Differential effects of 3,5-T2 and T3 on the gill regeneration and metamorphosis of the Ambystoma mexicanum (axolotl)

Thyroid hormones (THs) regulate tissue remodeling processes during early- and post-embryonic stages in vertebrates. The Mexican axolotl (Ambystoma mexicanum) is a neotenic species that has lost the ability to undergo metamorphosis; however, it can be artificially induced by exogenous administration of thyroxine (T4) and 3,3',5-triiodo-L-thyronine (T3). Another TH derivative with demonstrative biological effects in fish and mammals is 3,5-diiodo-L-thyronine (3,5-T2). Because the effects of this bioactive TH remains unexplored in other vertebrates, we hypothesized that it could be biologically active in amphibians and, therefore, could induce metamorphosis in axolotl. We performed a 3,5-T2 treatment by immersion and observed that the secondary gills were retracted, similar to the onset stage phenotype; however, tissue regeneration was observed after treatment withdrawal. In contrast, T4 and T3 immersion equimolar treatments as well as a four-fold increase in 3,5-T2 concentration triggered complete metamorphosis. To identify the possible molecular mechanisms that could explain the contrasting reversible or irreversible effects of 3,5-T2 and T3 upon gill retraction, we performed a transcriptomic analysis of differential expression genes in the gills of control, 3,5-T2-treated, and T3-treated axolotls. We found that both THs modify gene expression patterns. T3 regulates 10 times more genes than 3,5-T2, suggesting that the latter has a lower affinity for TH receptors (TRs) or that these hormones could act through different TR isoforms. However, both TH treatments regulated different gene sets known to participate in tissue development and cell cycle processes. In conclusion, 3,5-T2 is a bioactive iodothyronine that promoted partial gill retraction but induced full metamorphosis in higher concentrations. Differential effects on gill retraction after 3,5,-T2 or T3 treatment could be explained by the activation of different clusters of genes related with apoptosis, regeneration, and proliferation; in addition, these effects could be initially mediated by TRs that are expressed in gills. This study showed, for the first time, the 3,5,-T2 bioactivity in a neotenic amphibian.

Molecular evolutionary trends and feeding ecology diversification in the Hemiptera, anchored by the milkweed bug genome

BACKGROUND

The Hemiptera (aphids, cicadas, and true bugs) are a key insect order, with high diversity for feeding ecology and excellent experimental tractability for molecular genetics. Building upon recent sequencing of hemipteran pests such as phloem-feeding aphids and blood-feeding bed bugs, we present the genome sequence and comparative analyses centered on the milkweed bug Oncopeltus fasciatus, a seed feeder of the family Lygaeidae.

RESULTS

The 926-Mb Oncopeltus genome is well represented by the current assembly and official gene set. We use our genomic and RNA-seq data not only to characterize the protein-coding gene repertoire and perform isoform-specific RNAi, but also to elucidate patterns of molecular evolution and physiology. We find ongoing, lineage-specific expansion and diversification of repressive C2H2 zinc finger proteins. The discovery of intron gain and turnover specific to the Hemiptera also prompted the evaluation of lineage and genome size as predictors of gene structure evolution. Furthermore, we identify enzymatic gains and losses that correlate with feeding biology, particularly for reductions associated with derived, fluid nutrition feeding.

CONCLUSIONS

With the milkweed bug, we now have a critical mass of sequenced species for a hemimetabolous insect order and close outgroup to the Holometabola, substantially improving the diversity of insect genomics. We thereby define commonalities among the Hemiptera and delve into how hemipteran genomes reflect distinct feeding ecologies. Given Oncopeltus's strength as an experimental model, these new sequence resources bolster the foundation for molecular research and highlight technical considerations for the analysis of medium-sized invertebrate genomes.

Molecular evolutionary trends and feeding ecology diversification in the Hemiptera, anchored by the milkweed bug genome

BACKGROUND

The Hemiptera (aphids, cicadas, and true bugs) are a key insect order, with high diversity for feeding ecology and excellent experimental tractability for molecular genetics. Building upon recent sequencing of hemipteran pests such as phloem-feeding aphids and blood-feeding bed bugs, we present the genome sequence and comparative analyses centered on the milkweed bug Oncopeltus fasciatus, a seed feeder of the family Lygaeidae.

RESULTS

The 926-Mb Oncopeltus genome is well represented by the current assembly and official gene set. We use our genomic and RNA-seq data not only to characterize the protein-coding gene repertoire and perform isoform-specific RNAi, but also to elucidate patterns of molecular evolution and physiology. We find ongoing, lineage-specific expansion and diversification of repressive C2H2 zinc finger proteins. The discovery of intron gain and turnover specific to the Hemiptera also prompted the evaluation of lineage and genome size as predictors of gene structure evolution. Furthermore, we identify enzymatic gains and losses that correlate with feeding biology, particularly for reductions associated with derived, fluid nutrition feeding.

