Midwives' lived experiences of caring for women with mobility disabilities during pregnancy, labour and puerperium in Eswatini: a qualitative study.

BACKGROUND: Midwives encounter various difficulties while aiming to achieve excellence in providing maternity care to women with mobility disabilities. The study aimed to explore and describe midwives' experiences of caring for women with mobility disabilities during pregnancy, labour and puerperium in Eswatini. METHODS: A qualitative, exploratory, descriptive, contextual research design with a phenomenological approach was followed. Twelve midwives working in maternal health facilities in the Hhohho and Manzini regions in Eswatini were interviewed. Purposive sampling was used to select midwives to participate in the research. In-depth phenomenological interviews were conducted, and Giorgi's descriptive phenomenological method was used for data analysis. RESULTS: Three themes emerged from the data analysis: midwives experienced physical and emotional strain in providing maternity care to women with mobility disabilities, they experienced frustration due to the lack of equipment to meet the needs of women with mobility disabilities, and they faced challenges in providing support and holistic care to women with mobility disabilities during pregnancy, labour and puerperium. CONCLUSIONS: Midwives experienced challenges caring for women with mobility disabilities during pregnancy, labour and the puerperium in Eswatini. There is a need to develop and empower midwives with the knowledge and skill to implement guidelines and enact protocols. Moreover, equipment and infrastructure are required to facilitate support and holistic maternity care for women with mobility disabilities.

Capsule elongation occurs after first time shoulder dislocation A biomechanical in-vitro investigation on human cadaveric specimen.

Purpose: As capsule elongation is assumed to weaken the static stability of the shoulder joint, the purpose of this biomechanical study was to demonstrate that capsule elongation occurs immediately after a first-time shoulder dislocation and not just after recurrent dislocation events. We hypothesize an increment in joint clearance due to joint capsule elongation after a first-time dislocation. Methods: An experimental in-vitro study was conducted on 6 paired fresh frozen human shoulders (4 females; 2 males; 12 specimen) with a mean age of 80 (Range 67-89) years. The shoulder joint with the articular capsule was exposed and an inferior static tension force of 2.5 N was applied to the humerus prior to dislocation. Next, the humeral head was dislocated and was then immediately reduced back into the start position. The joint gap as well as joint capsule deformation was assessed using optical techniques. Results: The radiographic joint gap increased from 13.7 ± 6.9 mm (prior to dislocation) to 18.1 ± 6.5 mm (post dislocation) (p < .001). The increase in joint clearance was 4.4 mm. The joint capsule elongated from 5.9 ± 0.005 % (prior to dislocation) to 9.4 ± 0.007 % (post dislocation) (p < .001). The mean increase in joint capsule elongation was 3.5 %. Conclusions: Capsule elongation was observed immediately after a simulated first-time shoulder dislocation in an in-vitro model of elderly human cadavers. It might therefore not only be a phenomenon of recurrent dislocation events.

Primary bone graft stability after Latarjet surgery: biomechanical evaluation of a fixation technique with metal-free all-suture cerclage vs. cortical screws.

BACKGROUND: To reduce hardware-related complications in coracoid graft fixation to the anterior aspect of the glenoid, a metal-free Latarjet technique was recently introduced. The aim of this study was to compare the primary stability of a classic Latarjet procedure with 2 metal screws to a novel metal-free, all-suture cerclage method. It is hypothesized that fixation of the coracoid graft with 2 malleolar screws will provide higher primary stability compared with an all-suture cerclage technique. METHODS: This biomechanical in vitro study was conducted on 12 fresh-frozen cadaveric shoulders (6 matched pairs) with a mean donor age of 80 years (range, 67-89 years). Coracoid graft fixation was performed using a recently introduced all-suture cerclage technique (group A) or a classic Latarjet technique with two 4.5-mm malleolar screws (group B). The conjoint tendon was loaded with a static force of 10 N to simulate the sling effect. Graft loading with a probe head consisted of 6 ascending load levels (10-50 N, 10-100 N, 10-150 N, 10-200 N, 10-250 N, and 10-300 N) with 100 cycles each at 1 Hz. Relative motion of the bone graft to the glenoid was measured using an optic 3-dimensional system. RESULTS: While loading the conjoint tendon with 10 N, no difference in mean displacement of the bone-graft was found between both groups (P = .144). During cyclic loading, a significant difference in relative displacement for both groups was already detected in load level 1 (group A: 2398.8 µm vs. group B: 125.7 µm; P = .024), and this trend continued with the following load levels (P < .05). DISCUSSION AND CONCLUSION: The study demonstrated that the innovative metal-free, all-suture cerclage fixation technique results in higher micromotion than the classic coracoid graft fixation with 2 malleolar screws. According to the present biomechanical investigation, shoulders treated with a metal-free all-suture cerclage technique might need adapted rehabilitation protocols to protect the construct and allow for graft healing.

