TURN-IT: a novel turning intervention program to improve quality of turning in daily life in people with Parkinson's disease

BACKGROUND

People with Parkinson's disease (PD) have a high fall rate and many falls are associated with turns. Despite this, there is minimal research on effects of rehabilitation on the quality of turns. Further, quantifying turns in the home may have broader implications since rehabilitation of turns would ideally improve turning in real world mobility.

METHODS

Sixty people with PD and a history of falls will be randomized to receive either a novel TURNing InTervention (TURN-IT) or no intervention (control group). The TURN-IT group will be seen for 6 weeks (18 visits) for an individualized, progressive program that is based on the specific constraints of turning in PD. Wearable sensors will be used to measure 7 days of mobility, including turns, before and after intervention or control period. In addition, blinded assessments of gait, mobility and turns will occur before and after intervention for both groups and falls will be monitored for twelve months post intervention with bimonthly email questionnaires.

DISCUSSION

This study has the potential to change how we rehabilitate and assess turning in people with PD and falls. There are several novel aspects to our study including a comprehensive turning-focused intervention that is tailored to the underlying constraints that impair turning in people with PD. Further, our outcome measure of turning quality during 7 days of daily life is novel and has implications for determining real-life changes after rehabilitation. The ultimate goal of this rehabilitation intervention is to improve how patients turn in daily life and to reduce falls.

TRIALS REGISTRATION

This protocol is registered at clinicaltrials.gov; #NCT04897256; https://clinicaltrials.gov/ct2/show/NCT04897256?term=Horak&cond=Parkinson+Disease&draw=2&rank=4 .

Clustered cases of infections due to an uncommon methicillin-resistant Staphylococcus aureus originating in a maternity ward

OBJECTIVE

We aimed to report a community outbreak of an uncommon methicillin-resistant Staphylococcus aureus (MRSA) originating in a maternity ward.

PATIENTS AND METHODS

Cases were defined by epidemiological, clinical, and microbiological investigations. Microbiological investigations included phenotypic analysis, molecular typing, and whole-genome sequencing. To control the outbreak, we applied both national recommendations to prevent in-hospital transmission and the French High Council for Public Health guidelines on the management of community-acquired MRSA infections.

RESULTS

Between March and July 2016, seven patients with MRSA infections were identified: six skin and soft tissue infections and one pulmonary infection, including six microbiologically confirmed infections. Infections occurred in community settings, but a link with the same maternity ward was found for all patients. All MRSA strains had a t690 spa type, were tetracycline-resistant, and produced Panton-Valentine leukocidin. All isolates belonged to the sequence type 88 (ST88).

CONCLUSION

This outbreak highlights the largely underestimated risk of healthcare-associated infections in maternity wards. Healthcare workers should be aware of the importance of standard hygiene precautions and use of alcohol-based hand sanitizers for neonates and mothers.

Inflection points in longitudinal models: Tracking recovery and return to play following concussion

The return to play (RTP) process may occur during longitudinal studies tracking recovery after concussion. This factor, which is often omitted within statistical designs, could affect the fit and overall interpretation of the statistical model. This article demonstrates the difference in results and interpretation between 2 linear mixed-model designs: (1) a between-group longitudinal (GROUP) analysis and (2) a between-group longitudinal model that used an inflection point to account for changes around the time of RTP (RTP analysis). These analyses were conducted on instrumented balance data collected on 23 concussed athletes and 25 controls over 8 weeks following concussion. Total sway area and the range of mediolateral acceleration were used as outcome measures. No significant findings were found in the GROUP design for either outcome measure. In contrast, the RTP analysis revealed significant effects of time (P = .007) and RTP change (P = .007), and group*time (P = .028) and group*RTP change (P = .022) interactions for total sway area, and effects of group (P = .011), time (P = .010), and RTP change (P = .014), and group*time (P = .013) and group*RTP change interactions (P = .013) for range of mediolateral acceleration. For both outcomes, the RTP model fit the data significantly better on comparison of likelihood ratios (P ≤ .027). These results suggest that allowing for an inflection point in the statistical design may assist understanding of what happens around clinically meaningful time points. The choice of statistical model had a considerable effect on the interpretation of findings, and provokes discussion around the best method for analyzing longitudinal datasets when important clinical time points like RTP exist.

Carbon dioxide for euthanasia: concerns regarding pain and distress, with special reference to mice and rats

Carbon dioxide (CO2) is the most commonly used agent for euthanasia of laboratory rodents, used on an estimated tens of millions of laboratory rodents per year worldwide, yet there is a growing body of evidence indicating that exposure to CO2 causes more than momentary pain and distress in these and other animals. We reviewed the available literature on the use of CO2 for euthanasia (as well as anaesthesia) and also informally canvassed laboratory animal personnel for their opinions regarding this topic. Our review addresses key issues such as CO2 flow rate and final concentration, presence of oxygen, and prefilled chambers (the animal is added to the chamber once a predetermined concentration and flow rate have been reached) versus gradual induction (the animal is put into an empty chamber and the gas agent(s) is gradually introduced at a fixed rate). Internationally, animal research standards specify that any procedure that would cause pain or distress in humans should be assumed to do so in non-human animals as well (Public Health Service 1986, US Department of Agriculture 1997, Organization for Economic Cooperation and Development 2000). European Union guidelines, however, specify a certain threshold of pain or distress, such as 'skilled insertion of a hypodermic needle', as the starting point at which regulation of the use of animals in experimental or other scientific procedures begins (Biotechnology Regulatory Atlas n.d.). There is clear evidence in the human literature that CO2 exposure is painful and distressful, while the non-human literature is equivocal. However, the fact that a number of studies do conclude that CO2 causes pain and distress in animals indicates a need for careful reconsideration of its use. Finally, this review offers recommendations for alternatives to the use of CO2 as a euthanasia agent.

Do cognitive measures and brain circuitry predict outcomes of exercise in Parkinson Disease: a randomized clinical trial

BACKGROUND

There is emerging research detailing the relationship between balance/gait/falls and cognition. Imaging studies also suggest a link between structural and functional changes in the frontal lobe (a region commonly associated with cognitive function) and mobility. People with Parkinson's disease have important changes in cognitive function that may impact rehabilitation efficacy. Our underlying hypothesis is that cognitive function and frontal lobe connections with the basal ganglia and brainstem posture/locomotor centers are responsible for postural deficits in people with Parkinson's disease and play a role in rehabilitation efficacy. The purpose of this study is to 1) determine if people with Parkinson's disease can improve mobility and/or cognition after partaking in a cognitively challenging mobility exercise program and 2) determine if cognition and brain circuitry deficits predict responsiveness to exercise rehabilitation.

