Immunologic mechanisms in the maternal-fetal relationship

Until recently, the immunologic tolerance between a mother and her allogeneic fetus has been a highly speculative and poorly understood phenomenon. New data indicate that maternal acceptance of the fetal allograft necessitates a specific, protective immune response. This specific recognition apparently involves unique placental antigens with genes that are closely linked to HLA loci. Lack of recognition of these antigens, as in matings between partners with similar HLA profiles, may result in repeated spontaneous abortions caused by unsuppressed rejection mechanisms.     

The relationship between antibody concentration and target cell number in the induction of K cell-mediated haemolysis: evidence for asymmetry among reactants

The cytotoxic capacity of peripheral blood mononuclear cells for anti-D sensitized human O Rh(D) + ve (R1R2) erythrocytes was measured under conditions where antibody concentrations and target cell number were varied with respect to each other. It was observed that where sensitization was limiting, due either to target cell excess or increased antibody dilution, the relationship between lysis and antibody concentration was non-linear, and that the end-point dilution of anti-D at which measurable cytotoxicity occurred was dependent upon the source or concentration of effector cells. The asymmetrical relationship between cytotoxic activity and the degree of sensitization suggests that, in this system at least, there is extensive heterogeneity either among target erythrocytes in terms of their degree of sensitization and consequent susceptibility to lysis, and/or among effector cells in terms of their sensitization requirements for induction of cytotoxicity.     

Educating interprofessional learners for quality, safety and systems improvement

Most health professionals in training, as well as those in practice, lack the knowledge and skills they need to play an effective role in systems improvement. Until very recently, these competencies were not included in formal (or informal) educational curricula. Interprofessional collaboration - another core competency needed for successful systems improvement - is also inadequately taught and learned. Achieving Competence Today (ACT) was designed as a new model for interprofessional education for quality, safety and health systems improvement. The core of ACT is a four-module active learning course during which learners from different disciplines work together to develop a Quality Improvement Project to address a quality or safety problem in their own practice system. In this paper we describe the ACT program and curriculum model, discuss our strategies for maximizing ACT's interprofessional potential, and make recommendations for the future.     

A new way of caring for older people in the community

The government's modernisation agenda is challenging traditional practice by introducing new roles and concepts to meet the increasing healthcare needs of the older population and those with long-term conditions. Over the past two years several national pilots have been trialled to examine different models of managing care for these groups. One is the Evercare model, a case management approach to the delivery of care in the community for older people. This article focuses on a cohort of 12 nurses from three local primary care trusts who participated in the national Evercare pilot project from July 2003-April 2005. It examines the context for change, explores and appraises the development of a new role, and evaluates the educational partnership developed with a local university.