Nurse practitioner led implementation of huddles for staff in long term care homes during the COVID-19 pandemic

BACKGROUND

Staff working in long-term care (LTC) homes during COVID-19 frequently reported a lack of communication, collaboration, and teamwork, all of which are associated with staff dissatisfaction, health concerns, lack of support and moral distress. Our study introduced regular huddles to support LTC staff during COVID-19, led by a Nurse Practitioner (NP). The objectives were to evaluate the process of huddle implementation and to examine differences in outcomes between categories of staff (direct care staff, allied care and support staff, and management) who attended huddles and those who did not.

METHODS

All staff and management at one LTC home (< 150 beds) in Ontario, Canada were included in this pre-experimental design study. The process evaluation used a huddle observation tool and focused on the dose (duration, frequency) and fidelity (NP's adherence to the huddle guide) of implementation. The staff attending and non-attending huddles were compared on outcomes measured at post-test: job satisfaction, physical and mental health, perception of support received, and levels of moral distress. The outcomes were assessed with validated measures and compared between categories of staff using Bayesian models.

RESULTS

A total of 42 staff enrolled in the study (20 attending and 22 non-attending huddles). Forty-eight huddles were implemented by the NP over 15 weeks and lasted 15 min on average. Huddles were most commonly attended by direct care staff, followed by allied care/support, and management staff. All huddles adhered to the huddle guide as designed by the research team. Topics most often addressed during the huddles were related to resident care (46%) and staff well-being (34%). Differences were found between staff attending and non-attending huddles: direct care staff attending huddles reported lower levels of overall moral distress, and allied care and support staff attending huddles perceived higher levels of support from the NP.

CONCLUSIONS

NP-led huddles in LTC homes may positively influence staff outcomes. The process evaluation provided some understanding of why the huddles may have been beneficial: the NP addressed resident care issues which were important to staff, encouraged a collaborative approach to solving issues on the unit, and discussed their well-being.

TRIAL REGISTRATION NUMBER

NCT05387213, registered on 24/05/2022.

Cross-cultural validation and psychometric testing of the supportive supervisory scale in Spanish

BACKGROUND

Supervisory effectiveness in long-term care facilities has been identified a key factor in staff satisfaction and quality of care. Determining its utility in Spanish speaking countries will assist with understanding different cultural and health service contexts.

OBJECTIVES

To develop and psychometrically test the Supervisory Support Scale in Spanish. The Spanish version of the Supportive Supervisory Scale could be useful for cross-cultural comparisons of supervisory support, which is a key factor to improving work relationships in long-term care facilities.

METHODS

Validation was carried out with 405 participants in 37 long-term care facilities. One-way analysis of variance was the test of significance performed to examine the differences among the facilities and Pearson product-moment correlations were used to assess construct validation of the scale. The mean and standard deviation were calculated for each supervisory score in each facility. Structural equation modelling was used to confirm the dimensions of the scale.

RESULTS

The item-to-item correlations were positive, ranging from 0.44 to 0.78, indicating good reliability of the scale. The coefficient alpha for the total scale was 0.96. The 15-item had mean item scores which ranged from 2.89 to 3.96 (SD = 1.01-1.26). Standardised factor loadings ranged within a narrow range: 0.75-0.86 for the 'respecting uniqueness' latent variable and 0.76-0.88 for the 'being reliable' latent variable. Construct validity was demonstrated as measure was positively associated with job satisfaction (r = 0.412, p < 0.0001) and was negatively correlated with HCAs' stress and burden.

CONCLUSION

The two-factor solution identified in the original scale that highlighted two key attributes of the supervisor; being reliable and respecting uniqueness, was also demonstrated in the Spanish Supervisory Support Scale as there was a moderate fit of the model.

IMPLICATIONS FOR PRACTICE

The Spanish version of the Supportive Supervisory Scale could be useful for cross-cultural comparisons of supervisory support in nursing facilities which is a key factor to improving staff relationships and care in nursing facilities.

Supportive Supervision and Staff Intent to Turn Over in Long-Term Care Homes

Background and Objectives

To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness.

Research Design and Methods

Cross-sectional survey data of 5,645 PSWs working within 398 LTC homes in Ontario, Canada, were obtained and analysed through a series of multilevel regression models.