METHODS/DESIGN

This study is a randomized cross-over controlled intervention to take place at a University Balance Disorders Laboratory. The study participants will be people with Parkinson's disease who meet inclusion criteria for the study. The intervention will be 6 weeks of group exercise (case) and 6 weeks of group education (control). The exercise is a cognitively challenging program based on the Agility Boot Camp for people with PD. The education program is a 6-week program to teach people how to better live with a chronic disease. The primary outcome measure is the MiniBESTest and the secondary outcomes are measures of mobility, cognition and neural imaging.

DISCUSSION

The results from this study will further our understanding of the relationship between cognition and mobility with a focus on brain circuitry as it relates to rehabilitation potential.

TRIAL REGISTRATION

This trial is registered at clinical trials.gov (NCT02231073).

Abstract A77: Differential recruitment of myeloid derived immune cells and fibroblasts to the thyroid tumor microenvironment in mouse models of papillary and follicular thyroid cancer

Thyroid cancer is the most common endocrine malignancy, and its incidence has steadily increased worldwide over the last 30 years. Genetic alterations leading to the activation of the MAPK signaling pathway are crucial for the initiation and progression of thyroid cancer, as evidenced by the high frequency of activating mutations in BRAF, HRAS, NRAS, RET and TRK. Mutations in BRAF are observed in ~45% of papillary thyroid cancers (PTCs), while follicular thyroid cancer (FTC) is often associated with mutations in RAS. We have shown that thyroid specific expression of HrasG12V and Pten inactivation leads to the development of FTCs and poorly differentiated thyroid cancer (PDTC) in HrasG12V/Ptenhom/TPO-cre mice while thyroid specific expression of BrafV600E and loss of Pten leads to the rapid development of PTC and PDTC in BrafV600E/Ptenhom/TPO-cre mice with complete lethality by weaning. We sought to determine whether activation of Braf or Hras resulted in the differential recruitment of stromal cells to the thyroid tumor microenvironment in HrasG12V/Ptenhom/TPO-cre and BrafV600E/Ptenhom/TPO-cre mice. FACS analysis revealed a significant increase in the overall amount of CD45+ cells in Hras (60.95±5.28%) versus Braf (18.35±1.3%) driven murine thyroid tumors. However, we found that the population of CD45+ cells in Braf driven tumors was comprised of a higher percentage of CD11b+ myeloid cells (62.1±1.3%) in comparison to Hras (37.0±5.5%) driven tumors. We next measured levels of cytokine expression in tumor cell lines derived from BrafV600E/Ptenhom/TPO-cre and HrasG12V/Ptenhom/TPO-cre mice. Braf driven tumor cells expressed higher levels of GM-CSF in comparison to Hras driven tumor cells, which we hypothesize contributes to the larger myeloid compartment observed in BrafV600E/Ptenhom/TPO-cre thyroid tumors. Studies are ongoing to further characterize the immune cell populations in these tumors. FACS analysis also revealed an increase in CD45-CD326-CD140α+ fibroblast infiltrate in Braf versus Hras driven thyroid tumors (68.4±0.424% versus 9.8±4.27%, p<.0001). Fibroblasts are a major source of type I collagen (Col1a1), which has been linked to the immunosuppression of tumor infiltrating leukocytes via inhibition of Leukocyte-associated immunoglobulin-like receptor 1 (LAIR1). Therefore, we hypothesized that the increase in fibroblast infiltrate observed in Braf driven thyroid tumors would result in a subsequent increase in Col1a1 production, thus potentially leading to a more immunosuppressive thyroid tumor microenvironment in PTC. Indeed, levels of Col1a1 gene expression were significantly upregulated an average of 80 fold (p<.0001) in Braf versus Hras driven thyroid tumors, with no significant difference in Col1a1 expression between Hras driven tumors and WT thyroid controls. Histopathological analysis via Picrosirius red staining confirmed higher levels of total and fibrillar collagen in Braf versus Hras driven tumors. In addition, microarray analysis of human thyroid tumors revealed that Col1a1 expression levels are highest in PTCs, particularly in those with mutations in BRAF, and lowest in FTCs and follicular variant PTC, which are both associated with a high RAS mutation rate. Because FTCs and PTCs have distinct pathological features and differ in prognosis and responses to therapy, we aim to translate these findings to the discovery of more personalized diagnostic and treatment strategies that are targeted toward the thyroid tumor microenvironment.

Citation Format: Lee Ann King, Sergey Novitsky, Julio Ricarte-Filho, Philip Owens, Aime T. Franco. Differential recruitment of myeloid derived immune cells and fibroblasts to the thyroid tumor microenvironment in mouse models of papillary and follicular thyroid cancer. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Immunology and Immunotherapy: A New Chapter; December 1-4, 2014; Orlando, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2015;3(10 Suppl):Abstract nr A77.

Compensatory stepping in Parkinson's disease is still a problem after deep brain stimulation randomized to STN or GPi

The effects of deep brain stimulation (DBS) on balance in people with Parkinson's disease (PD) are not well established. This study examined whether DBS randomized to the subthalamic nucleus (STN; n = 11) or globus pallidus interna (GPi; n = 10) improved compensatory stepping to recover balance after a perturbation. The standing surface translated backward, forcing subjects to take compensatory steps forward. Kinematic and kinetic responses were recorded. PD-DBS subjects were tested off and on their levodopa medication before bilateral DBS surgery and retested 6 mo later off and on DBS, combined with off and on levodopa medication. Responses were compared with PD-control subjects (n = 8) tested over the same timescale and 17 healthy control subjects. Neither DBS nor levodopa improved the stepping response. Compensatory stepping in the best-treated state after surgery (DBS+DOPA) was similar to the best-treated state before surgery (DOPA) for the PD-GPi group and the PD-control group. For the PD-STN group, there were more lateral weight shifts, a delayed foot-off, and a greater number of steps required to recover balance in DBS+DOPA after surgery compared with DOPA before surgery. Within the STN group five subjects who did not fall during the experiment before surgery fell at least once after surgery, whereas the number of falls in the GPi and PD-control groups were unchanged. DBS did not improve the compensatory step response needed to recover from balance perturbations in the GPi group and caused delays in the preparation phase of the step in the STN group.

