Helminth infection protects mice from anaphylaxis via IL-10-producing B cells.

Modulation of the immune system by infection with helminth parasites, including schistosomes, is proposed to reduce the levels of allergic responses in infected individuals. In this study we investigated whether experimental infection with Schistosoma mansoni could alter the susceptibility of mice to an extreme allergic response, anaphylaxis. We formally demonstrate that S. mansoni infection protects mice from an experimental model of systemic fatal anaphylaxis. The worm stage of infection is shown to mediate this protective effect. In vivo depletion studies demonstrated an imperative role for B cells and IL-10 in worm-mediated protection. Furthermore, worm infection of mice increases the frequency of IL-10-producing B cells compared with that in uninfected mice. However, transfer of B cells from worm-infected mice or in vitro worm-modulated B cells to sensitized recipients exacerbated anaphylaxis, which was attributed to the presence of elevated levels of IL-4-producing B cells. Worm-modulated, IL-10-producing B cells from IL-4-deficient, but not IL-5-, IL-9- or IL-13-deficient, mice conferred complete resistance to anaphylaxis when transferred to naive mice. Therefore, we have dissected a novel immunomodulatory mechanism induced by S. mansoni worms that is dependent on an IL-10-producing B cell population that can protect against allergic hypersensitivity. These data support a role for helminth immune modulation in the hygiene hypothesis and further illustrate the delicate balance between parasite induction of protective regulatory (IL-10) responses and detrimental (IL-4) allergic responses.

Clinical nurse specialists' knowledge specific to Medicare structures and processes.

PURPOSE: The purpose of this study was to describe clinical nurse specialists' (CNSs) knowledge of Medicare structures and processes using a multiple-choice examination. DESIGN: This descriptive study used the survey method with a convenient sample. SETTING: Potential subjects received the research study packet at the address designated by them for membership mailings sent from the National Association of Clinical Nurse Specialists (NACNS). SAMPLE: The population of interest was practicing CNSs. The accessible population was NACNS members drawn from the 2002 mailing list organized by zip code. Every third mailing label was skipped. The remaining list members (N = 950) received a study packet. There was a 14.42% response rate with 137 respondents. Eighty-two percent held a master's degree in nursing. METHODS: A 46 item multiple-choice examination was developed based upon a content map established after a review of the available Medicare-related literature and consultation with Medicare advanced practice nurse providers. Content validity was established. Survey packets with the instrument, Scantron answer key, informational letter, and demographic profile were sent to potential subjects. Returned responses were keyed for correct answers. Relationships between demographic variables, raw score, and self-reported Medicare expertise were analyzed. Qualitative data elicited on the demographic form were thematically analyzed. FINDINGS: The examination had a.67 coefficient. Correlation of examination raw score to self-reported Medicare content expertise was 0.982 (P =.000). One third of the examination questions were incorrectly answered by 30% or more of respondents. Percentage correct scores ranged from 60.9 to 95.7 (M = 62.7%; SD = 10.46). Respondents offered 40 comments. Eleven comments related to a self-recognized Medicare knowledge deficit. Four responses highlighted that graduate studies had not provided them with the knowledge necessary for understanding reimbursement issues. Ten respondents expressed an interest in locating some type of educational resource addressing the Medicare system, reimbursement processes, and opportunities. CONCLUSIONS: Findings suggest that NACNS members have Medicare program knowledge deficits. Respondents recognize their deficiencies and are interested in obtaining more information about Medicare but are uncertain as to available resources or networking opportunities that might support them in this process. Graduate nursing programs may need to evaluate the amount of information provided within curriculums specific to insurance reimbursement and Medicare structures and processes. Study limitations include the low response rate and indeterminate sample representativeness. IMPLICATIONS FOR PRACTICE: Educators should examine CNS curriculums to ensure the adequacy of Medicare program information. Continuing education programs and conference workshops addressing Medicare information should be offered to CNSs interested in increasing their expertise or exploring provider opportunities. There may be entrepreneurial opportunities available to CNSs interested in developing an expertise in Medicare programs. Future research studies should quantify potential benefits to Medicare beneficiaries when CNSs participate as providers.