Results

Overall, analyses support the assertion that the effect of supervisory support on intent to turn over is partially mediated by job satisfaction. However, happiness may act as an effect modifier rather than as a confounder.

Discussion and Implications

These results reinforce the importance of supportive supervision for PSWs working in LTC homes and highlight the multifaceted role of nurses in LTC, who traditionally provide the majority of PSW supervision. Nurses must be equipped with competencies and skills that reflect the complex organisational environments in which they work. However, these results must also be interpreted in context with the limitations of cross-sectional data; future research should incorporate prospective data collection and clarify the potential role of happiness.

PATTERN OF PHENOTYPIC VIABILITY AND FECUNDITY SELECTION IN A NATURAL POPULATION OF IMPATIENS PALLIDA

Estimates of viability and fecundity selection of 13 phenotypic characters for 1,536 individuals of Impatiens pallida growing in 24 locations within a single natural population were compared. Directional viability selection of cotyledon area, day of initial leaf production, number of leaves, and stem length was detected throughout this population. Directional fecundity selection of cotyledon area, day of initial flower production, number of leaves present on day of initial flower production, stem length on day of initial flower production, number of leaves, and stem length was also detected. Phenotypic selection of these characters was strong in some cases, and the strength of selection was significantly heterogeneous among locations. For several of the characters, directional phenotypic selection within the population was significantly positive in some locations and significantly negative in others separated by only a few meters. Fecundity selection was stronger than viability selection for some characters, implying that fecundity selection was at least as important as viability selection within this population. Soil moisture levels and light intensities played a larger role than soil nutrient levels in determining the patterns of both viability and fecundity selection, and differences in directional viability selection were more strongly related to environmental variation than were differences in fecundity selection. The pattern of phenotypic selection could not be reliably inferred from the patterns of mortality and reproduction alone.

Comparing a combination of validated questionnaires and level III portable monitor with polysomnography to diagnose and exclude sleep apnea

STUDY OBJECTIVES

Questionnaires have been validated as screening tools in adult populations at risk for obstructive sleep apnea (OSA). Portable monitors (PM) have gained acceptance for confirmation of OSA in some patients with a high pretest probability of the disorder. We evaluated the combined diagnostic utility of 3 validated questionnaires and a Level III PM in the diagnosis and exclusion of OSA, as compared with in-laboratory polysomnography (PSG) derived apnea hypopnea index (AHI).

METHODS

Consecutive patients referred to the Sleep Disorders Clinic completed 3 testing components: (1) 3 questionnaires (Berlin, STOP-Bang, and Sleep Apnea Clinical Score [SACS]); (2) Level III at-home PM (MediByte) study; and (3) Level I in-laboratory PSG. The utility of individual questionnaires, the Level III device alone, and the combination of questionnaires and the Level III device were compared with the PSG.

RESULTS

One hundred twenty-eight patients participated in the study (84M, 44F), mean ± SD age 50 ± 12.3years, BMI 31 ± 6.6 kg/m(2). At a PSG threshold AHI = 10, the PM derived respiratory disturbance index (RDI) had a sensitivity and specificity of 79% and 86%, respectively. The sensitivity and specificity for the other screening tools were: Berlin 88%, 25%; STOP-Bang 90%, 25%; SACS 33%, 75%. The sensitivity and specificity at a PSG AHI = 15 were: PM 77%, 95%; Berlin 91%, 28%; STOP-Bang 93%, 28%; SACS 35%, 78%.

CONCLUSIONS

Questionnaires alone, possibly given a reliance on sleepiness as a symptom, cannot reliably rule out the presence of OSA. Objective physiological measurement is critical for the diagnosis and exclusion of OSA.

Validation of the MediByte® type 3 portable monitor compared with polysomnography for screening of obstructive sleep apnea

BACKGROUND

Portable monitors are increasingly being used as a diagnostic screening tool for obstructive sleep apnea (OSA), and in-laboratory validation of these devices with polysomnography (PSG) is required.

OBJECTIVE

To assess the reliability of the MediByte (Braebon Medical Corporation, Canada) type 3 screening device compared with overnight PSG.

