Changes in fibroblast growth factor receptors-1c, -2c, -3c, and -4 mRNA in granulosa and theca cells during ovarian follicular growth in dairy cattle.

The various fibroblast growth factors (FGF) regulate their function via binding to 4 main FGF receptor (FGFR) subtypes and their splice variants, FGFR1b, FGF1c, FGFR2b, FGFR2c and FGFR3c and FGFR4, but which of these FGFR are expressed in the granulosa (GC) and theca cells (TC), the 2 main cell layers of ovarian follicles, or change during follicular development is unknown. We hypothesized that FGFR1c, FGFR2c and FGFR3c (but not FGFR4) gene expression in GC (but not TC) would change with follicular development. Hence, the objective of this study was to determine if abundance of FGFR1c, FGFR2c, FGFR3c, and FGFR4 mRNA change according to follicular size, steroidogenic status, and days post-ovulation during growth of first-wave dominant follicles in Holstein cattle exhibiting regular estrous cycles. Estrous cycles of non-lactating dairy cattle were synchronized, and ovaries were collected on either d 3 to 4 (n = 8) or d 5 to 6 (n = 8) post-ovulation for GC and TC RNA extraction from small (1-5 mm), medium (5.1 to 8 mm) or large (8.1-18 mm) follicles for real-time PCR analysis. In GC, FGFR1c and FGFR2c mRNA relative abundance was greater in estrogen (E2)-inactive (ie, concentrations of E2 < progesterone, P4) follicles of all sizes than in GC from large E2-active follicles (ie, E2 > P4), whereas FGFR3c and FGFR4 mRNA abundance did not significantly differ among follicle types or days post-estrus. In TC, medium E2-inactive follicles had greater FGFR1c and FGFR4 mRNA abundance than large E2-active and E2-inactive follicles on d 5 to 6 post-ovulation whereas FGFR2c and FGFR3c mRNA abundance did not significantly differ among follicle types or day post-estrus. In vitro experiments revealed that androstenedione increased abundance of FGFR1c, FGFR2c and FGFR4 mRNA in GC whereas estradiol decreased FGFR2c mRNA abundance. Neither androstenedione nor estradiol affected abundance of the various FGFR mRNAs in cultured TC. Taken together, the findings that FGFR1c and FGFR2c mRNA abundance was less in GC of E2-active follicles and FGFR1c and FGFR4 mRNA was greater in TC of medium inactive follicles at late than at early growing phase of the first dominant follicle support an anti-differentiation role for FGF and their FGFR as well as support the idea that steroid-induced changes in FGF and their receptors may regulate selection of dominant follicles in cattle.

Comparison of effects of four weaning methods on health and performance of beef calves.

Weaning of beef calves is a stressful event that negatively impacts health and performance. A variety of interventions have been proposed to reduce stress and improve gains following weaning. This study used 288 7- to 8-month-old calves from two separate locations, to examine four different weaning strategies, as well as the impact of shipment. Calves were blocked by weight and sex, and then randomly assigned to one of four treatments: abrupt weaning (AW), where calves were separated from the dam on day 0 (D0) and allowed no further contact with the dam; fence line (FL), where calves were weaned on D0 but had fence line contact with dams for 7 days; nose flap (NF), where on day -6 calves received a nose flap that interferes with suckling, then had the flap removed and were weaned from the dam on D0; and intermittent separation (SEP), where calves were removed from dams for 24-h intervals on day -13 and day -6, then weaned on D0, but allowed fence line contact with the dam for 7 days. Each treatment group was further divided into two subgroups, one of which was shipped early (D0 for AW, day 7 for others) or shipped later (day 28). Body weight and sickness were recorded for all groups. Results showed a negative impact on gain for early shipping compared to later shipping, and poorer gain in AW calves than most other treatments. Results of the analyses of morbidity were inconclusive. This study found that delayed shipment following FL weaning improves performance under common management conditions for the US cow-calf industry.

