Development of the American College of Rheumatology Patient-Reported Outcome Quality Measures for Systemic Lupus Erythematosus

OBJECTIVE

As part of a Centers for Disease Control and Prevention-funded American College of Rheumatology (ACR) initiative, we sought to develop quality measures related to Patient Reported Outcome Measure (PROM) use for systemic lupus erythematosus (SLE) clinical care.

METHODS

An expert workgroup composed of physician, patient, and researcher representatives convened to identify patient-reported outcome (PRO) domains of greatest importance to people with SLE. A patient advisory panel separately ranked domains. PROMs assessing priority domains were identified through structured literature review, and detailed psychometric reviews were conducted for each PROM. In a Delphi process, the expert workgroup rated PROMs on content validity, psychometric quality, feasibility of implementation, and importance for guiding patient self-management. The patient advisory panel reviewed PROMs in parallel and contributed to the final recommendations.

RESULTS

Among relevant PRO domains, the workgroup and patient partners ranked depression, physical function, pain, cognition, and fatigue as high-priority domains. The workgroup recommended at least once yearly measurement for (1) assessment of depression using the Patient Health Questionnaire or Patient Reported Outcomes Measurement Information System (PROMIS) depression scales; (2) assessment of physical function using PROMIS physical function scales or the Multi-Dimensional Health Assessment Questionnaire; and (3) optional assessments of fatigue and cognition. Pain scales evaluated were not found to be sufficiently superior to what is already assessed in most SLE clinic visits.

CONCLUSION

Expert workgroup members and patient partners recommend that clinicians assess depression and physical function at least once yearly in all people with SLE. Additional PROMs addressing cognition and fatigue can also be assessed. Next steps are to incorporate PROM-based quality measures into the ACR The Rheumatology Informatics System for Effectiveness registry.

Development of American College of Rheumatology Quality Measures for Systemic Lupus Erythematosus: A Modified Delphi Process With Rheumatology Informatics System for Effectiveness (RISE) Registry Data Review

OBJECTIVE

We aimed to develop readily measurable digital quality measure statements for clinical care in systemic lupus erythematosus (SLE) using a multistep process guided by consensus methods.

METHODS

Using a modified Delphi process, an American College of Rheumatology (ACR) workgroup of SLE experts reviewed all North American and European guidelines from 2000 to 2020 on treatment, monitoring, and phenotyping of patients with lupus. Workgroup members extracted quality constructs from guidelines, rated these by importance and feasibility, and generated evidence-based quality measure statements. The ACR Rheumatology Informatics System for Effectiveness (RISE) Registry was queried for measurement data availability. In 3 consecutive Delphi sessions, a multidisciplinary Delphi panel voted on the importance and feasibility of each statement. Proposed measures with consensus on feasibility and importance were ranked to identify the top 3 measures.

RESULTS

Review of guidelines and distillation of 57 quality constructs resulted in 15 quality measure statements. Among these, 5 met high consensus for importance and feasibility, including 2 on treatment and 3 on laboratory monitoring measures. The 3 highest-ranked statements were recommended for further measure specification as SLE digital quality measures: 1) hydroxychloroquine use, 2) limiting glucocorticoid use >7.5 mg/day to <6 months, and 3) end-organ monitoring of kidney function and urine protein excretion at least every 6 months.

CONCLUSION

The Delphi process selected 3 quality measures for SLE care on hydroxychloroquine, glucocorticoid reduction, and kidney monitoring. Next, measures will undergo specification and validity testing in RISE and US rheumatology practices as the foundation for national implementation and use in quality improvement programs.

Treating Systemic Lupus Erythematosus (SLE): The Impact of Historical Environmental Context on Healthcare Perceptions and Decision-Making in Charleston, South Carolina

Introduction: Over 400,000 slaves were taken from Africa and brought to Charleston, South Carolina, as part of the transatlantic slave trade during the 18th and 19th centuries. Due to these negative historical events, the healthcare of African Americans in Charleston may be compromised in regard to chronic illnesses and other conditions affecting minorities, such as lupus. Materials and Methods: The current study used an ethnographic approach to obtain the perspectives of lupus patients with the goal of identifying gaps within current research. In addition to patient perspectives, the geographical location of Charleston, South Carolina was considered through inquiries around culture, community, advocacy, and client/patient interaction to establish a narrative for the themes that emerged. Results: The eleven major themes identified were connectedness, knowledge, experience with lupus, compliance, clinical trial participation, career and planning for the future, visits, access to resources, lifestyle, transition from child to adult care, and an overarching theme of self-management. Conclusion: Understanding healthcare perceptions and decision-making among culturally diverse populations, particularly those who have been defined by centuries of substandard care, marginalization, exploitation, and distrust, is critical to the development of culturally tailored interventions designed to improve patient outcomes and reduce health disparities.

