The experiences of internationally educated nurses in the southeastern United States of America.

BACKGROUND: US healthcare facilities have addressed nursing shortages in part by recruiting internationally educated nurses (IENs), and studies suggest IENs may make up a significant percentage of the nursing workforce in urban hospitals. Despite the economic recession of 2008-2012, international nurse migration is expected to continue. Little is known about IENs in the southeastern USA, and no studies have compared their perspectives to those of their US counterparts. OBJECTIVE: The purpose of this study was to gain a deeper understanding about the experiences of IENs compared to those of US registered nurses (RNs) practising in two urban hospitals in southeastern USA. METHODS: This study involved two rounds of semi-structured interviews of 82 IENs and US RNs. Interviews focused on themes relating to education, barriers to practice, intent to stay in nursing and IENs' migration experiences. FINDINGS AND DISCUSSION: Most IENs interviewed migrated to the USA after 1990 to join their family and do not plan to return to their home countries to practise. Most IENs initially received their Associate Degree in Nursing; many have obtained their Bachelor of Science in Nursing degree. IENs and newly licensed US RNs faced similar barriers when they began practising in the USA, but IENs faced additional challenges adjusting to the attitudes of US patients, the perceived lack of respect for nurses and delivering total patient care. CONCLUSIONS: IENs would benefit from orientation regarding the cultural differences in the USA. In other ways, their challenges are similar to those of US RNs; policies regarding education, recruitment and retention could target both groups together.

An intestinal threadworm as a reservoir and intermediate host for Swine influenza virus : a confirmation and amplification of shope's syndrome.

A laboratory model exemplifying Shope's concept of virus carriage by helminths was developed using Strongyloides ratti (Sandground, 1925), swine influenza virus, and caesarean-originated, barrier-sustained (COBS) mice and rats. It was shown that S. ratti can act as a carrier of swine influenza virus and infect mice, despite the fact that the nematode has undergone a complete life cycle after exposure to virus in infected rats. COBS rats were inoculated with the virus via the intranasal route and subsequently infected with S. ratti. The larvae and eggs found in the feces collected from these rats were allowed to develop in vitro. These second generation filariform larvae were then inoculated subcutaneously into COBS mice. At necropsy, 5-8 days postinoculation, swine influenza virus was isolated from 15% of the mouse lungs. In control studies, swine influenza virus was not isolated from the feces of the COBS rats which served as a source of both unexposed and exposed S. ratti. Swine influenza virus was recovered in vitro from S. ratti homogenates. It is suggested that this laboratory model be used to study more closely the various aspects of the ecology of virus-helminth relationships in vertebrate hosts.

When protons attack: microbial strategies of acid adaptation.

Inducible tolerance to acidic and alkaline environments is recognized as an important survival strategy for many prokaryotic and eukaryotic microorganisms. Recent developments in understanding this phenomenon include the identification of regulatory genes, specific tolerance mechanisms and genes associated with tolerance. In addition, there is significant evidence linking pH responses with virulence.

Spiroplasma sp. 16S rDNA in Creutzfeldt-Jakob disease and scrapie as shown by PCR and DNA sequence analysis.

The pathogenesis of the transmissible spongiform encephalopathies (TSE), which include Creutzfeldt-Jakob disease (CJD) in humans and scrapie in sheep, remains an enigma. In this paper we present evidence for the association of Spiroplasma sp., a wall-less prokaryote, with TSE. We have shown PCR amplification of Spiroplasma 16S rDNA in TSE-infected brain tissues (13 of 13 CJD cases and 5 of 9 scrapie cases) and not in control brains (0 of 50). Direct sequencing of the amplified PCR products has confirmed the presence of Spiroplasma-like DNA in all 5 of the TSE brains tested. Our evidence is not necessarily in conflict with involvement of a PrPres--a protease-resistant host-derived protein referred to as the prion--in the pathogenesis of TSE, since there is evidence that another factor is involved. We propose a bacterium, namely Spiroplasma, as this associated factor although the role of Spiroplasma in TSE cannot be determined from these experiments. The presence of the nucleic acid sequence of this microbe in all cases of TSE in our laboratory and not in controls provides direct evidence of the association of Spiroplasma sp. with TSE.

Inducible acid tolerance mechanisms in enteric bacteria.

