Project 2000 students' perceptions of their training

This paper reports on the findings of a study conducted into the perceptions of final year Project 2000 pre-registration students towards their pre-registration education programme The aim of the research was to discover how students perceive their training in terms of value, relevance, intellectual potency, teaching methods and organization Data were collected using the Hoste scale which has been developed for the evaluation of educational courses A convenience sample of students (n = 131) within one college of nursing were invited to participate Findings include a particularly high level of satisfaction with Project 2000 in terms of value, breadth and relevance Organization and liveliness of the course were perceived much less satisfactorily There was a trend for a statistically significant difference between the mean scores of the theoretical and practical components of the course The findings are discussed with particular reference to the perceptions of theory and practice within the educational programme     

Acromegaly Secondary to Growth Hormone-releasing Hormone Secreted by an Incidentally Discovered Pheochromocytoma

Ectopic growth hormone-releasing hormone (GHRH)-secreting tumors are rare and cause acromegaly with somatotroph hyperplasia. We report a case of acromegaly secondary to GHRH secretion by an incidentally discovered pheochromocytoma in a normotensive patient. A 23-year-old man presented with signs and symptoms of acromegaly. Laboratory evaluation confirmed the diagnosis and magnetic resonance imaging (MRI) revealed a sellar mass which was thought to be a macroadenoma and surgically resected. The patient was not cured and medical treatment was indicated. An abdominal ultrasound performed before initiation of medical treatment showed a solid/cystic lesion superiorly to the right kidney. An abdominal MRI confirmed an adrenal tumor. Hormonal workup of the adrenal incidentaloma revealed elevated urinary cathecolamine and total metanephrines findings strongly suggestive of a pheochromocytoma. Acromegaly was then suspected to be due to ectopic secretion of GHRH by the tumor. Patient underwent surgical resection and histopathologic examination confirmed a pheochromocytoma which stained positively for GHRH. Also, review of the pituitary specimen confirmed somatotrophic hyperplasia. Genetic analysis of the ret proto-oncogene showed no mutation. Pituitary MRI was repeated 10 months after pheochromocytoma resection and revealed a slightly enlarged pituitary and partial empty sella. The diagnosis of acromegaly caused by ectopic production of GHRH is a challenging task. A careful histopatological examination of the surgically excised pituitary tissue has a key role to arouse the suspicion and guide the investigation of a secondary cause of acromegaly.     

The evaluation of a semiautomated computer method to determine the effects of DMSO on <Emphasis Type="Italic">Giardia lamblia</Emphasis>–intestinal cell interaction

In this work, we describe a semiautomated computer method to evaluate the activity of a common drug solvent, dimethyl sulfoxide (DMSO), on in vitro Giardia lamblia–host cell interaction. To compare the number of intestinal cells (IEC-6) and the adhered trophozoites over a specific area in control and treated coculture, a computer routine was created. Using video-light microscopy and digital image-processing tools, the operator was able to count the number of epithelial cells or parasites when they were still lying on the slide surface and without the need to detach them from the substrate for counting with a hemocytometer or other counting devices. Using this strategy, we calculated the total cell number per area and verified the effects of different concentrations of DMSO on G. lamblia–intestinal cell interaction and on the IEC-6 culture. At concentrations of 0.2% and 1%, this solvent produced a fragmentation on the monolayer of epithelial cells. However, DMSO did not affect the attachment of G. lamblia. In the course of these experiments, we compared the semiautomated method to the manual counting method and found that the first one generated smaller standard deviations (SD) than the second.     

Conceptualizing advanced nursing practice: curriculum issues to consider in the educational preparation of advanced practice nurses in the UK

The findings from a Florence Nightingale Scholarship to the USA and Canada, investigating the educational preparation of advanced practice nurses, are reported. The author considers a number of issues facing curriculum designers who might wish to develop clinically based advanced practice nurse programmes in the UK. Utilizing the experiential nature of personal visits, along with the available literature, the strategy adopted by some American and Canadian universities is highlighted to exemplify curriculum issues likely to be encountered in the UK. A definition of advanced nursing practice is provided as a foundation for discussion on curricular construction. This is followed by a discussion on advanced role nomenclature and components and characteristics of the 'nurse practitioner', 'clinical nurse specialist', 'nurse consultant' and 'nurse clinician', in order to clarify terminology and disentangle different advanced practice roles. The issues examined include the academic level of advanced practice nurse programmes; the determination of curricular content based on both a 'generalist' and 'specialist' model of practice; factors considered when exploring advanced practice competencies; and the resource implications for delivering opposing curriculum models. The paper suggests that there is a unique opportunity for advanced practice nursing to establish a key collaborative relationship in the delivery of health care, based on a nursing model, graduate study and the integration of key nursing and related concepts into clinical practice.     

