The Scottish Centre for Autism preschool treatment programme. I: A developmental approach to early intervention.

Early intervention is an area of intense current interest for parents and professionals. This article describes a mainstream National Health Service (NHS) approach to early intervention, developed at the Scottish Centre for Autism. The aims of treatment are to improve the child's early social communication and social interaction skills, leading to the potential development of play and flexibility of behaviour. This is achieved by 1:1 intensive treatment by trained therapists, and a schedule of parent training. The treatment protocol incorporates a child led approach; the use of imitation as a therapeutic strategy; using language contingent on activities; and the introduction of flexibility into play and social exchanges.

Expression of the thimet oligopeptidase gene is regulated by positively and negatively acting elements.

Thimet oligopeptidase (TOP) is a thiol-dependent metallopeptidase, which can cleave and thereby modulate the activity of many neuropeptides. The enzyme is active in many endocrine tissues, including testis, brain, and pituitary. In rat, the richest source of TOP is the testes, with a specific activity fivefold that of brain. The mechanism whereby rat TOP expression is regulated at the transcriptional level has been examined by reporter gene assay and electromobility shift assays after isolation of 1020 bp of upstream sequence. Computer analysis predicts a number of potential transcription factor-binding sites, which were examined by deletion analysis and DNA-binding studies. The promoter or its deletion fragments were fused to luciferase reporter gene vectors and introduced into GH3 pituitary, COS-1 kidney, MAT-Lu prostate, and GC-2spd(ts) spermatid cells. Two regions of the promoter have been identified: a positively acting region (-901/-219) and a strong negatively acting region (-219/-102). Concomitantly, potential transcription factors interacting with the cis-acting elements of the promoter were studied by gel electromobility shift assays. This work has identified a number of transcription factor-binding sites. However, no differences in the binding behavior in the various cell lines was observed.

Distribution of thimet oligopeptidase (E.C. 3.4.24.15) in human and rat testes.

Thimet oligopeptidase (TOP:E.C. 3.4.24.15) is a thiol sensitive metalloendopeptidase which is widely distributed and active in most tissues including testis, brain and pituitary. In the median eminence it is postulated to play a role in the degradation of GnRH released from the hypothalamus and thus to modulate LH levels. In the rat and human, the testis is the richest source of TOP activity with levels 3- to 5-fold higher than that of the brain. In order to define the exact localisation of this enzyme within the rat and human testis, the distribution of TOP in the developing and adult gonad was examined in situ and in isolated cells by immunohistochemistry, western blotting and northern blotting analysis. Ontogeny studies have demonstrated that TOP is detectable by western blotting from 9 days with levels of expression increasing with the age of the animal. Immunolocalisation of the protein in the interstitium was positive from 9 days onwards but was negative within the seminiferous tubules before 35 days of age, whereas TOP mRNA was not detected within the testis until 35 days of age with subsequent stable expression levels up to 90 days. In the adult rat testis, a strong TOP immunoreactivity was observed within seminiferous tubules, in elongating and elongated spermatids and residual bodies. In the interstitial compartment, immunoreactivity was also observed in Leydig cells and throughout the interstitial space. Western blot analyses confirmed the distribution of expression observed using immunochemistry, however Leydig cells display a lower signal than expected from the immunohistochemical data. Northern hybridization showed that the transcript is present in pachytene spermatocytes, early spermatids, and residual bodies, whereas its presence was not observed in Leydig cells probably due to very low levels of expression of the message. Analyses of various human tissue extracts showed that the testis displays the highest levels of TOP mRNA, with immunohistochemical experiments revealing that, as in the rat, the protein is principally expressed in elongated spermatids/residual bodies, and in Leydig cells. It is concluded that in the human and rat testes, TOP is highly expressed, in particular in post-meiotic germ cells and Leydig cells. The possible involvement of TOP in proteolytic events associated with the process of spermiogenesis and Leydig cell function is currently under investigation.

Shunt infections in children: presentation and management.

Since the earliest attempt at surgical management of hydrocephalus, infection has been a significant complication. For better assessment and care the neuroscience nurse needs to be aware of the signs and management of this condition. A retrospective review of 68 infections in 61 children was undertaken. Results showed an increased incidence of infection in the first nine months after surgery. Gram positive organisms (Staphylococcus epidermidis and Staphylococcus aureus) were most frequent; Propionobacter acnes was a significant pathogen in adolescence. Presenting symptoms included fever (26%), abdominal pain (19%), wound changes (22%) and indicators of shunt malfunction (33%). Elevated white blood cells (WBCs) in spinal fluid from shunt tap and positive cultures were most reliable laboratory data. Culturing of causative organism was sometimes difficult. A value regulated system for ventricular drainage which allows greater mobility for the patient is described.

A Flavobacterium meningosepticum outbreak among intensive care patients.

A Flavobacterium meningosepticum outbreak, involving 12 infected and 47 colonized intensive care patients during the months of February through July 1990, was investigated. F. meningosepticum was isolated from tap water and ice, but these environmental strains eventually proved to be distinct from those colonizing patients. A review of newly colonized patients' charts revealed that a common factor among the patients was daily changes of ventilator tubing pasteurized in the hospital's central sterile department. More than 90% of patients in the outbreak had been on ventilators that used the pasteurized tubing. An investigation of the pasteurization process found that two pasteurizer tanks had been operating at suboptimal temperatures (< 62 degrees C). Cultures of water from the tanks and droplets of water found in the pasteurized tubing grew species of Acinetobacter, Moraxella, and Pseudomonas but did not grow F. meningosepticum. After deficiencies in the pasteurization process were corrected, the outbreak terminated. Despite the failure to culture F. meningosepticum, an analysis of gram-negative bacillary isolates showed that the deficiency in the pasteurization process was a major contributor to colonization of ventilated patients by bacteria ubiquitous in tap water.

Feminism and nurse-midwifery. Historical overview and current issues.

Despite the fact that the profession of nurse-midwifery and feminism are both disciplines concerned with women and issues affecting women's lives, there has been little investigation or acknowledgement of relationships between their two paradigms. The work presented here is an attempt to discover both similarities and differences between nurse-midwifery and feminist thought. Using a historical approach, it is shown that despite the common goal of improving and maintaining women's status in the world, whether in general or more specifically with regard to health, feminist theorists and nurse-midwives, to a large degree, have worked separately from each other, rarely acknowledging in any formal way the importance of the other discipline. Current issues that have an effect on the practice of nurse-midwifery today--lay midwifery, the profession of nursing, and nurse-midwifery research--are presented in relation to contemporary feminist thought.