Abstract B04: Hras and Kras have different transformational capacity in murine models of thyroid carcinoma

Thyroid cancer is the most common endocrine malignancy, and incidences are rising. MAP kinase (MAPK) signaling has been implicated in playing a critical role in the initiation and maintenance of thyroid cancer, as evidenced by the high incidence of non-overlapping mutations of the genes encoding RET and TRK, as well as of NRAS, HRAS, KRAS and BRAF. RAS mutations are found in 40-50% of follicular carcinomas (FTC) and 20-40% of follicular adenomas (FA), as well as follicular variant of papillary cancer (FVPTC). The most common mutations associate with thyroid tumors are in HRAS and NRAS, most often in codon 61. This is in contrast to most other epithelial tumors where KRAS codon 12/13 mutations are most common. We hypothesized that Ras isoforms have different transformational potential in thyroid epithelium. To test this hypothesis, we developed mice with a thyroid-specific knock-in of oncogenic Hras combined homozygous loss of Pten (HrasG12V/PtenHom). We report that a thyroid specific knock-in of HrasG12V coupled with Pten inactivation leads to the development of FTCs and poorly differentiated thyroid cancer (PDTCs) by 47-52 weeks of age in HrasG12V/PtenHom/TPO-cre mice. In stark contrast, mice with a thyroid specific knock-in of KrasG12D and loss of Pten (KrasG12D/PtenHom/TPO-cre) develop FTCs which rapidly progress to PDTCs and anaplastic thyroid cancer with 50% lethality at 7 weeks and complete lethality by 20 weeks. These data suggest that Kras and Hras, in cooperation with PI3K signaling, likely play distinct roles in the development and progression of disease. We sought to dissect the role of Hras versus Kras activation in FTC development. We derived stable cell lines from HrasG12V/PtenHom/TPO-cre and obtained a similar line from Kras tumors to identify cellular and molecular responses to Hras versus Kras activation and their impact on tumor phenotype. Utilizing a phospho-protein expression array, we determined that Kras activation leads to increased phosphorylation of members of the p38 MAPK pathway, whereas Hras activation increases mTOR effectors. Pathway profiling indicated differences in transcript levels of MAPK effects in response to Kras versus Hras activation. KrasG12D/Ptenhom cells had increased expression of cell cycle regulators including cyclinD1, whereas extracellular matrix protein Col1a1 was unregulated in Hras-driven cells. Further, Kras-driven cells have an increased ability to form thyrospheres on low-adherence tissue culture plate. These results suggest that Kras induced tumors have a larger population of self-renewing cells and therefore may account for the increase virulence of this oncogene in thyrocytes. These studies demonstrate a clear phenotypic difference between mutant Hras and Kras in thyroid epithelium, and suggest that the increase transformative property of mutant Kras might be mediated by over-expression of proteins that increase cell proliferation and mediate transition through the cell cycle.

Citation Format: Lee Ann King, Nolan West, Aime Franco. Hras and Kras have different transformational capacity in murine models of thyroid carcinoma. [abstract]. In: Proceedings of the AACR Special Conference on RAS Oncogenes: From Biology to Therapy; Feb 24-27, 2014; Lake Buena Vista, FL. Philadelphia (PA): AACR; Mol Cancer Res 2014;12(12 Suppl):Abstract nr B04. doi: 10.1158/1557-3125.RASONC14-B04

Abstract 4291: Hras versus Braf activation determines follicular versus papillary thyroid cancer development

Thyroid cancer is the most common endocrine malignancy, and incidences are rising. MAP kinase (MAPK) signaling has been implicated in playing a critical role in the initiation and maintenance of thyroid cancer, as evidenced by the high incidence of non-overlapping mutations of the genes encoding RET and TRK, as well as of NRAS, HRAS, KRAS and BRAF. Follicular thyroid cancer (FTC) is commonly associated with mutations of the RAS family of oncoproteins, while papillary thyroid cancer (PTC) is often associated with mutations in BRAF. To determine whether mode of MAPK activation played a role in thyroid cancer development in mice, we generated HrasG12V and BrafV600E knock-in models. We report that a thyroid specific knock-in of HrasG12V and Pten inactivation leads to the development of FTCs and poorly differentiated thyroid cancer (PDTCs) by 47-52 weeks of age in HrasG12V/Ptenhom/TPO-cre mice. In stark contrast, mice with a thyroid specific knock-in of BrafV600E and loss of Pten (BrafV600E/Ptenhom/TPO-cre) rapidly develop PDTCs and anaplastic thyroid cancer with complete lethality by weaning, suggesting that Braf and Hras, in cooperation with PI3K signaling, likely play distinct roles in the development and progression of disease. We next sought to dissect the role of Hras versus Braf activation in FTC versus PTC development. We derived stable cell lines from HrasG12V/Ptenhom/TPO-cre and BrafV600E/Ptenhom/TPO-cre tumors in order to identify cellular and molecular consequences of Hras versus Braf activation and their potential impact on tumor phenotype. We have found significant differences in phosphorylation of kinases in response to Hras versus Braf activation. Hras activation leads to increased phosphorylation of mTOR effectors, while Braf activation increases CREB activation. Studies are ongoing to identify the molecular mechanism of these observed differences. We have also shown a significant decrease in the growth of HrasG12V/Ptenhom (p=0.0009) and BrafV600E/Ptenhom (p=0.0001) cells treated with the MEK1/2 inhibitor PD0325901, suggesting that activated Hras or Braf-even in the context of Pten loss-partially relies on MAPK signaling to reach its full oncogenic potential. We have recently employed a PCR array approach to identify differences in the expression of genes related to the MAPK pathway in HrasG12V/Ptenhom and BrafV600E/Ptenhom cell lines. We noted an up-regulation of Myc, Cdkn1a, and Sfn in BrafV600E/Ptenhom cells in comparison to HrasG12V/Ptenhom cells, which may contribute to the different pathophysiology of HrasG12V/Ptenhom and BrafV600E/Ptenhom tumor sub-types. Because FTCs and PTCs have different responses to therapy, we seek to identify the cellular and physiological consequences of Ras versus Raf activation which will hopefully aid in the discovery of novel therapeutic and prevention strategies for thyroid cancer.

Citation Format: Lee Ann King, Jeffrey Knauf, Ronald Ghossein, James Fagin, Aime T. Franco. Hras versus Braf activation determines follicular versus papillary thyroid cancer development. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4291. doi:10.1158/1538-7445.AM2013-4291

Outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli O104:H4 among French tourists returning from Turkey, September 2011

Eight cases of diarrhoea, including two cases of haemolytic uraemic syndrome (HUS), were identified among 22 French tourists who travelled to Turkey in September 2011. A strain of Escherichia coli O104:H4 stx2-positive, eae-negative, hlyA-negative, aggR-positive, ESBL-negative was isolated from one HUS case. Molecular analyses show this strain to be genetically similar but not indistinguishable from the E. coli O104:H4 2011 outbreak strain of France and Germany. Although the source of infection was not identified, we conclude that the HUS cases had probably been infected in Turkey.