Complications and revisions in anatomic and reverse short stem shoulder arthroplasty.

INTRODUCTION: One current trend in the field of shoulder arthroplasty is a design shift to shorter and metaphyseal fixed humeral stem components. The aim of this investigation is to analyze complications resulting in revision surgery after anatomic (ASA) and reverse (RSA) short stem arthroplasty. We hypothesize that complications are influenced by the type of prosthesis and indication for arthroplasty. MATERIALS AND METHODS: A total of 279 short stem shoulder prostheses were implanted by the same surgeon (162 ASA; 117 RSA), and 223 of these prostheses were implanted as primary procedures; in 54 cases, arthroplasty was performed secondary to prior open surgery. Main indications were osteoarthritis (OA) (n = 134), cuff tear arthropathy (CTA) (n = 74) and posttraumatic deformities (PTr) (n = 59). Patients were evaluated at 6 weeks (follow-up 1; FU1), 2 years (FU2) and the time span of the last follow-up defined as FU3 with a minimum FU of 2 years. Complications were categorized into early complications (within FU1), intermediate complications (within FU2) and late complications (> 2 years; FU3). RESULTS: In total, 268 prostheses (96.1%) were available for FU1; 267 prostheses (95.7%) were available for FU2 and 218 prostheses (77.8%) were available for FU3. The average time for FU3 was 53.0 months (range 24-95). A complication leading to revision occurred in 21 prostheses (7.8%), 6 (3.7%) in the ASA group and 15 (12.7%) in the RSA group (p < 0.005). The most frequent cause for revision was infection (n = 9; 42.9%). After primary implantation, 3 complications (2.2%) occurred in the ASA and 10 complications (11.0%) in the RSA group (p < 0.005). The complication rate was 2.2% in patients with OA, 13.5% in CTA and 11.9% in PTr. CONCLUSIONS: Primary reverse shoulder arthroplasty had a significantly higher rate of complications and revisions than primary and secondary anatomic shoulder arthroplasty, respectively. Therefore, indications for reverse shoulder arthroplasty should be critically questioned in each individual case.

Women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium in Eswatini.

Background: People living with disabilities are often women and the elderly and those from low-income families. There is paucity in research on women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium in Eswatini. Aim: To explore and describe women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium in Eswatini. Setting: The study was conducted in the Hhohho and Manzini regions in Eswatini, between March 2019 and July 2019. Methods: A qualitative, exploratory, descriptive and contextual research design was followed. Purposive sampling and snowballing techniques were used to sample women with mobility disabilities to participate in the research. Individual interviews were conducted, and Giorgi's method of data analysis was used. Results: Women with mobility disabilities experienced midwives as being brutal, unsupportive and judgemental. In addition, participants reported several maternity care challenges related to a lack of protocol and infrastructure, and they needed to be cared for by experienced midwives during pregnancy, labour and puerperium. Conclusion: Women with mobility disabilities experienced various challenges during pregnancy, labour and puerperium in Eswatini. There is a need to develop guidelines to facilitate support and holistic maternity care for these women. Contribution: The study contributed to the scientific knowledge of women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium.

'A tool we need': Midwives' descriptions and recommendations of an ideal obstetric triage tool.

Background: The obstetric triage tool (OBTT) is used to record the clinical findings following obstetric triage (OBT). The recorded OBTT provides midwives with clinical information leading to diagnosis of existing and potential maternal and foetal problems that may lead to intrapartum complications, planning of specific midwifery care and communication among the midwifery team about the woman in labour. Aim: This study aimed to explore and describe midwives' experiences of the OBTT used during admission of women in labour in the Bojanala district. Setting: This study was conducted in the two selected facilities in Bojanala district in North West province. Methods: This study is a derivative of a major study, entitled 'Midwives' experiences of OBT by midwives in the Bojanala district'. A qualitative, explorative and descriptive research design was followed. Nine purposefully sampled midwives with over 5 years of clinical midwifery experience, employed in the Bojanala district, attended a semistructured interview. Data obtained were analysed using Colaizzi's descriptive method of data analysis according to the themes and categories which emerged. Results: One central theme with 10 subthemes emerged. Midwives verbalised their dissatisfaction with the current OBTT and made recommendations for the revision of the tool. Conclusion: The study highlighted midwives' experiences of the OBTT and recommendations for an ideal tool based on their knowledge of admission of a woman in labour. Contribution: This study provides a new OBTT from midwives' perspectives that could be useful in improving pregnancy and labour outcomes in clinical midwifery practice.