Abstract P5-07-05: Obesity, adipose inflammation, and race in patients with early stage breast cancer

Background: Elevated body mass index (BMI) is associated with increased risk of estrogen receptor-positive postmenopausal breast cancer. Mechanistically, most individuals with elevated BMI have breast white adipose tissue inflammation (WATi) which confers increased breast cancer risk, particularly in those with existing benign breast disease. Individuals with WATi have elevated in-breast expression of aromatase and several systemic changes that increase breast cancer risk, including hyperinsulinemia and higher levels of C-reactive protein. However, women with normal BMI but high levels of body fat are also likely to harbor WATi and are at increased risk of postmenopausal breast cancer. The accuracy of BMI for assessing adiposity and predicting obesity-related disorders, including cancer, varies across race and ethnicity. Whether the association between BMI and WATi varies by race is unknown. Here we aimed to characterize relationships among breast WATi and clinicopathologic features in a racially diverse cohort undergoing mastectomy for breast cancer treatment.

Methods: Non-tumorous breast tissue and fasting blood were collected from women undergoing mastectomy for breast cancer treatment or prevention at a single center serving a racially diverse patient population. Breast WATi was detected by the presence of crown-like structures in the breast (CLS-B), which are composed of a dead/dying adipocyte surrounded by CD68+ macrophages. Clinicopathologic data were abstracted from electronic medical records. Associations among categorical variables were examined using Fisher's exact test. Relationships between continuous variables were examined using the Spearman correlation.

Results: As of May 18, 2018 62 patients have been accrued; median age 55 (range 32 to 84). Self-reported race distribution was: 36 (58%) Asian, 5 African American (8%), 20 (32%) Caucasian, and 1 (2%) unknown. Breast tissue has been analyzed for WATi in 60 cases thus far. Clinicopathologic features stratified by the presence or absence of breast WATi are presented in. Breast WAT inflammation was associated with obesity (P=0.02) and a trend to association was observed with dyslipidemia (P&lt;0.09).

VariableBreast WATi Absent (n=25)Breast WATi Present (n=35)Age, years  Median (range)51 (32 to 71)59 (36 to 80)BMI, kg/m2  Median (range)22.5 (18.1 to 35.3)28.0 (19.2 to 38.9)BMI Category  Underweight1 (4%)0 (0%)Normal16 (64%)10 (29%)Overweight5 (20%)18 (51%)Obese3 (12%)7 (20%)Race, n (%)  Asian15 (60%)19 (54%)African American2 (8%)3 (9%)Caucasian8 (32%)12 (34%)Unknown0 (0%)1 (3%)Menopausal Status, n (%)  Pre10 (40%)12 (34%)Post15 (60%)23 (66%)Hypertension, n (%)7 (28%)16 (46%)Diabetes mellitus, n (%)0 (0%)5 (14%)Dyslipidemia, n (%)1 (4%)11 (31%)

Conclusions: Breast adipose inflammation is associated with elevated BMI and possibly metabolic syndrome disorders in a racially diverse population. These findings are consistent with observations from predominantly Caucasian cohorts. Race-specific characteristics will also be examined. Study accrual is ongoing and updated results will be presented.

Citation Format: Iyengar NM, Siegel B, Malik M, Giri DD, Tsai J, Hughes M, Adam A, Williams S, Zhou XK, Rodgers W, Ginter P, Patel A, Yong F, Cherian A, August P, Dannenberg AJ. Obesity, adipose inflammation, and race in patients with early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-07-05.

Epstein-Barr virus-positive mucocutaneous ulcer of the oral cavity in a patient who had had a renal transplant

The Epstein-Barr virus-positive mucocutaneous ulcer is a new phenomenon that was first described in 2014, and we know of only 67 reported cases. We describe a case in a patient who had had a renal transplant.