Two outbreaks of botulism associated with consumption of green olive paste, France, September 2011

Two family outbreaks of botulism (a total of nine cases) were identified in south-east and northern France in early September 2011. The source of infection was considered to be a ground green olive paste. Botulinum type A toxin was identified in seven cases and in the incriminated olive paste. Incorrect sterilisation techniques were observed at the artisanal producer’s workshop. These episodes highlight the potential public health threat of Clostridium botulinum linked to inadequate sterilisation of food products.

A web-based survey on mephedrone

BACKGROUND

This study sought to collect information on the former legal-high 'mephedrone' using a web-based survey targeted at mephedrone users.

METHODS

The survey was advertised on websites frequented by drug users. Individuals were invited to complete the survey if they had taken mephedrone on at least one occasion in the past.

RESULTS

One thousand and six completed forms were received from declared users, making this the largest survey on mephedrone to date.

CONCLUSION

Results showed that mephedrone users consider its effects to compare best with those of MDMA, and while MDMA was considered marginally safer and its effects more pleasurable, mephedrone's appeal lay in its availability, low price and reliable purity.

Effect of environmental enrichment during the rearing phase on subsequent eggshell quality in broiler breeders

This study set out to investigate if access to an enriched environment during the rearing phase influences subsequent production and eggshell quality in broiler breeders. Broiler breeder pullets were reared under standard rearing conditions (control treatment) or under standard conditions with an environmental enrichment of bales of plastic-wrapped wood shavings (enriched treatment). At 19 weeks of age both groups were transported to a laying facility and housed in standard pens according to treatment type. Egg weight, shape, shell thickness, non-destructive deformation, breaking strength, stiffness and ultrastructural quality were compared at beginning of lay (25 weeks old), peak production (31 weeks old), mid-lay (45 weeks old) and end of lay (57 weeks old). Production and hatchery data were also collected throughout lay. Significant treatment-age interactions were detected for non-destructive deformation, breaking strength and stiffness, such that birds which had received prior enrichment went on to maintain a better shell quality with age. The measurements of total shell thickness, mammillary thickness and effective shell thickness all showed a trend for a treatment-age interaction. Significant age effects were found for weight, shape index, shell thickness, breaking strength and stiffness. All production and hatchery data also demonstrated significant changes with age. It is concluded that early enrichment with bales of wood shavings may provide a novel approach to the maintenance of eggshell quality at a time when calcium metabolism begins to reduce in efficiency.

Artifactual formylation of the secondary amine of duloxetine hydrochloride by acetonitrile in the presence of titanium dioxide: implications for HPLC method development

Duloxetine hydrochloride, a secondary amine containing pharmaceutical, currently marketed as Cymbalta, is shown to undergo N-formylation as an artifact of sample preparation prior to HPLC analysis for impurities. The reaction was discovered as a result of an investigation into variability in the levels of N-formyl duloxetine observed upon HPLC analysis. The reaction is catalyzed by sonication and/or light in the presence of titanium dioxide and is proposed to occur via a radical-initiated mechanism. The mechanism is supported by controlled sample preparation studies with deuterium-labeled acetonitrile and LC/MS studies that showed incorporation of one deuterium into N-formyl duloxetine. This discovery is broadly relevant because sonication is commonly used to aid dissolution of pharmaceuticals in acetonitrile for HPLC analysis, titanium dioxide is a commonly used excipient, the amount of light found in modern analytical laboratories is sufficient to cause the reaction to occur, and secondary amines are present in the structures of many pharmaceuticals. The artifactual reaction was effectively eliminated by changing the sample solvent to methanol and replacing sonication with shaking to aid sample dissolution.

Botulism and hot-smoked whitefish: a family cluster of type E botulism in France, September 2009

A family cluster of three cases of type E botulism were identified in south-east France in September 2009. The suspected food source of infection was a vacuum packed hot-smoked whitefish of Canadian origin purchased by the family during a visit to Finland and consumed several weeks later in France on the day prior to symptom onset. No leftover fish was available to confirm this hypothesis. Vacuum packed hot-smoked whitefish has previously been associated with cases of type E botulism in multiple countries, including Finland, Germany, the United States and Israel.

Community-wide outbreak of Escherichia coli O157:H7 associated with consumption of frozen beef burgers

On 24-25 October 2005 a cluster of five haemolytic uraemic syndrome (HUS) cases was reported in southwest France. An investigation was undertaken to identify the outbreak source and implement control measures. Cases were defined as individuals with HUS or diarrhoea with isolation of Escherichia coli O157:H7 in stools or a positive antibody response to E. coli O157 lipopolysaccharide, resident in southwest France with symptom onset after 19 September 2005. Sixty-nine identified patients had symptom onset between 5 October and 3 November 2005, including 17 cases of HUS. One brand of frozen beef burgers produced on 22 August 2005 was consumed by all patients in the week before symptom onset. E. coli O157:H7 strains from patients, patients' burgers and the manufacturing plant were genetically related. This is the largest community-wide outbreak of E. coli O157:H7 in France to date and the first associated with consumption of contaminated frozen beef burgers.

Two severe cases of botulism associated with industrially produced chicken enchiladas, France, August 2008

Two severe familial cases of botulism were reported to the health authorities in Brittany, north-west France, on 11 August 2008. An investigation was undertaken to identify additional cases, the vehicle of transmission, and to put in place adapted control measures.

Introduction of human papillomavirus (HPV) vaccination into national immunisation schedules in Europe: Results of the VENICE 2007 survey

The European Union Member States are simultaneously considering introducing HPV vaccination into their national immunisation schedules. The Vaccine European New Integrated Collaboration Effort (VENICE) project aims to develop a collaborative European vaccination network. A survey was undertaken to describe the decision status and the decision-making process regarding the potential introduction of human papillomavirus (HPV) vaccination into their national immunisation schedules. A web-based questionnaire was developed and completed online in 2007 by 28 countries participating in VENICE. As of 31 October 2007, five countries had decided to introduce HPV vaccination into the national immunisation schedule, while another seven had started the decision-making process with a recommendation favouring introduction. Varying target populations were selected by the five countries which had introduced the vaccination. Half of the surveyed countries had undertaken at least one ad hoc study to support the decision-making process. According to an update of the decision-status from January 2008, the number of countries which had made a decision or recommendation changed to 10 and 5 respectively. This survey demonstrates the rapidly evolving nature of HPV vaccine introduction in Europe and the existence of expertise and experience among EU Member States. The VENICE network is capable of following this process and supporting countries in making vaccine introduction decisions. A VENICE collaborative web-space is being developed as a European resource for the decision-making process for vaccine introduction.

