A qualitative study of the impact of endometriosis on male partners

STUDY QUESTION

What is the impact of endometriosis on male partners of women with the condition?

SUMMARY ANSWER

Endometriosis significantly impacts men across several life domains and can negatively impact emotional well-being.

WHAT IS KNOWN ALREADY

Endometriosis has been shown to negatively impact women's quality of life and may strain intimate relationships. Little is known about the impact on male partners.

STUDY DESIGN, SIZE, DURATION

The ENDOPART study was a cross-sectional, qualitative study of 22 women with endometriosis and their male partners (n = 44) in the UK (2012–2013).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Inclusion criteria: laparoscopic diagnosis of endometriosis; the presence of symptoms for at least a year; partners living together. Data were collected via face to face, semi structured interviews with partners interviewed separately. Data were analysed thematically, assisted by NVivo 10.

MAIN RESULTS AND THE ROLE OF CHANCE

Men reported that endometriosis affected many life domains including sex and intimacy, planning for and having children, working lives and household income. It also required them to take on additional support tasks and roles. Endometriosis also had an impact on men's emotions, with responses including helplessness, frustration, worry and anger. The absence of professional or wider societal recognition of the impact on male partners, and a lack of support available to men, results in male partners having a marginalized status in endometriosis care.

LIMITATIONS REASONS FOR CAUTION

Self-selection of participants may have resulted in a sample representing those with more severe symptoms. Couples included are in effect ‘survivors’ in relationship terms, therefore, findings may underestimate the contribution of endometriosis to relationship breakdown.

WIDER IMPLICATIONS OF THE FINDINGS

The study extends knowledge about the impact of endometriosis on relationships, which thus far has been drawn largely from studies with women, by providing new insights about how this condition affects male partners. Healthcare practitioners need to take a more couple-centred, biopsychosocial approach toward the treatment of endometriosis, inclusive of partners and relationship issues. The findings demonstrate a need for information and support resources aimed at partners and couples.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Economic and Social Research Council (reference ES/J003662/1). The authors have no conflicts of interest.

t-Darpp is an elongated monomer that binds calcium and is phosphorylated by cyclin-dependent kinases 1 and 5

t‐Darpp (truncated isoform of dopamine‐ and cAMP‐regulated phosphoprotein) is a protein encoded by the PPP1R1B gene and is expressed in breast, colon, esophageal, gastric, and prostate cancers, as well as in normal adult brain striatal cells. Overexpression of t‐Darpp in cultured cells leads to increased protein kinase A activity and increased phosphorylation of AKT (protein kinase B). In HER2+ breast cancer cells, t‐Darpp confers resistance to the chemotherapeutic agent trastuzumab. To shed light on t‐Darpp function, we studied its secondary structure, oligomerization status, metal‐binding properties, and phosphorylation by cyclin‐dependent kinases 1 and 5. t‐Darpp exhibits 12% alpha helix, 29% beta strand, 24% beta turn, and 35% random coil structures. It binds calcium, but not other metals commonly found in biological systems. The T39 site, critical for t‐Darpp activation of the AKT signaling pathway, is a substrate for phosphorylation by cyclin‐dependent kinase 1 and cyclin‐dependent kinase 5. Gel filtration chromatography, sedimentation equilibrium analysis, blue native gel electrophoresis, and glutaraldehyde‐mediated cross‐linking experiments demonstrate that the majority of t‐Darpp exists as a monomer, but forms low levels (< 3%) of hetero‐oligomers with its longer isoform Darpp‐32. t‐Darpp has a large Stokes radius of 4.4 nm relative to its mass of 19 kDa, indicating that it has an elongated structure.