Group Environment Questionnaire and its Applicability in an Exercise Setting

The Group Environment Questionnaire (GEQ) has recently been modified by Spink and Carron to assess group cohesion in exercise settings. However, as they point out, fitness classes possess a minimum number of criteria necessary to satisfy the requirements of a group. Therefore, applying an instrument developed to measure cohesion in sport teams to exercise classes may produce potential threats to the validity of the modified scale. Hence, the present study administered the modified GEQ to 307 exercise participants in the 3rd week of classes to test the factorial validity of the scale. The overall model was deemed an inadequate fit, and a modified version was suggested that retained the original four-factor structure. A second study administered the modified GEQ to 43 exercise participants at weeks 3 and 7 of typical aerobics classes and found that group cohesion did not develop over time and was not related to exercise adherence.

Texting to Increase Adolescent Physical Activity: Feasibility Assessment

OBJECTIVE

Feasibility trials assess whether a behavior change program warrants a definite trial evaluation. This paper reports the feasibility of an intervention consisting of Self Determination Theory-informed text messages, pedometers, and goal prompts to increase adolescent physical activity.

METHODS

A 4-group randomized design with baseline and immediate post-study assessments was used. Groups (pedometer; pedometer + goal prompt; pedometer + goal prompt + theory-informed texts; no-treatment control) were systematically varied to assess the additive effect of intervention components on objectively measured physical activity (ie, ActiGraph). The primary outcome of the 12-week intervention was program feasibility. Changes in average daily step counts and minutes of moderate-to-vigorous physical activity also were examined. Post-intervention research with a subset of participants examined program reactions.

RESULTS

Participants (N = 160) were evenly split by sex, mostly 14-15 years old, and of diverse race/ethnicity. Feasibility criteria were met. The attrition rate was less than 2%. Modest increases in average daily step counts and moderate-to-vigorous physical activity were observed in all groups except the control group. Participants reported positive reactions to the intervention.

CONCLUSIONS

An intervention consisting of pedometers, theory-informed texts, and goal prompts, is a feasible and acceptable method for promoting physical activity to adolescents.

Microvascular reconstruction of facial defects in settings where resources are limited

The surgical treatment of defects caused by noma is challenging for the surgeon and the patient. Local flaps are preferred, but sometimes, because of the nature of the disease, there is not enough local tissue available. We describe our experience of free tissue transfer in Ethiopia. Between 2008 and 2014, 34 microsurgical procedures were done over 11 missions with the charity Facing Africa, predominantly for the treatment of defects caused by noma (n=32). The mean duration of operation was 442 minutes (range 200 - 720). Six minor wound infections were treated conservatively and did not affect outcome, a return to theatre was required in 4 patients with wound infections and one with a haemorrhage; 2 flaps failed and 2 partially failed, one patient developed an oronasal fistula, and one had an infection at the donor site that required a repeat graft. In settings where resources are limited, free flaps can be used when local tissue is not available and they cause less morbidity than pedicled tissue transfer.

Total reconstruction of the nose in settings where resources are limited

We describe a series of 8 patients who had total reconstruction of the nose during 4 separate missions to Ethiopia. The aetiology was noma (n=3), assault (n=2), acid burn (n=1), squamous cell carcinoma (n=1), and a sequela of meningococcal septicaemia (n=1). Reconstruction was with forehead flaps when adequate tissue was available (n=6) and with radial forearm flaps when it was not (n=2). Some reconstructive approaches require procedures to be done in stages, and in settings where resources are limited, difficulties with the continuity of care and provision for the management of complications, must be overcome.

Texting to Increase Physical Activity Among Teenagers (TXT Me!): Rationale, Design, and Methods Proposal

Background

Physical activity decreases from childhood through adulthood. Among youth, teenagers (teens) achieve the lowest levels of physical activity, and high school age youth are particularly at risk of inactivity. Effective methods are needed to increase youth physical activity in a way that can be maintained through adulthood. Because teens text a great deal, text messages promoting walking, a low cost physical activity, may be an effective method for promoting sustainable physical activity.

Objective

The objective of our study was to determine the effect of pedometers, self selected step goals, and texts grounded in the self-determination theory (SDT) on physical activity among the teens.

Methods

“TXT Me!” was a 12 week intervention that texted 14-17 year olds to increase their daily physical activity by increasing the number of steps they take each day. The intervention was grounded in the SDT. Formative research with the teens helped construct the intervention and develop the texts. A total of 84 texts were developed (12 to set a step goal, and 72 promoting autonomy, competence, and relatedness). The pilot evaluation used a four group, randomized design (n=160). After baseline data collection, the participants were randomized to one of four conditions (no treatment control, pedometer only, pedometer + weekly prompts, pedometer + weekly prompts + SDT grounded texts). Data were collected at baseline and immediately upon completion of the study. The primary outcome was physical activity, measured by 7 days of accelerometry. Basic psychological needs, physical activity motivation, process evaluation, and program satisfaction data were also collected.

