An assessment of Irish farmers' knowledge of the risk of spread of infection from animals to humans and their transmission prevention practices.

The aim of this study was to ascertain farmers' knowledge of the risk of spread of infection from animals to humans, and their transmission prevention practices. This was a survey of farmers who submitted material to Ireland's Regional Veterinary Laboratories in 2015. There was an 84% response rate (1044 farmers). Ninety per cent of farmers were not aware that infection can be acquired from apparently healthy animals. Over half were not aware that disease could be contracted from sick poultry or pets. Conversely, the knowledge of the risk to pregnant women of infection from birthing animals was high (88%). Four-fifths of farmers sourced drinking water from a private well, and of these, 62% tested their water less frequently than once a year. Of dairy farmers, 39% drank unpasteurised milk once a week or more frequently. Veterinarians were the most commonly cited information source for diseases on farms. The survey findings indicate that the level of farmers' knowledge and awareness of the spread of infection from animals to humans is a concern. Further education of the farming community is needed to increase awareness of both the potential biohazards present on farms and the practical measures that can be taken to mitigate the risk of zoonoses.

Use of neoadjuvant chemotherapy prior to radical hysterectomy in cervical cancer: monitoring tumour shrinkage and molecular profile on magnetic resonance and assessment of 3-year outcome.

The objective of this study is to assess tumour response to neoadjuvant chemotherapy prior to radical hysterectomy in cervical cancer using magnetic resonance (MR) to monitor tumour volume and changes in molecular profile and to compare the survival to that of a control group. Eligibility included Stage Ib-IIb previously untreated cervical tumours >10 cm(3). Neoadjuvant chemotherapy in 22 patients (methotrexate 300 mg x m(-2) (with folinic acid rescue), bleomycin 30 mg x m(-2), cisplatin 60 mg m(-2)) was repeated twice weekly for three courses and followed by radical hysterectomy. Post-operative radiotherapy was given in 14 cases. A total of 23 patients treated either with radical surgery or chemoradiotherapy over the same time period comprised the nonrandomised control group. MR scans before and after neoadjuvant chemotherapy and in the control group documented tumour volume on imaging and metabolites on in vivo spectroscopy. Changes were compared using a paired t-test. Survival was calculated using the Kaplan-Meier method. There were no significant differences between the neoadjuvant chemotherapy and control groups in age (mean, s.d. 43.3+/-10, 44.7+/-8.5 years, respectively, P=0.63) or tumour volume (medians, quartiles 35.8, 17.8, 57.7 cm(3) vs 23.0, 15.0, 37.0 cm(3), respectively, P=0.068). The reduction in tumour volume post-chemotherapy (median, quartiles 7.5, 3.0, 19.0 cm(3)) was significant (P=0.002). The reduction in -CH(2) triglyceride approached significance (P=0.05), but other metabolites were unchanged. The 3-year survival in the chemotherapy group (49.1%) was not significantly different from the control group (46%, P=0.94). There is a significant reduction in tumour volume and -CH(2) triglyceride levels after neoadjuvant chemotherapy, but there is no survival advantage.

Oral history of Florence Downs; the early years.

BACKGROUND: Florence Downs is a well-recognized nursing leader, educator, editor, and scholar who helped shape nursing as an intellectual discipline, and wrote extensively about the importance of links between research and practice. OBJECTIVES: Through the use of oral history data garnered over 15 hours of interviews, we constructed a narrative that describes some of Downs' formative experiences. METHODS: Oral history is used to place the "stories" of an individual into a social and cultural context, in this case, the development of the profession of nursing. RESULTS: From the interviews, several strands emerged that defined Downs' extended career, including the importance of developing a community of scholars both in and outside of nursing, the dangers of parochialism, and the necessity of a perspective on life that melded a keen sense of humor. Factors that affected Downs' style and choice, especially her mother, and her educational experiences, were revealed. DISCUSSION: From the interviews we gained a sense of how Downs constructed her conceptual universe of nursing, as well as the language and political effectiveness to overcome barriers confronting the intellectual growth of nursing mounted by other nursing leaders as well as traditional academic disciplines.

A reflection on values in turbulent times.

We discuss how organizations, as cultures, react to times of turbulence, stress, and the importance of their foundational values during those times. By adapting the framework pioneered by the organizational analyst Manfred Kets de Vries, we use psychodynamic concepts to discuss a descriptive typology of behavior in which persons and organizations engage under stress. We also discuss the hazards inherent in losing sight of common core values, the dangers in the disconnects between stated values and behaviors, and how those disconnects can be destructive to organizations and to persons. We conclude with a plan that involves achieving insight, trust, and open communication on which members of organizations can base discussion and find common ground in articulating common core values. Throughout the article, we make applications to nursing organizations to focus attention on the currency of this topic for the profession.

