Manual translaryngeal jet ventilation

The manual translaryngeal jet technique is a safe and reliable method of emergency ventilation, providing adequate gas exchange and high levels of oxygenation for the patient who requires positive pressure breathing. It can be performed more rapidly than other invasive means of airway control and, with close attention to the proper technique, has proved safe and effective in maintaining normal blood gases for prolonged periods. Further work is required to define proper inspiratory-to-expiratory ratios better and to determine whether the technique is protective against aspiration. The equipment and technique should be familiar and readily available to every emergency clinician.     

STUDIES ON RABBIT LYMPHOCYTES IN VITRO : VI. THE INDUCTION OF BLAST TRANSFORMATION WITH SHEEP ANTISERA TO RABBIT IGA AND IGM

Sheep antisera specific for the three major immunoglobulin groups of the rabbit, i.e. IgG (γ-chain), IgA (α-chain), and IgM (µ-chain), are each able to induce blast transformation of the peripheral lymphocytes of the rabbit when added to in vitro cultures. The per cent of lymphocytes transformed with each antiserum indicate that one-fourth of the peripheral lymphocytes carry or have the capacity to synthesize molecules of all three of the major immunoglobulin groups, and that the remaining three-fourths carry or have the capacity to synthesize only two (IgG and IgM). The data do not permit direct conclusions concerning the ability of a single cell to produce molecules belonging to more than one immunoglobulin group at the same time, or the ability of a given cell to make a transition from the synthesis of molecules of one immunoglobulin group to those of another group.     

Can Bronchoscopic Airway Anatomy Be an Indicator of Autism?

Bronchoscopic evaluations revealed that some children have double branching of bronchi (designated “doublets”) in the lower lungs airways, rather than normal, single branching. Retrospective analyses revealed only one commonality in them: all subjects with doublets also had autism or autism spectrum disorder (ASD). That is, 49 subjects exhibited the presence of initial normal anatomy in upper airway followed by doublets in the lower airway. In contrast, the normal branching pattern was noted in all the remaining 410 subjects who did not have a diagnosis of autism/ASD. We propose that the presence of doublets might be an objective, reliable, and valid biologic marker of autism/ASD.     

Predictors of job satisfaction for rural acute care registered nurses in Canada

This study examines predictors of job satisfaction among rural acute care registered nurses. The data are from a cross-sectional national survey, which was part of a larger project, The Nature of Nursing Practice in Rural and Remote Canada. This analysis suggests that a combination of individual, workplace, and community characteristics are interrelated predictors of job satisfaction for rural acute care nurses. There were nine variables that accounted for 38% of the total variance in job satisfaction. Four variables alone (available and up-to-date equipment and supplies, satisfaction with scheduling and shifts, lower psychological job demands, and home community satisfaction) explained 33% of the variance. Recruitment and retention strategies in rural areas must acknowledge that rural nurses' work lives and community lives are inextricably intertwined. Attention to these issues will help ensure high-quality working environments and a continued commitment to quality nursing care in the rural hospital settings in Canada.     

Prevalence of hip fracture risk factors in women aged 70 years and over

We estimated the prevalence of common risk factors for hip fracture and the numbers needed to treat (NNT) to prevent a hip fracture in various high-risk population groups, using a postal risk factor survey of women aged 70 years and above from General Practices in Grampian and Yorkshire. Recorded risk factors included prior fracture of any type; low body weight; smoking; and family history of fracture. The prevalence rates of hip fracture risk factors were 34%, 7% and 11% for previous fracture, maternal hip fracture and smoking, respectively for the Grampian practices (low body weight being defined as falling in the lowest quartile) and 34%, 7% and 7% for a single practice in the York area. Applying previously published estimates of risk, NNT analysis produced a value of about 300 for women with no risk factors, whilst for women with three risk factors it was between 32 and 71, depending on which risk factors were present and assuming intervention reduced fracture rates by 30% or 50%. Groups of women at high risk of hip fracture can easily be identified in primary care and offered treatment, with realistic prospects of hip fracture prevention.     

IMMUNOGLOBULINS IN THE SKIN IN DERMATITIS HERPETIFORMIS AND CŒLIAC DISEASE

The unaffected skin of eighteen patients with dermatitis herpetiformis (D.H.), twenty-two patients with cœliac disease (C.D.), and eight controls were examined using direct immunofluorescence and class-specific fluorescein-conjugated anti-human IgA, IgM, and IgG antisera. All eighteen patients with D.H. showed IgA deposits in the skin: in seventeen the deposits were only found in the dermal papillæ, whilst in one it was found in a continuous line below the basement membrane, confirmed by immuno-electronmicroscopy. IgM deposits were also found in the dermal papillæ in three patients with D.H. and IgG deposits below the basement membrane in one patient. In cœliac disease, however, only one of the twenty-two patients showed papillary IgA deposits and one had continuous IgM deposits. These immunoglobulin deposits in D.H. and C.D. seem to be on the reticulin of the dermal papillæ. It is suggested that in D.H. there is a fault of the reticulin in the skin and small intestine, whilst in cœliac disease it is present in the small intestine but not in the skin. The reticulin cross-reacts with gluten complexes to give rise to an immunological reaction. In support of this hypothesis we have demonstrated cross-reactivity between gluten and reticulin.