Results

To our knowledge, this is one of the first studies to explore the use of stand alone, SDT grounded texts, supported by pedometers and prompts to set a self selected step goal, as a method for increasing physical activity among teens.

Conclusions

This pilot study will contribute valuable information regarding whether theoretically grounded text messages show promise as an effective method to increase physical activity among teens.

Trial Registration

Clinicaltrials.gov NCT01482234; http://clinicaltrials.gov/ct2/show/NCT01482234 (Archived by WebCite at http://www.webcitation.org/6NYvRMOoq).

The Effect of Different Response Formats on Ratings of Exerciser Stereotypes

In this study we examined the relationships of different response formats, respondent gender, and activity level, to ratings of exercise stereotypes. Participants (N = 203) completed 8 question sets about 8 exerciser stereotypes. In each questionnaire, 1 question was inadvertently measured twice with different response options of definitely would not like to do this/definitely would like to do this (NL anchor) or definitely false/definitely true (FT anchor). Results showed that ratings on the FT statements were significantly higher than those on NL statements for 2 stereotypes: judgmental young women and overweight. There were also significant effects of gender by activity level on ratings of runners. Both gender and activity levels were related to ratings of liking to exercise for some, but not all, of the stereotypes.

Awareness of Canada's Physical Activity Guide to Healthy Active Living in a large community sample

PURPOSE

Determine the proportion of adults aware of Canada's Physical Activity Guide to Healthy Active Living (Guide) and its specific recommendations (objective 1); whether key demographic factors (objective 2a) and physical activity behavior (objective 2b) are associated with awareness and specific familiarity with the Guide; and if changes in awareness and specific recommendations with the Guide occurred over a 1-year period (objective 3a and 3b).

DESIGN

Random selection with computer-assisted telephone interviewing.

SETTING

Edmonton, Alberta, Canada.

SUBJECTS

A total of 2803 adults 18 years or older completed interviews from 4831 telephone contacts (response rate, 58.0%), and after 1 year, 1423 individuals (55%) completed interviews.

MEASURES

Demographic, physical activity, Guide awareness.

ANALYSIS

Chi-square, analysis of variance.

RESULTS

At baseline, 27.3% were aware of the Guide, and 15.6% were familiar with the Guide's specific recommendations. Younger individuals (p=.01), women (p<.001), and those with a higher education (p<.001) were more likely to be generally aware of the Guide, and women were also more specifically aware (p=.01). Physical activity levels were positively associated with the general (p<.001) and specific (p<.001) awareness of the Guide. Changes in general familiarity and specific recommendations over 1 year were observed.

CONCLUSIONS

The majority of those surveyed were not familiar with the Guide. Men, individuals with a lower education, and older individuals may need to be specifically targeted.

Effect of pretesting on intentions and behaviour: a pedometer and walking intervention

This study addressed the influence of pedometers and a pretest on walking intentions and behaviour. Using a Solomon four-group design, 63 female university students were randomly assigned to one of four conditions: pedometer and pretest (n = 16), pedometer and no pretest (n = 16), no pedometer and pretest (n = 15), no pedometer and no pretest (n = 16). The pretest conditions included questions on walking, intentions to walk 12,500 steps per day, and self-efficacy for walking 12,500 steps per day. In the pedometer conditions a Yamax Digi-Walker SW-650 pedometer was worn for one week. All participants completed posttest questions. While significant pretest x pedometer interactions would have indicated the presence of pretest sensitisation, no such interactions were observed for either intention or self-reported walking. Wearing pedometers reduced intentions for future walking and coping self-efficacy. However, after controlling for pretest self-reported walking, pedometer use resulted in more self-reported walking. We conclude that wearing a pedometer increased self-reported walking behaviour but that a pretest did not differentially influence walking intentions, behaviour, or self-efficacy.

Adoption of the Healthy Heart Kit by Alberta family physicians

OBJECTIVE

The Healthy Heart Kit (HHK) is a risk management and patient education kit for the prevention of cardiovascular disease (CVD) and the promotion of CV health. There are currently no published data examining predictors of HHK use by physicians. The main objective of this study was to examine the association between physicians' characteristics (socio-demographic, cognitive, and behavioural) and the use of the HHK.

