Discovery of a Novel Bromodomain and Extra Terminal Domain (BET) Protein Inhibitor, I-BET282E, Suitable for Clinical Progression

The functions of the bromodomain and extra terminal (BET) family of proteins have been implicated in a wide range of diseases, particularly in the oncology and immuno-inflammatory areas, and several inhibitors are under investigation in the clinic. To mitigate the risk of attrition of these compounds due to structurally related toxicity findings, additional molecules from distinct chemical series were required. Here we describe the structure- and property-based optimization of the in vivo tool molecule I-BET151 toward I-BET282E, a molecule with properties suitable for progression into clinical studies.

Behavior, health, and productivity of early-lactation dairy cows supplemented with molasses in automated milking systems

The objective of this study was to determine the effect of molasses-based liquid feed (LF) supplementation within automated milking systems (AMS) on the behavior, health, and production of early-lactation dairy cows. In 6 commercial AMS dairy herds, 390 dairy cows were randomly assigned before calving to 1 of 2 treatments, within farm, balanced by parity: (1) control group (CON) receiving a standard AMS pellet [mean = 3.9 kg/d on a dry matter (DM) basis, n = 188], or (2) same amount of standard AMS pellet (mean = 3.6 kg/d on a DM basis, n = 202) plus 1 kg/d DM of LF for multiparous cows (1.6 kg/d as fed) and 0.88 kg/d DM for primiparous cows (1.4 kg/d as fed). Across farms, cows were fed partial mixed rations similar in ingredient and nutrient composition. Cows on the LF treatment received supplementation for the first 60 d in milk (DIM). Blood samples were taken 2 times/wk for the first 3 wk postcalving to assess β-hydroxybutyrate (BHB). Samples with BHB ≥1.2 mmol/L were classified as a positive case of subclinical ketosis (SCK). Cow body condition and lameness were scored every 10 d postcalving until 60 DIM. No differences were detected between treatments for milk yield (average milk yield = 37.4 ± 1.98 kg/d) and milking frequency (average milking frequency = 3.2 ± 0.01 times/d). Similarly, no difference between treatments in daily AMS visits was detected (average AMS visits = 5.3 ± 0.3 times/d). However, CON cows experienced more AMS refusals/d than LF cows (LF = 1.6 refusals/d, CON = 2.1 refusals/d). No difference between treatments in daily rumination time was detected (average rumination time = 476 ± 10.8 min/d). Treatment was associated with the number of times cows tested positive for SCK; cows on LF had fewer repeated diagnoses of SCK, such that 15% of cows on LF had ≥3 diagnoses of SCK out of 5 tests, compared with 27% of CON cows. Cows receiving molasses tended to have lower blood BHB values at ∼15 DIM. Molasses supplementation also allowed cows to maintain a more stable body condition score, as LF cows tended to lose less body condition over the first 60 DIM compared with CON cows. Overall, the results of this study demonstrate that supplementing a molasses-based LF to AMS cows may help support the energy demands of milk production in early lactation and, thus, reduce the incidence of repeat positive SCK tests during that time period.

Effect of diet-induced negative energy balance on the feeding behavior of dairy cows

The objective of this study was to determine how feeding behavior of dairy cows is altered in response to diet-induced negative energy balance, and if this response varies depending on dietary particle size distribution. Multiparous Holstein cows (n = 30; days in milk = 59 ± 5; parity = 2.8 ± 0.19), producing 44.6 ± 1.2 kg/d of milk, were fed (on a dry matter basis) a lactating diet [net energy of lactation (NE_L) = 1.66 Mcal/kg; 68% forage, including 1.8% wheat straw] during a 2-wk baseline period. To induce negative energy balance, cows were then exposed for 3 wk to 1 of 2 diets formulated for a 20% reduction in energy available for milk (NE_L = 1.58 Mcal/kg; 73% forage, including 17.2% wheat straw). These diets were identical, only varying in straw chop length: (1) long straw diet (LS): straw chopped with a 10.2-cm screen, or (2) short straw diet (SS): straw chopped with a 2.54-cm screen. Cows consumed 25.6 ± 0.26 kg/d during the baseline period. Dry matter intake decreased on the experimental diets; dry matter intake was greater for the SS diet as compared with the LS diet (23.1 vs. 22.5 kg/d; standard error = 0.47). During the baseline period, cow serum nonesterified fatty acids (NEFA) and blood β-hydroxybutyrate averaged 0.27 ± 0.02 and 0.71 ± 0.05 mmol/L, respectively. During the experimental period, NEFA and β-hydroxybutyrate averaged 0.34 and 1.04 mmol/L, respectively, with a peak of NEFA (0.63 ± 0.06 mmol/L) occurring 4 d after dietary change. During baseline, cows produced 42.3 ± 0.33 kg/d of milk; milk yield was decreased for both SS cows and LS cows during the experimental period (SS = 39.0, LS = 37.8 kg/d; standard error = 0.67). On the experimental diets, cows spent more time eating (266.8 vs. 221.8 min/d), had longer meal lengths (46.9 vs. 37.5 min/meal), and consumed fewer meals (7.1 vs. 7.7 meals/d) compared with the baseline period. Within the experimental period, LS cows spent more time eating per day than SS cows (LS = 281.3, SS = 252.2 min/d). During the baseline period cows sorted against long particles (>19 mm), did not sort medium particles (8 to 19 mm), and sorted for short (4 to 8 mm) and fine (<4 mm) particles. Cows did not change sorting of long particles on the SS diet, but increased sorting against these on the LS diet. On the SS diet cows did not change their sorting of short and fine particles. On the LS diet cows increased sorting for short and fine particles. In the baseline period, no association was detected between feed sorting and serum NEFA concentration. During the experimental period, greater NEFA concentration was associated with greater sorting in favor of short particles for both the LS and SS diets. Furthermore, greater NEFA concentration was associated with greater sorting against the longest particles for both the LS and SS diets. No associations of blood and meal variables were detected during the experimental period. Overall, cows altered their feed sorting behavior in response to experiencing a diet-induced period of negative energy balance and the severity of negative energy balance was associated with the extent of that change in feed sorting.

