The proposed Research is a pilot study which addresses the learning needs of persons undergoing surgery. The long-term objective is to assure quality and cost-effective ostomy patient education. Limited research is available on patients' perceptions of their learning needs,m appropriate time frames for teaching content, adjustment to the ostomy, self-care skills, and knowledge about the ostomy and primary disease. Early discharge from the hospital has limited the amount of time allowed for discharge teaching, and an important question to be asked is how has the limited teaching period affected adjustment and rehabilitation. The primary teacher of ostomy patients is an Enterostomal Therapy (ET) nurse who has additional continuing education in the area of stoma care. The first research question, Is there a difference between what ostomy patients think they need to know, and when, and what ET nurses think the ostomy patient needs to know, and when?, will be addressed by a 16 item ostomy knowledge and skills inventory to be distributed to a group of ostomy patients and ET nurses. The subjects will be requested to rate the importance of each item and to identity when the item should be learned/taught. A comparison of the two groups will be computed. The results will be used to address the research question. The following questions will be addressed by a longitudinal study of new ostomy patients: How do anxiety levels (State Train Anxiety Inventory), ostomy adjustment (Ostomy Adjustment Scale Revised), self-care skills and ostomy knowledge (Ostomy Knowledge and Self-Care Skills Assessment), change over time (2-6 weeks, 3 months, 6 months, 1 year); and to what degree is ostomy adjustment related to ostomy knowledge level, self-care skills, anxiety level, and learning styles (Learning Styles Inventory)? Adjustment to ostomy surgery occurs over time and requires a person to learn new content and skills, and adapt to a change in body function and image. Identifying current patient outcomes will provide direction for future nursing intervention. The results from this research are related directly to the ostomy patient population, but it is possible to expand the research questions to other important patient education areas (e.g., diabetes, hypertension, transplantation, mastectomy). GROUP=R01DK43904 The long-term goals of this project are to understand the mechanisms which regulate the processes of proliferation and differentiation of human hematopoietic cells, and to determine the causes of the aberrant differentiation characteristic of acute leukemias. During the process of normal differentiation, mature myeloid cells, such as monocytes and neutrophils, gradually lose the ability to proliferate and become permanently arrested in Go/G1. This loss of proliferative capacity, termed "terminal differentiation," does not occur in certain other hematopoietic cells, such as lymphocytes. Although mature circulating T and B lymphocytes are also arrested in Go, they can be readily induced to re- enter the cell cycle and proliferate in response to specific antigen or mitogen. The process of terminal differentiation does not occur normally in some acute leukemic cells, such as AML, leading to an accumulation of proliferating, undifferentiated blasts. Unfortunately, little is known about the regulation of terminal differentiation. It is likely that the control of both proliferation and terminal differentiation occurs in G1. In preliminary studies, we have shown that the product of the retinoblastoma susceptibility gene, Rb, is likely to be involved in G1 cell cycle control in hematopoietic cells. The data are consistent with a model in which Rb functions to block progression through G1, and that this block is reversed in normal cells by phosphorylation of Rb. Thus, the ability to phosphorylate, and therefore inactivate, Rb is a critical control point in late G1. We have shown that all hematopoietic cells express unphosphorylated Rb in G1; and that lymphocytes, but not terminally differentiated monocytes, express an Rb kinase which can phosphorylate Rb at G1/S. We have identified a potential Rb-kinase, p34cdc2, and have demonstrated that expression of p34cdc2 is regulated in T cells by mitogens. p34cdc2 has been shown to be essential at G1/S since blocking induction of p34cdc2 with antisense oligodeoxynucleotides partially inhibits both entry into S and Rb phosphorylation. The major focus of this proposal is to define the roles of Rb and Rb-kinases in cell cycle control, and to understand what role Rb plays in the control of proliferation, differentiation, and leukemic transformation of hematopoietic cells. It is anticipated that these results may be of value in both the understanding of normal hematopoiesis, and ultimately in the understanding of the abnormal differentiation properties of leukemic cells.