METHODS

All registered family physicians in Alberta (n=3068) were invited to participate in the "Healthy Heart Kit" Study. Consenting physicians (n=153) received the Kit and were requested to use it for two months. At the end of this period, a questionnaire collected data on the frequency of Kit use by physicians, as well as socio-demographic, cognitive, and behavioural variables pertaining to the physicians.

RESULTS

The questionnaire was returned by 115 physicians (follow-up rate = 75%). On a scale ranging from 0 to 100, the mean score of Kit use was 61 [SD=26]. A multiple linear regression showed that "agreement with the Kit" and the degree of "confidence in using the Kit" was strongly associated with Kit use, explaining 46% of the variability for Kit use. Time since graduation was inversely associated with Kit use, and a trend was observed for smaller practices to be associated with lower use.

CONCLUSION

Given these findings, future research and practice should explore innovative strategies to gain initial agreement among physicians to employ such clinical tools. Participation of older physicians and solo-practitioners in this process should be emphasized.

Factors influencing the adoption of an innovation: an examination of the uptake of the Canadian Heart Health Kit (HHK)

BACKGROUND

There is an emerging knowledge base on the effectiveness of strategies to close the knowledge-practice gap. However, less is known about how attributes of an innovation and other contextual and situational factors facilitate and impede an innovation's adoption. The Healthy Heart Kit (HHK) is a risk management and patient education resource for the prevention of cardiovascular disease (CVD) and promotion of cardiovascular health. Although previous studies have demonstrated the HHK's content validity and practical utility, no published study has examined physicians' uptake of the HHK and factors that shape its adoption.

OBJECTIVES

Conceptually informed by Rogers' Diffusion of Innovation theory, and Theory of Planned Behaviour, this study had two objectives: (1) to determine if specific attributes of the HHK as well as contextual and situational factors are associated with physicians' intention and actual usage of the HHK kit; and (2), to determine if any contextual and situational factors are associated with individual or environmental barriers that prevent the uptake of the HHK among those physicians who do not plan to use the kit.

METHODS

A sample of 153 physicians who responded to an invitation letter sent to all family physicians in the province of Alberta, Canada were recruited for the study. Participating physicians were sent a HHK, and two months later a study questionnaire assessed primary factors on the physicians' clinical practice, attributes of the HHK (relative advantage, compatibility, complexity, trialability, observability), confidence and control using the HHK, barriers to use, and individual attributes. All measures were used in path analysis, employing a causal model based on Rogers' Diffusion of Innovations Theory and Theory of Planned Behaviour.

RESULTS

115 physicians (follow up rate of 75%) completed the questionnaire. Use of the HHK was associated with intention to use the HHK, relative advantage, and years of experience. Relative advantage and the observability of the HHK benefits were also significantly associated with physicians' intention to use the HHK. Physicians working in solo medical practices reported experiencing more individual and environmental barriers to using the HHK.

CONCLUSION

The results of this study suggest that future information innovations must demonstrate an advantage over current resources and the research evidence supporting the innovation must be clearly visible. Findings also suggest that the innovation adoption process has a social element, and collegial interactions and discussions may facilitate that process. These results could be valuable for knowledge translation researchers and health promotion developers in future innovation adoption planning.

Conscientiousness and the intention-behavior relationship: predicting exercise behavior

The present study examined the moderating role of conscientiousness within the theory of planned behavior (TPB) for exercise behavior during usual vs. unusual context. Affective and cognitive attitude, subjective and descriptive norm, perceived behavioral control, behavioral intention, past behavior, conscientiousness, and self-reported behavior were assessed in relation to exercising in a sample of university students (n = 146). Conscientiousness was found to significantly moderate the intention-behavior relationship when the behavior was performed in unusual context (exercising during a reading week of term), but not when behavior was performed in usual context (exercising during a normal week of term). The findings indicate a role for conscientiousness in understanding intention-behavior relationships when the context of behavior is changing or unknown.

Perceived neighbourhood correlates of walking among participants visiting the Canada on the Move website

BACKGROUND

The purposes of this study were to: 1) explore the potential role of sex in the association between the perceived environment and walking; and 2) determine the efficacy of an Internet-based research platform for collecting population-level physical activity and correlates data.

METHODS

Visitors to the Canada on the Move website were asked questions about their demographics, physical activity participation and perceptions of their neighbourhood environment. A total of 3,144 Canadians (2,036 women; 609 men) completed the survey. Level of walking was regressed on eight measures of perceived neighbourhood environment in a series of logistic regressions.