The midwives' experiences of the use of obstetric triage and obstetric triage tool during labour in Bojanala district.

Background: Obstetric triage (OBT) is a standardised procedure, which plays a vital role in identifying women with obstetric risks upon admission for labour worldwide. In the last few years, considerable attention has been paid to perinatal problem identification programmes, and it has been determined that the inconsistent use of OBT delays midwives' responses to both existing and potential clinical problems amongst women in labour. This delay results in negative and serious perinatal outcomes that could have been prevented. This study was conducted to explore and describe midwives' experiences with OBT in Bojanala district. Aim: This study aimed to explore and describe midwives' experiences with OBT in Bojanala district. Setting: This study was conducted in Bojanala district of the North West Province. Two public healthcare facilities were selected where midwifery care and OBT services are rendered. Methods: A qualitative, descriptive, explorative research design was followed. Nine purposefully sampled midwives participated in a one-on-one in-depth interview. Data were analysed using Collaizi's descriptive method based on the themes and categories that emerged. Results: Three themes emerged. Midwives experienced the OBT tool to be inadequate; and that the low staff number contributes to an imbalance in the midwife-patient ratio. Midwives were also dissatisfied with less support they receive from their management. Conclusion: The study highlighted midwives' experiences of the use of OBT, as presented through their lived experiences. The midwives experienced challenges, which hindered them from practicing OBT to the best of their abilities. Contribution: The study highlighted challenges experienced by midwives regarding OBT, which directly influence the outcomes of pregnancy and labour.

Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study.

BACKGROUND: Midwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care. AIM: This research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings. SETTING: Midwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital. METHODS: A convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: 'How is it for you to be a midwife in South Africa?' Transcribed interviews were analysed using thematic coding. RESULTS: Five themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife. CONCLUSION: Midwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services. CONTRIBUTION: This research provides evidence of the midwifery experience with implications for needed health policy change.

Health supplements for allergic rhinitis: A mixed-methods systematic review.

Allergic rhinitis is a chronic inflammatory condition caused by an exaggerated response of the immune system to common allergens. Most pharmacological therapies tend to be palliative and in some cases are associated with adverse effects. There is a growing tendency for people to self-medicate with health supplements as they are generally considered safe, however clinical studies relating to their efficacy and safety are limited. This mixed-methods systematic review aims to synthesise the available evidence relating to the treatment of allergic rhinitis with a variety of health supplements. A total of 57 062 articles were derived from searching seven online databases and evidence from 48 RCTs and 10 observational studies were reviewed for methodological quality and risk of bias. No qualitative studies meeting the inclusion criteria could be found, therefore only a quantitative review was performed. Promising evidence for the following single supplements were found: apple polyphenols, tomato extract, spirulina, chlorophyll c2, honey, conjugated linoleic acid, MSM, isoquercitrin, vitamins C, D and E, as well as probiotics. Combination formulas may also be beneficial, particularly specific probiotic complexes, a mixture of vitamin D3, quercetin and Perilla frutescens, as well as the combination of vitamin D3 and L. reuteri. Owing to the paucity of good quality evidence, recommendations pertaining to the use of health supplements for allergic rhinitis should involve a shared decision-making process between the healthcare provider and the patient, taking into account their efficacy, safety and cost. Further good quality clinical studies and qualitative research would further our understanding of the role these health supplements may play in future treatment protocols.

Three J-proteins impact Hsp104-mediated variant-specific prion elimination: a new critical role for a low-complexity domain.

