Epstein-Barr virus genomes are restricted to secondary neoplastic cells following bone marrow transplantation

DNA from mononuclear blood and tumor cells from 33 patients undergoing bone marrow transplantation for leukemia was examined for the presence of Epstein-Barr virus (EBV) genomes by blot hybridization. Four groups of patients were studied soon after engraftment, during long-term remission, after relapse of the original leukemia, and after development of secondary B cell neoplasms. Only the cells of patients with secondary neoplasms demonstrated EBV genomes, where all five adequately studied samples were positive. Samples from all other patient categories were negative for EBV genomes. We conclude that EBV genomes do not frequently persist in normal engrafted lymphocytes or in mononuclear cells of patients suffering recurrent leukemia. These results are consistent with EBV playing a role in the genesis of secondary B cell neoplasms following bone marrow transplantation.     

The future role of day hospitals for the elderly: the case for a nursing initiative

This paper describes the results of a research project investigating activity levels and consumer perceptions at two contrasting day hospitals for the elderly. Day hospitals traditionally function on a medical model with an important emphasis placed on treatment and discharge. Their claim to provide a therapeutic regime has been questioned however, the suggestion being that there are higher levels of such activities in day centres. The results of this study demonstrate that activity levels at day hospitals are far higher than previous research indicates but that the emphasis on discharge is contrary to the expressed needs of the majority of consumers. In view of the prevailing demographic trends the paper concludes with suggestions for service innovation with specific reference to the role of the nursing profession.     

Higher education: the coping stone of nursing education?

For many years the nursing profession in the United Kingdom has sought ways of improving the education of nurses. The present article explores some of the issues surrounding the recent proposals for an alternative to the long-standing apprenticeship system, namely that of moving basic nurse education into institutions of higher education. In particular, it focuses upon and explores the views of clinical nurse teachers and nurse tutors. In order to provide an historical context, the article begins by outlining the history of nurse education over the last century with reference to the various reports that have been published throughout the period. Before discussing the results of a questionnaire completed by those currently involved in the training and education of nurses, the article also considers the experience of other countries where collegiate education for nurses has been introduced.     

Who is in control? An investigation of nurse and patient beliefs relating to control of their health care

This study compares nurse and patient beliefs regarding control of health and perceptions of the amount of patient control. Data were collected from 21 nurses and 32 patients on a mixed surgical ward, using a series of self-report questionnaires. No difference was found between nurse and patient perceptions of patient control. However, nurses were found to have a significantly greater desire for control over their own health care and a significantly weaker belief in the influence of powerful others (i.e. doctors and nurses) than did patients. It is suggested that such differences in nurse and patient beliefs will have significant effects on how nurses and patients feel about the care patients receive. Implications of the findings for nursing theory and nurse education are also considered. In the light of previous research showing the stress-reducing effects of giving control to patients who want and expect it, the study calls for the development of a tool to assess the amount of control desired by each patient. This should help to ensure that nursing care is congruent with the control beliefs of the patient, rather than those of the nurse.     

Polymorphism of the promoter of the HLA-A locus

Of the first 350 bases upstream of the ATG signal sequences were obtained representing the following HLA-A locus alleles: A^*01, A^*0102, A^*02, A^*0202, A^*0206, A^*0207, A^*03, A^*0302, A11.2, A11.1, A^*68, A^*68011, A^*30, A^*3002, A^*23, A^*24, A^*26, A^*2602, A^*25, A^*29, A^*2902, A^*31, A^*31011, A^*32, A^*3201, A^*33, A^*3301, A^*3303, A^*34, A^*6601, A^*6602 A^*74, A^*80. We found 21 polymorphic positions of which a surprisingly large number (altogether 9) represent allele specific exchanges. For all 35 alleles tested of the HLA-A locus we found 16 different types of promoter. While all tested A2 subtypes, A^*0201, A^*0202, A^*0206, A^*0207 share the same promoter, there were in contrast several situations in which different subtypes of the same group have different promoters. This is true for HLA A^*01, A^*0102; A^*03, A^*0302; A^*30, A^*3002; A^*6601, A^*6602; A^*32, A^*3201; A^*29, A^*2902. Looking at the binding sites for nuclear factors, we observe that TATA-box, CAT-box, Enhancer B, the interferon response sequence and the Enhancer A (except HLA-A30 has one base exchange) are conserved within the HLA-A locus. The interferon response sequence shows for all A-locus alleles a double base pair exchange (TT for AC). In comparison with the promoter polymorphism of the HLA-B locus (Yao et al., 1995) we find a surprising diversity of the promoters in the HLA-A locus. While for the B-locus promoters large groups of sometimes strongly different alleles share the same promoter, in the HLA-A locus there is a private promoter for almost each allele and sometimes even each subtype. This lead to the conclusion that the promoter polymorphisms of the HLA-A and the HLA-B locus have been subjected to different selection pressure in evolution.     

Accuracy of specific IgE in the prediction of asthma: development of a scoring formula for general practice

BACKGROUND: For the diagnosis of asthma in young children, GPs have to rely on history taking and physical examination, as spirometry is not possible. The additional diagnostic value of specific immunoglobulin E (IgE) to inhalent allergens remains unclear. AIM: To assess the predictive accuracy of specific IgE to cat, dog, and/or house dust mites in young children for the subsequent development of asthma at the age of 6 years. DESIGN OF STUDY: Prospective follow-up study. SETTING: Seventy-two general practices. METHOD: A total of 654 children, aged 1-4 years, visiting their GPs for persistent coughing (>/= 5 days), were tested for IgE antibodies by radio allergosorbent testing (RAST). Parents completed a questionnaire on potential risk indicators. Those children who showed an IgE-positive status (12.7%) and a random sample of those with an IgE-negative status (<0.5 U/ml) were followed up to the age of 6 years when the asthma status was established. The main outcome measure was asthma at the age of 6 years (combination of both symptoms and/or use of asthma medication, and impaired lung function). RESULTS: Addition of RAST results to a prediction model based on age, wheeze, and family history of pollen allergy increased the area under the receiver operating characteristic (ROC) curve from 0.76 to 0.87. Furthermore, RAST improved patient differentiation as indicated by a change in the range of asthma probabilities from 6-75% before the IgE test, to 1-95% after the IgE-test. CONCLUSION: Sensitisation to inhalant allergens in 1-4-year-olds, as shown by RAST, is a useful diagnostic indicator for the presence of asthma at the age of 6 years, even after a clinical history has been obtained. This model should preferably be validated in a new population before it can be applied in practice.     

Severe aplastic anemia: a prospective study of the effect of early marrow transplantation on acute mortality

A prospective randomized trial of therapy for severe aplastic anemia was designed to compare early bone marrow transplantation with conventional treatments. All patients with a sibling matched at the major histocompatibility region were transplanted. Transplantation was performed with 17-100 (median 33) days of original diagnosis. Conventional treatments included transfusion support with or without androgens. Twenty-four of 36 patients intered on the transplant arm are alive after 4-20 (median 9) mo with full marrow reconstitution. Only two are limited by chronic graft-versus-host disease. In contrast only 12 of 31 conventionally treated patients are alive. Six of these survivors have improved, five incompletely. The 19 nontransplant deaths have occurred within 1-11 (median 3) mo of diagnosis. Compared to nontransplant regimens, early transplantation more effectively restores normal marrow function and decreases the acute mortality of severe marrow aplasia (p = 0.006). Pending longer follow-up, early marrow transplantation appears to be the most effective available treatment for severe aplastic anemia.