G protein-coupled receptor 34 in ovarian granulosa cells of cattle: changes during follicular development and potential functional implications.

Abundance of G protein-coupled receptor 34 (GPR34) mRNA is greater in granulosa cells (GCs) of cystic vs normal follicles of cattle. The present experiments were designed to determine if GPR34 mRNA in granulosa cell [GC] changes during selection and growth of dominant follicles in cattle as well as to investigate the hormonal regulation of GPR34 mRNA in bovine GC in vitro. In Exp. 1, estrous cycles of nonlactating cows were synchronized and then ovariectomized on either day 3-4 or 5-6 after ovulation. GPR34 mRNA abundance in GC was 2.8- to 3.8-fold greater (P < 0.05) in small (1-5 mm) and large (≥8 mm) estrogen-inactive dominant follicles than in large estrogen-active follicles. Also, GPR34 mRNA tended to be greater (P < 0.10) in F2 than F1 follicles on day 3-4 postovulation. In Exp. 2-7, ovaries were collected at an abattoir and GC were isolated and treated in vitro. Expression of GPR34 was increased (P < 0.05) 2.2-fold by IGF1. Tumor necrosis factor (TNF)-α decreased (P < 0.05) the IGF1-induced GPR34 mRNA abundance in small-follicle GC, whereas IGF1 decreased (P < 0.05) GPR34 expression by 45% in large-follicle GC. Treatment of small-follicle GC with either IL-2, prostaglandin E2 or angiogenin decreased (P < 0.05) GPR34 expression, whereas FSH, cortisol, wingless 3A, or hedgehog proteins did not affect (P > 0.10) GPR34 expression. In Exp. 6 and 7, 2 presumed ligands of GPR34, L-a-lysophosphatidylserine (LPPS) and LPP-ethanolamine, increased (P < 0.05) GC numbers and estradiol production by 2-fold or more in small-follicle GC, and this response was only observed in IGF1-treated GC. In conclusion, GPR34 is a developmentally and hormonally regulated gene in GC, and its presumed ligands enhance IGF1-induced proliferation and steroidogenesis of bovine GC.

Reconstructing larval growth and habitat use in an amphidromous goby using otolith increments and microchemistry.

High-resolution analysis of growth increments, trace element chemistry and oxygen isotope ratios (δ18 O) in otoliths were combined to assess larval and post-larval habitat use and growth of Awaous stamineus, an amphidromous goby native to Hawai'i. Otolith increment widths indicate that all individuals experience a brief period of rapid growth during early life as larvae and that the duration of this growth anomaly is negatively correlated with larval duration. A protracted high-growth period early in larval life is associated with a lower ratio of Sr:Ca, which may reflect low salinity conditions in nearshore habitats. A distinct shift in δ18 O (range: 4-5‰) is closely associated with the metamorphic mark in otoliths, indicating that larval metamorphosis occurs promptly upon return to fresh water. Strontium and other trace elements are not as tightly coupled to the metamorphosis mark, but confirm the marine-to-freshwater transition. Integration of microstructural and microchemical approaches reveals that larvae vary substantially in growth rate, possibly in association with habitat differences. Although time and financial costs make it difficult to achieve large sample sizes, present results show that examining even a small number of individuals can lead to novel inferences about early life history in diadromous fishes and illustrates the value of integrating analyses.

Changes in fibroblast growth factor 9 mRNA in granulosa and theca cells during ovarian follicular growth in dairy cattle.