Prions are self-propagating protein isoforms that are typically amyloid. In Saccharomyces cerevisiae, amyloid prion aggregates are fragmented by a trio involving three classes of chaperone proteins: Hsp40s, also known as J-proteins, Hsp70s, and Hsp104. Hsp104, the sole Hsp100-class disaggregase in yeast, along with the Hsp70 Ssa and the J-protein Sis1, is required for the propagation of all known amyloid yeast prions. However, when Hsp104 is ectopically overexpressed, only the prion [PSI+] is efficiently eliminated from cell populations via a highly debated mechanism that also requires Sis1. Recently, we reported roles for two additional J-proteins, Apj1 and Ydj1, in this process. Deletion of Apj1, a J-protein involved in the degradation of sumoylated proteins, partially blocks Hsp104-mediated [PSI+] elimination. Apj1 and Sis1 were found to have overlapping functions, as overexpression of one compensates for loss of function of the other. In addition, overexpression of Ydj1, the most abundant J-protein in the yeast cytosol, completely blocks Hsp104-mediated curing. Yeast prions exhibit structural polymorphisms known as "variants"; most intriguingly, these J-protein effects were only observed for strong variants, suggesting variant-specific mechanisms. Here, we review these results and present new data resolving the domains of Apj1 responsible, specifically implicating the involvement of Apj1's Q/S-rich low-complexity domain.

Experiences of women enrolled in a prevention of mother to child transmission of human immunodeficiency virus infection programme in Zimbabwe.

BACKGROUND: Prevention of mother-to-child transmission (PMTCT) programmes have been reported to reduce the rate of transmission of human immunodeficiency virus (HIV) infection by 30% - 40% during pregnancy and childbirth. The PMTCT transmission is achieved by offering HIV prophylaxis or initiating antiretrovirals to pregnant women who test HIV positive. Being aware of the experiences of these women will assist in planning and implementing the relevant care and support. The study was conducted in three phases. AIM: This article will address phase 1 which is to explore and describe the experiences of pregnant women living with HIV. SETTING: The study setting was a PMTCT site in a Provincial Hospital, in Zimbabwe. METHODS: The study design was qualitative, exploratory, descriptive and contextual. In-depth face-to-face interviews were conducted from a purposive sample of 20 pregnant women. Thematic data analysis was performed. RESULTS: Six themes emerged: realities of disclosure, a need for quality of life, perceived stigmatisation, inadequate knowledge on infant feeding, continuity of care, empowerment and support. CONCLUSIONS: The study concluded that pregnant women living with HIV require empowerment and support to live positively with HIV.

Ubuntu-the Essence of Caring and Being: A Concept Analysis.

What is the South-African concept of caring? In Africa, the principle of Ubuntu introduces the concept of belonging and caring. The purpose of this concept analysis was thus to analyze the concept of Ubuntu. The 8 steps of a concept analysis by Walker and Avant were used.

Experiences of women enrolled in a prevention of mother to child transmission of human immunodeficiency virus infection programme in Zimbabwe

Background: Prevention of mother-to-child transmission (PMTCT) programmes have been reported to reduce the rate of transmission of human immunodeficiency virus (HIV) infection by 30% ­ 40% during pregnancy and childbirth. The PMTCT transmission is achieved by offering HIV prophylaxis or initiating antiretrovirals to pregnant women who test HIV positive. Being aware of the experiences of these women will assist in planning and implementing the relevant care and support. The study was conducted in three phases.Aim: This article will address phase 1 which is to explore and describe the experiences of pregnant women living with HIV.Setting: The study setting was a PMTCT site in a Provincial Hospital, in Zimbabwe.Methods: The study design was qualitative, exploratory, descriptive and contextual. In-depth face-to-face interviews were conducted from a purposive sample of 20 pregnant women. Thematic data analysis was performed.Results: Six themes emerged: realities of disclosure, a need for quality of life, perceived stigmatisation, inadequate knowledge on infant feeding, continuity of care, empowerment and support.Conclusions: The study concluded that pregnant women living with HIV require empowerment and support to live positively with HIV

Experiences of women enrolled in a prevention of mother to child transmission of human immunodeficiency virus infection programme in Zimbabwe