RESULTS

Individuals who reported interesting scenery (OR=1.41, 95% CI 1.17-1.71) and many places to go that were within easy walking distance (OR=1.39, 95% CI 1.18-1.64) were more likely to report walking at a level sufficient to derive health benefits. For women, interesting scenery in and around their neighbourhood (OR=1.40, 95% CI 1.13-1.74) and the presence of many places to go within easy walking distance (OR=1.42, 95% CI 1.17-1.72) were associated with walking at a sufficient level. Among men, no significant associations were found between the perceived environment measures and walking.

CONCLUSIONS

The results from this study provide additional support for the use of models in which sex is treated as a potential moderator of the link between the perceived environment and physical activity. Further, the results support the use of an Internet-based research platform to collect data on the correlates of physical activity.

Path model of psychological antecedents to pain experience: experimental and clinical findings

OBJECTIVES

Two studies are described addressing how anxiety, fear of pain, and catastrophizing impact on pain experience.

METHODS

In study 1, 66 undergraduates (34 men, 32 women) completed measures of state and trait anxiety, fear of pain, and catastrophizing prior to participating in a cold pressor procedure. In study 2, 60 undergraduates (30 men, 30 women) completed the same measures and participated in dental hygiene treatment and rated the pain they experienced during a scaling procedure (removing deposits from the tooth surface).

RESULTS

In both studies, fear of pain and catastrophizing were significantly correlated with pain intensity ratings, and fear of pain and catastrophizing were correlated with each other. Trait anxiety was correlated with catastrophizing but not with fear of pain or pain. Path analyses revealed significant paths from trait anxiety to state anxiety, from trait anxiety to catastrophizing, and from catastrophizing to pain intensity ratings.

DISCUSSION

The findings suggest that although fear of pain and catastrophizing are related constructs, catastrophizing provides unique predictive ability for pain ratings, while fear of pain does not. Clinical and theoretical implications of these findings are discussed.

Visualization of negative signaling in B cells by quantitative confocal microscopy

Numerous biochemical experiments have invoked a model in which B-cell antigen receptor (BCR)-Fc receptor for immunoglobulin (Ig) G (FcgammaRII) coclustering provides a dominant negative signal that blocks B-cell activation. Here, we tested this model using quantitative confocal microscopic techniques applied to ex vivo splenic B cells. We found that FcgammaRII and BCR colocalized with intact anti-Ig and that the SH2 domain-containing inositol 5'-phosphatase (SHIP) was recruited to the same site. Colocalization of BCR and SHIP was inefficient in FcgammaRII-/- but not gamma chain-/- splenic B cells. We also examined the subcellular location of a variety of enzymes and adapter proteins involved in signal transduction. Several proteins (CD19, CD22, SHP-1, and Dok) and a lipid raft marker were co-recruited to the BCR, regardless of the presence or absence of FcgammaRII and SHIP. Other proteins (Btk, Vav, Rac, and F-actin) displayed reduced colocalization with BCR in the presence of FcgammaRII and SHIP. Colocalization of BCR and F-actin required phosphatidylinositol (PtdIns) 3-kinase and was inhibited by SHIP, because the block in BCR/F-actin colocalization was not seen in B cells of SHIP-/- animals. Furthermore, BCR internalization was inhibited with intact anti-Ig stimulation or by expression of a dominant-negative mutant form of Rac. From these results, we propose that SHIP recruitment to BCR/FcgammaRII and the resulting hydrolysis of PtdIns-3,4,5-trisphosphate prevents the appropriate spatial redistribution and activation of enzymes distal to PtdIns 3-kinase, including those that promote Rac activation, actin polymerization, and receptor internalization.

Glycolipid-enriched membrane domains are assembled into membrane patches by associating with the actin cytoskeleton

Nonionic detergent lysates of cells contain a glycolipid-enriched membrane (GEM) fraction. It has been proposed that the GEM fraction represents poorly solubilized GEM microdomains, or lipid rafts. However, the properties of GEM domains in intact cells remain controversial. To study the properties of a GEM-associated protein using confocal microscopy, GFP was targeted to GEM domains using the N-terminal domain of p56(lck) (LckNT). Imaging of HeLa cells expressing LckNT-GFP showed that it was targeted to large actin-rich patches in the plasma membrane that contained up to a fivefold enrichment of protein. Double-labeling experiments showed that the patches were selectively enriched with other GEM-associated molecules. Furthermore, the patches were resistant to extraction by TX-100, and disrupting GEM domains by extracting cholesterol also disrupted colocalization of LckNT-GFP with F-actin. Analogous to the actin-rich patches in HeLa cells, LckNT-GFP colocalized with actin-rich membrane caps in stimulated T cells. Furthermore, disrupting the GEM-targeting signal of LckNT-GFP also inhibited its targeting to membrane caps. Altogether, these findings extend previous studies by showing that association of GEM domains with the actin cytoskeleton provides a mechanism for targeting signaling molecules to membrane patches and caps.