Rabies prevention: the role of serology in parenteral vaccination of companion animals and livestock

Rabies virus (RABV)-specific antibodies generated in response to rabies vaccination provide the basis for the establishment of rabies protection and hence rabies control and prevention. Rabies serology is the primary and most appropriate way to determine vaccination efficacy. Various immunological methods, such as serum neutralisation, enzyme-linked immunosorbent assay, the indirect fluorescent antibody test and immunochromatographic (or lateral flow) assay can detect and measure these antibodies. These methods range from complex to simple and from highly precise to approximate. Rabies serology interpretation, cut-off levels and method limitations are important considerations that oftentimes are overlooked when evaluating the results of tests that measure the immune response to rabies vaccination or RABV antigen exposure. In addition, a meaningful result may depend on the timing of obtaining the samples. Practical issues such as the costs of testing and accessibility of test reagents or facilities play an increasingly important role in the success of rabies elimination efforts in developing areas. The discovery of new lyssaviruses in recent years means that the rabies vaccines currently in use should be evaluated to determine whether or not they confer protection against these viruses. Methods that can be adapted for the measurement of RABV-specific antibodies are needed. Whether used for diagnosis, serosurveillance, or determination of individual or group vaccine response, rabies serology has a great impact on rabies control and prevention efforts. It is critical, therefore, that not only does the method employed generate results that are applicable, but that these results are interpreted correctly. To ensure that this is the case, it is crucial to know exactly what the test was designed to measure and to understand its limitations.

Reporting of treatment fidelity in behavioural paediatric obesity intervention trials: a systematic review

Behavioural interventions for paediatric obesity are promising, but detailed information on treatment fidelity (i.e. design, training, delivery, receipt and enactment) is needed to optimize the implementation of more effective interventions. Little is known about current practices for reporting treatment fidelity in paediatric obesity studies. This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, describes the methods used to report treatment fidelity in randomized controlled trials. Treatment fidelity was double-coded using the National Institutes of Health Fidelity Framework checklist. Three hundred articles (N = 193 studies) were included. Mean inter-coder reliability across items was 0.83 (SD = 0.09). Reporting of treatment design elements within the field was high (e.g. 77% of studies reported designed length of treatment session), but reporting of other domains was low (e.g. only 7% of studies reported length of treatment sessions delivered). Few reported gold standard methods to evaluate treatment fidelity (e.g. coding treatment content delivered). General study quality was associated with reporting of treatment fidelity (p < 0.01) as was the number of articles published for a given study (p < 0.01). The frequency of reporting treatment fidelity components has not improved over time (p = 0.26). Specific recommendations are made to support paediatric obesity researchers in leading health behaviour disciplines towards more rigorous measurement and reporting of treatment fidelity.

From trust on intimacy: A new inventory for examining erikson's stages of psychosocial development

A new inventory for examining the first six of Erikson's psychosocial stages is described. The self-report questionnaire, developed in a pilot study of 97 adolescents and tested in a study of 622 adolescents, has 12 items for each subscale. Measures of reliability and validity are reported. It is concluded that the Erikson Psychosocial Stage Inventory (EPSI) is a useful measure for researchers interested in development from early adolescence and in mapping changes as a function of life events.

Spatiotemporal model of barley and cereal yellow dwarf virus transmission dynamics with seasonality and plant competition

Many generalist pathogens are influenced by the spatial distributions and relative abundances of susceptible host species. The spatial structure of host populations can influence patterns of infection incidence (or disease outbreaks), and the effects of a generalist pathogen on host community dynamics in a spatially heterogeneous community may differ from predictions derived via simple models. In this paper, we model the transmission of a generalist pathogen within a patch framework that incorporates the movement of vectors between discrete host patches to investigate the effects of local host community composition and vector movement rates on disease dynamics.We use barley and cereal yellow dwarf viruses (B/CYDV), a suite of generalist, aphid-vectored pathogens of grasses, and their interactions with a range of host species as our case study. We examine whether B/CYDV can persist locally or in a patch framework across a range of host community configurations. We then determine how pathogen-mediated interactions between perennial and annual competitors are altered at the local and regional scale when the host populations are spatially structured. We find that the spatial configuration of the patch system, host composition within patches, and patch connectivity affect not only the ability of the pathogen to invade a fragmented system, but also determine whether the pathogen facilitates the invasion of a non-native host species. Further, our results suggest that connectivity can interact with arrival time and host infection tolerance to determine the success or failure of establishment for newly arriving species.

Health promotion in community pharmacy

In this study, health promotion activity in community pharmacies and pharmacists' perceptions of the barriers to increasing health promotion activity were investigated. A stratified sample (30) was investigated using a structured interview. Health promotion activities were undertaken in all pharmacies in the study. The number of times advice was given or a query dealt with was estimated to be around 1,400 per week for this sample. Health promotion activity was 2.5 times more likely to be reactive than proactive. Other issues were identified which suggest that pharmacists' activities in this field tend to be passive and product orientated. Barriers identified included remuneration issues, space, time, training and insufficient liaison with other health professionals and health promotion units.