Hospital workplace experiences of registered nurses that have contributed to their resignation in the Durban metropolitan area

TITLE

Hospital workplace experiences of registered nurses that have contributed to their resignation in the Durban Metropolitan Area.

AIM

The purpose of this research was to explore and describe the hospital workplace experiences that had contributed to the resignations of Registered Nurses in the Durban Metropolitan Area.

METHODOLOGY

The broad perspective governing this research is qualitative in nature. The researcher employed a phenomenological approach specifically because the researcher was interested in identifying, describing and understanding the subjective experiences of individual nurses at the two Private and two Provincial health care institutions selected to participate in the study - in respect of their decision (s) to resign from their employment, and/or to leave the nursing profession. Two semistructured interviews were conducted with each participant by the researcher. The researcher applied the principle of theoretical saturation and a total of fifteen participants were interviewed and thirty interviews were conducted. Experiential themes and subthemes in the data were identified by a process of meaning condensation, and the data were managed by means of a qualitative software package - NVIVO (QSR - NUD*IST).

FINDINGS

The resignations of registered nurses in the Durban Metropolitan Area were found to be linked to their respective hospital workplace experiences. These experiences related to their physical working conditions and environment and included the following: unsupportive management structures, autocratic and dehumanizing management styles, negative stereotypy of nurses and the nursing profession, lack of autonomy in the workplace, professional jealousies and fractures within the profession, sub-optimal physical working conditions and shortage of staff, equipment and lack of appropriate surgical supplies, concerns regarding occupational safety e.g. the increasing exposure of health care personnel to HIV and AIDS; lack of opportunities for promotion or continuing one's professional education, the experience of workplace violence--predominantly in the form of verbal and psychological abuse, inaccurate systems of performance assessment (Joint Performance Management, Reports, Personal Profile systems)--compounded by favouritism and racism; and inadequate remuneration.

CONCLUSION

In terms of the findings of this study, the participants' lived experiences in terms of their respective hospital workplace experiences indicated that neither the maintenance factors nor the motivator factors were optimally represented, experienced or enjoyed in their respective workplaces. In terms of Herzberg's Motivator-Maintenance theory, the registered nurses who participated in this study may be described as being 'not satisfied' and 'dissatisfied' with their hospital workplace experiences, physical conditions and environment. A number of recommendations pertaining to strategies for the retention of registered nurses were made for the consideration of both Provincial and Private health care authorities, hospital management structures and the nursing profession respectively. Recommendations for further nursing research were also made.

Phenotypic and genotypic characterisation of persistent baculovirus infections in populations of the cabbage moth (Mamestra brassicae) within the British Isles

The genotypic relatedness of persistent baculovirus infections within UK populations of Mamestra brassicae was assessed by sequencing amplified regions from polyhedrin and ie1. Most populations harboured Mamestra brassicae (Mb) nucleopolyhedrosis virus (NPV) which showed very little genotypic variation between populations. However, one population harboured a virus that closely resembled a baculovirus found previously only in Pine Beauty Moth (Panolis flammea) populations in Scotland. Persistent baculoviruses that had emerged spontaneously as lethal, overt infections from two of the insect populations were compared with the type strain of MbNPV and a mixture of P. flammea (Pafl) NPV strains, isolated from a single host, by bioassay in virus-free Spodoptera exigua larvae. Reactivated baculoviruses were as pathogenic as the stock virus and showed phenotypic characteristics closest to the type strain they most resembled genetically. Sequence data from the insect host cytochrome oxidase genes were compared and showed a high degree of sequence conservation between populations and it was not possible to determine whether the persistent baculovirus infections had arisen on many occasions or whether they represented a single initial infection that had spread with the host. However, the presence of two distinct virus genotypes in separate M. brassicae populations suggests multiple colonisations of the host are a possibility.

Gender awareness among Veterans Administration health-care workers: existing strengths and areas for improvement

In response to the growing number of women within the Veterans Health Administration (VHA), along with the challenge of meeting their health-care needs in a historically male-focused setting, VHA has supported a variety of research projects aimed at evaluating and improving the status of women's health and health-care experiences. While these efforts have primarily focused on aspects of care such as the availability and accessibility of services and the provision of timely care, this study focused on the contribution of interpersonal aspects of care. Specifically, staff gender awareness, conceptualized as health-care workers' gender-role ideology or attitudes, gender sensitivity, and knowledge was examined. Findings revealed both strengths and weaknesses in domains of staff gender awareness and significant relationships between staff demographics and gender awareness components.

Relationships among alcohol use, hyperarousal, and marital abuse and violence in Vietnam veterans

Alcohol use (frequency and quantity) and the hyperarousal feature of PTSD were examined in relation to male-perpetrated marital abuse and violence using data from 376 couples who participated in the National Vietnam Veterans Readjustment Study. Veteran's self-reported hyperarousal was significantly associated with partner's report of physical violence and psychological abuse toward her. Differential relationships were found between veteran's self reported drinking frequency and drinking quantity and the outcomes; of the two components, only the average quantity consumed per occasion was independently related to husband-to-wife violence. Moreover, a complex interaction emerged between hyperarousal and the two dimensions of alcohol consumption in predicting violence, with the relationship between hyperarousal and violence varying as a function of both drinking frequency and drinking quantity.

Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: a prospective analysis

The authors examined the relationship over time of posttraumatic stress disorder (PTSD) and depression symptoms in a sample of Gulf War veterans. A large sample (N = 2,949) of Gulf War veterans was assessed immediately following their return from the Gulf region and 18-24 months later. Participants completed a number of self-report questionnaires including the Mississippi Scale for Combat-Related PTSD (T. M. Keane, J. M. Caddell, & K. L. Taylor, 1988) and the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983) at both time points and an extended and updated version of the Laufer Combat Scale (M. Gallops, R. S. Laufer, & T. Yager, 1981) at the initial assessment. A latent-variable, cross-lag panel model found evidence for a reciprocal relation between PTSD and Depression. Follow-up models examining reexperiencing, avoidance-numbing, and hyperarousal symptoms separately showed that for reexperiencing and avoidance-numbing symptoms, the overall reciprocal relation held. For hyperarousal symptoms, however, the association was from early hyperarousal to later depression symptoms only.

Posttraumatic stress disorder and retrospectively reported stressor exposure: a longitudinal prediction model

There has been recent concern about the degree to which posttraumatic stress disorder (PTSD) symptomatology influences reports of prior exposure to highly stressful life events. In this longitudinal study of 2,942 male and female Gulf War veterans, the authors documented change in stressor reporting across 2 occasions and the association between change and PTSD symptom severity. A regression-based cross-lagged analysis was used to examine the relationship between PTSD symptom severity and later reported stressor exposure. Shifts in reporting over time were modestly associated with PTSD symptom severity. The cross-lagged analysis revealed a marginal association between Time 1 PTSD symptom severity and Time 2 reported stressor exposure for men and suggested that later reports of stressor exposure are primarily accounted for by earlier reports and less so by earlier PTSD symptomatology.

Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: a prospective analysis

The authors examined the relationship over time of posttraumatic stress disorder (PTSD) and depression symptoms in a sample of Gulf War veterans. A large sample (N = 2,949) of Gulf War veterans was assessed immediately following their return from the Gulf region and 18-24 months later. Participants completed a number of self-report questionnaires including the Mississippi Scale for Combat-Related PTSD (T. M. Keane, J. M. Caddell, & K. L. Taylor, 1988) and the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983) at both time points and an extended and updated version of the Laufer Combat Scale (M. Gallops, R. S. Laufer, & T. Yager, 1981) at the initial assessment. A latent-variable, cross-lag panel model found evidence for a reciprocal relation between PTSD and Depression. Follow-up models examining reexperiencing, avoidance-numbing, and hyperarousal symptoms separately showed that for reexperiencing and avoidance-numbing symptoms, the overall reciprocal relation held. For hyperarousal symptoms, however, the association was from early hyperarousal to later depression symptoms only.

Posttraumatic stress disorder and retrospectively reported stressor exposure: a longitudinal prediction model

There has been recent concern about the degree to which posttraumatic stress disorder (PTSD) symptomatology influences reports of prior exposure to highly stressful life events. In this longitudinal study of 2,942 male and female Gulf War veterans, the authors documented change in stressor reporting across 2 occasions and the association between change and PTSD symptom severity. A regression-based cross-lagged analysis was used to examine the relationship between PTSD symptom severity and later reported stressor exposure. Shifts in reporting over time were modestly associated with PTSD symptom severity. The cross-lagged analysis revealed a marginal association between Time 1 PTSD symptom severity and Time 2 reported stressor exposure for men and suggested that later reports of stressor exposure are primarily accounted for by earlier reports and less so by earlier PTSD symptomatology.

Growth factor enhanced retroviral gene transfer to the adult central nervous system

The use of viral vectors for gene delivery into mammalian cells provides a new approach in the treatment of many human diseases. The first viral vector approved for human clinical trials was murine leukemia virus (MLV), which remains the most commonly used vector in clinical trials to date. However, the application of MLV vectors is limited since MLV requires cells to be actively dividing in order for transduction and therefore gene delivery to occur. This limitation precludes the use of MLV for delivering genes to the adult CNS, where very little cell division is occurring. However, we speculated that this inherent limitation of ML V may be overcome by utilizing the known mitogenic effect of growth factors on cells of the CNS. Specifically, an in vivo application of growth factor to the adult brain, if able to induce cell division, could enhance MLV-based gene transfer to the adult brain. We now show that an exogenous application of basic fibroblast growth factor induces cell division in vivo. Under these conditions, where cells of the adult brain are stimulated to divide, MLV-based gene transfer is significantly enhanced. This novel approach precludes any vector modifications and provides a simple and effective way of delivering genes to cells of the adult brain utilizing MLV-based retroviral vectors.

Coping with Gulf War combat stress: mediating and moderating effects

The authors examined relationships between method of coping with combat-related stress and psychological symptoms among Gulf War Army personnel (N = 1,058). Participants were surveyed on return from the Gulf region (Time 1) with the Coping Responses Inventory (R. Moos, 1990) and a measure of combat exposure. Outcomes were symptom measures of posttraumatic stress disorder (PTSD) and depression. At Time 2 (18-24 months) participants completed the same symptom measures and an index of postwar stress. Higher proportions of approach-based coping in the war zone were related to lower levels of psychological symptoms. Combat exposure moderated the effects of coping on Time 1 PTSD. Coping predicted changes in symptoms of depression but not PTSD. Combat exposure affected changes in depression through postwar stress but had a direct negative effect on PTSD.

Mutagenesis of the active site coding region of the Autographa californica nucleopolyhedrovirus chiA gene

The chitinase of Autographa californica nucleopolyhedrovirus (AcMNPV) is required for the characteristic liquefaction of baculovirus-infected insect larvae. Alignments of the putative active sites of a range of chitinases revealed two highly conserved residues, glutamate and aspartate, which have been proposed to constitute the catalytic residues of the active site. These residues were mutated in the AcMNPV chitinase. Three recombinant viruses were generated, AcchiA(D311G), AcchiA(E315G) and AcchiA(D311G E315G), which contained mutations at either the glutamate, the aspartate or both. It was demonstrated that chitinase protein production was unaffected by the mutation of these residues. However, mutation of both residues resulted in the attenuation of chitinolytic activity and the cessation of liquefaction of Trichoplusia ni larvae infected with AcchiA(D311G E315G). Mutagenesis of the glutamate residue led to a reduction in exochitinase activity and a delay in the appearance of endochitinase activity. In addition, larvae infected with this virus, AcchiA(E315G), liquefied more slowly than those larvae infected with wild-type AcMNPV. Mutagenesis of the aspartate residue resulted in a reduction of exochitinase activity but an unexpected enhancement of endochitinolytic activity. Liquefaction of AcchiA(D311G)-infected larvae was observed at the same time as that of AcMNPV-infected larvae.

Sedation for intractable distress of a dying patient: acute palliative care and the principle of double effect

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded the Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The case presented is of a young man dying of recurrent epithelioid hemangioendothelioma, distressed with stridor and severe pain, whose poorly controlled symptoms were successfully treated with an infusion of propofol, titrated to provide effective comfort in the last few hours of the patient's life. The tenet of double effect, which allows aggressive treatment of suffering in spite of foreseeable but unintended consequences, is reviewed. The patient's parents were invited and contributed to the Rounds, providing compelling testimony to the power of the presence of clinicians at the time of death and the importance of open communication about difficult ethical issues.

Solid-phase extraction for profiling of ecstasy tablets

A solid-phase extraction (SPE) procedure has been developed for impurity profiling of illicit tablets containing 3,4-methylenedioxy-N-methyl-amphetamine (MDMA, ecstasy). Following initial comparison of liquid-liquid extraction and solid-phase extraction, SPE was found to be preferable because it afforded higher extraction efficiencies and shorter extraction times. Procedure blank samples were also analyzed to identify constituents of the extracts which did not originate in the ecstasy tablets. The developed procedure was subsequently applied to 12 samples of seized ecstasy tablets and a comparison was made of these samples to determine similarities and obtain inferences with respect to commonality of origin.