Fibroblast growth factor 9 (FGF9) has been suggested to act as an antidifferentiation factor in cattle by reducing steroidogenesis and increasing cell proliferation in granulosa (GC) and theca (TC) cells. The objective of this study was to characterize FGF9 mRNA abundance in GC and TC during development of dominant follicles in dairy cattle. Estrous cycles of nonlactating dairy cattle were synchronized, and ovaries were collected on either d 3 to 4 (n=8) or 5 to 6 (n=8) postovulation for GC and TC RNA extraction from small (1-5mm), medium (5.1-8mm), and large (8.1-18mm) follicles for PCR analysis. The FGF9 mRNA abundance was greater in GC than in TC. In GC, FGF9 mRNA abundance was greater in small, medium, and large estrogen-inactive [i.e., concentrations of estradiol (E2)P4) follicles at both early (d 3-4) and late (d 5-6) growing phases of first dominant follicle. Abundance of FGF9 mRNA increased in medium-sized follicles from early to late growing phase of the dominant follicle. In TC, FGF9 mRNA abundance was greater in large E2-inactive follicles than in large E2-active follicles on d 3 to 4 postovulation; no significant differences in TC FGF9 mRNA existed among follicle types on d 5 to 6 postovulation. Correlations among levels of follicular fluid hormones and FGF9 mRNA levels revealed significant negative correlations between GC FGF9 mRNA abundance and follicular fluid E2 (r=-0.68), free IGF-1 (r=-0.63), and E2-to-P4 ratio (r=-0.58). In summary, abundance of FGF9 mRNA in GC and TC increases in medium-sized follicles during development of dominant follicles and is less in dominant E2-active than subordinate E2-inactive follicles, suggesting that FGF9 signaling could contribute to normal follicle development and steroidogenesis in dairy cattle.

Colonization and demographic expansion of freshwater fauna across the Hawaiian archipelago.

It is widely accepted that insular terrestrial biodiversity progresses with island age because colonization and diversification proceed over time. Here, we assessed whether this principle extends to oceanic island streams. We examined rangewide mtDNA sequence variation in four stream-dwelling species across the Hawaiian archipelago to characterize the relationship between colonization and demographic expansion, and to determine whether either factor reflects island age. We found that colonization and demographic expansion are not related and that neither corresponds to island age. The snail Neritina granosa exhibited the oldest colonization time (~2.713 mya) and time since demographic expansion (~282 kya), likely reflecting a preference for lotic habitats most prevalent on young islands. Conversely, gobioid fishes (Awaous stamineus, Eleotris sandwicensis and Sicyopterus stimpsoni) colonized the archipelago only ~0.411-0.935 mya, suggesting ecological opportunities for colonization in this group were temporally constrained. These findings indicate that stream communities form across colonization windows, underscoring the importance of ecological opportunities in shaping island freshwater diversity.

[STIGMA AND HIV / AIDS AMONG PUERTO RICAN PARENTS / MOTHERS AND ADOLESCENTS]. / ESTIGMA Y VIH/SIDA ENTRE PADRES/MADRES Y ADOLESCENTES PUERTORRIQUEÑOS/AS.

Communication between parents and adolescents about sexuality is important for the healthy development of young people. Stigmatizing attitudes towards HIV/AIDS may adversely impact this communication. The aim of this study was to identify stigmatizing attitudes towards HIV/AIDS among Puerto Rican parents and adolescents. This effort is part of the Cuídalos Project which aimed to test a web-based intervention to increase communication about sexuality and health among parents and adolescents through an experimental design with 458 parent/adolescent (13-17 years of age) dyads. For the purposes of this article we report descriptive statistics on HIV/AIDS stigma attitudes gathered as part of our baseline measurement. Both parents and adolescents manifested stigmatizing attitudes towards HIV/AIDS. In light of these results it is necessary to continue developing interventions to reduce stigma among this population. Parents can be an invaluable asset to reduce stigma among adolescents and to help prevent sexual risk behaviors and new infection.

Changes in brain ribonuclease (BRB) messenger RNA in granulosa cells (GCs) of dominant vs subordinate ovarian follicles of cattle and the regulation of BRB gene expression in bovine GCs.