CONCLUSIONS

With the milkweed bug, we now have a critical mass of sequenced species for a hemimetabolous insect order and close outgroup to the Holometabola, substantially improving the diversity of insect genomics. We thereby define commonalities among the Hemiptera and delve into how hemipteran genomes reflect distinct feeding ecologies. Given Oncopeltus's strength as an experimental model, these new sequence resources bolster the foundation for molecular research and highlight technical considerations for the analysis of medium-sized invertebrate genomes.

Der Vergleich zweier Prozentsätze und die Analyse von Mehrfeldertafeln auf Unabhängigkeit oder Homogenität und Symmetrie mit Hilfe der Informationsstatistik 2 I

Die vorliegende Arbeit zeigt an Hand von Beispielen, daß mit Hilfe der Informationsstatistik 2 I und den in den einschlägigen Arbeiten tabelliert vorliegenden 2n · In n Werten der in der therapeutischen Statistik häufige Vergleich von Prozentsätzen schnell und exakt durchgeführt werden kann. Kontingenztafeln können mit dieser Technik elegant auf Unabhängigkeit und Symmetrie geprüft werden. Darüber hinaus lassen sich n-dimensionale Kontingenztafeln praktisch nur über die Informationsstatistik auf Unabhängigkeit oder Homogenität, bedingte Unabhängigkeit und Wechselwirkung prüfen.

Loss of desmoglein 2 promotes tumorigenic behavior in pancreatic cancer cells

The ability to maintain cell-cell adhesion is crucial for tissue integrity and organization. Accordingly, loss of cohesiveness plays a critical role in cancer invasion and metastasis. Desmosomes are cell junctions providing strong intercellular adhesive strength and dysregulation of desmosomal constituents contributes to cancer progression through altered cell signaling pathways. Here, we focused on the desmosomal adhesion molecules Desmoglein 2 (Dsg2) and Desmocollin 2 (Dsc2), and their contribution to migration and invasion in pancreatic cancer cells. Silencing of Dsg2 but not Dsc2 resulted in loss of cell cohesion and enhanced migration, and invasion of pancreatic adenocarcinoma cells. To identify potential pathways regulated by Dsg2, we performed kinase arrays and detected the activity of ERK and growth factor receptors to be significantly enhanced in Dsg2-deficient cells. Consequently, inhibition of ERK phosphorylation in Dsg2 knockdown cells normalized migration. Loss of Dsg2 resulted in reduced levels of the desmosomal adapter protein and transcriptional regulator Plakoglobin (PG) in an ERK-dependent manner, whereas other desmosomal molecules were not altered. Overexpression of PG rescued enhanced migration induced by silencing of Dsg2. These results identify a novel pro-migratory pathway of pancreatic cancer cells in which loss of Dsg2 reduces the levels of PG via deregulated MAPK signaling.

Dynamic BMP signaling polarized by Toll patterns the dorsoventral axis in a hemimetabolous insect

Toll-dependent patterning of the dorsoventral axis in Drosophila represents one of the best understood gene regulatory networks. However, its evolutionary origin has remained elusive. Outside the insects Toll is not known for a patterning function, but rather for a role in pathogen defense. Here, we show that in the milkweed bug Oncopeltus fasciatus, whose lineage split from Drosophila's more than 350 million years ago, Toll is only required to polarize a dynamic BMP signaling network. A theoretical model reveals that this network has self-regulatory properties and that shallow Toll signaling gradients are sufficient to initiate axis formation. Such gradients can account for the experimentally observed twinning of insect embryos upon egg fragmentation and might have evolved from a state of uniform Toll activity associated with protecting insect eggs against pathogens.

Ion metabolism in aHalobacterium : II. Ion concentrations in cells at different levels of metabolism

The changes in concentration of K(+), Na(+) and Cl(-) are given in growing cultures of aHalobacterium species subjected to cold, lack of O2 or starvation. In growing cells, the ion concentration ratios across the cell membrane were 1,000∶1 (inside:outside) for K(+) and 1∶2 for Na(+). In bacteria with a low rate of endogenous metabolism induced by 24-hr starvation, the ratios were 500∶1 for K(+) and 1∶4 for Na(+). O2 and a substrate were required for K(+) uptake in growing bacteria, but not for the maintenance of K(+) and Na(+) gradients in starving bacteria. The exchange of K(+), Na(+) and Li(+) across the cell membrane of starving bacteria was found to have a time constant for 50% completion of the process of 20 to 30 sec. The exchange of cell Cl(-) with NO 3 (-) was a twostage process with time constants of approximately 2 min and 2-1/2 hr. The results are explained in terms of the binding of most of the cell K(+) which brings about the distribution of Na(+) and Cl(-) according to the Gibbs-Donnan equilibrium; the role of metabolism is to induce changes in the mean ion-activity coefficients.

Cell-virus Interactions with the Polyoma Virus: The Induction of Cell Transformation and Malignancy in vitro

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Insulin-like growth factor 1-coated sutures improve anastomotic healing in an experimental model of colitis

BACKGROUND

: Exogenously applied insulin-like growth factor (rhIGF-1) may improve normal intestinal healing. This study examined the effect of rhIGF-1-coated sutures on anastomotic healing in experimental colitis.

