Key words: autotaxin; lysophospholipase D; thyroid carcinoma; motilityAutotaxin (ATX) is a 125 kDa glycoprotein that was originally isolated from the conditioned medium of human melanoma A2058 cells. ATX stimulates random and directed motility in a variety of tumor cell lines, including those from prostate and breast carcinomas, melanomas, neuroblastomas and renal-cell carcinoma. [1][2][3][4] Sequence analysis of ATX revealed significant homology to a family of cell surface type I phosphodiesterases, 5 and ATX has recently been newly classified as a member of the ecto-nucleotide pyrophosphate/phosphodiesterase family (E-NPP). Three structurally related mammalian E-NPPs are known, NPP1 (PC-1), NPP2 (ATX, PD-I␣) and NPP3 (gp130 RB 13-6 , PD-I␤, B10). Members of the E-NPP family are capable of hydrolyzing phosphodiester bonds of nucleotides and nucleic acids and pyrophosphate bonds of nucleotides and nucleotide sugars. In addition, they can hydrolyze 3Ј,5Ј-cAMP to AMP, nucleoside 5Ј-triphosphates, such as ATP, to AMP and 2xP i , nucleoside 5Ј-diphosphates, such as ADP, to AMP and P i , or NAD ϩ to AMP and nicotinamide mononucleotide. 6 Recently, ATX (NPP-2) was also shown to hydrolyze lysophosphatidyl choline (LPC) to lysophosphatidic acid (LPA). 7,8 Active phosphodiesterase, lyso-phospholipase D (lyso-PLD) and migration-stimulating activity of ATX depends on the presence of 4 defined amino acid residues, threonine 210 and histidines 316, 360 and 475, within the ATX molecule. 9 When comparing the substrate specificity of ATX with that of the related family members NPP1 and NPP3, only NPP2 displayed a lyso-PLD activity, whereas NPP1 and NPP3 had a much higher nucleotide pyrophosphatase activity. 10

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High fidelity patient simulation (HFPS) has become an increasingly popular teaching methodology in nursing education. To date, there have not been any published studies investigating HFPS scenarios incorporating medical and psychiatric nursing content. This study utilized a quasi-experimental design to assess if HFPS improved student knowledge and retention of knowledge utilizing three parallel 30-item Elsevier HESI(TM) Custom Exams. A convenience sample of 37 senior level nursing students participated in the study. The results of the study revealed the mean HESI test scores decreased following the simulation intervention although an analysis of variance (ANOVA) determined the difference was not statistically significant (p = .297). Although this study did not reveal improved student knowledge following the HFPS experiences, the findings did provide preliminary evidence that HFPS may improve knowledge in students who are identified as "at-risk." Additionally, students responded favorably to the simulations and viewed them as a positive learning experience.

Sepsis is a potentially fatal response to infection affecting patients across the life span. Sepsis can progress from systemic inflammatory response to severe sepsis and septic shock if not recognized promptly and managed effectively. Risk factors for sepsis include age, gender, the presence of invasive devices (eg, urinary catheters), and chronic medical conditions (eg, chronic obstructive pulmonary disease). Sepsis awareness is essential and includes identification of population-focused risk factors, recognition of clinical signs and symptoms, and timely implementation of interventions. The purpose of this article was to examine sepsis in older adults, including prevalence, atypical presentation of the condition, and considerations for sepsis management in the elderly population.

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