Pre-eclampsia is a pregnancy-specific syndrome of unknown etiology, defined by clinical findings of elevated blood pressure combined with proteinuria and oedema. The decidual portion of the spiral arteries of women who later develop pre-eclampsia does not undergo the normal pregnancy-induced remodelling that converts these vessels to high volume-low resistance conduits. We have postulated that this failure leads to vascular spasm, restricted blood flow, placental ischaemia and the release of toxic substances that enter the maternal circulation, resulting in multi-organ disease. The complex and interwoven pathways of endocrine, paracrine and autocrine factors appear to result in a vicious cycle of endothelial cell dysfunction, which is expressed clinically as pre-eclampsia.
Education, professional training, certification, and work patterns of 988 laboratory directors employed in 440 clinical laboratories licensed under the Clinical Laboratories Improvement Act of 1967 are examined. Directors of hospital laboratories as opposed to independent laboratories were more likely to be physicians (82.8% vs. 68.0%), to have completed a formal residency program (75.5% vs. 62.0%), and to be certified in both anatomic and clinical pathology (65.3% vs. 57.1%). Only 51.9% of pathologists confined their work to a single laboratory, while 64.8% of directors with Ph.D.s or other doctorates directed only one laboratory. Most laboratories (81.5%) have at least one associate director. Hospital directors are more often full time (30 or more hours per week) than their independent laboratory counterparts, 74.4% vs. 42.4%, respectively. When the education and experience of individuals entering the field between the 1950s and 1970s are examined, it is evident that fewer individuals with bachelor's or master's degrees now are able to qualify as laboratory directors.
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