METHODS

: Acute colitis was induced in rats by dextran sodium sulphate (DSS). Inflammation was assessed by clinical Disease Activity Index (DAI), myeloperoxidase (MPO) measurement and histological examination. A distal colonic anastomosis was performed using sutures coated with rhIGF-1 dissolved in poly(D,L-lactide) (PDLLA) under general anaesthetic. Anastomotic healing was evaluated histologically, and by hydroxyproline measurement and bursting parameters after 1, 3 and 7 days, and compared with healthy, DSS and DSS + PDLLA controls.

RESULTS

: DAI, MPO and histological inflammation scores were significantly increased in all animals treated with DSS. Bursting occurred less often within the anastomotic line on day 3 in the IGF group than in DSS controls (three versus eight of ten). On day 7, the IGF group had significantly increased histological healing scores (mean(s.e.m.) 12.5(0.7) versus 9.2(0.8) (P < 0.050)) and hydroxyproline content (4.6(0.3) versus 3.6(0.1) mg/g tissue; P < 0.050) compared with DSS controls.

CONCLUSION

: IGF-1-coated sutures improve important aspects of anastomotic healing in rats with experimental colitis.

The molecular regulators of macrophage and granulocyte development. Role of MGI-2/IL-6

The development of a cell culture system for the in vitro cloning and clonal differentiation of normal hematopoietic cells made it possible to identify the proteins that regulate growth and differentiation of different hematopoietic cell lineages and the change in normal controls that produce leukemia. A model system with myeloid cells has identified different myeloid cell colony-inducing proteins, which we called MGI-1 (= CSF, including IL-3). There is another protein that we first described in 1976 and called MGI-2 in 1980 that induces differentiation of myeloid cells to macrophages or granulocytes without inducing the clonal growth of myeloid cells. The four CSF proteins and IL-1 induce the production of MGI-2 in myeloid cells and MGI-2 induces the production of GM-CSF. This shows the participation of MGI-2 in the network of interactions with different myeloid regulatory proteins. Using a monoclonal antibody to MGI-2, amino acid sequencing, and recombinant protein, we have shown in collaboration with the Genetics Institute that the major form of MGI-2 (MGI-2A) is IL-6. This shows that IL-6 is a myeloid cell differentiation inducing protein. The results also suggest new clinical potentials for MGI-2/IL-6.

Cell differentiation and tumour suppression

Identification of growth and differentiation-inducing proteins and how they interact in normal development has made it possible to identify the molecular basis of normal development and the mechanisms that uncouple growth and differentiation so as to produce malignant cells. When normal cells have been changed into cancer cells, the malignant phenotype can again be suppressed. Results on the molecular control of growth and differentiation in normal myeloid haemopoietic cells, changes in the normal developmental programme in myeloid leukaemia, and the suppression of malignancy in myeloid leukaemia and sarcomas have shown that (1) malignancy can be suppressed either with or without genetic changes in the malignant cells, (2) suppression of malignancy by inducing differentiation does not have to restore all the normal controls, and (3) genetic abnormalities which give rise to malignancy can be bypassed and their effects nullified by inducing differentiation which stops cells from multiplying.

Regulation of leukaemic cells by interleukin 6 and leukaemia inhibitory factor

Interleukin 6 (IL-6) and leukaemia inhibitory factor (LIF) can have pleiotropic effects on different cell types. M1 myeloid leukaemic cells respond to IL-6 with activation of a terminal differentiation programme which includes activation of genes for certain haemopoietic regulatory proteins (IL-6, IL-1 alpha, IL-1 beta, granulocyte-macrophage colony-stimulating factor [GM-CSF], M-CSF, tumour necrosis factor and transforming growth factor [TGF] beta 1) and for receptors for some of these proteins, thus establishing a network of positive and negative regulatory cytokines. IL-6 and some other cytokines also induce during differentiation sustained levels of transcription factors that can regulate and maintain gene expression in the differentiation programme. M1 leukaemic cells induced to differentiate with IL-6 undergo programmed cell death (apoptosis) on withdrawal of IL-6, and can be rescued from apoptosis by IL-6, IL-3, M-CSF, G-CSF or IL-1, but not by GM-CSF. These differentiating leukaemic cells can also be rescued from apoptosis by the tumour promoter TPA (12-O-tetradecanoylphorbol-13-acetate) but not by the non-tumour-promoting isomer 4-alpha-TPA, and rescue from apoptosis can be achieved by different pathways. Apoptosis can also be induced in undifferentiated M1 leukaemic cells by expression of the wild-type form of the tumour suppressor p53 protein and IL-6 can rescue the cells from this wild-type p53-mediated apoptosis. There are clones of M1 cells that differentiate with IL-6 but not with LIF and another M1 clone that differentiates with either IL-6 or LIF. Differentiation induced by IL-6 or LIF is inhibited by TGF-beta 1. The pleiotropic effects of LIF, like those of IL-6, are presumably also in a network of interacting regulatory proteins.