High predictive value of immune-inflammatory biomarkers for schizophrenia diagnosis and association with treatment resistance

Objectives. Recent schizophrenia (SCZ) research aims to establish biomarkers with high predictive value for the diagnosis, severity of illness or treatment resistance. SCZ is accompanied by activated immune-inflammatory pathways, including increased levels of cytokines and chemokines, but few studies tried to identify predictive properties of such measures. Methods. We included 54 medicated SCZ patients and 118 healthy controls and examined 15 cytokines and chemokines. Possible associations between these immune-inflammatory biomarkers and the diagnosis of SCZ, severity of illness and treatment resistance were investigated. Results. SCZ is associated with a specific cytokine – chemokine profile, i.e., increased CCL11, MIP-1α, sTNF-R1 and sTNF-R2 levels, and decreased levels of IP-10, TNF-α, IL-2 and IL-4. The combination of five biomarkers (sTNF-R1, sTNF-R2, CCL11, IP-10, IL-4) may predict the diagnosis of SCZ with a sensitivity of 70.0% and a specificity of 89.4%. There was a weak association between the negative symptoms and biomarkers, i.e., IL-2 (inversely) and CCL11 (positively). Patients with treatment resistance showed increased levels of sTNF-R1, sTNF-R2 and MCP-1. Conclusions. The findings of this study reinforce that SCZ is associated with a pro-inflammatory profile and suggest that some immune mediators may be used as reliable biomarkers for the diagnosis of SCZ and treatment resistance.     

Evolutionary pattern in the OXT-OXTR system in primates: Coevolution and positive selection footprints