METHODS

To cover a range of OSA severity, a consecutive series of patients wore the screening device while simultaneously undergoing PSG. Data acquired from the screener and PSG were blinded and scored separately. The number of apneas and hypopneas per hour were calculated using recording time (respiratory disturbance index [RDI]) for the MediByte device, and sleep time (apnea-hypopnea index [AHI]) for PSG.

RESULTS

Data from 73 patients with a mean age of 53 years and body mass index of 32.2 kg⁄m2 showed high measurement association between the RDI and AHI, with a Pearson correlation of 0.92, accounting for 85% of the variance. Based on Bland-Altman measurement agreement, the mean difference between the RDI and AHI (-5.9±11.2 events⁄h) indicated screener under-reporting. For an AHI of greater than 15 events⁄h, the sensitivity and specificity of the screener was 80% and 97%, respectively; for an AHI of greater than 30 events⁄h, the positive predictive value was 100%, while the negative predictive value was 88%.

CONCLUSION

The MediByte device accurately identified patients without OSA and had a high sensitivity for moderate-to-severe OSA.

Detection of low frequency external electronic identification devices using commercial panel readers

The ability of a commercially available panel reader system to read International Standards Organization-compliant electronic identification devices under commercial dairy conditions was examined. Full duplex (FDX-B) and half-duplex (HDX) low frequency radio-frequency identification external ear tags were utilized. The study involved 498 Holstein cows in the final 6 wk of gestation. There were 516 total electronic identification devices (n = 334 HDX and n = 182 FDX-B). Eighteen FDX-B were replaced with HDX during the study due to repeated detection failure. There were 6,679 HDX and 3,401 FDX-B device detection attempts. There were 220 (2.2%) unsuccessful and 9,860 (97.8%) successful identification detection attempts. There were 9 unsuccessful detection attempts for HDX (6,670/6,679 = 99.9% successful detection attempts) and 211 unsuccessful detection attempts for FDX-B (3,190/3,401 = 93.8% successful detection attempts). These results demonstrate that this panel system can achieve high detection rates of HDX devices and meet the needs of the most demanding management applications. The FDX-B detection rate was not sufficient for the most demanding applications, requiring a high degree of detection by panel readers. The lower FDX-B rate may not be inherent in the device technology itself, but could be due to other factors, including the particular panel reader utilized or the tuning of the panel reader.

Advice and advocacy save lives

Tobacco use remains the leading cause of preventable premature death in the United States and, increasingly, around the world. This paper describes the critical role physicians can play in decreasing tobacco use by providing smoking cessation advice and engaging in antismoking advocacy. By helping patients who smoke to quit and working to diminish the economic and political power of the tobacco industry, physicians and other health professionals can help "make smoking history."

Type 5 phosphodiesterase regulation of human sperm motility

OBJECTIVE

Inhibition of phosphodiesterases results in the buildup of intracellular cyclic nucleotides, which have been shown to affect sperm motility and acrosome reaction. The objective of this study was to determine whether the cyclic guanosine monophosphate-specific type 5 phosphodiesterase inhibitor sildenafil has an effect on sperm motility and acrosome parameters.

STUDY DESIGN

Sperm cells were washed by two-layer colloid wash and resuspended in modified human tubal fluid with 5% serum albumin. They were incubated in the presence of different concentrations (0-40 nmol/L) of the type 5 phosphodiesterase inhibitor sildenafil. Aliquots of sperm were removed at hours 0, 4, 24, and 48, and motility parameters were measured on the Hamilton-Thorn HTM-C (Hamilton-Thorn Research, Danvers, Mass) motility analyzer. Sperm acrosomes were analyzed with the Spermac (Stain Enterprises, South Africa; distributed by Sage Biopharma, Bedminster, NJ) acrosome stain.

RESULTS

Sperm progressive motility and hyperactivation were stimulated to greater than the control at hour 4, followed by a decrease. There was a dose-dependent effect of the type 5 phosphodiesterase inhibitor on sperm motility parameters but not on percentage of cells with acrosome reaction. The type 5 phosphodiesterase inhibitor stimulated sperm acrosome reaction by almost 50% above the control.