The correlation of chemical and physical corn kernel traits with production performance in broiler chickens and laying hens

A study was conducted to determine the influence on broiler chicken growth and laying hen performance of chemical and physical traits of corn kernels from different hybrids. A total of 720 male 1-d-old Ross-308 broiler chicks were allotted to floor pens in 2 replicated experiments with a randomized complete block design. A total of 240 fifty-two-week-old Hy-Line W-36 laying hens were allotted to cages in a randomized complete block design. Corn-soybean meal diets were formulated for 3 broiler growth phases and one 14-wk-long laying hen phase to be marginally deficient in Lys and TSAA to allow for the detection of differences or correlations attributable to corn kernel chemical or physical traits. The broiler chicken diets were also marginally deficient in Ca and nonphytate P. Within a phase, corn- and soybean-based diets containing equal amounts of 1 of 6 different corn hybrids were formulated. The corn hybrids were selected to vary widely in chemical and physical traits. Feed consumption and BW were recorded for broiler chickens every 2 wk from 0 to 6 wk of age. Egg production was recorded daily, and feed consumption and egg weights were recorded weekly for laying hens between 53 and 67 wk of age. Physical and chemical composition of kernels was correlated with performance measures by multivariate ANOVA. Chemical and physical kernel traits were weakly correlated with performance in broiler chickens from 0 to 2 wk of age (P<0.05, | r |<0.42). However, from 4 to 6 wk of age and 0 to 6 wk of age, only kernel chemical traits were correlated with broiler chicken performance (P<0.05, | r |<0.29). From 53 to 67 wk of age, correlations were observed between both kernel physical and chemical traits and laying hen performance (P<0.05, | r |<0.34). In both experiments, the correlations of performance measures with individual kernel chemical and physical traits for any single kernel trait were not large enough to base corn hybrid selection on for feeding poultry.

The correlation of chemical and physical corn kernel traits with growth performance and carcass characteristics in pigs

Corn kernel composition may affect its nutritive value and, thus, pig growth performance and carcass characteristics. The objective of this study was to determine the influence of the chemical and physical traits of corn kernels from different hybrids on the growth performance and carcass characteristics of pigs. A total of 288 crossbred pigs were grown in a 3-phase program from 21 kg of BW until slaughter at 113 kg of BW with 12 pens (4 pigs/pen) per dietary treatment. Target BW for each phase were 20 to 40 kg (grower 1), 40 to 80 kg (grower 2), and 80 to 120 kg (finisher). In each phase, diets were formulated to be marginally deficient in Lys, TSAA, Ca, Na, and nonphytate P to improve the likelihood of detecting differences in performance due to corn hybrid. Each of 6 corn hybrids represented a wide range of kernel chemical and physical traits and was substituted for corn in a common diet formulation on an equal weight basis to make the 6 dietary treatments. Physical and chemical composition of the kernels were analyzed and correlated with performance measures by multivariate ANOVA. Kernel density was correlated with i.m. fat (IMF) content in LM (r = -.35, P < 0.05). Stenvert grinding time was correlated (P < 0.05) with ADG during the grower 1 phase (r = 0.26), ADFI during the grower 2 phase (r = 0.27), final BW (r = 0.27), and IMF (r = -0.36). The amylose content of the cornstarch was correlated (P < 0.05) with ADG during the grower 2 phase (r = -0.28) and with BW at the end of the grower 2 phase (r = -0.27). The NDF content of the kernels was correlated (P < 0.05) with ADG during the finisher phase (r = -0.30), final BW (r = -0.33), and number of days to market (r = 0.31). The ADF content of the kernels was correlated (P < 0.05) with ADG during the grower 1 phase (r = -0.26), final BW (r = -0.26), and IMF (r = 0.31). The correlations of performance measure variation with individual kernel hybrid physical and chemical traits were statistically significant yet not large enough to base corn hybrid selection for feeding pigs on any single kernel chemical or physical trait.

Creation of a CT Image Library for the Lung Screening Study of the National Lung Screening Trial

The CT Image Library (CTIL) of the Lung Screening Study (LSS) network of the National Lung Screening Trial (NLST) consists of up to three annual screens using CT imaging from each of 17,308 participants with a significant history of smoking but no evidence of cancer at trial enrollment (Fall 2002-Spring 2004). Screens performed at numerous medical centers associated with 10 LSS-NLST screening centers are deidentified of protected health information and delivered to the CTIL via DVD, external hard disk, or Internet/Virtual Private Network transmission. The collection will be completed in late 2006. The CTIL is of potential interest to clinical researchers and software developers of nodule detection algorithms. Its attractiveness lies in its very specific, well-defined patient population, scanned via a common CT protocol, and in its collection of evenly spaced serial screens. In this work, we describe the technical details of the CTIL collection process from screening center retrieval through library storage.

1D and 3D models of auto-regulated cerebrovascular flow

The Circle of Willis (CoW) is a ring-like structure blood vessels at the base of the brain that distributes arterial blood to the cerebral mass. 1D and 3D CFD models of the Circle of Willis have been created to simulate clinical scenarios such as inclusions in afferent arteries and absent circulus vessels. Both models capture cerebral haemodynamic auto-regulation using proportional-integral controller to modify efferent artery distances to maintain optimal efferent flowrates for a given cycle geometry and afferent blood pressure. The models can be used to identify at-risk cerebral arterial geometries and conditions prior to surgery or other clinical procedures. The model is particularly relevant in this instance, with its fast execution time suitable for real-time clinical decisions and senario testing, as long as it captures the necessary details as a model would. Results show excellent correlation between models for the transient efferent flux profile with differences more than 5%. The assumption of strictly Poiseulile flow in the model allows more flow through the geometrically extreme communicating arteries than the 3D model. This discrepancy is overcome by increasing the resistance to flow in the ACoA the 1D model to better match the resistance seen in the 3D model, significantly improving correlation of the results.