Abstract 4093: t-Darpp stimulates protein kinase A activity by interacting with its RI regulatory subunit

t-Darpp is the truncated form of the dopamine- and cAMP-regulated phosphoprotein of 32 kDa (Darpp-32) and has been demonstrated to confer resistance to trastuzumab, a Her2-targeted anticancer agent, via sustained signaling through the phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)/Akt pathway. t-Darpp over-expression results in enhanced activity of protein kinase A (PKA), but the mechanism of t-Darpp-mediated PKA activation is poorly understood. In the PKA holoenzyme, when the catalytic subunits are bound to regulatory subunits RI or RII, kinase activity is inhibited. We investigated PKA activity and holoenzyme composition in cell lines that over-express t-Darpp (SK.tDrp) or a T75A phosphorylation mutant (SK.tDrp.T75A), as well as an empty vector control cell line (SK.empty). We also evaluated protein-protein interactions between t-Darpp and PKA catalytic (PKAc) or regulatory subunits RI and RII in those cell lines. Whereas SK.tDrp cells had elevated PKA activity, SK.tDrp.T75A cells did not. In agreement with the effects on activity, a proximity ligation assay showed that SK.tDrp cells, but not SK.tDrp.T75A cells, had diminished association of RI with PKAc. Moreover, t-Darpp was seen to bind directly to RI in co-immunoprecipitation studies. Cells that express both Darpp-32 and t-Darpp had PKA activity levels and RI-PKAc association that were similar to control SK.empty cells. This is consistent with our published findings that Darpp-32 reverses t-Darpp’s effects on trastuzumab resistance and CREB DNA binding activity (downstream of PKA). Taken together, our data suggest that T75 phosphorylation is crucial for t-Darpp-mediated PKA activation and this activation appears to occur through direct binding to RI and release of RI from PKAc. The t-Darpp-RI interaction could be a druggable target to reduce PKA activity in drug-resistant cancer.

Citation Format: Dirk Theile, Shuhui Geng, Erin Denny, Jamil Momand, Susan E. Kane. t-Darpp stimulates protein kinase A activity by interacting with its RI regulatory subunit [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4093. doi:10.1158/1538-7445.AM2017-4093

Abstract 5866: t-Darpp chemoresistence protein: insights into its structure, oligomerization status, calcium-binding properties and phosphorylation sites

t-Darpp, one of two protein isoforms encoded by the PPP1R1B gene, is overexpressed in gastric, esophageal, colon, prostate, and breast cancers; and confers resistance to trastuzumab in Her2+ breast cancer cells. To gain insight into the trastuzumab-resistance mechanism of t-Darpp, we studied its structure, oligomerization status, metal-binding properties, and sites of phosphorylation. Circular dichroism spectroscopy analysis showed that recombinant t-Darpp exhibits 12% alpha helix, 29% beta strand, 24% beta turn and 35% random coil character at 25°C. Upon mild heat treatment (50°C for five min) the secondary structure does not appreciably change. Metal ion-binding analyses through inductively coupled plasma-mass spectrometry and graphite furnace-atomic absorption indicated that t-Darpp co-purifies with calcium, but not other metals commonly found in biological systems. The T75 site, critical for t-Darpp activation of the Akt signaling pathway, is a substrate for phosphorylation by cyclin-dependent kinase 1 (CDK1) and cyclin-dependent kinase 5 (CDK5). Gel filtration chromatography, sedimentation equilibrium analysis, native blue gel electrophoresis, and glutaraldehyde-mediated crosslinking experiments showed that the majority of t-Darpp (calculated mass = 19 kDa) exists as a monomer, but forms low levels (&lt; 3%) of hetero-oligomers with its longer isoform Darpp-32. t-Darpp has a relatively large Stokes radius of 4.4 nm, suggesting an elongated structure. In summary, this study indicates that t-Darpp is an elongated, mild-heat-stable, and monomeric calcium-binding protein that is capable of being phosphorylated at T75 by CDK1 and CDK5. Blockage of t-Darpp calcium binding capacity or T75 phosphorylation may therefore help sustain Her2+ breast cancer sensitivity to trastuzumab therapy.