The molecular control of normal and leukemic hematopoiesis: myeloid cells as a model system

The establishment of a cell culture system for the clonal development of hematopoietic cells has made it possible to identify the proteins that control growth and differentiation of different hematopoietic cell lineages and to discover the molecular basis of normal and abnormal cell development in blood-forming tissues. A model system with myeloid cells has shown that normal hematopoietic cells require different proteins to induce cell multiplication and cell differentiation and that a cascade of interactions between proteins determines the correct balance between immature and mature cells in normal development. Gene cloning has shown that there is a family of different genes for these proteins. Normal protein regulators of hematopoiesis can control the abnormal growth of certain types of leukemic cells and suppress malignancy by inducing differentiation to mature non-dividing cells, and there are different pathways of inducing differentiation. Results from studies on the molecular control of growth and differentiation in normal myeloid hematopoietic cells, on changes in the normal developmental program, and on the suppression of malignancy in myeloid leukemia have shown that (a) malignancy can be suppressed by inducing differentiation either with or without genetic changes in the malignant cells, (b) this suppression of malignancy does not have to restore all the normal controls, and (c) genetic abnormalities that give rise to malignancy, which include changes in homeobox genes, can be bypassed and their effects nullified by inducing differentiation that stops cells from multiplying.

Epigenetics and the plasticity of differentiation in normal and cancer stem cells

Embryonic stem cells are characterized by their differentiation to all cell types during embryogenesis. In adult life, different tissues also have somatic stem cells, called adult stem cells, which in specific niches can undergo multipotent differentiation. The use of these adult stem cells has considerable therapeutic potential for the regeneration of damaged tissues. In both embryonic and adult stem cells, differentiation is controlled by epigenetic mechanisms, and the plasticity of differentiation in these cells is associated with transcription accessibility for genes expressed in different normal tissues. Abnormalities in genetic and/or epigenetic controls can lead to development of cancer, which is maintained by self-renewing cancer stem cells. Although the genetic abnormalities produce defects in growth and differentiation in cancer stem cells, these cells have not always lost the ability to undergo differentiation through epigenetic changes that by-pass the genomic abnormalities, thus creating the basis for differentiation therapy. Like normal stem cells, cancer stem cells can show plasticity for differentiation. This plasticity of cancer stem cells is also associated with transcription accessibility for genes that are normally expressed in different tissues, including tissues other than those from which the cancers originated. This broad transcription accessibility can also contribute to the behavior of cancer cells by overexpressing genes that promote cell viability, growth and metastasis.

Cytokines as suppressors of apoptosis

Many cytokines have been isolated by their ability to induce growth and have been called growth factors. But these cytokines are also essential to induce cell viability, and cell viability and growth can be separately regulated. Using as examples myeloid hematopoietic cells, lymphocytes and neuronal cells, in vitro and in vivo studies have shown the role of cytokines in inducing viability of different cell types during development to mature cells. Some cytokines can act on more than one cell type. Cytokines induce viability of normal and cancer cells by suppressing the apoptotic machinery activated by wild-type p53, or by cytotoxic agents including irradiation and compounds used in cancer chemotherapy. Cytokines can be used to decrease apoptosis in normal cells and inhibition of cytokine activity may improve cancer therapy by enhancing apoptosis in cancer cells. The apoptosis suppressing function of cytokines is mediated by changing the balance in the activity of apoptosis inducing and suppressing genes. Apoptosis suppression is upstream of caspase activation in the apoptotic process. Cytokines can suppress multiple pathways leading to apoptosis, only some of which were suppressed by other agents such as some antioxidants, Ca(2+)-mobilizing compounds and protease inhibitors.

From a lived body to a medicalized body: diagnostic transformation and chronic fatigue syndrome

This paper addresses the diagnostic dilemma posed by chronic illness that offers no demonstrable evidence of serious physical disorders or pathology. Is a diagnosis such as chronic fatigue syndrome (CFS) disabling because it encourages people to identify with it? Does it become a self-fulfilling prophecy? In providing people with a name, and thus allowing them to confirm the legitimacy of their suffering, a diagnosis of CFS may help them to relate to their world and, hence, facilitate their recovery. One of the most relevant questions pertaining to a diagnosis of CFS concerns how people deal with suffering when it does not come with a biomedically established pathology. I draw upon material provided by 21 men and women diagnosed with CFS. My analysis concerns the ambivalence involved in the diagnostic process and its implications for the relationship between self-identity and chronicity.

How to steer clear of legal hassles when you fire

Recent court decisions and the publicity they've gotten may explain why lawsuits from ex-employees are on the rise. However, you can keep firing from coming back to haunt you by taking several precautionary steps. In this article, the author suggests what you need to do before, during, and after you fire an employee to help prevent wrongful discharge suits. As well, the article explores steps you can take to keep unemployment benefits to a minimum.

