Neurofibromin and its inactivation of Ras are prerequisites for osteoblast functioning.

Skeletal problems and osteoporosis occur in up to 50% affected neurofibromatosis type 1 (NF1) humans. Inactivation of neurofibromin results in deregulation of Ras signal transduction. Little is known of bone biology in humans with NF1. The goal of our work was to determine if loss-of-function of Nf1 gene was associated with altered bone homeostasis and Ras signal transduction. Because homozygous Nf1 mice are embryonically lethal, heterozygote Nf1 (Nf1+/-) male mice were used to investigate skeletal phenotypes and osteoprogenitor functions, using standard in vivo and in vitro assays. We found that bone mass and geometry of Nf1+/- mice did not differ from wild type controls, despite a trend to less bone formation. Nf1+/- committed osteoprogenitors from femur metaphysis exhibited premature apoptosis and higher proliferation. Ras signaling was activated in primary Nf1+/- bone marrow-inducible osteoprogenitors. Inducible osteoprogenitors exhibited lower induction of osteoblast differentiation, assessed as alkaline phosphatase positive CFU-f. A screen of osteoblast marker genes showed a selective increase in osteopontin (OPN) mRNA and protein expression in these cells. OPN protein was increased in Nf1+/- bone, especially in cortical bone matrix. Because bone cell abnormalities in Nf1 haploinsufficiency were detected in vitro, redundant pathways must compensate for the deregulation of Ras signaling in vivo to maintain normal bone mass and function in vivo. Our in vitro data revealed that neurofibromin and its control of Ras signaling are required for osteoprogenitor homeostasis.

Health policy and the private sector. New vistas for nursing.

During the past two decades, the drive to rein in rising health care costs has shifted some of the power in health care policy making from professional groups, government agencies, and not-for-profit health care organizations to large for-profit corporations (1-4). This has been a world-wide phenomenon, as the provision and financing of health care services is shifted from governments to private health care organizations (5,6). In the United States, the shift in power is manifested in profound ways. Market competition and bottom-line economics have permeated the health care system, creating powerful new incentives for mergers, other corporate restructuring, and the shift to for-profit status by formerly not-for-profit insurance companies and providers. Private sector health care is now increasingly influenced by for-profit organizations (3). Moreover, the health insurance industry has been transformed as traditional indemnity insurance is replaced by versions of managed care. The role of government, or the public sector, in setting parameters for health care financing and standards for the delivery of health care services is increasingly outpaced in cost cutting by organizations that directly face the bottom line. In addition, private foundations, many of which are under the auspices of managed care organizations, now fund a large proportion of health care research and demonstration projects, a task once largely within the realm of the government. Through education and experience, nurses have developed political sophistication and understanding of policy making in the public sector (7). The challenge now is to educate nurses to adapt their political and policy strategies to the new health care milieu. This challenge is particularly crucial for advanced practice nurses, who must survive in a managed care environment.

NPACE nurse practitioner practice characteristics, salary, and benefits survey: 1999. Nurse Practitioner Associates for Continuing Education.

The purpose of this article is to present the results of a practice characteristics, salary, and benefits survey of 1,557 nurse practitioners from the United States who attended national nurse practitioner conferences in Las Vegas, Nevada, Orlando, Florida, Chicago, Illinois, and Boston, Massachusetts, in 1999. Specific data are presented on the demographics of the population, practice characteristics and responsibilities, benefits for full- and part-time employees, and salary by region, years of practice, type of certification, and location of the practice. The salary data were compared with the 1995-1996 and 1996-1997 NPACE practice characteristics, salary, and benefits surveys (Pulcini & Fitzgerald, 1997; Pulcini, Vampola, & Fitzgerald, 1998).

The relationship between characteristics of women with mental retardation and outcomes of the gynecologic examination.

This study examines the relationships among client characteristics and the outcomes of gynecologic examination success, sedation use, and cooperation with the examination in a sample of 99 women with mental retardation who received services from a nurse-managed women's health clinic in a large county medical center. Client characteristics that were associated with a successful gynecologic examination for this population of women were isolated. The findings from this study suggest that the presence of behavioral problems, profound mental retardation, and expressive language difficulties are important signals to providers. Special approaches are necessary when performing gynecologic examinations for women with mental retardation.

NPACE nurse practitioner practice characteristics, salary, and benefits survey.

The purpose of this article is to present the results of a survey of practice characteristics, salary, and benefits of 1,763 nurse practitioners (NPs) from the eastern United States who attended national NP conferences in Chicago, Illinois, and Boston, Massachusetts, in the fall of 1996 and in San Diego, California, and Orlando, Florida, in the spring of 1997. Specific data are presented on the demographics of the population; practice characteristics and responsibilities; benefits for full- and part-time employees; and salary by region, years of practice, type of certification, and location of the practice. The salary data were compared with the 1995-1996 NPACE practice characteristics, salary, and benefits survey for the eastern United States.

Framework for analyzing health care models serving adults with mental retardation and other developmental disabilities.

A conceptual framework was presented for describing, comparing, and analyzing the structure of health care models serving adults with mental retardation/developmental disabilities (MR/DD). This framework, which was drawn from Donabedian's (1980) work on the components of quality of health care-structure, process, and outcome-provides a basis for comparing health service models according to three key domains: measures of access, comprehensiveness, and cost. We used this framework to describe three existing programs that use different models to serve this population.