Discontinuing treatment in children with chronic, critical illnesses.

Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.

The aspartate aminotransferase-catalysed exchange of the alpha-protons of aspartate and glutamate: the effects of the R386A and R292V mutations on this exchange reaction.

1H-NMR was used to follow the aspartate aminotransferase-catalysed exchange of the alpha-protons of aspartate and glutamate. The effect of the concentrations of both the amino acids and the cognate keto acids on exchange rates was determined for wild-type and the R386A and R292V mutant forms of aspartate aminotransferase. The wild-type enzyme is found to be highly stereospecific for the exchange of the alpha-protons of L-aspartate and L-glutamate. The R386A mutation which removes the interaction of Arg-386 with the alpha-carboxylate group of aspartate causes an approximately 10,000-fold decrease in the first order exchange rate of the alpha-proton of L-aspartate. The R292V mutation which removes the interaction of Arg-292 with the beta-carboxylate group of L-aspartate and the gamma-carboxylate group of L-glutamate causes even larger decreases of 25,000- and 100,000-fold in the first order exchange rate of the alpha-proton of L-aspartate and L-glutamate respectively. Apparently both Arg-386 and Arg-292 must be present for optimal catalysis of the exchange of the alpha-protons of L-aspartate and L-glutamate, perhaps because the interaction of both these residues with the substrate is essential for inducing the closed conformation of the active site.

Concept of death in a sample of Israeli kibbutz children.

The study of children's concept of death and factors that affect its acquisition continue to evolve. In this study, the concept of death of 22 Israeli children (aged 5-12 years), were assessed using vignettes. Participants' understanding of finality, universality, inevitability, and total concept of death were explored using the Concept of Death Assessment (CODA). The child's developmental level was assessed using an interactive developmental tool based on a Piagetian/constructivist framework (R. B. Sund, 1976). Development was scored as a continuous, rather than as a dichotomous variable. In this sample, age was the only significant predictor of concept of death (p less than .01). Children had an accurate concept of death as young as 6 years, however, it was not possible to determine an upper age limit by which children had an accurate concept of death. The mean developmental score was 64.8% +/-18.7. Still, 45% of this sample had an accurate concept of death, and 95.5% had an accurate understanding of finality. Environmental factors unique to an Israeli sample that might affect concept acquisition are explored. Questions remain about the interrelationship of development and concept acquisition.

13C NMR study of how the oxyanion pKa values of subtilisin and chymotrypsin tetrahedral adducts are affected by different amino acid residues binding in enzyme subsites S1-S4.

A range of substrate-derived chloromethane inhibitors have been synthesized which have one to four amino acid residues. These have been used to inhibit both subtilisin and chymotrypsin. Using 13C NMR, we have shown that all except one of these inhibitors forms a tetrahedral adduct with chymotrypsin, subtilisin, and trypsin. From the pH-dependent changes in the chemical shift of the hemiketal carbon of the tetrahedral adduct, we are able to determine the oxyanion pKa in the different inhibitor derivatives. Our results suggest that in both the subtilisin and chymotrypsin chloromethane derivatives the oxyanion pKa is largely determined by the type of amino acid residue occupying the S1, subsite while binding in the S2-S4 subsites only has minor effects on oxyanion pKa values. Using free energy relationships, we determine that the different R groups of the amino acid residues binding in the S1 subsite only have minor effects on the oxyanion pKa values. We propose that the lower polarity of the chymotrypsin active site relative to that of the subtilisin active site explains why the oxyanion pKa is higher and more sensitive to the type of chloromethane inhibitor used in the chymotrypsin derivatives than in the subtilisin derivatives.

Conceptual and technical considerations when combining large data sets.

Secondary analysis provides a useful method for the development of new knowledge. Larger samples can be constructed, and secondary analysis can be enhanced when data sets are combined. A standardized method for combining large data sets is crucial, yet literature on methods for combining large data sets for secondary analysis is lacking. The purpose of this article is to outline and explain the process of combining two or more large data sets (n = 276, n = 125) for secondary analysis by using these authors' previous work with large oncology and AIDS caregiver data sets.

Issues to consider when choosing and using large national databases for research of families.

Secondary analysis of large national databases offers promise for research of families. In this article, issues that the secondary analyst must consider when choosing a database for research of families are described. Potential advantages and limitations of databases are discussed. Strategies to minimize potential limitations are highlighted.

Conceptual and pragmatic considerations in conducting a secondary analysis. An example from research of families.

