Short-term equine interaction for reducing test anxiety and facilitating coping skill development in college students during examination periods: A preliminary study

Mental health concerns are common among college students and more prevalent during examination periods when stress and anxiety are heightened. While the benefits of equine interaction have been reported, the impact of short-term equine interaction on coping skills valuable for managing test anxiety have yet to be studied. Therefore, the purpose of this preliminary study was to evaluate the impact of short-term equine interaction during the college examination period on development of coping skills and anxiety levels associated with testing, both self-reported and those reflected in physiological measures. Full-time college students engaged in a one-hour equine interaction session held on campus at the onset of final exam week. Participants completed a survey targeting perception of anxiety levels and coping skills. Heart rate and salivary cortisol measurements were collected pre- and post-session. Paired t-tests were performed between pre- and post- session measures and correlations between survey answers and physiological measures determined. Significant reductions were found in all areas of anxiety (Overall Academics P = 0.0003, Final Exam Preparation P = 0.0003, Taking Final Exam P = 0.0003). The reduction in exam-related anxiety was positively correlated to cortisol concentrations (r = 0.69, P = 0.03) with lower concentrations (P = 0.05) and increased heart rate (P = 0.003) post-session. Regarding coping skills, improvements were observed post-session in assertiveness (P = 0.008). Skill development coupled with reduced anxiety supports the potential benefits short-term equine interaction can offer students during the high stress periods, but these findings should be confirmed with more in-depth study.

Novel Role for Cardiolipin as a Target of Therapy to Mitigate Myocardial Injury Caused by Venoarterial Extracorporeal Membrane Oxygenation

BACKGROUND

Cardiolipin is a mitochondrial-specific phospholipid that maintains integrity of the electron transport chain (ETC) and plays a central role in myocardial ischemia/reperfusion injury. Tafazzin is an enzyme that is required for cardiolipin maturation. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) use to provide hemodynamic support for acute myocardial infarction has grown exponentially, is associated with poor outcomes, and is under active clinical investigation, yet the mechanistic effect of VA-ECMO on myocardial damage in acute myocardial infarction remains poorly understood. We hypothesized that VA-ECMO acutely depletes myocardial cardiolipin and exacerbates myocardial injury in acute myocardial infarction.

METHODS

We examined cardiolipin and tafazzin levels in human subjects with heart failure and healthy swine exposed to VA-ECMO and used a swine model of closed-chest myocardial ischemia/reperfusion injury to evaluate the effect of VA-ECMO on cardiolipin expression, myocardial injury, and mitochondrial function.

RESULTS

Cardiolipin and tafazzin levels are significantly reduced in the left ventricles of individuals requiring VA-ECMO compared with individuals without VA-ECMO before heart transplantation. Six hours of exposure to VA-ECMO also decreased left ventricular levels of cardiolipin and tafazzin in healthy swine compared with sham controls. To explore whether cardiolipin depletion by VA-ECMO increases infarct size, we performed left anterior descending artery occlusion for a total of 120 minutes followed by 180 minutes of reperfusion in adult swine in the presence and absence of MTP-131, an amphipathic molecule that interacts with cardiolipin to stabilize the inner mitochondrial membrane. Compared with reperfusion alone, VA-ECMO activation beginning after 90 minutes of left anterior descending artery occlusion increased infarct size (36±8% versus 48±7%; P<0.001). VA-ECMO also decreased cardiolipin and tafazzin levels, disrupted mitochondrial integrity, reduced electron transport chain function, and promoted oxidative stress. Compared with reperfusion alone or VA-ECMO before reperfusion, delivery of MTP-131 before VA-ECMO activation reduced infarct size (22±8%; P=0.03 versus reperfusion alone and P<0.001 versus VA-ECMO alone). MTP-131 restored cardiolipin and tafazzin levels, stabilized mitochondrial function, and reduced oxidative stress in the left ventricle.

CONCLUSIONS

We identified a novel mechanism by which VA-ECMO promotes myocardial injury and further identify cardiolipin as an important target of therapy to reduce infarct size and to preserve mitochondrial function in the setting of VA-ECMO for acute myocardial infarction.

Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center

BACKGROUND

Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality.

RESULTS

Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84-0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72-0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race.

CONCLUSIONS

Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.