Background: Prevention of mother-to-child transmission (PMTCT) programmes have been reported to reduce the rate of transmission of human immunodeficiency virus (HIV) infection by 30% ­ 40% during pregnancy and childbirth. The PMTCT transmission is achieved by offering HIV prophylaxis or initiating antiretrovirals to pregnant women who test HIV positive. Being aware of the experiences of these women will assist in planning and implementing the relevant care and support. The study was conducted in three phases. Aim: This article will address phase 1 which is to explore and describe the experiences of pregnant women living with HIV. Setting: The study setting was a PMTCT site in a Provincial Hospital, in Zimbabwe. Methods: The study design was qualitative, exploratory, descriptive and contextual. In-depth face-to-face interviews were conducted from a purposive sample of 20 pregnant women. Thematic data analysis was performed. Results: Six themes emerged: realities of disclosure, a need for quality of life, perceived stigmatisation, inadequate knowledge on infant feeding, continuity of care, empowerment and support. Conclusions: The study concluded that pregnant women living with HIV require empowerment and support to live positively with HIV

Birth stories from South Africa: Voices unheard.

BACKGROUND: The manner that birth events unfold can have a lasting impact on women. Giving voice to women's experiences is key in the creation of care that embodies humanistic, family-centred service. AIM: The aim of this research was to describe the experiences of women receiving care during childbirth. METHODS: The design was qualitative and descriptive using thematic analysis to analyse women's birth stories. A purposive sample of women (N=12) who had recently given birth in South Africa was selected. Participants were recruited who had delivered across a variety of settings: public, private, and maternity hospital, as well as at home. Data were collected using in-depth interviews and field notes. FINDINGS: Four themes were noted: cocoon of compassionate care, personal regard for shared decision-making, beliefs about birth, and protection. Themes demonstrated both caring and non-caring behaviours including feelings of sadness, loneliness and being unwanted, being scared and uncertain, and overall dissatisfaction with the birth experience. Irrespective of setting, patients felt the absence of shared decision-making; the exception was where care was with midwives in an independent maternity hospital or at home. DISCUSSION: A period of high vulnerability, birth is often met with care perceived as non-caring and lacking in compassion. Many women reported failure to be included as a partner in decision-making where birth occurred in private or public hospital settings. Where a midwifery model of care was in place, experiences were uniformly positive. CONCLUSIONS: Fundamental change is needed in midwifery education and scope of practice, with overhaul of health system resourcing.

Whole genome sequencing identifies missense mutation in MTBP in Shar-Pei affected with Autoinflammatory Disease (SPAID).

BACKGROUND: Autoinflammatory diseases in dogs are characterized by complex disease processes with varying clinical signs. In Shar-Pei, signs of inflammation including fever and arthritis are known to be related with a breed-specific predisposition for Shar-Pei Autoinflammatory Disease (SPAID). RESULTS: Clinical and histopathological examinations of two severely SPAID-affected Shar-Pei revealed signs of inflammation including fever, arthritis, and perivascular and diffuse dermatitis in both dogs. A multifocal accumulation of amyloid in different organs was found in one SPAID-affected case. Whole genome sequencing resulted in 37 variants, which were homozygous mutant private mutations in SPAID-affected Shar-Pei. Nine SNVs with predicted damaging effects and three INDELs were further investigated in 102 Shar-Pei affected with SPAID, 62 unaffected Shar-Pei and 162 controls from 11 different dog breeds. The results showed the missense variant MTBP:g.19383758G > A in MTBP to be highly associated with SPAID in Shar-Pei. In the region of this gene a large ROH (runs of homozygosity) region could be detected exclusively in the two investigated SPAID-affected Shar-Pei compared to control dog breeds. No further SPAID-associated variant with predicted high or moderate effects could be found in genes identified in ROH regions. This MTBP variant was predicted to affect the MDN2-binding protein domain and consequently promote proinflammatory reactions. In the investigated group of Shar-Pei older than six years all dogs with the mutant genotype A/A were SPAID-affected whereas SPAID-unaffected dogs harbored the homozygous wildtype (G/G). Shar-Pei with a heterozygous genotype (G/A) were shown to have a 2.13-fold higher risk for disease development, which gave evidence for an incomplete dominant mode of inheritance. CONCLUSIONS: The results of this study give strong evidence for a variant in MTBP related with proinflammatory processes via MTBP-MDM2 pathway. Thus, these results enable a reliable detection of SPAID in Shar-Pei dogs.

Compassion fatigue in nurses: A metasynthesis.