Brain ribonuclease (BRB) is a member of the ribonuclease A superfamily that is constitutively expressed in a range of tissues and is the functional homolog of human ribonuclease 1. This study was designed to characterize BRB gene expression in granulosa cells (GCs) during development of bovine dominant ovarian follicles and to determine the hormonal regulation of BRB in GCs. Estrous cycles of Holstein cows (n = 18) were synchronized, and cows were ovariectomized on either day 3 to 4 or day 5 to 6 after ovulation during dominant follicle growth and selection. Ovaries were collected, follicular fluid (FFL) was aspirated, and GCs were collected for RNA isolation and quantitative polymerase chain reaction. Follicles were categorized as small (1-5 mm; pooled per ovary), medium (5-8 mm; individually collected), or large (8.1-17 mm; individually collected) based on surface diameter. Estradiol (E2) and progesterone (P4) levels were measured by radioimmunoassay (RIA) in FFL. Abundance of BRB messenger RNA (mRNA) in GCs was 8.6- to 11.8-fold greater (P < 0.05) in small (n = 31), medium (n = 66), and large (n = 33) subordinate E2-inactive (FFL E2 < P4) follicles than in large (n = 16) dominant E2-active (FFL E2 > P4) follicles. In the largest 4 follicles, GCs BRB mRNA abundance was negatively correlated (P < 0.01) with FFL E2 (r = -0.65) and E2:P4 ratio (r = -0.46). In experiment 2, GCs from large (8-22 mm diameter) and small (1-5 mm diameter) follicles were treated with insulin-like growth factor 1 (IGF1; 0 or 30 ng/mL) and/or tumor necrosis factor alpha (0 or 30 ng/mL); IGF1 increased (P < 0.05) BRB mRNA abundance, and tumor necrosis factor alpha decreased (P < 0.001) the IGF1-induced BRB mRNA abundance in large-follicle GCs. In experiment 3 to 6, E2, follicle-stimulating hormone, fibroblast growth factor 9, cortisol, wingless 3A, or sonic hedgehog did not affect (P > 0.10) abundance of BRB mRNA in GCs; thyroxine and luteinizing hormone increased (P < 0.05), whereas prostaglandin E2 (PGE2) decreased (P < 0.05) BRB mRNA abundance in small-follicle GCs. Treatment of small-follicle GCs with recombinant human RNase1 increased (P < 0.05) GCs numbers and E2 production. In conclusion, BRB is a hormonally and developmentally regulated gene in bovine GCs and may regulate E2 production during follicular growth in cattle.

Field evaluation of a model for predicting nitrogen losses from drained lands.

The N simulation model, DRAINMOD-N II, was field-tested using a 6-yr data set from an artificially drained agricultural site located in eastern North Carolina. The test site is on a nearly flat sandy loam soil which is very poorly drained under natural conditions. Four experimental plots, planted to a corn (Zea mays)-wheat (Triticum aestivum L.)-soybean (Glycine max.) rotation and managed using conventional and controlled drainage, were used in model testing. Water table depth, subsurface drainage, and N concentration in drain flow were measured and meteorological data were recorded continuously. DRAINMOD-N II was calibrated using the data from one plot; data sets from the other three plots were used for model validation. Simulation results showed an excellent agreement between observed and predicted nitrate-nitrogen (NO(3)-N) losses in drainage water over the 6-yr period and a reasonable agreement on an annual basis. The agreement on a monthly basis was not as good. The Nash-Sutcliffe modeling efficiency (EF) for monthly predictions was 0.48 for the calibration plot and 0.19, 0.01, and -0.02 for the validation plots. The value of the EF for yearly predictions was 0.92 for the calibration plot and 0.73, 0.62, and -0.10 for the validation plots. Errors in predicting cumulative NO(3)-N losses over the 6-yr period were remarkably small; -1.3% for the calibration plot, -8.1%, -2.8%, and 4.0% for the validation plots. Results of this study showed the potential of DRAINMOD-N II for predicting N losses from drained agricultural lands. Further research is needed to test the model for different management practices and soil and climatological conditions.

Tracing nitrate transport and environmental impact from intensive swine farming using delta nitrogen-15.