Doctors' attitudes and practices regarding smoking cessation during pregnancy

OBJECTIVE

To investigate the current smoking cessation practices and attitudes of doctors working in the public antenatal services, as well as their perceived barriers to addressing the issue in the context of routine care.

STUDY DESIGN

The study was qualitative, consisting of 14 semistructured, one-to-one interviews with doctors purposefully sampled from 5 public sector hospitals in Cape Town, South Africa.

RESULTS

The doctors in this study regarded HIV, poor nutrition, alcohol abuse and psychosocial stress as equal or higher risks to pregnant women than smoking. They tended to underestimate the magnitude of the risk of smoking during pregnancy. Doctors were unaware of the guidelines offering clinicians brief, structured approaches to smoking cessation counselling and were generally pessimistic that they could influence the smoking behaviour of pregnant women, especially poor, disadvantaged women who face multiple barriers to achieving health-enhancing behaviour. However, most doctors were concerned about improving their communication with pregnant women about smoking and open to adopting new approaches or tools that could assist them. Perceived barriers to providing smoking cessation interventions included a lack of counselling skills and educational resources, other pressing priorities, too little time, and the levels of stress currently experienced by doctors and midwives working in public sector hospitals as a result of dramatic staff and budget cuts.

CONCLUSION

The study suggests that doctors working in the public sector antenatal services are not routinely addressing the issue of smoking during pregnancy or using effective methods to assist women to give up smoking. Doctors need convincing that smoking cessation interventions can be effective. The promotion and provision of evidence-based guidelines such as the Clinical Practice Guideline for Treating Tobacco Use and Dependence (Fiore, 2000), with minimal training, is a possible strategy for integrating smoking cessation interventions into routine antenatal care in South Africa.

Media interventions to increase cervical screening uptake in South Africa: an evaluation study of effectiveness

Successful cervical cancer prevention depends on reaching, screening and treating women with pre-invasive disease. We aimed to evaluate the effectiveness of two media interventions-a photo-comic and a radio-drama-in increasing cervical screening uptake. A randomized controlled trial compared a photo-comic on cervical cancer screening with a placebo comic. One month after the comics were distributed a radio-drama paralleling the photo-comic was broadcast on the community radio station and a retrospective evaluation was carried out. The trial was set in Khayelitsha, a peri-urban squatter community near Cape Town, South Africa. A random sample consisted of 658 women between the ages of 35 and 65 years, from a stratified sample of census areas. The main outcome measure was self-reported cervical screening uptake 6 months after distribution of the comics. Seven percent (18 of 269) of women who received the intervention photo-comic reported cervical screening during the 6 months follow-up, compared with 6% (25 of 389) of controls (P = 0.89). Women who recalled hearing the radio-drama were more likely to report attending screening (nine of 53, 17%) than those who did not (19 of 429, 4%; P < 0.001). We conclude that the photo-comic was ineffective in increasing cervical screening uptake in this population. The radio-drama may have had more impact, but only a minority of women recalled being exposed to it. Future research must concentrate not only on achieving high level of exposure to health messages, but also on investigating the links between exposure and action.

Teenage women's use of contraceptives in two populations

BACKGROUND

Adolescent patterns of contraceptive use might be different in various populations and might have changed in the last 30 years. More appropriate use of contraception could prevent unplanned pregnancy.

METHODS

We interviewed 378 women in rural East Tennessee and 396 women in suburban-urban Baltimore, all of whom were aged 18 to 50 years, in a convenience sampling about their memories of sexual experiences and early contraceptive use.

RESULTS

First sexual experiences began at a younger age in women from Tennessee than in women from Baltimore. Sexual experiences occurred at an earlier age during the last 15 years in Baltimore women. Contraceptive use at first sexual experience has approximately doubled in both locations, from 7% to 15% in Tennessee and from 42% to 75% in Baltimore during the last 15 years. The primary reason in Baltimore is increased use of condoms. Condom use in Tennessee is very low.

CONCLUSIONS

These two populations are using contraception and condoms differently. Although the two populations are diverse, it could help physicians to learn about the particular contraceptive practices of their patient population to help their patients more appropriately with their contraceptive needs.