CONCLUSION

These results suggest that inhibition of type 5 phosphodiesterase activity in human sperm resulted in enhanced progressive motility and hyperactivation. In addition, inhibition of type 5 phosphodiesterase also caused an increase in acrosome reaction. This suggests a role for type 5 phosphodiesterase in preventing premature acrosome reaction, which is associated with failed fertilization.

Preferences for body type and body characteristics associated with attractive and unattractive bodies: Jackson and McGill revisited

The present investigation replicates Jackson and McGill's study (1996) and extends it by considering the effects of respondents' own height, weight, and body mass on perceptions of attractiveness. Results, although generally supportive of those found by Jackson and McGill, point to the influence of respondents' own physical characteristics in the process of perceptions of attractiveness: only 1 of Jackson and McGill's 3 (of a possible 19) differences between responses of African- and Euro-American women was corroborated (the importance of silky hair for Euro-American women), whereas a second difference (the importance of round buttocks for African-American women) disappeared when controlling for respondents' weight, height, and body mass. Although differences between the two investigations may be attributed to regional differences in the surveyed students (Michigan and North Carolina), the small effect of one's own weight, height, and body mass in assessing an other-sex person's attractiveness may reflect adherence to norms learned very early in life that are subject to regional variations.

Effect of cardiopulmonary bypass on urethral blood flow as measured by laser Doppler flowmetry

PURPOSE

Previous reports have implicated urethral ischemia as a potential predisposing factor for the increased incidence of urethral strictures after cardiac bypass surgery. These reports were based on indirect measurements of urethral blood flow. We directly measured and compared urethral perfusion before and during cardiopulmonary bypass.

MATERIALS AND METHODS

A total of 10 patients undergoing cardiac bypass surgery (mean age 70) and 4 undergoing various surgery without cardiopulmonary bypass (mean age 54) were studied prospectively. A 16F silicone urethral catheter was placed in each patient before surgery. Urethral blood flow was measured intraoperatively using the Vasamedics PR-434 implantable prism laser probe before and during cardiopulmonary bypass.

RESULTS

In the patients undergoing cardiopulmonary bypass there was an overall 50+/-28% decrease in flow (range 0 to 88%, p <0.001) compared to pre-bypass levels. Stratification of the patients into warm versus cold cardioplegia revealed a mean percent decrease in flow of 58+/-20% (range 41 to 87%, p <0.05) for the warm and 44+/-33% (range 0 to 88%, p <0.05) for the cold group. Only 1 bypass case showed no significant decrease in mean flow. There was no significant decrease in urethral blood flow in the nonbypass group.

CONCLUSIONS

Our study demonstrates that there is decreased blood flow to the urethral mucosa during cardiopulmonary bypass. This finding lends support to the idea of urethral ischemia as a contributing factor in the pathogenesis of urethral strictures following cardiac bypass surgery.

A comparison of three free and total PSA assays

Prostate-specific antigen (PSA) has emerged as the most predictive test of whether or not a man has prostatic carcinoma. The free to total PSA ratio provides important enhancement in specificity, thus obviating unnecessary negative biopsies. In the absence of an international standard for total PSA, much less free PSA, variation between manufacturers may cause confusing results. We sought to compare three different manufacturer's free and total PSA assays in a population consisting of consecutive patients who had PSA testing in a reference laboratory in Germany. Between April 1994 and July 1996, serum specimens from 240 men were evaluated with three different free and total PSA assays. Indications for PSA determination were based on the referring physician, who also provided the clinical diagnosis. Total and free PSA were measured on the same freeze-thaw cycle with Chiron Diagnostics, Enzymun Boehringer Mannheim, and Hybritech Tandem-R assays. Seventy-nine men had carcinoma of the prostate, 120 had clinical evidence of benign prostatic hyperplasia and 27 were without evidence of prostatic disease. The Chiron ACS: 180 free to total ratio compared very well with the Tandem-R assay at the 95% sensitivity level, affording 17 and 22% specificity respectively. Using the range of total PSA of 4-10 ng/ml, the increase in specificity of the free to total PSA is quite significant, and the specificity of the Enzymun assays is greatly improved. (Specificity of 49%, 29% and 25% at 95% sensitivity for ACS, Enzymun and Tandem respectively.) This data, based on 'real world' clinical experience, shows significant variation between different manufacturers' assays. There was significant equivalence between the Chiron and Hybritech assays. The Enzymun assay performed well only when data from the total PSA range of 4-10 ng/ml was included. Clinicians must be aware of which manufacturers' assays for both the free and total PSA their laboratory staff is utilizing, and laboratory technicians must provide meaningful outcome data based on the patient population they serve with respect to the performance of these assays.