One-dimensional and three-dimensional models of cerebrovascular flow

The Circle of Willis is a ring-like structure of blood vessels found beneath the hypothalamus at the base of the brain. Its main function is to distribute oxygen-rich arterial blood to the cerebral mass. One-dimensional (1D) and three-dimensional (3D) computational fluid dynamics (CFD) models of the Circle of Willis have been created to provide a simulation tool which can potentially be used to identify at-risk cerebral arterial geometries and conditions and replicate clinical scenarios, such as occlusions in afferent arteries and absent circulus vessels. Both models capture cerebral haemodynamic autoregulation using a proportional-integral (PI) controller to modify efferent artery resistances to maintain optimal efferent flow rates for a given circle geometry and afferent blood pressure. The models can be used to identify at-risk cerebral arterial geometries and conditions prior to surgery or other clinical procedures. The 1D model is particularly relevant in this instance, with its fast solution time suitable for real-time clinical decisions. Results show the excellent correlation between models for the transient efferent flux profile. The assumption of strictly Poiseuille flow in the 1D model allows more flow through the geometrically extreme communicating arteries than the 3D model. This discrepancy was overcome by increasing the resistance to flow in the anterior communicating artery in the 1D model to better match the resistance seen in the 3D results.

Gambling activities of young Australians: developing a model of behaviour

As more gambling venues open in Australia, youth gambling as problem behaviour has been identified. The aim of this study was to assess youth gambling in a population with easy access to gambling, and to evaluate the adequacy of a model for predicting adolescent gambling frequency and problem gambling. The model comprised a combination of the Theory of Reasoned Action (TRA) (Ajzen & Fishbein, 1980), personality variables (venturesomeness, impulsiveness), and cognitive bias variables derived from Weinstein's (1980) propositions concerning unrealistic optimism about future life events. A sample of 1017 school- and university-based adolescents indicated relatively low frequencies of gambling and low scores on the problem gambling scale, with males scoring higher than females on both measures. The TRA was supported with about 30% of the variance of each of gambling behaviour and problem gambling accounted for by intentions, attitudes, and subjective norms. Personality factors added significantly to the prediction of gambling. The cognitive bias variables, although independently not statistically significant, further contributed to prediction.

HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery

HeartCare is an Internet-based information and support service for patients recovering at home from coronary artery bypass graft (CABG) surgery. The system is designed to meet the nursing challenges in health information to support needs of CABG patients. HeartCare (a) provides information and support, tailored to patients' individual and changing recovery needs during CABG recovery, (b) makes recovery information more accessible for timely use by patients, and (c) extends the scope of nursing services to CABG patients from hospital through home. An ongoing randomized controlled study is underway to evaluate the clinical outcomes of patients' use of the HeartCare system and to examine its acceptance as a usable resource for postCABG patients who have limited previous computer experience.

Eliciting exercise preferences in cardiac rehabilitation: initial evaluation of a new strategy

Cardiac rehabilitation (CR) programs may be more effective in promoting long-term exercise if participants are helped to devise exercise programs that are individually tailored to their exercise preferences. This paper describes an initial evaluation of 'CHOICE' (Creating better Health Orientation by Improving Communication about Exercise experiences), an instrument designed to elicit cardiac patients' exercise preferences. In individual interviews with 16 women, CHOICE was used to help participants select exercise features that were important to them for maintaining long-term exercise. Exercise preferences were then summarized on individual preference forms. Study participants in this pilot study had no problems in selecting exercise features contributing to exercise maintenance and could easily discriminate between their relative importance. Further, there were large variations in the importance participants placed on different exercise features. This suggests the need for eliciting patients' exercise preferences so exercise programs can be individually designed. In conclusion, CHOICE is an applicable instrument for eliciting exercise preferences.

Induction of Epstein-Barr virus kinases to sensitize tumor cells to nucleoside analogues

The presence of Epstein-Barr virus (EBV) in the tumor cells of some EBV-associated malignancies may facilitate selective killing of these tumor cells. We show that treatment of an EBV(+) Burkitt's lymphoma cell line with 5-azacytidine led to a dose-dependent induction of EBV lytic antigen expression, including expression of the viral thymidine kinase (TK) and phosphotransferase (PT). Azacytidine treatment for 24 h modestly sensitized the cell line to all nucleosides tested. To better characterize EBV TK with regard to various nucleoside analogues, we expressed EBV TK in stable cell clones. Two EBV TK-expressing clones were moderately sensitive to high doses of acyclovir and penciclovir (PCV) (62.5 to 500 microM) and to lower doses of ganciclovir (GCV) and bromovinyldeoxyuridine (BVdU) (10 to 100 microM) compared to a control clone and were shown to phosphorylate GCV. Similar experiments in a transient overexpression system showed more killing of cells transfected with the EBV TK expression vector than of cells transfected with the control mutant vector (50 microM GCV for 4 days). A putative PT was also studied in the transient transfection system and appeared similar to the TK in phosphorylating GCV and conferring sensitivity to GCV, but not in BVdU- or PCV-mediated cell killing. Induction of EBV kinases in combination with agents such as GCV merits further evaluation as an alternative strategy to gene therapy for selective killing of EBV-infected cells.

Exposure of hooded capuchin monkeys (Cebus apella cay) to a rabid bat at a zoological park

On 27 May 1999, a big brown bat (Eptesicus fuscus) was discovered on an island exhibit at the Denver Zoo that contained a troop of 15 hooded capuchin monkeys (Cebus apella cay). The monkeys were attacking the bat when it was discovered. The bat was collected and humanely euthanatized without direct handling and submitted to the Colorado Department of Public Health and Environment Virology Laboratory for rabies evaluation. The monkeys had not been vaccinated against rabies virus. The next day, the laboratory confirmed that the bat was positive for rabies. The recommendations from the Colorado Department of Public Health and Environment and the Centers for Disease Control and Prevention were to euthanatize the monkeys or quarantine them and comply with the human nonvaccinated postexposure protocol. A 1-ml dose of a killed rabies vaccine was administered i.m. in the hip on each of days 2, 7, 12, 19, and 33 postexposure, and a single dose of human rabies immune globulin was administered i.m. 5 days postexposure. Blood was collected under anesthesia in order to evaluate the immune response after rabies vaccination from six monkeys 5 days postexposure, six monkeys 19 days postexposure (five of the six monkeys were the same monkeys bled 5 days postexposure), 15 monkeys 67 days postexposure, and 13 monkeys approximately 1 yr postexposure. All of the monkeys developed and maintained levels of rabies virus neutralizing antibody above 0.05 IU/ml by 67 days postexposure. Although a serologic titer of 0.05 IU/ml indicates an adequate human response after rabies vaccination, no similar information is available for nonhuman primates. To date, none of the monkeys has succumbed to rabies.