Citation Format: Patrycja Magdziarz, You Feng, Dianlu Jiang, Elizabeth Parga, Arianna Celis, Erin Denny, Xiaoying Wang, Martin Phillips, Feimeng Zhou, Susan E. Kane, Jamil Momand. t-Darpp chemoresistence protein: insights into its structure, oligomerization status, calcium-binding properties and phosphorylation sites [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5866. doi:10.1158/1538-7445.AM2017-5866

The content of attenuated psychotic symptoms in those at clinical high risk for psychosis

Recent research has started to focus on identifying individuals who are at clinical high risk of developing psychosis as a means to try and understand the predictors and mechanisms involved in the progress to a full psychotic episode. The aim of the current study was to provide an initial description and prevalence rates of specific content found within attenuated positive symptoms. The Content of Attenuated Positive Symptoms (CAPS) codebook was used by independent raters to determine the presence of content within a sample of written vignettes. Krippendorff's alpha was used to determine inter-rater reliability. Overall, the majority of items fell in or above an acceptable range of reliability. There was heterogeneity present in the types of content endorsed. However, the most commonly endorsed items included being perplexed by reality, increased hypervigilence, being gifted, hearing indistinct and distinct sounds, seeing figures or shadows, something touching the individual, and unpleasant smells. The use of the CAPS codebook is a reliable way to code the content of attenuated positive symptoms. Identifying and monitoring the presence of certain content may provide insight into the presence of other comorbid issues and the potential for future conversion.

The Percutaneous shunting in Lower Urinary Tract Obstruction (PLUTO) study and randomised controlled trial: evaluation of the effectiveness, cost-effectiveness and acceptability of percutaneous vesicoamniotic shunting for lower urinary tract obstruction

BACKGROUND

Congenital lower urinary tract obstruction (LUTO) is a disease associated with high perinatal mortality and childhood morbidity. Fetal vesicoamniotic shunting (VAS) bypasses the obstruction with the potential to improve outcome.

OBJECTIVE

To determine the effectiveness, cost-effectiveness and patient acceptability of VAS for fetal LUTO.

DESIGN

A multicentre, randomised controlled trial incorporating a prospective registry, decision-analytic health economic model and preplanned Bayesian analysis using elicited opinions. Patient acceptability was evaluated by interview in a qualitative study.

SETTING

Fetal medicine departments in the UK, Ireland and the Netherlands.

PARTICIPANTS

Pregnant women with a male singleton fetus with LUTO.

INTERVENTIONS

In utero percutaneous VAS compared with conservative care.

MAIN OUTCOME MEASURES

The primary outcome was survival to 28 days. Secondary outcome measures were survival and renal function at 1 year of age, cost of care and cost per additional life-year and per disability-free survival at the end of 1 year.

RESULTS

The trial stopped early with 31 women randomised because of difficulties in recruitment. Of those randomised to VAS and conservative management, 3/16 (19%) and 2/15 (13%), respectively, did not receive their allocated intervention. Based on intention-to-treat analysis, survival at 28 days was higher if allocated VAS (50%) than conservative management (27%) [relative risk (RR) 1.88, 95% confidence interval (CI) 0.71 to 4.96, p = 0.27]. At 12 months survival was 44% in the VAS arm and 20% in the conservative arm (RR 2.19, 95% CI 0.69 to 6.94, p = 0.25). Neither difference was statistically significant. Of survivors at 1 year, two in the VAS arm had no evidence of renal impairment and four in the VAS arm and two in the conservative arm required medical management. One baby in the conservative arm had end-stage renal failure at 1 year. VAS was more expensive because of additional surgery and intensive care. VAS cost £15,500 per survivor at 1 year and £43,900 per disability-free year. Elicited expert opinions showed uncertainty in the effect of VAS at 28 days. In a Bayesian analysis combining elicited opinion with the results, uncertainty of the benefit of VAS remained (RR 1.31, 95% credible interval 0.84 to 2.18). The acceptability study identified visualisation of the fetus during ultrasound scanning, perceiving a personal benefit, and altruism as positive influences on recruitment. Fear of the VAS procedure and the perceived severity of LUTO influenced non-participation. The need for more detailed information about the condition and its implications during pregnancy and following delivery was a further important finding of this research. Recruitment was hampered by logistical and regulatory difficulties, a lower incidence of LUTO and lower antenatal diagnosis rate [estimated to be 3.34 (95% CI 2.95 to 3.72) per 10,000 total births and 47%, respectively, in an associated epidemiological study] and high termination of pregnancy rates. In the registry women also demonstrated a clear preference for conservative management.