Natural-abundance delta15N showed that nitrate generated from commercial land application of swine (Sus scrofa domesticus) waste within a North Carolina Coastal Plain catchment was being discharged to surface waters by ground water passing beneath the sprayfields and adjacent riparian buffers. This was significant because intensive swine farms in North Carolina are considered non-discharge operations, and riparian buffers with minimum widths of 7.6 m (25 ft) are the primary regulatory control on ground water export of nitrate from these operations. This study shows that such buffers are not always adequate to prevent discharge of concentrated nitrate in ground water from commercial swine farms in the Mid-Atlantic Coastal Plain, and that additional measures are required to ensure non-discharge conditions. The median delta15N-total N of liquids in site swine waste lagoons was +15.4 +/- 0.2% vs. atmospheric nitrogen. The median delta15N-NO3 values of shallow ground water beneath and adjacent to site sprayfields, a stream draining sprayfields, and waters up to 1.5 km downstream were + 15.3 +/- 0.2 to + 15.4 +/- 0.2%. Seasonal and spatial isotopic variations in lagoons and well waters were greatly homogenized during ground water transport and discharge to streams. Neither denitrification nor losses of ammonia during spraying significantly altered the bulk ground water delta15N signal being delivered to streams. The lagoons were sources of chloride and potassium enrichment, and shallow ground water showed strong correlation between nitrate N, potassium, and chloride. The 15N-enriched nitrate in ground water beneath swine waste sprayfields can thus be successfully traced during transport and discharge into nearby surface waters.

Explaining leptokurtic movement distributions: intrapopulation variation in boldness and exploration.

Leptokurtic distributions of movement distances observed in field-release studies, in which some individuals move long distances while most remain at or near their release point, are a common feature of mobile animals. However, because leptokurtosis is predicted to be transient in homogeneous populations, persistent leptokurtosis suggests a population heterogeneity. We found evidence for a heterogeneity that may generate persistent leptokurtosis. We tested individuals of the Trinidad killifish Rivulus hartii for boldness in a tank test and released them back into their native stream. Boldness in the tank test predicted distance moved in the field releases, even after effects of size and sex were removed. Further, data from a 19-mo mark-recapture study showed that individual growth correlated positively with movement in a predator-threatened river zone where the Rivulus population is spatially fragmented and dispersal is likely to be a hazardous activity. In contrast, no such correlation existed in a predator-absent zone where the population is unfragmented. These results show that a behavioral trait, not discernible from body size or sex, contributes to dispersal and that a component of fitness of surviving "dispersers" is elevated above that of "stayers," a fundamental assumption or prediction of many models of the evolution of dispersal through hazardous habitat.

A technique for performing transesophageal echocardiography in patients with Zenker's diverticulum.

A patient with a large Zenker's diverticulum and narrow, angulated passageway successfully underwent transesophageal echocardiography using a pediatric endoscope, short esophageal overtube, and a pediatric transesophageal echocardiographic probe.

Effect of oral creatine supplementation on isokinetic torque production.

PURPOSE: This study was conducted to examine the effect of oral creatine supplementation on the decline in peak isokinetic torque of the quadriceps muscle group during an endurance test. METHODS: Twenty-three active, but untrained, male subjects performed isokinetic strength tests on a Cybex II dynamometer at 180 degrees x s(-1). The protocol consisted of pre- and post-tests with five sets of 30 maximum volitional contractions with a 1-min rest period between sets. Subjects returned to perform the posttest after 5 d of placebo (4 x 6 g glucose x d(-1), N = 12) or creatine (4 x 5 g creatine + 1 g glucose x d(-1), N = 11) supplementation. Supplements and testing were administered in a double blind fashion. Peak torque was measured during each contraction and the 30 contractions were averaged for each set. RESULTS: A three-way mixed ANOVA with one between factor (placebo vs creatine) and two within factors (pre/post supplementation and sets 1-5) revealed no significant interactions, P > 0.05. The placebo vs creatine main effect was also nonsignificant, whereas the pre/post and set effects were significant (P < 0.05). Peak torque increased (approximately 3%) from pre- to post-testing, (P = 0.04), but the absolute magnitude of the differences is unlikely to be of any practical significance. Peak torque decreased from sets 1 to 4, whereas sets 4 and 5 were not different. A priori contrasts comparing the creatine group's performance pre vs post test for the fourth and fifth sets were nonsignificant (P > 0.05). CONCLUSIONS: Based on within and between group comparisons, we were unable to detect an ergogenic effect of oral creatine supplementation on the decline in peak torque during isokinetic exercise at 180 degrees x s(-1).

