Entrepreneurial nurses and midwives in the United Kingdom: an integrative review

AIM: This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. BACKGROUND: Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. METHODS: Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$'social enterprise$'mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. RESULTS: Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. CONCLUSION: Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors.     

Heat shock protein expression in rat skeletal muscle after repeated applications of pulsed and continuous ultrasound

Nussbaum EL, Locke M. Heat shock protein expression in rat skeletal muscle after repeated applications of pulsed and continuous ultrasound.

Objective

To determine whether repeated ultrasound treatments are capable of increasing the expression of heat shock protein (HSP) 72 and HSP 25 in rat skeletal muscles.

Design

In vivo, experimental, controlled study.

Setting

Animal laboratory.

Animals

Male Sprague-Dawley rats (n=9).

Interventions

Ultrasound (1MHz, 15min, 2.0cm² transducer) continuous at 1.0W/cm² spatial average temporal average intensity (CONTUS) or pulsed at 2.0W/cm² spatial average temporal peak intensity 50% duty cycle (PULS50) was applied on 4 consecutive days to the lower leg muscles of 1 hindlimb in each rat (n=9).

Main Outcome Measures

Twenty-four hours after the final ultrasound application, hindlimb muscles were removed, weighed, and assessed for HSP 72 and HSP 25 content by Western blotting. Bands from blots were quantified and data were assessed using t tests (α=.05).

Results

Ultrasound did not affect core or contralateral hindlimb muscle temperature. Average muscle temperatures during the final day ultrasound treatments were 38.71°±0.30°C when using PULS50 and 38.16°±0.57°C when using CONTUS. PULS50 significantly increased HSP 25 content in the plantaris and soleus muscles and HSP 72 content in the plantaris muscles. CONTUS significantly increased HSP 72 content in the white gastrocnemius muscle.

Conclusions

HSPs can be induced in skeletal muscle when ultrasound is used on a repeated basis to treat soft tissue.     

巨噬细胞迁移抑制因子通过CC趋化因子配体2诱导巨噬细胞聚集

巨噬细胞迁移抑制因子最初是由于能抑制体外巨噬细胞随机迁移而被发现,现在它作为一种重要的调节因子参与一系列炎症性疾病过程.我们最近发现,巨噬细胞迁移抑制因子的缺失使一些由炎症介质诱发的白细胞-内皮细胞相互作用减弱,提示巨噬细胞迁移抑制因子在炎症反应中起作用的机制之一是促进白细胞聚集.……     

Syngeneic transplantation with peripheral blood mononuclear cells collected after the administration of recombinant human granulocyte colony-stimulating factor

Five syngeneic transplants were performed in four patients following myeloablative therapy using unmodified peripheral blood mononuclear cells (PBMCs) collected after the administration of recombinant human granulocyte colony stimulating factor (rhG-CSF) to normal donors. The only toxicity experienced by the four normal donors was bone pain. Four patients received two collections of PBMCs, and a second transplant was performed in one patient with one collection. The patients received a median of 20.53 x 10(8) total nucleated cells/kg (range 20 to 25.5), 11.3 x 10(8) total mononuclear cells/kg (range 6.52 to 17.2), 113.1 x 10(4)/kg CFU-GM (range 46.7 to 211.8) and 9.6 x 10(6) CD34+ cells/kg (range 1.6 to 12.6) Post-transplant growth factors were not administered. The median time to an absolute neutrophil count greater than 0.5 x 10(9)/L was 14 days (range 10 to 18). The median time to platelet transfusion independence was 11 days (range 10 to 13). Two patients had the number of CD3+ T lymphocytes determined in the pheresis product. An average of 3.04 x 10(10) CD3+ cells were collected per pheresis. This represents an approximate 1 log increase over the number of T lymphocytes in a typical bone marrow transplant. Rh-GCSF can be used to mobilize peripheral blood progenitor cells from normal donors with minimal toxicity. Studies of allogeneic transplants using PBMCs collected after rhG-CSF administration to determine permanent grafting ability and the incidence and severity of graft-versus-host disease are warranted.     