CONCLUSIONS

Survival to 28 days and 1 year appears to be higher with VAS than with conservative management, but it is not possible to prove benefit beyond reasonable doubt. Notably, prognosis in both arms for survival and renal function is poor. VAS was substantially more costly and unlikely to be regarded as cost-effective based on the 1-year data. Parents should be counselled about the risks of pregnancy loss with or without VAS insertion. The National Institute for Health and Care Excellence interventional procedures guidance (IPG 202) should be updated to reflect this new evidence. Babies in the PLUTO trial should be followed up long term for the different outcomes.

TRIAL REGISTRATION

ISRCTN53328556.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 17, No. 59. See the NIHR Journals Library website for further project information.

Abstract A058: t-Darpp is phosphorylated by cdk1 and cdk5 in HER2+ breast cancer cells

Background: We have previously shown that levels of the 32kDa dopamine and cAMP-regulated phosphoprotein Darpp-32 (Dp32) and its amino-truncated isoform t-Darpp (tDp) are altered in trastuzumab-resistant HER2+ breast cancer cells. Specifically, tDp is upregulated in models of trastuzumab resistance and over-expression of the protein is sufficient to confer trastuzumab resistance. Dp32 antagonizes the effect of tDp, exhibiting overall growth inhibitory properties in breast cancer cell lines. In neuronal cells, Dp32 is regulated by phosphorylation at two key threonine residues, T34 and T75. The T34 site is present only in Dp23 as tDp is truncated by the first 39 amino acids. The latter site is phosphorylated predominantly by cdk5 in vivo and by either cdk5 or cdk1 in vitro. It is not known whether tDp is similarly phosphorylated or if the same kinases act in breast cancer cells as in neuronal cells. Because we have preliminary data suggesting an interaction between tDp and cdk1 (but not cdk5) in HER2+ breast cancer cells, we investigated whether cdk1 or cdk5 could phosphorylate tDp at the T75 site.

Methods: We performed in vitro kinase assays using recombinant tDp and commercial cdk1 and cdk5 enzymes. Phosphorylation was also examined in cells that overexpress endogenous tDp (SK/HerR and BT/HerR cells), that overexpress exogenous tDp (SK.tDp cells) or that express exogenous tDp and Dp32 (SK.dDp). Cells were treated with either RO-3306, a cdk1 inhibitor, or Roscovitine, a pan-cdk inhibitor with preference for cdk5, and assayed by Western blotting for T75 phosphorylation. All experiments were repeated three times and calculated for statistical significance.

Results: In vitro kinase assays demonstrated that both cdk1 and cdk5 were capable of phosphorylating tDp at the T75 residue, with an apparent preferential activity by cdk1. In cell lines, RO-3306 led to decreased T75 phosphorylation within one hour. The effect of RO-3306 was also confirmed in a dose-dependent manner with optimal inhibition at a concentration of 10 μM. Roscovitine also led to decreased T75 phosphorylation at a concentration of 20 μM. In cells that express both Dp32 and tDp, the cdk inhibitors led to decreased phosphorylation of both proteins to similar extents.

Conclusion: Our study provides new insight into cdk1-mediated regulation of tDp and Dp32. We demonstrate that both cdk1 and cdk5 are able to phosphorylate these proteins but that cdk1 appears to be the predominant mediator of phosphorylation in breast cancer cell lines. A possible competition might occur between Dp32 and tDp, given their similar propensity for phosphorylation by cdk1. Further examination of the relationship between the two kinases and their activities toward tDp and Dp32 will help us delineate the mechanism by which tDp mediates trastuzumab resistance and Dp32 antagonizes this phenotype.

Citation Format: Erin Denny, Arianna Celis, Jamil Momand, Susan E. Kane. t-Darpp is phosphorylated by cdk1 and cdk5 in HER2+ breast cancer cells. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Breast Cancer Research: Genetics, Biology, and Clinical Applications; Oct 3-6, 2013; San Diego, CA. Philadelphia (PA): AACR; Mol Cancer Res 2013;11(10 Suppl):Abstract nr A058.