Risk in numbers--difficulties in the transformation of genetic knowledge from research to people--the case of hereditary cancer

Difficulties in communicating diagnostic information are exacerbated when the 'diagnosis' is a 'genetic risk' for cancer. The risk estimation demanded in this situation differs from other types of probability estimations. Observations of participants in 45 consultation sessions between physicians and potential patients were conducted at a clinic for hereditary cancer to explore the communication of genetic information. Thirty-three sessions were audiotaped, transcribed verbatim and analyzed, along with notes from the other sessions. A dominant theme was found to be numerical discussion of risk. Further analysis resulted in the description of problems for practitioners in the process of translating scientific knowledge into clinical management. Problems in providing information include unclear aims of the consultation sessions, mixing various types of background information and probabilities, recognizing how low the predictive values are, and difficulties in communicating the relationship between probability and conclusions. Problems in communicating information about the genetic risk for cancer are of at least two types: dilemmas arising from uncertainties implicit in the nature of the information itself and difficulties in communicating information in a manner that those concerned can interpret. These issues need clarification, so that information with far-reaching consequences can be made as clear and comprehensible as possible for those involved.

Giving your staff the proper perspective: the 25 basic truths

In most medical practices, new employees delve into the specifics of their jobs without getting the lay of the land. They do not always know what kind of attitude, conduct, or perspective they will need to succeed in their new jobs. It is up to their new bosses to provide this insight. In this article, the author presents 25 basic "truths" every medical practice employee should know from the start. These truths could be added to a handbook for new employees. In addition, more seasoned staff members could read them; they are in an excellent position to contribute additional "truths" of their own that are specific to the practice and specialty.

Nonverbal aids for improving staff communication

Speaking face-to-face is the most common form of communication between doctor(s)/office managers and members of the professional practice staff. However, several nonverbal aids can enhance understanding tremendously and may be used in addition to or instead of speaking. In this article, we will explore when and how to use the best nonverbal communication aids. These include memos, a staff bulletin board, an office mail center, correspondence routing, paycheck inserts, a staff newsletter, and staff surveys. This article also includes a sample staff survey and suggests situations that are not appropriate for using nonverbal aids.

How to handle part-time, flex-time, and job-sharing employees

Offering employment structures other than traditional full-time positions in your practice can help you draw excellent job applicants and also can enable you to increase morale, job satisfaction, and productivity. However, there are many decisions you must make when offering a part-time, flex-time, or job-sharing position. This article explores the pros and cons of offering alternative job structures. It suggests ways to make part-time, flex-time, or job-sharing positions work most effectively, both for the employee and for your practice. In addition, this article suggests which positions are best suited to alternative structures.

How to make staff training more effective

An employee-training program offers many benefits both to employees and to the professional practice. However, it takes time, effort, and know-how to structure an effective training program. This article offers guidelines for staff training and explores specific training techniques that work. Among these are narrated demonstration, role-playing, flashcard training, study motivation exams, and tuition reimbursement programs. In addition, this article offers a script of a sample role-playing session.

Regulation of p53 stability and p53-dependent apoptosis by NADH quinone oxidoreductase 1

The tumor suppressor gene wild-type p53 encodes a labile protein that accumulates in cells after different stress signals and can cause either growth arrest or apoptosis. One of the p53 target genes, p53-inducible gene 3 (PIG3), encodes a protein with significant homology to oxidoreductases, enzymes involved in cellular responses to oxidative stress and irradiation. This fact raised the possibility that cellular oxidation-reduction events controlled by such enzymes also may regulate the level of p53. Here we show that NADH quinone oxidoreductase 1 (NQO1) regulates p53 stability. The NQO1 inhibitor dicoumarol caused a reduction in the level of both endogenous and gamma-irradiation-induced p53 in HCT116 human colon carcinoma cells. This reduction was prevented by the proteasome inhibitors MG132 and lactacystin, suggesting enhanced p53 degradation in the presence of dicoumarol. Dicoumarol-induced degradation of p53 also was prevented in the presence of simian virus 40 large T antigen, which is known to bind and to stabilize p53. Cells overexpressing NQO1 were resistant to dicoumarol, and this finding indicates the direct involvement of NQO1 in p53 stabilization. NQO1 inhibition induced p53 degradation and blocked wild-type p53-mediated apoptosis in gamma-irradiated normal thymocytes and in M1 myeloid leukemic cells that overexpress wild-type p53. Dicoumarol also reduced the level of p53 in its mutant form in M1 cells. The results indicate that NQO1 plays an important role in regulating p53 functions by inhibiting its degradation.

Reducing and managing overtime

Overtime is undesirable for many reasons. It can deteriorate staff morale, reinforce and reward inefficiency, and reach deep into your practice's pockets, often without improving your bottom line. Many employers overuse overtime and hold many misconceptions about their legal obligations. This article explores specific practice management methods for reducing or eliminating the need for overtime. It dispels three popular misconceptions about employers' legal obligations when paying overtime. Finally, it summarizes the basic rules for paying overtime, including how to calculate an employee's regular rate of pay, how to structure a legitimate workweek, and when and how overtime payments should be made.

'I got a letter...' a qualitative study of women's reasoning about attendance in a cervical cancer screening programme in urban Sweden

OBJECTIVE

This explorative study aims at investigating how 'healthy' women describe and reason about participation in a cervical cancer screening programme in Sweden. The study is part of a multidisciplinary research project studying a population-based cervical cancer-screening programme from the perspective of different actors.