Faculty development in communication skills instruction: insights from a longitudinal program with "real-time feedback"

Responsibility for teaching communication skills often falls to a multidisciplinary group of faculty who lack both a common model for teaching and prior experience teaching communication in small groups. This article describes East Tennessee State University's multifaceted faculty development program in teaching communication skills. The program was developed and implemented in three phases. First, a two-step Delphi approach helped identify core communication skills. Phase two gave faculty the opportunity to practice identifying communication teaching issues and effective strategies for working with small groups. The third phase involved the videotaping of faculty teaching small groups of students. These tapes were reviewed both individually and in faculty groups. The tapes were also reviewed by students, who provided realtime, moment-to-moment feedback to the faculty. Implementation and review of the program has helped to identify new strategies for effectively facilitating small-group teaching of communication skills.

Lifetime patterns of contraception and their relationship to unintended pregnancies

BACKGROUND

For the past 30 years many effective methods of contraception have been available, yet unintended pregnancy rates still range from 30% to 50% in many populations. We examined patterns of women's contraceptive use throughout their lives and relate them to unintended pregnancy.

METHODS

A total of 396 women aged 18 to 50 years chosen by convenience sampling from a family practice residency office were interviewed in a cross-sectional study about their history of using and changing contraception, and whether they believed they became pregnant while using a method of contraception. We analyzed the data for correlations and significance using chi-square and Student t tests.

RESULTS

Most women had used both condoms and oral contraceptive pills, and tried an average of 3.54 methods during a lifetime. Two patterns of women's use of contraception emerged that describe 75% of the women. One third of the women--those who indicated a pattern of following their first method with a less effective method--are significantly more likely to have an unintended pregnancy while using contraception (odds ratio=1.4). The other group (50% of the entire sample) used increasingly effective methods and were less likely to have an unintended pregnancy.

CONCLUSIONS

Pregnancy is an inherent natural consequence of sexual intercourse, even when using very effective contraceptive methods. By asking a few questions about a woman's history of contraceptive use, physicians may be able to determine those who are more likely to be at risk for an unintended pregnancy.

The transtheoretical model of smoking: comparison of pregnant and nonpregnant smokers

Pregnant smokers represent a special population of women smokers. Since smoking affects both the mother and the unborn child, it might be hypothesized that pregnant women should be highly motivated to quit smoking during pregnancy. Results from both naturalistic studies and intervention studies have generally shown only modest changes in smoking during pregnancy. To help design more effective interventions tailored for this special population of smokers, more information is needed on how they differ from other smokers. The current study was designed to examine patterns and differences on constructs of the Transtheoretical Model between low-income culturally diverse pregnant and nonpregnant female smokers. Groups were compared on the distribution of the stages of change. In addition, stage and group comparisons were conducted for the pros and cons of smoking, situational temptations to smoke, and the processes of change. The sample included 103 economically disadvantaged, culturally diverse pregnant women and a matched group of 103 nonpregnant women smokers. Pregnant smokers as a group were similar to their nonpregnant peers on their readiness for quitting. In general, the patterns observed across the stages of change were consistent with those seen in other populations of smokers. The primary difference found between the groups were on the cons of smoking, habit-related temptations to smoke, and experiential processes of change. Specifically, pregnant women perceived a less negative attitude toward their smoking, were more tempted in habit-related situations, and made less use of important experiential processes of change. The implications of these findings for designing interventions tailored for this special group of smokers are discussed.

Learning to listen: formative research in the development of AIDS education for secondary school students

AIDS, as a social phenomenon, is highly politicized and is an emotive issue. In South Africa there is considerable disagreement between different sectors and stakeholders involved in school education about what constitutes an appropriate approach to AIDS education. For AIDS education programmes in schools to make cultural sense and to be effective, adequate formative research of the social context and cultural meaning of the salient behaviours needs to be done, and this understanding needs to inform programme development. The school community needs to be involved in the programme design and evaluation. This paper describes some of the formative research undertaken during the development of an AIDS education programme for secondary school students in South Africa. The study was undertaken during 1991 and 1992 in a Cape Town secondary school. A description of three components of the formative research is given. For each, the qualitative research methods used, the difficulties encountered, some of the results, and their value are discussed. Qualitative research methods were able to provide a more holistic understanding of student sexuality and its cultural context. These methods also provided the means with which to develop a partnership with the teachers in the process of developing the AIDS education programme. Furthermore, when this partnership broke down, they provided the means to explore the crisis that emerged around conflicting assumptions and cultural values the researchers and the "researched' held with respect to AIDS education. The generalizability of the study's results and the transferability of the AIDS education programme that was developed are discussed with respect to the exigencies of epidemiology to impact on the public health of large populations, and those of qualitative research methods to generate in-depth understanding in limited contexts.