Clinical and manometric features of the lower esophageal muscular ring.

OBJECTIVE: In contrast to the well-recognized Schatzki's ring, the lower esophageal muscular ring remains a poorly defined entity. The purpose of this study is to report on the clinical features of three patients with lower esophageal muscular rings and review the literature on this disorder, to better understand its importance as a cause of dysphagia. METHODS: Three patients presenting to the West Roxbury VA Medical Center were identified as having a contractile, focal narrowing in the distal esophagus by upper GI series. Clinical histories were obtained and endoscopic and manometric evaluations were performed. RESULTS: The three patients had symptoms consisting of chronic, intermittent dysphagia for both liquids and solids. The results of barium swallows and upper endoscopic examinations were similar and revealed a focal, thick constriction of variable luminal diameter located a few centimeters above the squamocolumnar junction. Esophageal motility testing revealed peristaltic, high-amplitude, long-duration, and multiple peaked contractions. Lower esophageal sphincter function was normal. The patients derived partial or only temporary relief of dysphagia with esophageal dilation with rigid dilators. All three patients had significant symptomatic responses to anticholinergic agents. CONCLUSIONS: Lower esophageal muscular rings are an uncommon but important cause of dysphagia. Significant esophageal motility abnormalities can be found in symptomatic patients. Distinguishing the lower esophageal muscular ring from the Schatzki's ring is important because of differences in the treatment and outcome of the two conditions.

Oxidative deamination of hydrolyzed fumonisin B(1) (AP(1)) by cultures of Exophiala spinifera.

Fumonisins are mycotoxins of world-wide distribution in maize infected by the fungus Fusarium verticillioides. They are highly toxic to certain livestock and are potential carcinogens. Exophiala spinifera, a black yeast fungus found on moldy maize kernels, was identified previously as capable of growing on fumonisin B1 as a sole carbon source and thus is a potential source for fumonisin detoxifying enzymes. Pure cultures of E. spinifera transform fumonisin B(1) to the amino polyol AP(1) plus free tricarballylic acid through the activity of a soluble extracellular esterase, and further transformation is evidenced by accumulation in culture supernatant of a less polar compound(s) lacking a fluorescamine-reactive amino group. A free amine is thought to be critical for biological activity of FB(1) or AP(1). As a first step towards characterizing this amine-modifying activity, we investigated the biotransformation of AP(1) by E. spinifera liquid cultures that had been previously grown in liquid medium containing AP(1) as a sole carbon source. Accumulation of AP(1)-derived metabolites was monitored by thin-layer chromatography of culture supernatants, and product metabolites were purified and evaluated by mass spectrometry and nuclear magnetic resonance. Two products of treatment of purified AP(1) with cultures of E. spinifera are shown to be N-acetyl AP(1) and a new compound, 2-oxo-12,16-dimethyl-3,5,10, 14,15-icosanepentol hemiketal (or 2-OP(1) hemiketal).

Relationship of the pelvic angle to the sacral angle: measurement of clinical reliability and validity.