SETTING AND METHODS

Data collection took place at three ante-natal health centres (ANHCs) in demographically diverse areas in the Stockholm region in spring 1995. Interviews were conducted and audiotaped with 66 'healthy' women at the ANHCs immediately before taking a Papanicolau test. Open questions such as 'Why have you come here today?' and 'What kind of test will you take?' were used to initiate the interview. Verbatim transcripts were analysed with a modified phenomenographical method to identify and describe qualitatively different ways of understanding cervical cancer screening.

RESULTS

Four different ways of reasoning about cervical cancer screening are described, with only one similar to the biomedical rationale for screening with focus on attending for the test/results. Two types of reasoning refer to the invitation letter as a catalyst, with one emphasizing benefits in attendance and the second emphasizing hinders to attendance. A final way of reasoning focuses on the individual's own proactive role in prevention. Common themes are also identified.

IMPLICATIONS

This study complements the research literature by providing a better knowledge base of the variations in reasoning among women attending screening, often seen as a homogenous group. It can contribute to better adapting the screening situation to the varied needs and expectations of the women who attend.

Getting the most from office temporaries

Practically every medical practice finds itself short-staffed at one time or another. In some cases, a temporary employee is all that is needed to keep the practice running smoothly. Because of this, many temporary employment agencies today gear themselves specifically to filling both administrative and clinical positions in medical practices. This articles explores when and how to hire a temporary employee. It suggests strategies for preparing for the temporary employee's arrival, orienting the employee to the practice and assigned tasks, and evaluating the temporary worker's performance. In addition, this article offers ideas about working well with temporary employment agencies, as well as likely policies one would encounter when trying to hire a temporary employee permanently.

Midwives' descriptions of their familiarity with cancer: a qualitative study of midwives working with population-based cervical cancer screening in urban Sweden

Nurse-midwives are responsible for taking Papanicolaou (Pap) smears in Swedish population-based cervical cancer screening programs. A research project examining the screening program from the perspective of different stakeholders includes an interview study of 21 midwives working in Stockholm. This article explores the way the midwives describe cancer-related knowledge and aspects of screening, contrasting this with relevant findings from a substudy of 66 healthy women participating in screening. A semistructured interview guide with open-ended questions was used to investigate ideas about benefits and risks in the screening program, risk factors for cervical cancer, the reliability of the test itself, sources of information/knowledge relevant for cervical cancer screening, and the manner in which the midwife described her role in the screening program. The transcripts of the audiotaped interviews were analyzed thematically using a team approach. The interviewed midwives showed a great deal of consensus in their descriptions of lacking familiarity with cervical cancer and its prevention and treatment. The midwives said they lack recent education and knowledge, often avoiding use of the word "cancer" with women attending screening. It seems that the midwives experienced little professional guidance in discussing cancer-related issues with women attending the screening program. In this study, they appeared to rely on personal knowledge, values, and experience instead.

31 ways to spark your staff's creativity and productivity

Staff creativity can help your practice run more smoothly and give it a competitive edge. In most cases, however, your staff's creativity needs to be fostered. You may do this in three very specific ways. First, you must communicate to your staff that their creativity is wanted and valued. Second, you must establish a climate that is conducive to creative thinking. And, third, you must reinforce staff creativity so it will continue to grow and flourish. This article offers 31 specific methods for achieving these goals, thereby improving your staff's creativity and achievement, as well as your practice's productivity and excellence.

[Interpreting messages from across knowledge boundaries in health care encounters]

Anthropological research into health issues may contribute to the discussion regarding doctor/patient communication and to understanding across knowledge boundaries. Anthropological studies in "other cultures" provide a mirror, and the question "Why are we doing what we are doing?" becomes relevant. Examples from research among immigrants in Swedish health care bring this question into focus. The relationship between scientific knowledge and lay knowledge is seen as problematical with regard not only to immigrants but also to any patient involved in today's preventive care, steeped as it is in rapid medical technological development. Scientific knowledge is recontextualized, interpreted and understood in all clinical situations. Research into this process is an urgent matter.

Targeting of N-CoR and histone deacetylase 3 by the oncoprotein v-erbA yields a chromatin infrastructure-dependent transcriptional repression pathway

Transcriptional repression by nuclear hormone receptors is thought to result from a unison of targeting chromatin modification and disabling the basal transcriptional machinery. We used Xenopus oocytes to compare silencing effected by the thyroid hormone receptor (TR) and its mutated version, the oncoprotein v-ErbA, on partly and fully chromatinized TR-responsive templates in vivo. Repression by v-ErbA was not as efficient as that mediated by TR, was significantly more sensitive to histone deacetylase (HDAC) inhibitor treatment and, unlike TR, v-ErbA required mature chromatin to effect repression. We find that both v-ErbA and TR can recruit the corepressor N-CoR, but, in contrast to existing models, show a concomitant enrichment for HDAC3 that occurs without an association with Sin3, HDAC1/RPD3, Mi-2 or HDAC5. We propose a requirement for chromatin infrastructure in N-CoR/HDAC3-effected repression and suggest that the inability of v-ErbA to silence on partly chromatinized templates may stem from its impaired capacity to interfere with basal transcriptional machinery function. In support of this notion, we find v-ErbA to be less competent than TR for binding to TFIIB in vitro and in vivo.