Site-selected introduction of modified purine and pyrimidine ribonucleosides into RNA by automated phosphoramidite chemistry

The study of modified nucleoside contributions to RNA chemistry, structure and function has been thwarted by the lack of a site-selected method of incorporation which is both versatile and adaptable to present synthetic technologies. A reproducible and versatile site-selected incorporation of nine differently modified nucleosides into hepta- and octadecamer RNAs has been achieved with automated phosphoramidite chemistry. The 5'-O-(4,4'-dimethoxytrityl-2'-O-tert-butyldimethylsilyl-ribonucleoside- 3'-O-(2-cyanoethyl-N,N-diisopropyl)phosphoramidite syntheses of m5C, D, psi, riboT, s2U, mnm5U, m1G and m2A were designed for compatibility with the commercially available major and 2'OH methylated ribonucleoside phosphoramidites. The synthesis of the m5C phosphoramidite was uniquely designed, and the first syntheses and incorporation of the two modified purine ribonucleosides are reported in detail along with that of psi, s2U, and mnm5U. Cleavage of RNA product from the synthesis support column, deprotection of the RNA, its purification by HPLC and nucleoside composition analysis are described. Modified nucleoside-containing tRNA domains were synthesized and purified in mumol quantities required for biophysical, as well as biochemical, studies. The anticodon domain of yeast tRNA(Phe) was synthesized with modified nucleosides introduced at the native positions: Cm32, Gm34, m1G37 (precursor to Y), psi 39 and m5C40. The T loop and stem was synthesized with riboT54 and the D loop and stem with D16 and D17. The E coli tRNA(Glu2) anti-codon codon domain was synthesized with mnm5U at wobble position 34, but an attempt at incorporating s2U at the same position failed. The unprotected thio group was labile to the oxidation step of the cyclical process. Chemically synthesized anticodon and T domains have been used in assays of tRNA structure and function (Guenther et al (1994) Biochimie 76, 1143-1151).

Ribosome binding of DNA analogs of tRNA requires base modifications and supports the "extended anticodon"

The efficiency of translation depends on correct tRNA-ribosome interactions. The ability of chemically synthesized yeast tRNA(Phe) anticodon domains to effectively inhibit the binding of native yeast tRNA(Phe) to poly(U)-programmed Escherichia coli 30S ribosomal subunits was dependent on a Mg(2+)-stabilized stem and an open anticodon loop, both facilitated by base modifications. Analysis of tRNA sequences has revealed that base modifications which negate canonical hydrogen bonding are found in 95% of those tRNA anticodon loop sequences with the potential to form two Watson-Crick base pairs across the loop. Therefore, we postulated that a stable anticodon stem and an open loop are prerequisites for ribosome binding. To test this hypothesis, DNA analogs of the yeast tRNA(Phe) anticodon domain were designed to have modification-induced, Mg(2+)-stabilized stems and open loops. The unmodified DNA analog neither bound to poly(U)-programmed 30S ribosomal subunits nor inhibited the binding of native tRNA(Phe). However, specifically modified DNA analogs did bind to ribosomal subunits and effectively inhibited tRNA(Phe) from binding. Thus, modification-dependent Mg(2+)-stabilized anticodon domain structures with open loops have evolved as the preferred anticodon conformations for ribosome binding.

5-Methylcytidine is required for cooperative binding of Mg2+ and a conformational transition at the anticodon stem-loop of yeast phenylalanine tRNA