Expression of the green fluorescent protein carried by Autographa californica multiple nucleopolyhedrovirus in insect cell lines

A recombinant AcMNPV containing the green fluorescent protein (gfp) gene under the polyhedrin promoter (polh) was used to investigate the expression of the gfp gene as well as the production of recombinant extracellular virus in 14 continuous insect cell lines, including Heliothis virescens (BCIRL-HV-AM1), Helicoverpa zea (BCIRL-HZ-AM1), Anticarsia gemmatalis (BCIRL-AG-AM1), Trichoplusia ni (TN-CL1), Spodoptera frugiperda (IPLB-SF21), Spodoptera exigua (BCIRL/AMCY-Se-E1 and BCIRL/AMCY-Se-E5), Bombyx mori (BMN), Sf9 (a clone of IPLB-SF21), and five cell line clones of BCIRL-HV-AM1. The susceptibility of the cell lines to the recombinant virus (AcMNPV.GFP) was ascertained by calculating the mean percentage number of green light-emitting cells as well as by TCID50 titration of extracellular virus with fluorescence as a sign of infection. Of the 14 cell lines tested, all were permissive with varying degrees to AcMNPV.GFP, except BCIRL-HV-AMCL2 and BCIRL-HZ-AM1, both grown in serum-containing medium, and BMN, grown in serum-free medium, which were nonpermissive to the virus. Except for BCIRL/AMCY-Se-E1, IPLB-SF21, and four of the five BCIRL-HV-AM1 clones, all the other cell lines (BCIRL-HV-AM1, BCIRL-AG-AM1, TN-CL1, Se-E5, and Sf9) expressed detectable levels of GFP by 48 h postinoculation. The BCIRL/AMCY-Se-E1 and IPLB-SF21 cells, grown in serum-free medium (Ex-Cell 401), expressed detectable levels of GFP at 72 h postinoculation. By contrast, in BCIRL/AMCY-Se-E1 in serum-containing medium (Ex-Cell 401 + 10% FBS [fetal bovine serum]), GFP was detected at 48 h postinoculation. Furthermore, TN-CL1 cells produced the largest mean percentage number of fluorescent (76.6%) cells in both serum-containing and serum-free medium (64.8%) at 120 h postinoculation. All the BCIRL-HV-AM1 clones showed no GFP expression until 96 h postinoculation, and only then about 1% of the cell population fluoresced. The mean extracellular virus (ECV) production at 120 h postinoculation was highest in BCIRL/AMCY-Se-E5 cells grown in Ex-Cell 401 + 10% FBS (37.8 x 10% TCID50/ml) followed by BCIRL-HV-AM1 in TC199-MK (33.4 x 10(6) TCID50/ml). Only the BCIRL-HV-AMCL3 clone produced any substantial level of ECV at 120 h postinoculation (16.9 x 10(6) TCID50/ml). However, there was no significant correlation between ECV production and the mean percentage number of fluorescent cells. This study provides further information on the susceptibility of 14 insect cell lines to a recombinant AcMNPV containing the green fluorescent protein gene. This information might avail researchers with information to facilitate decisions as to what other cell lines are available for in vitro studies of the gfp gene.

Linguistic styles: language use as an individual difference

Can language use reflect personality style? Studies examined the reliability, factor structure, and validity of written language using a word-based, computerized text analysis program. Daily diaries from 15 substance abuse inpatients, daily writing assignments from 35 students, and journal abstracts from 40 social psychologists demonstrated good internal consistency for over 36 language dimensions. Analyses of the best 15 language dimensions from essays by 838 students yielded 4 factors that replicated across written samples from another 381 students. Finally, linguistic profiles from writing samples were compared with Thematic Apperception Test coding, self-reports, and behavioral measures from 79 students and with self-reports of a 5-factor measure and health markers from more than 1,200 students. Despite modest effect sizes, the data suggest that linguistic style is an independent and meaningful way of exploring personality.

Linguistic styles: language use as an individual difference

Can language use reflect personality style? Studies examined the reliability, factor structure, and validity of written language using a word-based, computerized text analysis program. Daily diaries from 15 substance abuse inpatients, daily writing assignments from 35 students, and journal abstracts from 40 social psychologists demonstrated good internal consistency for over 36 language dimensions. Analyses of the best 15 language dimensions from essays by 838 students yielded 4 factors that replicated across written samples from another 381 students. Finally, linguistic profiles from writing samples were compared with Thematic Apperception Test coding, self-reports, and behavioral measures from 79 students and with self-reports of a 5-factor measure and health markers from more than 1,200 students. Despite modest effect sizes, the data suggest that linguistic style is an independent and meaningful way of exploring personality.

Course and predictors of posttraumatic stress disorder among Gulf War veterans: a prospective analysis

Rates and predictors of posttraumatic stress disorder (PTSD) over time are not well understood. This study is the first to look at the rates of PTSD immediately following war and 2 years later using a large cohort (N = 2,949) of Gulf War veterans. Using a cut score to indicate presumptive PTSD, 3% of participants exceeded the cutoff at Time 1 compared with 8% at Time 2. Those who exceeded the cutpoint at Time 1 were up to 20 times more likely to exceed the cutpoint at Time 2 than those who did not exceed the cutpoint at Time 1. Women and those with high levels of combat exposure were at increased risk for PTSD at both times. Being young, being single, and having previous combat experience were associated with increased risk at Time 1 only, whereas reservists and enlisted personnel were at increased risk at Time 2 only. These findings indicate that, although low initially, rates of PTSD increased substantially over time.

Course and predictors of posttraumatic stress disorder among Gulf War veterans: a prospective analysis

Rates and predictors of posttraumatic stress disorder (PTSD) over time are not well understood. This study is the first to look at the rates of PTSD immediately following war and 2 years later using a large cohort (N = 2,949) of Gulf War veterans. Using a cut score to indicate presumptive PTSD, 3% of participants exceeded the cutoff at Time 1 compared with 8% at Time 2. Those who exceeded the cutpoint at Time 1 were up to 20 times more likely to exceed the cutpoint at Time 2 than those who did not exceed the cutpoint at Time 1. Women and those with high levels of combat exposure were at increased risk for PTSD at both times. Being young, being single, and having previous combat experience were associated with increased risk at Time 1 only, whereas reservists and enlisted personnel were at increased risk at Time 2 only. These findings indicate that, although low initially, rates of PTSD increased substantially over time.

Partners' ratings of combat veterans' PTSD symptomatology

The current study examined the concordance of combat veterans' scores on the Mississippi Scale for Combat-Related PTSD, with scores on a parallel version of that instrument completed by partners to assess veterans' symptoms. Further, the study examined the impact of quality of the marital relationship on score concordance. Bivariate and multiple regression were used with a sample of 466 veteran-partner dyads obtained from the National Vietnam Veterans Readjustment Study. There was moderate agreement in symptom reporting between veterans and their partners and little evidence to suggest that the quality of the relationship impacted upon the association between partner and veteran scores.