Enteric micro-organisms have developed several inducible mechanisms for surviving transient periods of extreme acid stress. Salmonella typhimurium possesses an acid tolerance response (ATR) induced in minimal medium by short exposures to mild acid stress. More than 50 acid shock proteins (ASPs) are induced during adaptation. Eight ASPs are regulated by the major iron regulatory protein, Fur, in an unusual iron-independent manner. The two-component regulator, PhoP, is an autoinduced ASP that controls the induction of three additional ASPs. The stress sigma factor sigma S is an ASP that regulates induction of eight ASPs. Acid induction of sigma S is due to its decreased proteolytic turnover via the ClpXP protease in conjunction with the two-component-type response regulator MviA (RssB in Escherichia coli). Mutations in any of these three regulators leads to a defective ATR. Repair of pH stress-induced DNA damage appears to require the Ada protein (O6-methylguanine methyltransferase) since an ada mutant is both acid and alkaline sensitive. In contrast to S. typhimurium, E. coli and Shigella have acid resistance systems induced in complex media that include a glucose-repressed system protective at pH 2.5 without amino acid supplementation, a glutamate decarboxylase system that requires glutamate and an arginine decarboxylase system unique to E. coli.

The bifunctional NadR regulator of Salmonella typhimurium: location of regions involved with DNA binding, nucleotide transport and intramolecular communication.

NadR is the repressor protein that controls the expression of genes for NAD synthesis. It is also believed to be involved in nucleotide transport. Point mutations conferring different phenotypes were localized to six different regions within the nadR gene. That mutations affecting repression and transport all mapped within nadR confirms the bifunctional model for NadR action. The clustering of these mutations and 2 fusions revealed that those affecting repression lie in the amino terminal while those affecting transport occur in the carboxy-terminal. Mutations resulting in superrepression occurred within a central region of NadR that probably senses NAD concentrations. This region is predicted to direct the transition between NadR transport and repressor conformations.

Acid stress responses in enterobacteria.

The enteric microogranisms Salmonella, Escherichia coli and Shigella flexneri prefer to grow in neutral pH environments. They nevertheless experience dramatic pH fluctuations in nature and during pathogenesis. In response to environmental encounters with acid, these organisms have evolved complex, inducible acid survival strategies. Regulatory features include an alternative factor (sigma S), 2- component signal transduction systems (PhoP/Q; MviA/?) and the major iron regulatory protein Fur. Specific survival mechanisms include emergency pH homeostasis by inducible amino acid decarboxylases and probable roles for DNA repair, chaparonins, membrane biogenesis as well as others that remain poorly defined. Continued study of acid survival in these organisms will provide insights regarding stress management and will have a direct impact on our understanding of pathogenesis.

Immunologic properties of soluble materials from Brucella species.

The purpose in this study was to examine the immunogenic properties of various preparations of aqueous ether extracts of Brucella suis and Brucella canis. The B suis strain 3b and B canis strain RM-6-66 were grown on tryptose agar, and aqueous ether extracts were prepared from the cells. The ether was removed, and the extracts were clarified by centrifugation for 10 hours at 144,000 X g and fractionated by gel chromatography. The B suis endotoxin-containing precipitate, obtained from aqueous ether extracted material by ethanol precipitation, and fraction 1, prepared from ultracentrifugal supernate by column chromatography, protected mice against homologous infection. The B canis aqueous ether-extracted material also protected mice against B suis infections.

Serologic studies of Brucella suis and Brucella canis.

Brucella suis strain 3b and Brucella canis strain RM-6-66 were grown on tryptose agar, and aqueous ether extracts were prepared from the cells. The aqueous phase was clarified by centrifugation for a total of 10 hours at 144,700 times g and fractionated with gels and with diethylaminoethyl (DEAE) cellulose. Two fractions from B suis and 1 fraction from B canis were reactive in the indirect hemagglutination test. The sensitizing ability was destroyed by pronase, but was unaffected by ribonuclease or deoxyribonuclease. Apparently, protein or one of its subunits has an important role in antigenic specificity relating to indirect hemagglutination activity. Results in immunoelectrophoretic analysis indicated at least 22 antigens were in the ultracentrifugal supernate (144,700 times g) of B suis and 31 antigens were in a similar supernate of B canis. Results in immunodiffusion and agglutination absorption studies indicated a close relationship existed between B suis and B canis.

Antithrombotic therapy for cerebrovascular disease. Prevention and treatment of stroke.

Antithrombotic therapy in prevention and management of stroke is evolving rapidly as new clinical data better define indications. Stroke is a syndrome with several pathophysiologic bases, not one clinical entity. Optimal use of medical and surgical therapy requires definition of the specific mechanism of brain ischemia in the individual patient.