The role of modified nucleosides in tRNA structure and ion binding has been investigated with chemically synthesized RNAs corresponding to the yeast tRNA(Phe) anticodon stem and loop (tRNA(ACPhe). Incorporation of d(m5C) at position 14 of the stem of tRNA(ACPhe)-d(m5C14), CCAGACUGAAGAU-d(m5C14)-UGG, analogous to m5C40 in native tRNA(Phe), introduced a strong Mg2+ binding at a site distant from the m5C. A Mg(2+)-induced structural transition, detected by circular dichroism spectroscopy, was similar to that observed for the DNA analog of tRNA(ACPhe) (Guenther et al., 1992; Dao et al., 1992). In contrast, Mg2+ had little effect on unmodified tRNA(ACPhe)-rC14 or tRNA(ACPhe)-d(C14). Modified tRNA(ACPhe)-d(m5C14) bound two Mg2+ ions, and the binding was cooperative. The dissociation constant of the two Mg2+ ions from tRNA(ACPhe)-d(m5C14), 2.5 x 10(-9) M2, is the result of an RNA structure significantly stabilized by Mg2+ binding, delta G = -11.7 kcal/mol. The tRNA(ACPhe)-d(m5C14) structure, investigated by 1H NMR, had a double stranded stem of five base pairs and two additional base pairs across what was a seven membered loop in the unmodified tRNA(Phe)AC. Methylation of cytidine in the yeast tRNA(ACPhe) enables the molecule to form more than one conformation through a process regulated by Mg2+ concentration. Thus, the simplest of posttranscriptional modifications of tRNA, a methylation, is involved in a somewhat distant, internal-site Mg2+ binding and stabilization of tRNA structure, especially that of the anticodon stem and loop.

Iceman in the cold light of day

The discovery of a Neolithic corpse in an alpine glacier in 1991 attracted widespread attention. What has happened in the eighteen months since then reflects badly on European science.

Signal shaping by voltage-gated currents in retinal ganglion cells

The role of voltage-gated currents in information processing by retinal ganglion cells was assessed by comparing the light-evoked current and voltage responses of identified ganglion cells with those produced by current injection. These experiments show that the light-evoked signal is clipped at the bipolar-to-ganglion cell synapse because the synaptic current evoked by illumination with bright light is greater than that which the cell can convert into a change in action potential frequency. Ganglion cell responses to injected current fell into 2 classes: those producing sustained spiking responses and those producing transient responses. Further, this division is correlated with the light response of the cells; those producing transient responses to exogenous current produced transient responses to light, while those with sustained responses to current injection produced sustained responses to light flashes. The voltage-gated currents present in the ganglion cell membrane contribute to information processing in the retina by clipping the light-evoked signal and by producing transcience in the output of the retina.

Priapism in a stallion with generalized malignant melanoma

A Thoroughbred stallion developed priapism that was unresponsive to medical treatment and lavage of the corpus cavernosum penis with heparinized 0.9% NaCl solution. Three weeks after onset of priapism, the penis was firm and noncompliant, and penile pain sensation and ability to retract the penis were lost. Ultrasonography confirmed thrombosis of the corpus cavernosum penis. The stallion was euthanatized because of poor prognosis for return to breeding soundness. Necropsy revealed enlargement of numerous lymph nodes. The dorsal penile nerves were demyelinated distal to the crura of the penis. A diagnosis of generalized malignant melanoma was made; however, neither metastasis to the vertebral canal nor compression of spinal nerve roots as they exited the vertebral foramen was found. Priapism is a persistent erection without sexual arousal and is initially unassociated with penile paralysis, but if prolonged, leads to irreversible venous occlusion where collecting veins join the cavernous spaces. Damage to the dorsal penile nerves may explain the long-term penile paralysis and loss of sensation that accompanied priapism in this stallion. Priapism unassociated with the use of phenothiazine-derivative tranquilizers is uncommon in horses.

A presynaptic action of glutamate at the cone output synapse

Neurotransmitter release from many central nervous system synapses is regulated by 'autoreceptors' at the synaptic terminal, which bind the released transmitter and alter release accordingly. The photoreceptors of lower vertebrates are thought to use glutamate as a neurotransmitter. Glutamate conveys the visual signal to postsynaptic bipolar and horizontal cells, but has been reported not to act on the photoreceptors themselves. We show here that glutamate evokes a current, carried largely by chloride ions, in cones isolated from the tiger salamander retina. This response is localized to the synaptic terminal of the cone. Removing external sodium blocks this action of glutamate. These results suggest the existence of a positive feedback loop at the cone output synapse: over most of the light-response range, glutamate released by depolarization of the cone will cause further depolarization, increasing the gain of phototransduction. Glutamate released from rods may also polarize cones, modulating the gain of the cone output synapse. This system is surprisingly different from the autoreceptor systems for most other transmitters, which act in a negative feedback way.