In this article, the authors discuss conceptual and pragmatic considerations for conducting research of families using large secondary data sets. Conceptual considerations include establishing consistency among the theory, variables, and available data, and determining reliability and validity of the data in the context of the theory. Pragmatic considerations include the use of resources such as management of the data among several authors, criteria and methods for selection of a subsample, and, recoding of the data to examine dyadic difference scores. The Family Special Interest Group of the Eastern Nursing Research Society initiated this research as part of a project to analyze families using large national data sets. The purpose of the secondary analysis was to identify family beliefs about healt-promoting behaviors. Combining parent and teen data to create relational level data resulted in new information that had not been identified in the original survey.

Parent-teen worry about the teen contracting AIDS.

A secondary data analysis of the National Commission on Children: 1990 Survey of Parents and Children was conducted with a subsample of 457 parent-teen pairs who responded to the "worry about AIDS" question. The teen's worry about contracting AIDS was associated with race, parent's education, the amount of discipline from the parent for engaging in sex, the teen's desire to talk to the parent about the problem of sex, the teen's rating of the neighborhood as a safe place to grow up, whether the parent listened to the teen's telephone interview, and the parent's response to whether his or her teen had a history of sexually transmitted disease. Of the parent-teen pairs in the subsample, 46% (N = 210) agreed in their responses about worry. Agreement was more frequent among the parent-teen pairs when compared to randomly constructed surrogate pairs. Dyadic analysis supported a family system view of perceived susceptibility.

The pyridoxal-5'-phosphate-dependent catalytic antibody 15A9: its efficiency and stereospecificity in catalysing the exchange of the alpha-protons of glycine.

13C-NMR has been used to follow the exchange of the alpha-protons of [2-(13)C]glycine in the presence of pyridoxal-5'-phosphate and the catalytic antibody 15A9. In the presence of antibody 15A9 the 1st order exchange rates for the rapidly exchanged proton of [2-(13)C]glycine were only 25 and 150 times slower than those observed with tryptophan synthase (EC 4.2.1.20) and serine hydroxymethyltransferase (EC 2.1.2.1). The catalytic antibody increases the 1st order exchange rates of the alpha-protons of [2-(13)C]glycine by at least three orders of magnitude. We propose that this increase is largely due to an entropic mechanism which results from binding the glycine-pyridoxal-5'-phosphate Schiff base. The 1st and 2nd order exchange rates of the pro-2S proton have been determined but we were only able to determine the 2nd order exchange rate for the pro-2R proton of glycine. In the presence of 50 mM glycine the antibody preferentially catalyses the exchange of the pro-2S proton of glycine. The stereospecificity of the 2nd order exchange reaction was quantified and we discuss mechanisms which could account for the observed stereospecificity.

A restraint on restraints: the need to reconsider the use of restrictive interventions.

Children with behavior problems are put in units with milieu therapy for the support and guidance of a specialized health care team, supposedly experts in the care of children with these unique and urgent needs. The reality of such units, however, is that those with the most contact with the children are often inadequately prepared, both in terms of knowledge and skills, to manage disruptive behaviors. As a result, the milieu that is supposed to provide support and structure can actually exacerbate the trauma for the vulnerable child. Preliminary data are presented from an ongoing study that is investigating the experiences and memories of formerly hospitalized children. Three types of traumatic experiences are described: vicarious trauma, alienation from staff, and direct trauma. Many of the traumatic events endured by child patients are the result of an inappropriate use by staff of power and force. There was a marked lack of understanding by the children of why given interventions were used. Although coercive interventions are sometimes necessary, ethical, legal, and other professional considerations make it clear that more work is needed. Research to identify the patterns of lack of knowledge and skills, as well as to develop appropriate interventions are recommended.

Sibling bereavement: a concept analysis.

Investigators of sibling bereavement contend that the death of a sibling represents a unique and intense loss experience. The empirical literature, however, lacks conceptual clarity about the characteristics of sibling bereavement. Metaphors of siblingship are widely applied and may compromise the integrity of theory development specific to sibling bereavement, particularly as this knowledge base is broadened. There is an immediate need to extend the descriptive knowledge base for sibling bereavement beyond adolescence, in large part to prepare to address the needs of the great number of adults whose brothers and sisters have died as a result of AIDS. The purpose of this article is to examine the concept of sibling bereavement by reviewing the empirical literature and by applying the Wilsonian Method (1963) of concept analysis. A preliminary model addressing the factors of critical attributes and personal outcome variables for bereavement research specific to sibling loss is presented.

Dirty hands: the underside of marketplace health care.

The ethos of the corporation and the urgency for profit maximization place pressures on health care corporations to act in a way that may be incompatible with ethical practice. Profit-driven incentives often result in corporate deviance and criminal behavior. Nurses may be pressured to go along with schemes that may be unethical or illegal and because of shaky job markets may be unable to adhere to professional ethical guidelines. Recent events in health care are drawn on to argue that ethical theory and research must begin to consider the issue of moral compromise of professionals as a result of deviant organizational environments.