Cytotoxic T lymphocyte trafficking and survival in an augmented fibrin matrix carrier

Cell-based therapies have intriguing potential for the treatment of a variety of neurological disorders. One such example is genetically engineered cytotoxic T lymphocytes (CTLs) that are being investigated in brain tumor clinical trials. The development of methods for CTL delivery is critical to their use in the laboratory and clinical setting. In our study, we determined whether CTLs can migrate through fibrin matrices and if their migration, survival, and function could be modulated by adding chemokines to the matrix. Our results indicated that CTLs can freely migrate through fibrin matrices. As expected, the addition of the monocyte chemotactic protein-1 (MCP-1), also known as chemokine C-C motif ligand 2 (CCL2), to the surrounding media increased egress of the CTLs out of the fibrin clot. Interleukin (IL) -2 and/or IL-15 embedded in the matrix enhanced T cell survival and further promoted T cell migration. The interleukin-13 receptor alpha 2 specific (IL-13R alpha2) T cells that traveled out of the fibrin clot retained the capacity to kill U251 glioma cells. In summary, CTLs can survive and migrate robustly in fibrin matrices. These processes can be influenced by modification of matrix constituents. We conclude that fibrin matrices may be suitable T cell carriers and can be used to facilitate understanding of T cell interaction with the surrounding microenvironment.

Systematic reviews of qualitative evidence: what are the experiences of women with endometriosis?

Just as systematic reviews of quantitative research have developed over the last two decades, the use of a systematic review is also superseding narrative non-systematic reviews in qualitative research in an attempt to bring rigour to reviewing research evidence. Qualitative research is concerned with the subjective world and the way in which people interpret and make sense of the reality of their lives. This paper describes procedures for conducting a systematic review on qualitative research, and the methods for assessing the quality of qualitative research papers, using published qualitative research on endometriosis as an example to demonstrate these. The conclusion from the systematic review carried out is that the values and methods utilised for a systematic review can usefully be applied to qualitative research. The review of endometriosis research revealed that despite the impact of endometriosis on the lives of women sufferers, little qualitative research has been conducted, and much of that which exists lacks rigour in a number of key areas.

A model of non-uniform lung parenchyma distortion

A finite element model of mammalian lung parenchyma is used to study the effect of large non-uniform distortions on lung elastic behaviour. The non-uniform distortion is a uni-axial stretch from an initial state of uniform pressure expansion. For small distortions, the parenchymal properties are linearly isotropic and described by two elastic moduli. However, for large distortions, the parenchyma has anisotropic non-linear elastic properties described by five independent elastic moduli dependent on the degree of distortion; they are computed for a range of distortions and initial pressures. Ez, the Young's modulus in the direction of stretch, increases significantly with distortion (epsilon(z)) while Ex, the Young's modulus in the plane perpendicular to the stretch, is approximately constant. The greater the initial pressure, the bigger the difference between the two moduli at larger distortion strains. The shear modulus G(xz) is approximately independent of degree of distortion except at the highest initial pressure. The Poisson's ratio, nu(xz) is approximately constant with distortion strain for lower initial pressures, but increases significantly with epsilon(z) at higher pressures. Model predictions of the relation between G(xz) and initial uniform inflation pressure show a good correlation with reported experimental data for small distortion strains in a range of species. The model also exhibits similar behaviour to the experimentally measured uni-axial large deformations of a tri-axially pre-loaded block of parenchyma (Hoppin et al., 1975, Journal of Applied Physiology 39, 742-751).

Letters from a Nightingale nurse

Mary Cadbury was one of six daughters in a wealthy Birmingham family, all of whom took up professional or unpaid philanthropic work. In 1873 Mary began nurse training at the Nightingale School, St Thomas's Hospital, and regularly sent letters to family and friends, which provide a graphic account of the experience of a nurse in the latter half of the nineteenth century.