How to make staff meetings more enjoyable and productive

Staff meetings are a wonderful practice management tool, if they are well-planned and well-run. This article offers practical advice for planning and running productive staff meetings. It suggests calculating the actual cost of staff meetings and provides a formula for doing so. It describes three basic types of meetings--daily, regular, and special event--and all the how--to's you'll need for running each kind. It offers relevant advice for preparing and circulating a meeting agenda and minutes. It describes how to chair a meeting and suggests when to call meetings and when not to. Finally, this article establishes reasonable meeting expectations and provides a self-quiz to help you measure the effectiveness of your own staff meetings.

Knowledge of no return--getting and giving information about genetic risk

New genetic information can provide constructive preventive possibilities for individuals and for society but can also create new dilemmas for them. In consultations dealing with the risk of inheriting cancer, many problems connected with the notion of information exchange come to the surface. Individuals have to deal not only with the information given by the doctor, or how to give information to the doctor, but also with the problem of informing others, close kin with a similar risk potential, or getting information from them. In all these information exchanges concerning risk of cancer, different notions of 'information' are being invoked and used as resources in the talks, implying communicative problems at different levels. Some of these problems are discussed in this article.

Suppression or induction of apoptosis by opposing pathways downstream from calcium-activated calcineurin

Ca(2+)-mobilizing compounds such as the Ca(2+) ionophore A23187 or the endoplasmic reticulum Ca(2+) ATPase inhibitor thapsigargin can suppress or induce apoptosis in the same cells. The use of different calcineurin inhibitors has shown that both suppression and induction of apoptosis by the Ca(2+)-mobilizing compounds were mediated by calcineurin activation. Ca(2+)-mobilizing compounds activated p38 and p44/42 mitogen-activated protein kinases (MAPKs). Induction of apoptosis by the Ca(2+)-mobilizing compounds was suppressed by an inhibitor of p38 MAPK but not by an inhibitor of p44/42 MAPK. These MAPK inhibitors did not suppress apoptosis induction by wild-type p53 or by withdrawal of IL-6 from IL-6-dependent cells that are mediated by calcineurin-independent pathways. These MAPK inhibitors also did not affect the ability of Ca(2+)-mobilizing compounds to suppress apoptosis. The results indicate that (i) Ca(2+)- mobilizing compounds activate different and opposing pathways that diverge downstream from calcineurin activation that can either suppress or induce apoptosis in the same cells; (ii) p38 MAPK but not p44/42 MAPK is involved in induction of apoptosis but not in its suppression by the Ca(2+)-mobilizing compounds; and (iii) neither p38 nor p44/42 MAPKs mediate induction of apoptosis by some calcineurin-independent pathways.

Modification of Chromatin Structure by the Thyroid Hormone Receptor

Pioneering experiments and recent observations have established the thyroid hormone receptor as a master manipulator of the chromosomal environment in targeting the activation and repression of transcription. Here we review how the thyroid hormone receptor is assembled into chromatin, where in the absence of thyroid hormone the receptor recruits histone deacetylase to silence transcription. On addition of hormone, the receptor undergoes a conformational change that leads to the release of deacetylase, while facilitating the recruitment of transcriptional coactivators that act as histone acetyltransferases. We discuss the biological importance of these observations for gene control by the thyroid hormone receptor and for oncogenic transformation by the mutated thyroid hormone receptor, v-ErbA.

Research on risk and risk in research: theoretical and practical experiences from a multidisciplinary study on cervical cancer screening in urban Sweden

This article describes a qualitative research project on secondary cancer prevention that was conducted using a multidisciplinary team and that was inspired by perspectives from feminist research and fourth-generation evaluation. A screening program for cervical cancer was investigated from the perspective of different stakeholders through a series of substudies using a variety of qualitative approaches, in order to have a broad basis for consideration and negotiation of improvements. The first sections of this article describe the theoretical and methodological basis for the project, which triangulates a variety of qualitative and quantitative research strategies, whereas the latter sections describe some of our experiences, positive and negative, as a research team (and thus also as stakeholders) in actually conducting the studies.

Opportunities and burdens for nurse-midwives working in primary health care. An example from population-based cervical cancer screening in urban Sweden

In Sweden, nurse-midwives in primary health care are responsible for taking Papanicolaou smears in population-based cervical cancer screening programs. This article discusses the manner in which a group of nurse-midwives, working with the cervical cancer screening program, view both opportunities and burdens inherent in their work. Semistructured interviews were conducted with 21 nurse-midwives engaged in screening at seven antenatal health care centers in demographically different parts of Stockholm, using a team approach to collect and inductively analyze the interviews. Results indicate discrepancies between ideals guiding the midwives and their practice. Positive aspects described by the midwives appear to be related to an ideology of care, whereas perceived burdens include the midwives' sense of powerlessness, lack of congruence between midwives' ideology and screening organization, and lack of professional familiarity with cancer. Several of these features can be related to issues that are challenges for many health care practitioners today, even in other settings. Our conclusion is that the screening program has latent potential for further development of the role of the nurse-midwife as an advocate for women throughout the lifespan and in a variety of situations.