Randomized trial of a home recovery intervention following coronary artery bypass surgery

For this study a randomized clinical trial was designed to test the effects of an early home recovery information intervention on physical functioning, psychological distress, and symptom frequency 1 month following coronary artery bypass graft surgery (CABG). Recovery outcomes were compared between two groups: those receiving an audiotape of information on expected physical sensations and their management (Cardiac Home Information Program [CHIP]) in addition to the usual care, and those receiving the usual cardiac discharge information protocol. A nonprobability sample of 180 patients (84 women and 96 men; mean age = 62 years) was equally distributed between the two study groups. When controlling for age, comorbidity, and cardiac functional status, the results showed positive effects on physical functioning in women and psychological distress, vigor and fatigue in men. Consistent with other studies, women had worse physical functioning and more symptom frequency than men. These findings indicate that the CHIP intervention is an effective method to prepare CABG patients for home recovery.

The influence of uncertainty in illness, stress appraisal, and hope on coping in survivors of breast cancer

On the basis of Mishel's uncertainty in illness theory, Lazarus and Folkman's stress on appraisal and coping, and Herth's perspective of hope, this cross-sectional, correlational study was designed to examine the influence of uncertainty, stress appraisal, and hope on coping in 71 survivors of breast cancer. Uncertainty was measured by the Mishel Uncertainty in Illness: Community Scale, stress appraisal by the Stress Appraisal Index, hope by the Herth Hope Index, and coping by the Ways of Coping Questionnaires (WCQ).

Adult dogs receiving a rabies booster dose with a recombinant adenovirus expressing rabies virus glycoprotein develop high titers of neutralizing antibodies

Retired greyhound dogs, with low or absent antibody titers to rabies virus following previous vaccinations with commercially available vaccines, were immunized either subcutaneously or intramuscularly with a replication-defective recombinant adenovirus expressing the rabies virus glycoprotein termed Adrab.gp. Immunized animals developed high titers (geometric mean titers of 2630 and 5329) of viral neutralizing antibodies (VNA) against rabies virus by 10 days after vaccination. The antibody titers were even higher (geometric mean titers of 19349 and 122086) by 21 days after vaccination. The results indicate that the recombinant adenovirus expressing rabies virus glycoprotein is capable of inducing antibody immune responses in dogs and therefore may be developed as a rabies virus vaccine for dogs.

Extracellular matrix proteins protect small cell lung cancer cells against apoptosis: a mechanism for small cell lung cancer growth and drug resistance in vivo

Resistance to chemotherapy is a principal problem in the treatment of small cell lung cancer (SCLC). We show here that SCLC is surrounded by an extensive stroma of extracellular matrix (ECM) at both primary and metastatic sites. Adhesion of SCLC cells to ECM enhances tumorigenicity and confers resistance to chemotherapeutic agents as a result of beta1 integrin-stimulated tyrosine kinase activation suppressing chemotherapy-induced apoptosis. SCLC may create a specialized microenvironment, and the survival of cells bound to ECM could explain the partial responses and local recurrence of SCLC often seen clinically after chemotherapy. Strategies based on blocking beta1 integrin-mediated survival signals may represent a new therapeutic approach to improve the response to chemotherapy in SCLC.

Family-centered care after acute myocardial infarction

The experience of a cardiac event is a significant source of stress for both patients and their family members. The acute phase after myocardial infarction reflects a crisis for patients and family members as they attempt to reconcile the affect of the event and adapt to the uncertainties associated with hospitalization and the initial recovery process. This article reviews empirical research available to cardiovascular nurses that may guide family-centered care during the acute phase after myocardial infarction. Directions for practice and research focus on cardiovascular nursing interventions that address family needs after an acute myocardial infarction. The experience of an acute myocardial infarction is a source of stress for both patients and their family members and may be viewed as a crisis that significantly disrupts family functioning and dynamics. The trajectory of cardiovascular disease involves multiple adjustments by patients and family members as they attempt to reconcile the affect of the event and adapt to the uncertainties associated with the acute phase of illness. Efforts by patients and family members to manage the stressors associated with the acute phase of cardiovascular illness are often associated with alterations in physiologic and psychologic functioning.

Using PDSA (Plan-Do-Study-Act) to establish academic-community partnerships: the Cleveland experience

The Schools of Medicine and Nursing at Case Western Reserve University and the Program in Health Administration at Cleveland State University have created an interdisciplinary course in continuous improvement that emphasizes learning through experience, accommodates a large number of students, and has created new partnerships with Cleveland area health care organizations. An approach that respects these partners as customers and refines the relationships with serial tests of change (e.g., PDSA) has contributed significantly to this program's success.

Platelet-derived growth factor-BB and thrombin activate phosphoinositide 3-kinase and protein kinase B: role in mediating airway smooth muscle proliferation