Viscoelastic behavior of a lung alveolar duct model

A study is conducted into the oscillatory behavior of a finite element model of an alveolar duct. Its load-bearing components consist of a network of elastin and collagen fibers and surface tension acting over the air-liquid interfaces. The tissue is simulated using a visco-elastic model involving nonlinear quasi-static stress-strain behavior combined with a reduced relaxation function. The surface tension force is simulated with a time- and area-dependent model of surfactant behavior. The model was used to simulate lung parenchyma under three surface tension cases: air-filled, liquid-filled, and lavaged with 3-dimenthyl siloxane, which has a constant surface tension of 16 dyn/cm. The dynamic elastance (Edyn) and tissue resistance (Rti) were computed for sinusoidal tidal volume oscillations over a range of frequencies from 0.16-2.0 Hz. A comparison of the variation of Edyn and Rti with frequency between the model and published experimental data showed good qualitative agreement. Little difference was found in the model between Rti for the air-filled and lavaged models; in contrast, published data revealed a significantly higher value of Rti in the lavaged lung. The absence of a significant increase in Rti for the lavaged model can be attributed to only minor changes in the individual fiber bundle resistances with changes in their configuration. The surface tension was found to make an important contribution to both Edyn and Rti in the air-filled duct model. It was also found to amplify any existing tissue dissipative properties, despite exhibiting none itself over the small tidal volume cycles examined.

Modelling impact-initiated wave transmission through lung parenchyma in relation to the aetiology of exercise-induced pulmonary haemorrhage

Recently we proposed that exercise-induced pulmonary haemorrhage (EIPH) results from locomotory-impact-induced trauma by impact of the scapula on the chest wall during footfall and the consequent transmission of waves through the lung. A computational model has been developed to demonstrate that wave amplification and focusing occur in the dorsocaudal tip of the lung for waves originating on the anterior subscapular surface. The propagation of an acoustic wave was investigated in a simplified 2-dimensional representation of a vertical anterio-dorsal section of horse lung. It was demonstrated that a complicated pattern of waves is transmitted from the scapula to the dorsal region. Wave motion was characterised using the instantaneous rate of change of pressure with time (dp/dt) which is associated with lung injury. Due to wave reflection and focusing, dp/dt is transiently very high on the spinal and diaphragmatic lung walls, particularly in the vicinity of the dorsal tip. The model therefore predicts that lung injury may occur in the region in which EIPH is reported to originate.

Exercise-induced pulmonary haemorrhage (EIPH) in horses results from locomotory impact induced trauma--a novel, unifying concept

Exercise-induced pulmonary haemorrhage (EIPH) in horses, although of major welfare and economic importance worldwide, is of uncertain cause. It is accepted that the dorsocaudal region of the lung is particularly prone to the condition, but present theories of causation cannot satisfactorily explain the mechanism or pattern of occurrence. We propose that EIPH results from locomotory impact induced trauma; the mechanism being similar to that producing lung tissue damage following thoracic impact injury. In impact injury, the localised impulsive load on the chest wall is transmitted by pressure waves through the lung at a slower speed than in the chest wall. The waves are subsequently reflected from the distal chest wall and other structures, producing a complex pattern of wave motion; waves travelling from regions of large cross-section to narrower ones are amplified in magnitude, consequently these regions can experience very high local stresses. Compression/dilation and shear waves are produced within the parenchyma and the latter particularly have been implicated as the cause of parenchymal damage and rupture with oedema and haemorrhage. This form of soft tissue damage has been shown to occur at remarkably low loads with an impact velocity greater than about 11 m/s and pressure exceeding approximately 14 kPa. In the horse, the lung is subjected to comparable levels of locomotory derived impulsive force during moderate to high speed exercise and this is the basis of the mechanism causing EIPH. During locomotion, the force following ground-strike of the front legs is transmitted, with some attenuation, through the forelimbs to the scapulae. The anatomical arrangement of the scapula, coupled with the direction of the force at the shoulder (scapulo humeral joint) produces an impulsive force on the rib cage, approximately just below mid height of the frontal aspect of the chest approximately over the fourth rib. As a result, pressure waves are transmitted through the lung parenchyma towards the dorsal and caudal regions; these waves are subsequently reflected at the distal chest wall, spine and diaphragm causing a complex pattern of wave interaction. The observed locations of EIPH are at the sites where wave intensity is expected to be greatest due to changes in cross section and reflection. Based on available information, it is estimated that impulsive forces of more than 100 kPa, lasting approximately 10 ms, would be applied to the chest wall by each scapula in a 500 kg horse when galloping; this level of force would be sufficient to cause oedema and haemorrhage as observed in impact induced injury.