Oxytocin is a nonapeptide involved in a wide range of physiologic and behavioral functions. Until recently, it was believed that an unmodified oxytocin sequence was present in all placental mammals. This study analyzed oxytocin (OXT) in 29 primate species and the oxytocin receptor (OXTR) in 21 of these species. We report here three novel OXT forms in the New World monkeys, as well as a more extensive distribution of a previously described variant (Leu8Pro). In structural terms, these OXTs share the same three low-energy conformations in solution during molecular dynamic simulations, with subtle differences in their side chains. A consistent signal of positive selection was detected in the Cebidae family, and OXT position 8 showed a statistically significant (P = 0.013) correlation with litter size. Several OXTR changes were identified, some of them promoting gain or loss of putative phosphorylation sites, with possible consequences for receptor internalization and desensitization. OXTR amino acid sites are under positive selection, and intramolecular and intermolecular coevolutionary processes with OXT were also detected. We suggest that some New World monkey OXT-OXTR forms can be correlated to male parental care through the increase of cross-reactivity with its correlated vasopressin system.Oxytocin has crucial functions related to physiological processes and social behaviors in primates and other placental mammals. A nonapeptide (Cys-Tyr-Ile-Gln-Asn-Cys-Pro-Leu-Gly) (1), oxytocin (OXT-8Leu) is both a neurotransmitter released by neuronal cells in synapses and a hormone, activating receptors distant from the site of its synthesis through the circulatory system (2). In mammals, OXT acts as a hormone in uterine contraction during parturition and in milk ejection while lactating. It is also a key central nervous system neurotransmitter, regulating/modulating complex social and reproductive behaviors (i.e., pair bonding and parental care) (3–7).Until recently, it was believed that the OXT amino acid chain was the same in all placental mammals. However, Lee and colleagues (8) reported a T > C change in four New World monkeys (NWms), Saimiri sciureus, Cebus apella, Callithrix jacchus, and Aotus nancimae, substituting leucine to proline at position 8 (OXT-8Pro). This form was also found in Tupaia belangeri, a tree shrew species of Southeast Asia (8). OXT differs from its paralog vasopressin (AVP; Cys-Tyr-Phe-Gln-Asn-Cys-Pro-Arg-Gly) at positions 3 and 8. Variation at position 8 also identifies nonplacental OXT/AVP-like nonapeptides, such as mesotocin, present in some marsupials (7, 9). These findings dispel the notion of a universal OXT amino acid sequence for placental mammals. They also suggest that residue variability at position 8, in some cases associated with variations at positions 2–5, may be connected with the recognition, binding, and activation of receptors, potentially leading to species-specific functional changes (7, 10).OXT activity depends on adequate interaction with its unique receptor, OXTR, although it can also bind to the vasopressin receptors (AVPR1a, AVPR1b, and AVPR2) with lower affinity (11–13). Similar to other receptors that use G proteins as transducer signals across the cell membranes, OXTR is composed of seven transmembrane (TM1–TM7), four extracellular (N-terminal tail-ECL3), and four intracellular (ICL1-C-terminal tail) domains. ECL and ICL are important for the interaction with OXT and G proteins, respectively, whereas TMs are connected with both functions (7, 11).In contrast to what is observed for placental mammal OXT, OXTR presents hundreds of variants in regulatory and coding regions, including at the intraspecific level. In humans, OXTR single-nucleotide polymorphisms have been associated with several social behavioral phenotypes (14).The presence of OXT-OXTR-related systems throughout the animal kingdom indicates that their typical roles in placental mammals are likely exaptations of ancient functions, such as regulation of fluid balance and egg-laying (15, 16). Studies have attempted to investigate both the interaction of OXT-OXTR-like systems and their coevolution (11, 17). However, our knowledge about this nonapeptide-receptor system, including the extent of its variability in the primate order, remains limited.NWm emerged ∼30 million years ago. They are classified into 16 genera and ∼75 species and present a wide range of reproductive and social behaviors (18, 19), but little is known about their genetic variability and concurrent phenotypic variation (20).The present study reports results about OXT and OXTR diversity in 29 primate species, including 20 NWm species. These analyses include original OXT and OXTR sequences for 16 and 12 NWm species, respectively. We discuss details about the coevolution of these systems, as well as possible connections among reported genetic variability, positive selection, and some key species-specific biologic traits.     

Hours worked and patient visits provided by dentists in Australia

Background

The aim was to examine the numbers of hours worked and patient visits provided by age and gender of dentists in Australia, and compare with previous estimates to describe trends.

Methods

Data were collected from a random sample (N = 2961) of Australian dentists. Private sector dentists working in clinical practise were included in the analysis.

Results

The response rate was 49% (N = 1345 dentists). Hours per year worked and number of patient visits per year were lower for dentists aged 65 years and older compared with younger dentists, and were higher for male compared with female dentists aged 35–45 to 55–64 years. Hours per year worked were lower in 2013–2014 than reported in 2009–2010, but the number of patient visits in 2013–2014 was similar to the previously reported estimate from 2009–2010.

Conclusions

Hours worked and visits provided were only lower among older dentists aged 65 years or more. Male dentists tend to work more hours per year and provide more patient visits per year than female dentists. Over the last decade, Australian dentists maintained a stable output of visits per year despite a trend towards fewer hours worked per year.     

Dental insurance,service use and health outcomes in Australia: a systematic review

Private health insurance plays a key role in financing dental care in Australia. Having private dental insurance has been associated with higher levels of access to dental care, visiting for a check‐up and receiving a favourable pattern of services. Associations with better oral health have also been reported. In the absence of any existing review, this paper aims to systematically review the relationship between dental insurance and dental service use and/or oral health outcomes in Australia. A systematic search of online databases and subsequent sifting resulted in 36 publications, 33 of which were cross sectional and three cohort analyses. Dental service outcomes were more commonly reported than oral health outcomes. There was considerable heterogeneity in the outcome measures reported, for both service use and health outcomes. Overall, the majority of the evidence was from cross sectional studies and few studies reported analyses adjusted for confounding factors. The consolidated evidence points towards a positive association between dental insurance and dental visiting. Dentally insured adults are likely to have more regular access to dental care and have a more favourable pattern of service use than the uninsured. However, evidence of associations between dental insurance and oral health are mixed.