Retrovirally marked CD34-enriched peripheral blood and bone marrow cells contribute to long-term engraftment after autologous transplantation

We report here on a preliminary human autologous transplantation study of retroviral gene transfer to bone marrow (BM) and peripheral blood (PB)-derived CD34-enriched cells. Eleven patients with multiple myeloma or breast cancer had cyclophosphamide and filgrastim-mobilized PB cells CD34-enriched and transduced with a retroviral marking vector containing the neomycin resistance gene, and CD34-enriched BM cells transduced with a second marking vector also containing a neomycin resistance gene. After high-dose conditioning therapy, both transduced cell populations were reinfused and patients were followed over time for the presence of the marker gene and any adverse effects related to the gene-transfer procedure. All 10 evaluable patients had the marker gene detected at the time of engraftment, and 3 of 9 patients had persistence of the marker gene for greater than 18 months posttransplantation. The marker gene was detected in multiple lineages, including granulocytes, T cells, and B cells. The source of the marking was both the transduced PB graft and the BM graft, with a suggestion of better long-term marking originating from the PB graft. The steady- state levels of marking were low, with only 1:1000 to 1:10,000 cells positive. There was no toxicity noted, and patients did not develop detectable replication-competent helper virus at any time posttransplantation. These results suggest that mobilized PB cells may be preferable to BM for gene therapy applications and that progeny of mobilized peripheral blood cells can contribute long-term to engraftment of multiple lineages.     

Effects of Pre-pregnancy Obesity,Race/Ethnicity and Prematurity

To investigate the association between maternal pre-pregnancy obesity, race/ethnicity and prematurity. Retrospective cohort study of maternal deliveries at a single regional center from 2009 to 2010 time period (n = 11,711). Generalized linear models were used for the analysis to estimate an adjusted odds ratio with 95 % confidence interval of the association between maternal pre-pregnancy obesity, race/ethnicity and prematurity. Analysis controlled for diabetes, chronic hypertension, previous preterm birth, smoking and insurance status. The demographics of the study population were as follows, race/ethnicity had predominance in the White/Non-Hispanic population with 60.1 %, followed by the Black/Non-Hispanic population 24.2 %, the Hispanic population with 10.3 % and the Asian population with 5.4 %. Maternal pre-pregnancy weight showed that the population with a normal body mass index (BMI) was 49.4 %, followed by the population being overweight with 26.2 %, and last, the population which was obese with 24.4 %. Maternal obesity increased the odds of prematurity in the White/Non-Hispanic, Hispanic and Asian population (aOR 1.40, CI 1.12–1.75; aOR 2.20, CI 1.23–3.95; aOR 3.07, CI 1.16–8.13, respectively). Although the Black/Non-Hispanic population prematurity rate remains higher than the other race/ethnicity populations, the Black/Non-Hispanic population did not have an increased odds of prematurity in obese mothers (OR 0.87; CI 0.68–1.19). Unlike White/Non-Hispanic, Asian and Hispanic mothers, normal pre-pregnancy BMI in Black/Non-Hispanic mothers was not associated with lower odds for prematurity. The odds for mothers of the White/Non-Hispanic, Hispanic and Asian populations, for delivering a premature infant, were significantly increased when obese. Analysis controlled for chronic hypertension, diabetes, insurance status, prior preterm birth and smoking. Obesity is a risk factor for prematurity in the White/Non-Hispanic, Asian and Hispanic population, but not for the Black/Non-Hispanic population. The design and evaluation of weight-based maternal health programs that aggregate race/ethnicity may not be sufficient. The optimal method to address maternal pre-pregnancy and intra-pregnancy weight-related health disorders may need to be stratified along race/ethnicity adjusted strategies and goals. However, a more global preventative strategy that encompasses the social determinants of health may be needed to reduce the higher rates of prematurity among the Black/Non-Hispanic population.