The second missing link: Bible nursing in 19th century London

The London Bible and Domestic Female Mission was founded in 1857 by Ellen Ranyard. A nursing mission was added in 1868. The structure and work of the mission can be used to exemplify three strategies utilized in Victorian philanthropy. First, the use of working class women in the maintenance of social order, secondly the utilization of the middle class household to exemplify relations between the social classes, and thirdly the creation of districts in an attempt to recreate a 'golden age' of rural communities. Ranyard created a women's mission to women. As such it did not display the gender division of labour apparent in much health and caring work, but a hierarchical division of labour based on social class is evident.

Relationships between alveolar size and fibre distribution in a mammalian lung alveolar duct model

A finite element model, comprising an assemblage of tetrakaidecahedra or truncated octahedra, is used to represent an alveolar duct unit. The dimensions of the elastin and collagen fibre bundles, and the surface tension properties of the air-liquid interfaces, are based on available published data. Changes to the computed static pressure-volume behavior with variation in alveolar dimensions and fibre volume densities are characterized using distensibility indices (K). The air-filled lung distensibility (Ka) decreased with a reduction in the alveolar airspace length dimensions and increased with a reduction of total fibre volume density. The saline-filled lung distensibility (Ks) remained constant with alveolar dimensions and increased with decreasing total fibre volume density. The degree of geometric anisotropy between the duct lumen and alveoli was computed over pressure-volume cycles. To preserve broadly isotropic behavior, parenchyma with smaller alveolar airspace length dimensions required higher concentrations of fibres located in the duct and less in the septa in comparison with parenchyma of larger airspace dimensions.

A mathematical model for the morphology of the pulmonary acinus

A computational method is proposed for the construction of a three-dimensional space-filling model of an acinar ventilatory unit. Its geometry consists of truncated octahedra arranged in a cuboidal block. The ducts and alveoli are formed by opening specific common faces between polyhedra. The branching structure is automatically computed using algorithms solely to maximise the number of alveoli and minimise the average path lengths; it is not formed with reference to published experimental data. Properties of the model such as the total alveolar and ductal volumes, the distribution of individual path lengths to the alveolar sacs, and the average number of ducts per generation are calculated. The predicted morphology of the model compares well with published data for rat lungs.

The mechanical behavior of a mammalian lung alveolar duct model

A model for the mechanical properties of an alveolar duct is analyzed using the finite element method. Its geometry comprises an assemblage of truncated octahedral alveoli surrounding a longitudinal air duct. The amounts and distributions of elastin and collagen fiber bundles, modeled by separate stress-strain laws, are based upon published data for dogs. The surface tension of the air-liquid interface is modeled using an area-dependent relationship. Pressure-volume curves are computed that compare well with experimental data for both saline-filled and air-filled lungs. Pressure-volume curves of the separate elastin and collagen fiber contributions are similar in form to the behavior of saline-filled lungs treated with either elastase or collagenase. A comparison with our earlier model, based upon a single alveolus, shows the duct to have a behavior closer to reported experimental data.

The experience of in vitro fertilization and gamete intra-fallopian transfer

Research was conducted using qualitative techniques, in order to bridge the gap between radical feminist perspectives on in vitro fertilization programmes, which are usually theoretical in nature, and quantitative research which considers the experiences of women and couples involved in these programmes. Semi-focused interviews were carried out with 10 women who were currently undergoing, or had recently undergone, in vitro fertilization or gamete intra-fallopian transfer, in order to explore the experiences and the emotions associated with participation in these programmes. By utilizing a woman-centred approach, a richness of experiential data was obtained, which would not have been achievable by quantitative means, and yet the women involved were able to retain some control over the research process.

The future of health visiting

In recent months there has been a wealth of articles and speeches which have documented the need for changes to the current practice of health visiting. This paper reviews the current discussion on the future of health visiting and offers some alternative strategies.