Histopathologic evaluation of the canine prostate following electrovaporization

PURPOSE

Transurethral electrovaporization of the prostate (TVP) for symptomatic benign prostatic hypertrophy (BPH) has proven to be efficacious with minimal patient morbidity. When compared to transurethral resection of the prostate (TURP), TVP demonstrates comparable postoperative flow rates, American Urologic Association (AUA) symptom score indices, and a potential cost savings. However, in the human studies it has not been possible to correlate these clinical parameters with procedure-related histopathologic changes in the prostate immediately postoperative or during wound healing. The following study was done using a canine model in an effort to evaluate these histopathologic changes.

METHODS AND MATERIALS

Fifteen hounds (25-35 kg.) underwent antegrade electrovaporization of the prostate, via an open cystotomy, using a Circon ACMI USA series resectoscope and video equipment. The dogs were sacrificed and the prostates harvested at various intervals postoperatively (0-11 weeks). The prostates were evaluated grossly as well as histologically for cavitary defects, depth of necrosis, and cellular response.

RESULTS

Prostates examined immediately following the procedure demonstrated superficial necrosis (less than 2 mm.) in the region of vaporized tissue. One week postoperatively, the vaporized regions demonstrated an intense acute inflammation amidst superficial necrosis with focal hemorrhage and dystrophic calcification. Transient glandular cystic changes developed, but were resolving by seven weeks postoperatively. Re-epithelialization was underway by the third postoperative week and epithelial stratification underway by the fifth week. There was no extension of the initial two millimeter zone of necrosis at any time point examined.

CONCLUSION

TVP in the canine model vaporizes prostatic tissue at the site of contact. Only a shallow remnant of necrosis remains at the site of vaporization, indicating the highly localized effect of this technique. Healing at the site of vaporization occurs in a rapid and expected manner. These data provide a histopathologic rationale for the minimal morbidity and the efficacious nature of this technique demonstrated in clinical studies.

Use of a subcutaneous tunnel following replantation of an amputated penis

We describe a new technique for immobilization and protection of the penis following microsurgical replantation, using a subcutaneous tunnel created in the suprapubic area. This tunnel protects the phallus from reinjury while maintaining an anatomic position and a normothermic environment in the immediate postoperative period.

Electrovaporization of the prostate: new technique for treatment of symptomatic benign hyperplasia

This pilot study evaluated the efficacy of a newly configured roller electrode (Circon/ACMI Vaportrode) in the treatment of symptomatic benign prostatic hyperplasia. The electrode is used with a cutting current and an otherwise-standard (ACMI) resectoscope. Thirty-four patients with significant symptoms of bladder outlet obstruction were treated and evaluated. Among them, 20 were in urinary retention, and 14 had moderate to severely symptomatic bladder outlet obstruction. Thirty-three patients are voiding and available for follow-up. The other patient has not returned. All available patients have shown both subjective and objective voiding improvement. In the evaluable patients, the AUA Symptom Index decreased from a mean of 26 to 12. The mean postoperative peak urinary flow rate was 13 mL/sec. Complications occurred in three patients (post-operative bleeding in one, urinary retention in two). Electrovaporization allowed definitive treatment of bladder outlet obstruction with subjectively better visibility than transurethral resection (TURP). The potential for fluid and electrolyte shifts and resulting complications appears to be less than with TURP. Further study of this technique appears warranted.

One hundred consecutive laparoscopic pelvic lymph node dissections: comparing complications of the first 50 cases to the second 50 cases

OBJECTIVES

To report the outcome of our first 100 consecutive laparoscopic pelvic lymph node dissections (LPLND) and compare the early complication rate of the first 50 cases (14%) to the second 50 cases (4%).