In vitro host range of Autographa californica nucleopolyhedrovirus recombinants lacking functional p35, iap1 or iap2

We have examined the host range in different insect cell lines of Autographa californica nucleopolyhedrovirus (AcMNPV) recombinants lacking p35, iap1 or iap2. These genes encode, or are predicted to encode, anti-apoptotic proteins. Abrogation of p35 reduced the ability of AcMNPV to replicate in permissive cell lines derived from Spodoptera frugiperda insects by inducing apoptosis. In semi-permissive cell lines, such as Lymantria dispar and Spodoptera littoralis cells, we observed cytopathic effects after infection with AcMNPV but little virus production. Infection of these cells by AcMNPV lacking p35 resulted in apoptosis. However, p35-deficient viruses were still able to replicate normally in Trichoplusia ni, Mamestra brassicae and Panolis flammea cell lines. Disruption of AcMNPV iap1 and iap2 was found not to affect virus replication in any of the cell lines. It was also possible to disrupt both iap1 and iap2 in the same virus without loss of infectivity. A virus without iap1 and p35 demonstrated identical growth characteristics and host range to a virus lacking p35. We conclude that in cells which respond to AcMNPV infection by initiating programmed cell death, the p35 gene product alone is sufficient to inhibit apoptosis. Removal of iap1 or iap2 has no effect on virus replication, even in cell lines which do not undergo apoptosis in response to AcMNPV infection. Our results with two semi-permissive cell lines further indicate that whilst p35 is important in blocking block apoptosis, other factors are involved in restricting AcMNPV replication within these cells.

Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: risk factors, war-zone stressors, and resilience-recovery variables

Relationships among pretrauma risk factors (e.g., family instability, childhood antisocial behavior), war-zone stressors (e.g., combat, perceived threat), posttrauma resilience-recovery variables (e.g., hardiness, social support), and posttraumatic stress disorder (PTSD) symptom severity were examined. Data from a national sample of 432 female and 1,200 male veterans were analyzed using structural equation modeling. For both genders, direct links to PTSD from pretrauma, war-zone, and posttrauma variable categories were found; several direct associations between pretrauma and posttrauma variables were documented. Although war-zone stressors appeared preeminent for PTSD in men, posttrauma resilience-recovery variables were more salient for women. Researchers, policymakers, and clinicians are urged to take a broad view on trauma and its sequelae, especially regarding possible multiple exposures over time and the depletion and availability of important resources.

Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: risk factors, war-zone stressors, and resilience-recovery variables

Relationships among pretrauma risk factors (e.g., family instability, childhood antisocial behavior), war-zone stressors (e.g., combat, perceived threat), posttrauma resilience-recovery variables (e.g., hardiness, social support), and posttraumatic stress disorder (PTSD) symptom severity were examined. Data from a national sample of 432 female and 1,200 male veterans were analyzed using structural equation modeling. For both genders, direct links to PTSD from pretrauma, war-zone, and posttrauma variable categories were found; several direct associations between pretrauma and posttrauma variables were documented. Although war-zone stressors appeared preeminent for PTSD in men, posttrauma resilience-recovery variables were more salient for women. Researchers, policymakers, and clinicians are urged to take a broad view on trauma and its sequelae, especially regarding possible multiple exposures over time and the depletion and availability of important resources.

Modeling physical health and functional health status: the role of combat exposure, posttraumatic stress disorder, and personal resource attributes

This study examined associations of combat exposure and posttraumatic stress disorder (PTSD) with physical health conditions and also incorporated hardiness and social support as mediators and functional health status as an outcome. Data were derived from 1,632 male and female Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. Path analysis revealed that hardiness and social support operated primarily as intermediary variables between combat exposure and PTSD, and PTSD emerged as the pivotal variable explaining physical health conditions and functional health status. Gender-based differences in means and patterns of associations among variables were found. The results stress the importance of assessing trauma in clinical settings as a meaningful determinant of health outcomes.

Localization of a baculovirus-induced chitinase in the insect cell endoplasmic reticulum

Confocal immunofluorescence microscopy was used to demonstrate that the Autographa californica nucleopolyhedrovirus (AcMNPV) chitinase was localized within the endoplasmic reticulum (ER) of virus-infected insect cells. This was consistent with removal of the signal peptide from the chitinase and an ER localization motif (KDEL) at the carboxyl end of the protein. Chitinase release from cells, a prerequisite for liquefaction of virus-infected insect larvae, appears to be aided by synthesis of the p10 protein. Deletion of p10 from the AcMNPV genome delayed the appearance of chitinase activity in the medium of virus-infected cells by 24 h and also delayed liquefaction of virus-infected Trichoplusia ni larvae by the same period.

What makes a life good?

Two studies examined folk concepts of the good life. Samples of college students (N = 104) and community adults (N = 264) were shown a career survey ostensibly completed by a person rating his or her occupation. After reading the survey, participants judged the desirability and moral goodness of the respondent's life, as a function of the amount of happiness, meaning in life, and wealth experienced. Results revealed significant effects of happiness and meaning on ratings of desirability and moral goodness. In the college sample, individuals high on all 3 independent variables were judged as likely to go to heaven. In the adult sample, wealth was also related to higher desirability. Results suggest a general perception that meaning in life and happiness are essential to the folk concept of the good life, whereas money is relatively unimportant.

Daily goals, life goals, and worst fears: means, ends, and subjective well-being

This study addressed the relations among personal strivings (daily goals) and future life goals and worst fears. Eighty undergraduate participants (62 women, 18 men) listed their daily goals, their ultimate life goals, and their worst fears, and completed questionnaire measures of subjective well-being. Daily goals were content-analyzed for relevance to attaining life goals or avoiding worst fears. Daily goals that were instrumental to life goals or that avoided worst fears were rated as more important but also more difficult by participants. Working on daily goals avoiding one's worst fears was negatively related to measures of subjective well-being, controlling for daily goal progress, difficulty, ambivalence, and importance. Working on daily goals that were instrumental to one's life goals only weakly predicted well-being. The avoidance of worst fears interacted with daily goal appraisals such that individuals who experienced little progress at daily goals that served to avoid their "worst case scenario" experienced the lowest levels of subjective well-being. In addition, progress at daily goals that were relevant to accomplishing one's life goals was significantly more strongly related to subjective well-being than progress at daily goals that were unrelated to one's life goals. Results indicate that daily goals are used to enact life goals and avoid worst fears and that these means--end relations have implications for well-being.