Proliferation of airway smooth muscle results from persistent inflammatory cytokine and growth factor stimulation and is a critical component of airway luminal narrowing in chronic asthma. Using primary cultures of bovine tracheal smooth muscle (BTSM) cells to examine the signaling basis of cell proliferation, platelet-derived growth factor (PDGF)-BB and thrombin (which act through distinct receptor types) were found to induce DNA synthesis in BTSM cells. Mitogen-induced DNA synthesis could be completely inhibited by LY294002, a selective phosphoinositide 3-kinase (PtdIns 3-kinase) inhibitor. Exposure of BTSM cells to PDGF-BB or thrombin resulted in rapid activation of PtdIns 3-kinase and accumulation of phosphoinositide-3,4,5-trisphosphate. Protein kinase B, a novel signaling protein kinase, was identified in BTSM cells and was activated by PDGF-BB and thrombin in a PtdIns 3-kinase-dependent manner; this may underlie mitogen-stimulated activation of p70(s6k). PD98059, a mitogen-activated protein kinase kinase 1 inhibitor, also partially inhibited PDGF-BB- and thrombin-stimulated DNA synthesis, indicating a modulatory role for mitogen-activated protein kinase in proliferation. GF109203X, Ro 31-8220, calphostin C, and chelerythrine (selective protein kinase C inhibitors) had no effect on PDGF-BB- or thrombin-stimulated DNA synthesis, suggesting that, despite abolishment of mitogen-stimulated protein kinase C activity, cell proliferation stimulated by PDGF-BB and thrombin is protein kinase C-independent. These data demonstrate that the PtdIns 3-kinase/protein kinase B pathway represents a key signaling route in airway smooth muscle proliferation, with the mitogen-activated protein kinase kinase 1/mitogen-activated protein kinase cascade providing a complementary signal required for the full mitogenic response.

The presence of a constitutively active phosphoinositide 3-kinase in small cell lung cancer cells mediates anchorage-independent proliferation via a protein kinase B and p70s6k-dependent pathway

Small cell lung cancer (SCLC) is characterized by early and widespread metastases. Anchorage-independent growth is pivotal to the ability of tumor cells to survive and metastasize in vivo and, under in vitro conditions, allows transformed cells to form colonies in semisolid medium. Here, we report that of five SCLC cell lines tested, all exhibited high basal constitutive phosphoinositide 3-kinase (PI 3-kinase) activity, which results in high basal protein kinase B (PKB) and ribosomal p70 S6 kinase activity (p70s6k). Inhibition of PI 3-kinase activity markedly inhibited SCLC cell proliferation in liquid culture as a result of stimulating apoptosis and promoting cell cycle delay in G1. Furthermore, PI 3-kinase inhibition reduced basal SCLC cell colony formation in agarose semisolid medium that could not be overcome by the addition of neuropeptide growth factors. Thus, constitutive PI 3-kinase activity in SCLC cells plays an important role in promoting the growth and anchorage independence of SCLC. This is not due to activating ras mutations or increased basal src or focal adhesion kinase activity. These data represent the first description of constitutively activated PI 3-kinase/PKB in any human cancer. Constitutive activation of these integrin-dependent signaling events provides a molecular explanation for the anchorage-independent growth of SCLC cells and may account for the nonadherent phenotype and highly metastatic nature of this aggressive cancer. Up-regulation of the PI 3-kinase/PKB pathway may, therefore, represent a novel target for therapeutic intervention in SCLC.

Women's patterns of exercise following cardiac rehabilitation

BACKGROUND

Studies of long-term exercise maintenance after an acute cardiac event have been conducted almost exclusively with men, and the findings cannot be generalized to women.

OBJECTIVES

The aim of this study was to identify women's exercise patterns and adherence to recommended exercise maintenance after a cardiac rehabilitation (CR) program.

METHOD

Forty women who had a myocardial infarction or had undergone coronary artery bypass graft (CABG) surgery were recruited through convenience sampling immediately after completion of a phase II CR program. Exercise frequency, duration, and intensity were measured using wristwatch heart rate (HR) monitors during exercise for 3 months.

RESULTS

Results indicated that 12 of 40 (30%) women exercised five times or fewer during the 3-month study period. Only 11 women (27.5%) exercised three or more times per week. Women exercised an average of 5.2 sessions within their target HR during the entire study period. Maintenance of exercise dropped consistently during the course of the study. Although 83% of the participating women started exercising during the first month, after 1 month one third of the participants had stopped exercising. During the last week of the study, only 50% of the women were still exercising.

CONCLUSIONS

These findings indicate the women are exercising well below the recommended guidelines for exercise after acute cardiac events.

Theory construction based on standards of care: a proposed theory of the peaceful end of life

The contribution of developing a theory from this standard of care is that it can express a new unifying idea about the phenomenon of peaceful end of life for terminally ill patients. It allows for generating and testing hypotheses that can provide new insights into the nature of this phenomenon and can contribute to increased knowledge about nursing interventions that help patients toward a peaceful end of life. The process of theory development from standards of care as described in this article also can be applied to other phenomena. Clinical practice abounds with opportunities for theory development, yet nurses often do not use theories to guide their practice. Until now, little guidance has been provided to tap the richness of clinical knowledge for the development of middle-range theories. Whereas the method described in this article may still be further refined, it offers a promising approach for the development of theories that are applicable to practice and move beyond the scope of grand theories. Thus deriving theories from standards of care can offer an important contribution to the development of the discipline's scientific knowledge base and enhanced practice.

Designing HeartCare: custom computerized home care for patients recovering from CABG surgery

With the current trend toward discharge of cardiac artery bypass graft (CABG) patients from the hospital after 5 days, clinicians must make effective use of existing computer technology to provide more efficiently the services once available during the patient's lengthier hospital stay. This paper describes the design of the HeartCare initiative, a computerized cardiac recovery service designed to provide home-care support for patients in the first three months following CABG surgery. Capitalizing on the expansion in health resources on the Internet, and building on the lessons from the ComputerLink projects, HeartCare will employ the World Wide Web platform in the generation of personalized in-home computerized access to recovery resources. Key implementation decisions include selection of WebTV/ as the home-based device, and application of Metadata to organizing health-related knowledge resources on the WWW.

Prescriptive theory of acute pain management in infants and children

PURPOSE

To present a middle-range nursing theory of acute pain management that provides direction for practice and research. CLIENT POPULATION: Patients from 6 months to 12 years old who have acute pain.

CONCLUSIONS

The potential of the proposed theory, Acute Pain Management in Infants and Children, is to assist nurses in managing clinical pain and to expand the knowledge and research base in children's pain.