METHODS

We reviewed 100 patients who underwent LPLND: Ninety-six patients had carcinoma of the prostate and underwent LPLND prior to radical prostatectomy or definitive radiation therapy. Four patients had histologically proved penile (2) or bladder carcinoma (2) and underwent LPLND to assess their pelvic lymph nodes.

RESULTS

We encountered 7 major and minor complications in our first 50 cases, and 2 minor complications in our second 50 cases. The overall complication rate was 9% (9 of 100).

CONCLUSIONS

We believe that modification of our operative technique and changes in patient management resulted in a lower complication rate in the second 50 patients. We conclude that although LPLND has a significant learning curve, it is a viable surgical staging option for patients with urologic pelvic malignancies.

Simultaneous estimation of pollen contamination and pollen fertilities of individual trees in conifer seed orchards using multilocus genetic data

Seed orchards of forest trees are established to produce genetically-improved seed for reforestation. Genetic efficiency requires seed orchards to be (1) reproductively isolated form surrounding trees, (2) that there be similar fertilities among all orchard trees, and (3) minimum inbreeding. Each aspect of seed orchard reproduction can be simultaneously estimated using the observed frequency of each multilocus gametic type contributed through fertilizing pollen and the expected multilocus gametic segregation frequencies of orchard tree and of the contaminating population. These genetic estimates are directly relevant to the genetics of the tree breeding program. The flexibility of sampling seed - the basic data for these techniques - allows great scope for hypothesis testing, including tests of the accuracy of predictions of biophysical models of pollen movement. A simple example and a white spruce seed orchard case study are presented to illustrate the estimation technique and to investigate its sensitivity.

Self-compatibility, autonomous self-pollination, and insect-mediated pollination in the clonal species Iris versicolor

In clonal species, sexual and asexual systems interact to create a hierarchy of reproduction. For example, self-pollination can occur within pollination units, flowers, ramets, or clones. We investigated the reproductive biology of a natural population of Iris versicolor using pollination manipulations and observations of pollinator behaviour. We found that (i) individuals were completely self-compatible, (ii) selfing rates were close to 100%, (iii) autonomous self-pollination can occur through stigma–anther contact or wind action, (iv) most seed and fruit set can be accounted for by insect pollination, and (v) facilitated self-pollination likely occurs because pollinators frequently visit more than one pollination unit within a flower. Our observations showed that flowers pass through three stages: (i) a male stage (in which pollen is freely available, but stigmas are inaccessible, preventing autogamy); (ii) a female stage (in which stigma flaps have reflexed and are receptive, but pollinators may have already removed most pollen grains, structuring opportunities for geitonogamy); and (iii) a strongly autogamous stage (in which stigma flaps have curled back to contact anthers, leading to delayed autonomous self-pollination). This hierarchy of relatedness among mates determines the genetic consequences of vegetative and sexual reproduction in clonal plants and influences their evolution. Key words: Iris, self-incompatibility, reproductive biology, clonal, pollination.

Effect of calcium entry blocker nitrendipine on renal function after renal vascular occlusion

The ability of the Ca entry blocker nitrendipine to improve postischemic renal function was studied in nine groups (n = 70) of rats. After anesthesia, nitrendipine was administered for 15 min through the femoral vein. The dose administered depended on the group. Group 1 (n = 7), the control, received only 0.9% NaCl, group 2 (n = 12) 0.25 mg/kg; group 3 (n = 10) 0.50 mg/kg; group 4 (n = 8) 0.75 mg/kg; group 5 (n = 6) 1.00 mg/kg; group 6 (n = 7) 1.50 mg/kg; group 7 (n = 7) 2.00 mg/kg; group 8 (n = 6) 2.50 mg/kg; and group 9 (n = 7) 3.00 mg/kg. After the administration of nitrendipine, the kidneys were rendered ischemic for one hour by cross-clamping the renal vessels. Comparison of 24-h creatinine clearances for 72 h after reversal of ischemia demonstrated that nitrendipine was capable of providing a degree of protection against renal ischemia and the protective effect was dose dependent (p less than .05).