Antitumor activity of bax and p53 naked gene transfer in lung cancer: in vitro and in vivo analysis

In vitro and in vivo data have demonstrated that virus-mediated p53 gene transfer can induce active cell death and lung tumor regression. In contrast, the therapeutic potential of bax, another apoptosis-inducing gene, has not been described. We compared p53 and bax cytotoxic effects by transient transfection of an average of 25 +/- 5% of the H-322 and H-358 bronchioloalveolar carcinoma cell lines in vitro. Under these conditions, bax expression killed 70 to 90% of the transfected cells whereas p53 killed only 40% of them. The killing activity of both genes involved apoptosis, as shown by TUNEL staining. Surprisingly, BrdU incorporation indicated that the cells that did resist Bax toxicity were blocked in the pre-S phase of the cell cycle, a result expected for p53 only. In vivo, repeated injections of naked DNA encoding Bax or p53 inhibited the growth of 4-mm preestablished H-322 tumors in nude mice. Growth retardation only, and not inhibition, was observed in H-358, a poorly transfectable and rapidly growing tumor. These results indicate that Bax and p53 share a similar, strong antitumor activity in vivo, even if the former is a more potent inducer of apoptosis in vitro.

Different mechanisms for suppression of apoptosis by cytokines and calcium mobilizing compounds

Overexpression of wild-type p53 in M1 myeloid leukemia cells induces apoptotic cell death that was suppressed by the calcium ionophore A23187 and the calcium ATPase inhibitor thapsigargin (TG). This suppression of apoptosis by A23187 or TG was associated with suppression of caspase activation but not with suppression of wild-type-p53-induced expression of WAF-1, mdm-2, or FAS. In contrast to suppression of apoptosis by the cytokines interleukin 6 (IL-6) and interferon gamma, a protease inhibitor, or an antioxidant, suppression of apoptosis by A23187 or TG required extracellular Ca2+ and was specifically abolished by the calcineurin inhibitor cyclosporin A. IL-6 induced immediate early activation of junB and zif/268 (Egr-1) but A23187 and TG did not. A23187 and TG also suppressed induction of apoptosis by doxorubicin or vincristine in M1 cells that did not express p53 by a cyclosporin A-sensitive mechanism. Suppression of apoptosis by A23187 or TG was not associated with autocrine production of IL-6. Apoptosis induced in IL-6-primed M1 cells after IL-6 withdrawal was not suppressed by A23187 or TG but was suppressed by the cytokines IL-6, IL-3, or interferon gamma. The results indicate that these Ca2+-mobilizing compounds can suppress some pathways of apoptosis suppressed by cytokines but do so by a different mechanism.

Therapists' anxiety and attitudes toward computerized documentation in the clinical setting

Many hospitals are converting to electronic records and allied health professionals are required to modify their traditional documentation practices to accommodate this new technology. This paper discusses a study conducted to determine the computer anxiety and attitudes of physical, occupational, and speech therapists in a large urban teaching hospital before and after the implementation of a computerized documentation system. Fifty-three therapists surveyed with a preinstallation questionnaire reported mild computer anxiety and generally good attitudes about the planned computer system. A greater amount of previous computer use and better self-related computer skills were consistent with less computer anxiety. Seven of the original sample became the first to use the computer system. After their six month trial period, surveys revealed a reduction in computer anxieties. Manual time logs completed before and after the system implementation revealed a significant decrease in total documentation time when using computers.

The diagnostic process and the boundaries of normality

This article illustrates a group of cancer patients' descriptions and explanations of their experiences of health care encounters involving professional and lay processes of diagnosis related to definitions of normality. An interdisciplinary approach, representing nursing and medical anthropology, has been used in attempting to better understand data derived from semistructured interviews with 46 persons diagnosed with cancer in the greater Stockholm area and with 29 of their significant others. We argue that people in this study tend to deal with disruptive situations by attempting to construct order. In the stories presented by these cancer patients, a diagnostic process becomes evident in which patients first become "nonnormal" within a popular framework and later meet positive criteria to become "normally diseased" with the legitimization this provides. We thus see a way for the involved actors to deal with potentially difficult situations by redefining the concept of normality.

The integration of psychosocial care in a general hospital: development of an interdisciplinary consultation program

The problems of multiple competing psychosocial services led to the development of an interdisciplinary consultation program in a university-affiliated Veterans Administration Hospital. The need for integration of services is frequently recognized but difficult to achieve. Representatives from Psychiatry, Psychology, Social Work, and Nursing worked out and carried through a coordinated plan to provide psychosocial consultation to the general hospital. Description of the initial experience focuses on the process of change within a traditional system. A case example which reflects the role and interaction of the disciplines is included. We found that the psychosocial system improved communication, established a pattern of interdisciplinary teaching and stressed preventive work.