Proteomic Alterations Associated with Biomechanical Dysfunction are Early Processes in the Emilin1 Deficient Mouse Model of Aortic Valve Disease.

Aortic valve (AV) disease involves stiffening of the AV cusp with progression characterized by inflammation, fibrosis, and calcification. Here, we examine the relationship between biomechanical valve function and proteomic changes before and after the development of AV pathology in the Emilin1-/- mouse model of latent AV disease. Biomechanical studies were performed to quantify tissue stiffness at the macro (micropipette) and micro (atomic force microscopy (AFM)) levels. Micropipette studies showed that the Emilin1-/- AV annulus and cusp regions demonstrated increased stiffness only after the onset of AV disease. AFM studies showed that the Emilin1-/- cusp stiffens before the onset of AV disease and worsens with the onset of disease. Proteomes from AV cusps were investigated to identify protein functions, pathways, and interaction network alterations that occur with age- and genotype-related valve stiffening. Protein alterations due to Emilin1 deficiency, including changes in pathways and functions, preceded biomechanical aberrations, resulting in marked depletion of extracellular matrix (ECM) proteins interacting with TGFB1, including latent transforming growth factor beta 3 (LTBP3), fibulin 5 (FBLN5), and cartilage intermediate layer protein 1 (CILP1). This study identifies proteomic dysregulation is associated with biomechanical dysfunction as early pathogenic processes in the Emilin1-/- model of AV disease.

The Arkansas AHEC model of community-oriented primary care.

This article explicates the Arkansas Area Health Education Center (AHEC) model of community-oriented primary care (COPC) and the role of the family nurse practitioner (FNP) in its implementation. The AHECs collaborate with local agencies to provide comprehensive, accessible, quality health care to specific patient populations, and offer learning opportunities to a wide variety of health professions students. The FNP demonstrates organizational and role competencies that include directing patient care, providing professional leadership, and developing the advanced practice nursing role. Two case studies are used to illustrate the FNPs' approach to COPC: (1) selection of interdisciplinary, multidisciplinary, and transdisciplinary approaches to management of a patient with chronic illnesses, and (2) the Sexual Assault Nurse Examiners Training Project.

Uncertainty, spiritual well-being, and psychosocial adjustment to chronic illness.

This research was undertaken to assess spiritual well-being as an internal coping resource to buffer the effects of uncertainty on psychosocial adjustment among 94 persons with diabetes mellitus. Five instruments were used to collect data; descriptive, correlational, multivariate, and content analysis procedures were used for data analysis. A predicted negative relationship between uncertainty and spiritual well-being was supported, with a stronger relationship between the existential well-being component of spiritual well-being and uncertainty than the religious well-being component. Uncertainty explained 43% of the variance in psychosocial well-being; existential well-being added an additional 10%, suggesting that it serves as a buffer between uncertainty and psychosocial well-being. The findings suggest that spiritual well-being may be an important internal resource for persons forced to adjust to uncertainty related to long-term health problems such as diabetes mellitus.

Computer conferencing: communication for distance learners.

Computer conferencing enables the user to easily and quickly communicate and access information from a remote site. The Nurse Practitioner Outreach program at the University of Texas School of Nursing at Galveston pilot-tested a program in which students at remote locations used computer conferencing to receive course assignments and interact with faculty members and one another. This program has provided valuable insights into the advantages and challenges of using computer conferencing in a nursing educational setting.

Facial cosmetic surgery: a primary care perspective.

Primary care providers are often the source of information regarding health matters including elective cosmetic surgery. Practitioners should know about the more common cosmetic surgical procedures to assist their clients in making informed decisions regarding these operations. This article describes facial cosmetic surgical procedures performed to modify the signs of aging, which includes rhytidectomy ("face lift"), blepharoplasty ("eyelid surgery"), chemical peels, and dermabrasion. Issues discussed include preoperative considerations, expected outcomes, length of recovery period, costs, and complications (hemorrhage, necrosis, nerve injury, psychologic sequelae). Because facial cosmetic surgery usually has a positive impact on one's self-esteem, there has been an overall increase in facial cosmetic procedures during the past decade.

Adverse toxic reaction to aqueous procaine penicillin G.

Aqueous procaine penicillin G therapy is frequently used in ambulatory care settings and clinicians have long been alerted to the potential allergic reactions that may occur with this therapy; however, the nonallergic toxic reaction has not been as widely publicized. A possible psychotic-like, pseudoanaphylactic reaction may occur within 60 seconds following an injection of aqueous procaine penicillin G. Two case reports and a review of the literature will be presented to alert clinicians to this reaction. Suggestions for management will also be offered.