Birth order and intelligence: an immunological interpretation.

The literature indicates that the IQs and school performance of children tend to decline with increasing order of birth. A hypothesis is here presented that the effect of birth order upon intellectual performance may result from an increasing probability of maternal immune attack upon the fetal brain in utero with order of parity. In support of this hypothesis, evidence is adduced from the literature that the fetal brain is antigenic, that fetal antigens may reach the immune system of the mother, that the incidence of maternal sensitization to fetal antigens increases with parity, that antibodies may readily cross the placenta and reach the fetal brain, that antibodies can be highly teratogenic, and that certain antibodies may damage, in a lasting way, the structure, function, and learning capacity of brains in experimental animals and human infants.

Gastrointestinal parasites of mountain gorillas (Gorilla gorilla beringei) in the Parc National des Volcans, Rwanda.

Ninety-eight fecal samples were collected from 74 free-living mountain gorillas (Gorilla gorilla beringei) from the Parc National des Volcans, Rwanda, between July 1995 and January 1997 and examined for parasites by Sheather's sugar and zinc sulfate flotation methods, trichrome staining, and larval cultures. All samples contained at least one parasite. Seventeen endoparasites were identified, including eight protozoa, seven nematodes, one cestode, and one trematode. Two species of arthropod mite were also recovered from the fecal samples. Parasites observed on fecal examinations included strongyle/trichostrongyle-type eggs (72/74) (representing Oesphagostomum sp., Trichostrongylus sp., Hyostrongylus spp., and possibly Murshidia sp.), Strongyloides sp. (1/74), Trichuris trichiura (2/74), Probstmayria sp. (7/74), Anoplocephala sp. (63/74), Entamoeba hartmanni cysts and trophozoites (19/70), Endolimax nana cysts (31/70), Iodamoeba buetschlii cysts (11/70), Endolimax nana or Iodamoeba buetschlii trophozoites (63/70). Entamoeba coli cysts and trophozoites (14/70), Entamoeba histolytica trophozoite (1/70), Chilomastix sp. cysts and trophozoites (31/70), and Giardia sp. cysts (2/70). In addition, one ascarid and one trematode egg were seen. There were no significant differences in the prevalence of parasites between males and females and between age groups: however, infants and juveniles appeared to have a lower prevalence of Anoplocephala gorillae, and the silverbacked males appeared to have a higher prevalence of Probstmayria sp. Parasite prevalence was consistent among the five social groups studied except Susa group had a significantly lower prevalence of Anoplocephala gorillae. Trichuris trichiura, Strongyloides sp., Chilomastix sp., and Endolimax nana were identified for the first time in this population, and it is possible that these parasites were of human origin. Although there were no obvious clinical effects due to the presence of these parasites, six parasites identified (Trichuris trichiura, Strongyloides sp., Oesphagostomum sp., Trichostrongylus sp., Entamoeba histolytica, and Giardia sp.) could potentially be pathogenic. Some of the parasite products and cultured larvae could not be speciated.

Field anesthesia of free-living mountain gorillas (Gorilla gorilla beringei) from the Virunga Volcano region, Central Africa.

Twenty-six anesthetic procedures involving 24 free-living mountain gorillas (Gorilla gorilla beringei) from Rwanda or the Democratic Republic of Congo were performed between February 1987 and October 1997. Sixteen procedures were performed to remove snares or to treat snare-related wounds, and four of the animals died without recovering consciousness because of their severe medical conditions. Ketamine was used for induction 19 times, tiletamine/zolazepam was used five times, and the agent was not recorded for two procedures. The mean (+/- SD) ketamine dosage for four animals of known weight was 7.1 +/- 0.9 mg/kg. All induction agents were delivered i.m. by remote injection, and mean induction times for ketamine and tiletamine/zolazepam were 5.5 +/- 2.6 min (n = 12) and 5.4 +/- 3.7 min (n = 5), respectively. Mean recovery times were significantly shorter with ketamine compared with tiletamine/zolazepam (42.0 +/- 24.9 min, n = 9 vs. 75.25 +/- 22.1 min, n = 4). Low hemoglobin oxygen saturation (mean = 86.7%) was recorded in three cases under ketamine anesthesia, and oxygen insufflation is therefore recommended to prevent hypoxemia. Gorillas induced with tiletamine/zolazepam had significantly higher respiratory rates compared with animals given ketamine. Successful anesthesia and recovery, in particular, depended on the assistance of local personnel.