AIMS AND OBJECTIVES: To interpret the body of qualitative work focusing on compassion fatigue to distil a common understanding that could then be applied to nursing care. BACKGROUND: Complex demands place extraordinary stress on nurses struggling to work in overburdened healthcare systems. The result can be the inability to care well for others, leading to compassion fatigue, burnout and increased numbers leaving the profession. Metasynthesis offers a means of more fully illuminating compassion fatigue and further understanding of practices which might reduce its negative consequences. DESIGN: Metasynthesis. METHOD: As a method designed to facilitate knowledge development, metasynthesis allowed for integration of qualitative study findings conducted between 1992-2016 using defined search terms. Six databases were searched for articles published in English. Nine papers met the criteria for review and metasynthesis was conducted using the meta-ethnographic approach detailed by Noblit and Hare. RESULTS: Four themes related to compassion fatigue were found by consensus discussion. The themes included: physical ("just plain worn out") and emotional symptoms ("walking on a tightrope"), triggering factors ("an unbearable weight on shoulders" and "alone in a crowded room"), and measures to overcome/prevent ("who has my back?"). CONCLUSIONS: Compassion fatigue is a concept of documented relevance to those in nursing and represents a basic inability to nurture others and engenders a temporal component. Synthesis of studies provides evidence of the veracity of the concept for application to clinical practice and research related to nursing care. RELEVANCE TO CLINICAL PRACTICE: Findings provide insight into the clinical milieu needed to prevent compassion fatigue. A theoretical model is presented which can be used to guide future research, as well as the creation of clinical practice policies which might mitigate the development of compassion fatigue and its potential consequences.

Heterogeneity of macrophages in canine histiocytic ulcerative colitis.

Histiocytic ulcerative colitis (HUC) is a chronic enteropathy which most notably occurs in Boxer dogs and French bulldogs. The inflamed mucosa is hallmarked by large, foamy, periodic acid-Schiff (PAS)-positive macrophages infiltrating the colonic mucosa. As little is known about their origin and phenotype, an immunohistochemical study was performed using different macrophage markers. Generally, canine colonic macrophages showed high expression of ionised calcium-binding adaptor molecule 1 and MHC class II. In canine HUC, macrophages revealed up-regulation of lysozyme and L1 Ag but decreased CD163 expression compared with controls, suggesting them to be pro-inflammatory cells, whereas the healthy colonic mucosa was characterised by an anti-inflammatory macrophage phenotype. In addition, PAS reaction was used to discriminate macrophage subpopulations. PAS- macrophages displayed higher expression of L1 Ag and CD64, whereas PAS+ cells, which were only present in HUC patients, were characterised by increased expression of lysozyme, inducible nitric oxide synthase and CD204. This indicates PAS+ cells to be mature macrophages contributing to the inflammatory process, which are most likely maintained by differentiation of immature PAS- macrophages continuously recruited from blood monocytes. In summary, macrophage heterogeneity in canine HUC probably illustrates their different maturation states and functions compared with the healthy animals.

Neuronal ceroid lipofuscinosis in an adult American Staffordshire Terrier. / Neuronale Zeroidlipofuszinose bei einem adulten American Staffordshire Terrier.

A female, 5-year-old American Staffordshire Terrier with severe progressive neurological deficits, particularly in terms of ataxia and keeping balance, was examined pathomorphologically and a genetic analysis was performed. In neurons of various localizations of the central nervous system an accumulation of a finely granular pale eosinophilic or light brown material was found. In addition, the cerebellum revealed marked degeneration and loss of Purkinje and inner granule cells. The accumulated PAS-positive, argyrophilic, autofluorescent material showed ultrastructurally a lamellar appearance suggestive of lipofuscin. Genetic analysis revealed the presence of a sequence variant in the ARSG gene encoding the lysosomal enzyme arylsulfatase G. This case report describes an adult-onset of a neuronal ceroid lipofuscinosis that shows similarities with a human disorder termed Kufs disease.

A Critical Evaluation on a Fulbright Experience.

PROBLEM: Although many Fulbright awardees have detailed experiences in varied countries, there is less discussion on the impact on the host institution and efforts to sustain the change between both participants. METHODS: The critical evaluation examines professional and personal impact of a Fulbright U.S. Scholar Award at the University of Johannesburg in South Africa. FINDINGS: This work details the influence of the host faculty in the experience for both the host faculty in the Department of Nursing and the scholar receiving the awarded. Challenges to achieve a successful exchange are described, and activities to sustain connections and maximize impact are presented, with particular emphasis on midwifery. CONCLUSIONS: Collaborative research and teaching activities strengthened through administrative endorsement support ongoing exchange.