Early pregnancy factor (EPF) is a secreted protein with growth regulatory and immunomodulatory properties. It functions as an autocrine growth factor for tumour cells and as an autocrine or paracrine growth factor for regenerating normal cells. Anti-EPF antibodies have demonstrable anti-tumour activity and, as a result, hybridomas which produce such antibodies are unstable. In this study, the phage display antibody techniques have been investigated as a means of producing recombinant anti-EPF antibodies. Mice were immunised with synthetic peptides which correspond to the N or C terminal regions of EPF, and their splenic tissue was used to make combinatorial antibody libraries. The Fab repertoire was displayed on the surface of phage and panned over recombinant EPF. Reactive Fabs were identified by ELISA and their binding was characterised by BIAcore analysis and functional studies. Three libraries with a size of greater than 5x10(7)cfu were constructed and a total of 26 unique Fabs with specific reactivity against EPF were identified. Three Fabs were purified and of these one demonstrated strong EPF neutralising activity, one had intermediate activity and the other was not neutralising. Phage display has provided the means of circumventing the problems of anti-EPF hybridoma development and has resulted in the production of antibodies with potential applications in the diagnosis of pregnancy and the diagnosis and therapy of cancer.

A descriptive survey design was utilised within a general intensive care environment, to describe the attitudes of nurses and relatives towards the provision of care by relatives to their critically ill loved one. Triangulation was employed utilising a questionnaire comprising a Likert scale, a checklist of participatory care activities, open questions and biographical questions. The total nurse population of the intensive care unit (ICU) was surveyed. 27 questionnaires were returned (a response rate of 75%). Of a possible 45 relatives surveyed, 20 returned questionnaires (a response rate of 44.4%). A high proportion of both the nurse and the relative samples (96.3% and 85% respectively) indicated their agreement with the concept of involving relatives in the physical care of their critically ill loved one. The results highlighted issues of personal choice for individual lay involvement and adequate information for families to become involved. For the nurse sample the major themes emergent were the problems of role adaptation for nurses and families involved, and building relationships. For the relative sample the categories emergent were adapting to the demanding ICU environment and identifying the parameters of their new caring role. The study suggests benefits, to both nurses and relatives, of lay participation in physical care of critically ill patients on the ICU environment.