and perceptions of family functioning.

The stress, coping resources, and family functioning of 36 mothers of children awaiting transplantation were evaluated. Using standardized assessment techniques, we found that, overall, 20% of mothers reported clinically elevated stress responses and that parenting stress was higher for mothers of children evaluated for solid organ transplantation (vs. bone marrow transplantation). Coping strategies characterized by maintenance of personal and family stability were strongly associated with lower levels of parenting stress. Findings also showed significant disruption in family planning and activities, as well as a strong association between lower socioeconomic status and higher parenting stress. There is a need for the longitudinal assessment of parental and family functioning throughout the transplantation process as well as for interventions designed to reduce parenting distress.

Effect of low-protein diet-induced intrauterine growth retardation on rat placental amino acid transport.

Given the central role of the placenta in nutrient transport to the fetus, one might propose that maternal nutrition would have a regulatory effect on this nutrient delivery. We have examined the effect of a low-protein adequate-calorie diet on specific amino acid transport processes by the rat placenta. Maternal weight, fetal weight, and placental weight were all significantly reduced in dams fed a low-protein (5% casein), isocaloric diet when compared with dams pair-fed a control (20% casein) diet. Even though maternal serum amino acid levels were maintained in the low-protein animals, fetomaternal serum amino acid ratios were significantly reduced, suggesting a reduction in nutrient transfer to the fetus. Apical and basal membrane vesicles were isolated from the placental trophoblast and were used to examine the amino acid transport capacity of both maternal-facing and fetal-facing membranes, respectively. Na+-dependent neutral amino acid transport mediated by system A was decreased in both membrane preparations, while transport mediated by system ASC was unaffected. The Na+-dependent anionic amino acid uptake by system X(-)AG (EAAC1) was reduced on the basal membrane, while the Na+-independent component was similar between the low-protein and control diet-fed dams. Cationic amino acid uptake was also reduced on both membrane surfaces. A decreased steady-state mRNA content for EAAC1 and CAT1 (system y+) suggests that reduced synthesis of the transporter proteins is responsible for the decrease in transport activity. Taken together, these data support the hypothesis that maternal protein malnutrition affects nutrient delivery to the fetus by downregulation of specific amino acid transport proteins.

Gastroesophageal reflux in the preterm infant.

Gastroesophageal reflux is a problem familiar to most pediatricians. The focus of this article is to provide a synopsis of the current state of knowledge regarding gastroesophageal reflux in the premature population, as well as to provide the practitioner with a rational basis upon which to diagnose and treat gastroesophageal reflux in this population.