PRACTICE IMPLICATIONS

To provide clinicians with prescriptions for pain reduction and a conceptual basis for pain interventions. Statement and theory testing are needed to determine adequacy of this theory for infants and children experiencing acute pain.

Taking aim at interdisciplinary education for continuous improvement in health care

Over the last 30 years, nursing faculty have achieved varying levels of success in their efforts to engage in interdisciplinary education. To sharpen the focus, the Institute for Healthcare Improvement sponsored a national demonstration project in which nursing faculty from four universities participated.

Reducing nosocomial pressure ulcers

The authors analyze the processes surrounding an initial failure and eventual success in implementing organizational change. The specific organizational change involves prevention and treatment of pressure ulcers. It provides insight as to how critical factors serve to bring about and sustain change in an organization. It also serves to illustrate deficiencies in traditional and popular change theories.

Effects of interventions to promote recovery in coronary artery bypass surgical patients

In this integrated review of the literature 19 published investigations of interventions to promote recovery following coronary artery bypass graft surgery (CABG) are analyzed. The most frequently tested CABG recovery intervention, preparatory information, effectively increased knowledge, and enhanced resumption of activities during recovery. However, its effect on mood states during recovery remains unclear. There was clear evidence that information interventions designed to increase individuals' knowledge about expected recovery experiences and coronary artery disease were effective. Analysis of the studies indicated that few women, elders, and minority races were included. An important area needing development and testing of interventions is secondary prevention of cardiac risk factors.

An examination of adolescent risk-taking using a story completion task

The aim of the study was to assess whether risk-taking as described in complete the story tasks written by adolescents could be predicted by the perceived consequences of the behaviours portrayed in the stories. The study involved analysis of story themes in terms of portrayal of participation in risky behaviour and the nature of story outcomes. Links between story elements were assessed and comparisons made of these projectively-based findings with previous self-report research. Participants were 570 adolescents aged 12 to 17 from secondary schools in Melbourne, Australia. Responses to four complete the story stimuli were coded according to whether story protagonists participated in the hypothetical risk posed, and in terms of the behavioural outcomes presented. Adolescents were more likely to write stores accepting negative than positive risks, and to expect short-term rather than long-term consequences. Perceived short-term consequences of risk-taking behaviour were predictive of risk participation, however long-term consequences were not. The study provided data about adolescent risk-taking which mirrored and extended the findings of self-report studies.

Epstein-Barr virus as a therapeutic target in Hodgkin's disease and nasopharyngeal carcinoma

Conventional approaches to the treatment of malignancy are often not curative or are associated with serious complications. New approaches to treatment are needed. A variety of specific approaches to the destruction of virus-associated tumor cells are illustrated in the context of EBV-associated Hodgkin's disease and nasopharyngeal carcinoma. Viral antigens expressed by tumors may be targeted by cytotoxic T cells. Other viral antigens not naturally expressed by tumors may be induced by pharmacologic manipulations such as treatment with demethylating agents. Viral enzymes not naturally expressed by tumors such as thymidine kinase may be induced by protein kinase C activators, thus rendering tumor cells sensitive to killing by ganciclovir.

Prediction of cervical cancer screening using the theory of reasoned action

Rates of Pap smears among 72 adult women were shown to be suboptimal and predicted indirectly by attitudes and subjective norms. Women perceived these examinations to be unpleasant and embarrassing.

Women's and men's preferences for cardiac rehabilitation program features

BACKGROUND

Current theories of human health behaviors suggest that clients' preferences for specific aspects of a health regimen are an important influence on their decisions to initiate and continue use of the regimen. Despite low rates of participation in cardiac rehabilitation programs, especially among women, little research has been done to determine patient preferences for features of cardiac rehabilitation programs. The purpose of this study was to identify and compare women's and men's preferences for specific cardiac rehabilitation program features.

METHODS

Using a descriptive survey design, a convenience sample of 65 individuals (33 men and 32 women) participating in a cardiac rehabilitation program completed a self-administered survey in which they indicated both the importance of each of 17 cardiac rehabilitation program features and the extent to which they had experienced each of the features.

RESULTS

Convenience factors (drive time, transportation, noninterference with other life activities, and ease of learning the exercises) were well-met preferences for both women and men. Men's and women's preferences were not well met for being able to discuss their progress with professionals and the ability to choose their own exercises. Men indicated that the ability to set their own goals was their greatest unmet preference. Women's preferences for not having pain and not tiring while exercising were significantly less well met than those of men.

CONCLUSIONS

These findings suggest that a cardiac rehabilitation program that is responsive to client preferences should emphasize joint goal setting with participants and discussion of progress, offer frequent encouragement from professionals, and provide a range of exercise choices. Attention to women's concerns about pain and fatigue while exercising should also be addressed in the program.

The effects of a discharge information intervention on recovery outcomes following coronary artery bypass surgery

This quasi-experimental study tested the effects of a discharge information intervention on physical and psychological outcomes 1 month following coronary artery bypass surgery (CABG). Recovery outcomes were compared between two groups of patients: those receiving an audiotape of information focusing on expected physical symptoms and their management in addition to usual care, and those receiving a usual cardiac discharge information protocol. The nonprobability sample of 82 patients were men and women and had a mean age of 64 years. The outcome measurements included psychological distress, measured by the Profile of Mood States, and physical functioning, measured by the Sickness Impact Profile. The audiotape intervention produced positive effects on physical functioning [F(1,80) = 6.37, p < 0.01]; the effects were maintained when age and post-operative length of stay were statistically controlled. No differences in psychological distress were found. Findings suggest that audiotapes containing discharge information about expected recovery experiences are a feasible and effective approach to enhancing the physical recovery of CABG patients.