A plasma membrane localization signal in the HIV-1 envelope cytoplasmic domain prevents localization at sites of vesicular stomatitis virus budding and incorporation into VSV virions

Previous studies showed that the HIV-1 envelope (Env) protein was not incorporated into vesicular stomatitis virus (VSV) virions unless its cytoplasmic tail was replaced with that of the VSV glycoprotein (G). To determine whether the G tail provided a positive incorporation signal for Env, or if sequences in the Env tail prevented incorporation, we generated mutants of Env with its 150-amino-acid tail shortened to 29, 10, or 3 amino acids (Envtr mutants). Cells infected with VSV recombinants expressing these proteins or an Env-G tail hybrid showed similar amounts of Env protein at the surface. The Env-G tail hybrid or the Envtr3 mutant were incorporated at the highest levels into budding VSV virions. In contrast, the Envtr29 or Envtr10 mutants were incorporated poorly. These results defined a signal preventing incorporation within the 10 membrane-proximal amino acids of the Env tail. Confocal microscopy revealed that this signal functioned by causing localization of human immunodeficiency virus type 1 Env to plasma membrane domains distinct from the VSV budding sites, where VSV proteins were concentrated.

Making genes green: creating green fluorescent protein (GFP) fusions with blunt-end PCR products

The jellyfish green fluorescent protein (GFP) has proven to be a useful tool in protein localization and trafficking studies. Fused to GFP, a protein of interest can be visualized and tracked in vivo through fluorescence microscopy. However, the process of making these fusion proteins is often tedious and painstaking. Here, we describe a simple and quick method for creating GFP fusion proteins using blunt-end PCR product ligation.

Recalling demonstrated and guided movements using imaginary and verbal rehearsal strategies

This study investigated the recall of movement patterns presented either by demonstration or guided movement with vision eliminated. Participants were instructed to rehearse and remember each of the 12 patterns using one of four strategies: imagery, verbal labeling, imagery and verbal labeling, or no rehearsal strategy (i.e., control condition). Recall was better for patterns that were demonstrated than for those presented via guided movement. In addition, more patterns were remembered if a combination of imagery and verbal labeling were employed as a rehearsal strategy compared to using imagery alone. These results are discussed using Annett's (1994) model showing the relationships between action, language, and imagination in the acquisition of motor skills.

A comparative analysis of ADL questions in surveys of older people

This article describes questions designed to assess limitations with respect to activities of daily living (ADLs) that were asked on the first wave of the AHEAD study, and it assesses their cross-sectional measurement properties. It also provides comparisons between those questions and parallel questions that have been asked on two other surveys of the elderly population in the United States: the 1984 Supplement on Aging (SOA) to the National Health Interview Survey and the screener for the 1982 National Long Term Care Survey (NLTCS). It also compares a single item from the 1990 Census. It then compares the ways in which the same individuals answer these different versions of ADL questions, using data from subsamples of the AHEAD respondents who were also asked the SOA, NLTCS, or Census questions. The analysis shows that there is a substantial amount of measurement error in the answers to ADL questions, and it suggests that this is a major contributor to apparent improvements and declines in functional health observed in longitudinal data.

Exclusion of CD45 inhibits activity of p56lck associated with glycolipid-enriched membrane domains

p56lck (Lck) is a lymphoid-specific Src family tyrosine kinase that is critical for T-cell development and activation. Lck is also a membrane protein, and approximately half of the membrane-associated Lck is associated with a glycolipid-enriched membrane (GEM) fraction that is resistant to solubilization by Triton X-100 (TX-100). To compare the membrane-associated Lck present in the GEM and TX-100-soluble fractions of Jurkat cells, Lck from each fraction was immunoblotted with antibody to phosphotyrosine. Lck in the GEM fraction was found to be hyperphosphorylated on tyrosine, and this correlated with a lower kinase specific activity relative to the TX-100-soluble Lck. Peptide mapping and phosphatase diagests showed that the hyperphosphorylation and lower kinase activity of GEM-associated Lck was due to phosphorylation of the regulatory COOH-terminal Tyr505. In addition, we determined that the membrane-bound tyrosine phosphatase CD45 was absent from the GEM fraction. Cells lacking CD45 showed identical phosphorylation of Lck in GEM and TX-100-soluble membranes. We propose that the GEM fraction represents a specific membrane domain present in T-cells, and that the hyperphosphorylation of tyrosine and lower kinase activity of GEM-associated Lck is due to exclusion of CD45 from these domains. Lck associated with the GEM domains may therefore consitute a reservoir of enzyme that can be readily activated.