There is a need to better document the reliability and validity of assessment measures used in physical therapy. Studies documenting the reliability of measurement of the pelvic angle and its relationship to sacral motion are presently inconclusive. The purpose of this study was twofold. First, we wanted to determine the reliability and validity of a goniometric measurement of the pelvic angle. We also wanted to test the hypothesis that there is a relationship between the pelvic angle and the sacral angle. Intertester and intratester reliability of goniometric pelvic angle measurements of 23 healthy young adults were examined using three different raters. Radiographic measurements of the pelvic and sacral angle using two raters and goniometric measurement of the pelvic angle using a single rater were taken from 15 patients with low back pain who had been referred for X-rays. Intraclass correlation coefficients (ICCs) of intratester reliability for goniometric measurements of the pelvic angle were .93, .96, and .96. The intertester reliability was .95. The ICCs for intratester reliability for radiological measurements were .92 and .95 for the sacral angle and .98 for both measurements of the pelvic angle. Intertester reliability coefficients were .86 and .88, respectively. The Pearson correlation coefficients for the goniometric and radiological measurements of the pelvic angle were .85 and .68. A comparison of the radiological and goniometric measurements of the pelvic angle with the sacral angle demonstrated low average correlations of .43 and .58, respectively. The results indicate a high level of correlation between and within testers for goniometric measurements of the pelvic angle but only a fair correlation between goniometric and radiological measurements of the pelvic angle.(ABSTRACT TRUNCATED AT 250 WORDS)

A contemporary analysis of medicolegal concerns for physician assistants and nurse practitioners.

The utilization of-PAs and NPs to expand the supply of traditional physician services to the public, at reduced costs, as proposed by President Nixon in 1971, has in 1994 become a national mandate. There is an increasing demand for the "traditional" physician services, which can be efficiently and cost effectively performed by nonphysician practitioners, such as PAs and NPs. Statutory changes permitting physicians "to delegate medical acts in an innovative manner" have been, at times, agonizingly slow. However, when compared to the NP statutes, the PA statutes have evolved at a rapid rate. It is postulated that this may be due to the fact that PAs who are totally dependent on physician supervision are more controllable and hence more acceptable to organized medicine than NPs who are currently flexing their political muscles in a quest for greater independence in their performance of traditional physician services. The reimbursability of the two professions is yet another important consideration. Nurse practitioners are "directly" reimbursed by third-party payors, such as Medicare and Medicade, for the traditional physician services they perform, while PA third-party reimbursement is, by law, paid directly to the employing physician or medical facility. Unlike NPs, PAs were conceived by organized medicine, the AMA, to provide a mechanism for physicians to expand their capability to treat increasing numbers of patients. Accordingly, PAs are tied to their supervising physician by the same governmental agencies that regulate physician licensure. Conversely, NPs, who derive their authority to practice from the various state nurse practice acts, have been, at times, impeded in their quest for an enlargement of their scope of practice, including independent prescriptive privileges. The NP bid for greater independence and enlargement of their scope of practice, on a national level, is viewed by organized medicine as an encroachment into the "independent" practice of medicine under the guise of providing advanced nursing care. Unlike PAs, whose professional existence depends on the supervision of a licensed physician, NPs are, by and large, independent of physician control by virtue of their status as licensed members of the nursing profession. While PAs and NPs were once thought to be virtually interchangeable, the divergence of the two professions over the past two decades has been such that all similarities have, for all intents and purposes, disappeared.(ABSTRACT TRUNCATED AT 400 WORDS)

Mock survey. Methodology for measuring compliance and facilitating change.

Every nurse executive is responsible for maintaining compliance to current externally established standards. As standards change, the nurse executive must evaluate the organization, making sure it continues to demonstrate compliance. This article describes how one organization used the Joint Commission on Accreditation of Healthcare Organizations' Agenda for Change as an opportunity to examine its nursing practice. The process included: 1) analyzing compliance to the 1991 standards; 2) developing an action plan to address deficiencies; and 3) developing and conducting a mock survey to monitor and evaluate effectiveness of the action plan. Increased staff comfort with the survey process, monitoring tools, and data regarding compliance to standards were the primary outcomes of this process. Leadership development, team building, and networking were also outcomes.