The effects of a discharge information intervention on recovery outcomes following coronary artery bypass surgery

This quasi-experimental study tested the effects of a discharge information intervention on physical and psychological outcomes 1 month following coronary artery bypass surgery (CABG). Recovery outcomes were compared between two groups of patients: those receiving an audiotape of information focusing on expected physical symptoms and their management in addition to usual care, and those receiving a usual cardiac discharge information protocol. The nonprobability sample of 82 patients were men and women and had a mean age of 64 years. The outcome measurements included psychological distress, measured by the Profile of Mood States, and physical functioning, measured by the Sickness Impact Profile. The audiotape intervention produced positive effects on physical functioning [F(1,80) = 6.37, p < 0.01]; the effects were maintained when age and post-operative length of stay were statistically controlled. No differences in psychological distress were found. Findings suggest that audiotapes containing discharge information about expected recovery experiences are a feasible and effective approach to enhancing the physical recovery of CABG patients.

Women's views of cardiac rehabilitation programs

BACKGROUND

Previous approaches to understanding participation in cardiac rehabilitation programs based on middle-aged men may not be useful to explain the participation of women. The focus group research method produces unique data about attitudes and experiences that can serve as an adjunct to other forms of data collection in an effort to develop models explaining cardiac rehabilitation participation. The aim of this pilot study was to examine the perceptions and experiences of women participating in a cardiac rehabilitation program using focus groups.

METHODS

Ten women (mean age 72 years) who had recently participated in a cardiac rehabilitation program were interviewed in focus groups of 6 and 4 members each using a semi-structured interview guide. Verbatim transcriptions of the focus group interviews were analyzed by two individuals using content analysis methods.

RESULTS

Results indicated that prior to participation women had no idea what to expect in a cardiac rehabilitation program. Features women liked most about the program included: (1) feeling "safe" during exercise because they were monitored; (2) peer group support during rehabilitation; and (3) pleasant, encouraging staff. Women desired more: (1) social interaction during the cardiac rehabilitation exercise sessions; (2) emotional support from staff members about all dimensions of cardiac recovery; and (3) exercise options other than cycle or treadmill.

CONCLUSIONS

Several cardiac rehabilitation program design and operational features are perceived by women as not meeting their needs. Although limited by its small sample size, findings from this study provide valuable insights into women's perceptions of cardiac rehabilitation programs.

CABG discharge information: addressing women's recovery

Women's descriptions of the coronary artery bypass surgery recovery experience were elicited for development of a preparatory discharge information intervention. In a convenience sample, 20 women (mean age = 67 years) were interviewed about the physical sensations, emotions, and concerns they experienced after CABG at three measurement points: discharge, 2 days after discharge, and 3 weeks following discharge. Many of the recovery experiences reported by women in this study are not addressed in traditional CABG discharge information.

A comparison of women's and men's symptoms during home recovery after coronary artery bypass surgery

OBJECTIVE

To compare women's and men's recovery symptoms during home recovery after coronary artery bypass grafting (CABG).

DESIGN

This secondary analysis used a survey design. Descriptive statistics and content analysis were used to compare women's and men's recovery symptoms.

SETTING

Subjects were interviewed about physical and emotional symptoms they experienced after CABG at three measurement points: 1 day before discharge, 2 days after being discharged, and 3 weeks after being discharged.

SUBJECTS

A purposive sample of 20 women and 20 men recovering from their first CABG.

RESULTS

More men than women reported fatigue, chest incision discomfort, and negative emotional symptoms. Unlike men, women described numbness and discomfort in their breasts during the first weeks of recovery. Women's and men's recovery emotions centered on concerns associated with their social circumstances. Women were more likely to be older, unemployed, unmarried, and live alone, and they were anxious about who would care for them during home recovery and where that recovery would take place. Men's anxiety centered first on their immediate physical recovery symptoms and then on long-term issues in regard to return to work and activities.

CONCLUSIONS

An understanding of these gender differences in CABG recovery is important so clinicians can tailor discharge planning to the specific needs of women and men.

Fear of weight gain: its correlates among school-aged adolescents

Correlations between fear of weight gain, dieting, risk-taking, and fears associated with adult status were observed for 110 school-aged adolescents.

The effects of a special computer network on caregivers of persons with Alzheimer's disease

Caregivers of persons with Alzheimer's disease (AD) are confronted with novel decision-making tasks that leave them at risk for social isolation. ComputerLink is a computer network providing information, communication, and decision-support functions for caregivers of persons with AD. One hundred two AD caregivers participated in a randomized field experiment to evaluate the effects of ComputerLink on confidence in decision making, decision-making skill, and social isolation. During the 1-year study period, AD caregivers averaged two encounters per week with ComputerLink for sessions lasting an average of 13 minutes. Access to ComputerLink enhanced caregivers' decision-making confidence. Decision-making skill was unaffected. ComputerLink access did not lead to changes in social isolation as measured by standard instruments. The decision-support function was used least often. Postings to ComputerLink's public bulletin board included both information-seeking and supportive messages. These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems.

Development of discharge information for recovery after coronary artery bypass surgery

Descriptions of coronary artery bypass graft (CABG) recovery experiences were elicited for development of a preparatory discharge information intervention. A convenience sample of 15 men and 5 women were interviewed about the concerns, emotions, and physical sensations they experienced after CABG and the actions they found most useful to manage the recovery at three time points: (a) discharge; (b) 2 days after discharge; and (c) 3 weeks after discharge. Concerns of subjects centered on pain management and return to independence in activities of daily living. Reports of negative emotions increased over the first month of recovery and included depression, anger, and anxiety. Subjects most frequently reported physical sensations associated with fatigue, chest incision, sleeping, leg incision, shoulder and neck muscles, and coughing. Descriptions of the CABG recovery experience provided data for development of discharge information, that focused on concrete experiences from the viewpoint of the person having CABG surgery and included orienting information about the onset, sequence, and duration of the experiences.

Networks for home care support: the ComputerLink project

Family caregivers of Alzheimer's patients often feel isolated by the restrictions placed on them by their role. The ComputerLink project was established to provide these caregivers with the information and support they need to make informed decisions about plans of care and to feel connected to others in similar circumstances.