Health promotion in a scheduled cyclical format

Many previously described health promotion programs focus on a limited number of issues, such as exercise, or direct their attention to multiple topics concurrently. In an effort to generate increased employee interest in important health concepts and to assure that appropriate emphasis is given to all relevant major health promotion topics, we have developed a four-year program, superimposed on our preexisting health maintenance/promotion structure. The first year of the program focuses on cardiovascular disease prevention; the second, on early cancer detection and prevention; the third, on psychologic and social issues; and the fourth, on other significant topics such as accidents, diabetes, pregnancy, and musculoskeletal disorders. Such an approach provides for a comprehensive program, maximizing the participation of available corporate and community resources, encourages employee participation by sequential attention to different issues, and affords the opportunity for directing attention to revisions and additions predicated by medical advances.

Effect of the calcium entry blocker verapamil on renal ischemia

The ability of the calcium entry blocker verapamil to ameliorate the effects of renal ischemia was studied in ten sheep. Postanesthesia, bilateral cutaneous ureterostomies were placed in each sheep to facilitate urine collection and analysis. Both kidneys were made ischemic for one hour by occluding each renal artery. However, immediately before occlusion of the right renal artery, 0.05 mg/kg of verapamil was injected into the artery. Comparison of urinary creatinine excretion and urine volume for 72 h after reversal of ischemia demonstrated that those kidneys pretreated with verapamil had greater functional preservation (p less than .05). In this study, verapamil appeared to provide protection against renal damage after an ischemic insult.

Specific immunity in mice to heartwater

Mice develop a specific immune response following infection with the mice strains of heartwater. In the case of the Kümm strain the agent can persist in some tissues for up to 365 days. Transfer of spleen cells from immune mice confers protection against homologous challenge in recipient mice showing that cell mediated immunity is important. A comparison with immune mechanisms occurring in other Rickettsia is discussed.

Variation in Male Fertilities and Pairwise Mating Probabilities in Picea glauca

Frequencies of multilocus male gametes in seeds collected from clones in several blocks of a white spruce seed orchard were analyzed as part of a 2-yr study of mating system variation in this species. Observed frequencies of male gamete types departed significantly from those expected assuming equal male fertilities among clones. Male gamete frequencies in seed crops were significantly heterogeneous among clones within blocks, and among blocks within clones. Clonal male fertilities were estimated from male gamete frequency data. These estimates were highly skewed, with a small proportion of the clones contributing male gametes to the majority of the seed. The estimates were significantly heterogeneous among clones within blocks, and among blocks within clones. Between-year variation in clonal male fertilities was also pronounced, with male fertilities of some clones changing by as much as three orders of magnitude. Clonal male fertility was significantly correlated with clonal male cone production in both years. These results are important with regard to assumptions made for the estimation of general combining ability, average genetic correlation among progeny from single parents, and expected response to selection in open-pollinated plant populations.

Renal preservation following severe ischemia and prophylactic calcium channel blockade

The ability of the calcium channel blocker verapamil to prevent renal ischemic damage was assessed in a randomized double blind study of 41 rats. Study animals received either intravenous verapamil or placebo prior to renal pedicle occlusion and contralateral nephrectomy. Rats receiving verapamil pretreatment demonstrated significantly greater functional preservation 48 hours after ischemia (p less than 0.005) and exhibited better overall survival rates. In this study verapamil provided protection against renal damage following ischemia.

Primary renal malignant fibrous histiocytoma: a case report and literature review

Malignant fibrous histiocytoma has been reported as a primary renal tumor in 7 cases, of which 4 had relevant clinical histories and followup. We report an additional case noting, as others have, the similarity in clinical presentation with renal cell carcinoma. Despite a radical operation this tumor often manifests local recurrence with subsequent distant metastases.

Voluntary dental laboratory certification program. Council on Prosthetic Services and Dental Laboratory Relations

Laboratory certification does not offer concrete guarantees of consistent high quality of products or services. It does, however, identify, for the dental profession, a competency and acceptability factor on which to base a predication of performance by the laboratory. Also, laboratory certification establishes a framework within which the dental laboratory industry can work to continue upgrading its facilities and personnel, demonstrates the concern of certified laboratories for continuing competence, and indicates to government and third-party payers a willingness to develop standards endorsed by the industry.