Signals determining protein tyrosine kinase and glycosyl-phosphatidylinositol-anchored protein targeting to a glycolipid-enriched membrane fraction

Glycosyl-phosphatidylinositol (GPI)-anchored membrane proteins and certain protein tyrosine kinases associate with a Triton X-100-insoluble, glycolipid-enriched membrane fraction in MDCK cells. Also, certain protein tyrosine kinases have been shown to associate with GPI-anchored proteins in other cell types. To characterize the interaction between GPI-anchored proteins and protein tyrosine kinases, GPI-anchored proteins were coexpressed with p56lck in HeLa cells. Both proteins were shown to target independently to the glycolipid-enriched membranes. Coimmunoprecipitation of GPI-anchored proteins and p56lck occurred only when both proteins were located in the glycolipid-enriched membranes, and gentle disruption of these membranes abolished the interaction. The GPI anchor was found to be the targeting signal for this membrane fraction in GPI-anchored proteins. Analysis of mutants indicated that p56lck was nearly quantitatively palmitoylated at Cys-5 but not palmitoylated at Cys-3. The nonpalmitoylated cysteine at position 3 was very important for association of p56lck with the membrane fraction, while palmitoylation at Cys-5 promoted only a low level of interaction. Because other src family protein tyrosine kinases that are associated with GPI-anchored proteins always contain a Cys-3, we propose that this residue, in addition to the N-terminal myristate, is part of a common signal targeting these proteins to a membrane domain that has been linked to transmembrane signaling.

Distributions of proteins and lipids in the erythrocyte membrane

Fluorescence digital imaging microscopy was used to characterize erythrocyte membrane domains. To investigate the role of specific proteins in forming lipid domains, erythrocyte ghosts were double-labeled with fluorescent phospholipids and a fluorescent label specific for band 3, the major integral membrane protein. Areas of enrichment, or domains, were observed for both the protein and lipid components. The size and enrichment of the protein and lipid domains in the membrane depended upon the ionic strength but not the temperature. Also, there was a higher correlation between the areas of band 3 and phosphatidylcholine enrichment than between band 3 and phosphatidylserine enrichment. This is consistent with band 3 playing a role in the formation of the phosphatidylcholine domains. Furthermore, areas of spectrin enrichment also were observed in immunofluorescently labeled ghosts, and the band 3 domains were found to coincide with the spectrin domains. Thus, the distribution of band 3 in ghosts is influenced by interactions with the cytoskeleton. Together, these experiments illustrate the type of membrane heterogeneity present in erythrocyte ghosts and the type of lipid and protein interactions that can affect the domains.

Time course of vitamin E repletion in the premature infant

Plasma and erythrocyte (RBC) tocopherol-isomer concentrations were determined serially in forty-two premature infants (25-35 weeks gestation) from birth to 8 weeks of age. For comparison purposes vitamin E status was also determined in six term infants over the first 8 d following birth and in a group of thirteen adult volunteers. Vitamin E intakes in term and preterm infants were calculated from recorded food intakes and blood transfusions. In term infants plasma vitamin E concentration rose from 1.9 mg/l (day 1) to 8.2 mg/l by day 8. In comparison preterm plasma vitamin E concentration, 0.3 mg/l (day 1), did not change appreciably by day 8 (0.7 mg/l). Likewise RBC vitamin E concentration increased in term infants from 1.3 mg/l (day 1) to 2.7 mg/l (day 8), while in preterm infants it remained unchanged, 1.5 mg/1 (day 1) v. 1.3 mg/l (day 8). Over the 3 weeks following birth, RBC vitamin E concentrations in the premature infants increased to adult values, while plasma vitamin E concentration did not reach the adult range until 8 weeks post-term. These slow changes in plasma vitamin E status occurred even though the vitamin E intake of these infants was similar to that proving adequate for term infants.