An evaluation of a video magnification-based system for respiratory rate monitoring in an acute mental health setting.

CONTEXT: One of the most important goals of inpatient psychiatric care is to provide a safe and therapeutic environment for both patients and staff. A small number of aggressive or agitated patients are difficult to sedate, even after multiple doses of sedating antipsychotics. Adverse effects can result in harm to the patient and staff and that observations are conducted without touching the patient. AIM: This study aims to determine if motion magnification can improve the feasibility of non-contact respirations monitoring over a video feed. METHODS: Registered nurses were invited to view seven pairs of pre-recorded footage of healthy volunteers and count the number of breaths that they observe over a period of one minute for each. One of the paired videos was unprocessed and the other magnified the motion of chest rise and fall. RESULTS: Nursing observation of respirations showed an improvement in reduction of count error from 15.7 % to 1.5 % after video magnification of respiratory movement. Nurses also stated that viewing the processed video was much easier to make their observations from. CONCLUSION: It is possible to use magnified video to monitor respirations of patients during circumstances where it is potentially difficult to obtain. Further observational studies should be conducted on a larger scale with this type of technique and is urgently needed to inform practice.

Serological evidence for the co-circulation of two lineages of influenza D viruses in equine populations of the Midwest United States.

Influenza D virus (IDV) is a newly described influenza type of the Orthomyxoviridae virus family that was first isolated from diseased swine in 2011 and has subsequently been detected in cattle around the world in 2014. In addition, serological evidence for IDV infection in humans has been recently established. Despite all the progress, the full range of susceptible hosts for this novel virus has yet to be determined, but includes swine, bovine, small ruminants and human. This study was designed to determine if equine is a possible host to this newly emerging influenza virus. Three hundred and sixty-four equine serum samples were collected in 2015 from 141 farms within the Midwestern United States. Serum samples were examined using hemagglutination inhibition (HI) assay against two established IDV lineages (D/OK and D/660) and one IDV-related human ICV lineage (C/JHB). Results of this study showed 44 (44 of 364, 12%) samples positive for antibodies against D/OK, 39 (39 of 364, 11%) samples positive for antibodies against D/660, and 41 (41 of 364, 11%) samples positive for antibodies against C/JHB. A subset of these samples was further confirmed via microtitre neutralization (MN) assay. Our data demonstrated that horses are susceptible to two lineages of IDV, and that these viruses were present in equine populations throughout multiple Midwestern states of the United States. These findings continue to support the need for further surveillance of IDV viruses in agricultural species to work towards a better understanding of the full host range and natural reservoirs of influenza D virus.

Phosphodiesterase 11 (PDE11) regulation of spermatozoa physiology.

Fertilization is well correlated with sperm concentration, rate of forward motility, and percentage of live, uncapacitated ejaculated spermatozoa, which is regulated in part by cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Phosphodiesterases (PDEs) hydrolyze cyclic nucleotides to their corresponding monophosphates, thereby counterbalancing the activities of cAMP and cGMP, and PDE11 is highly expressed in the testis, prostate, and developing spermatozoa. However, a physiological role of PDE11 is not known. We generated PDE11 knockout (PDE11-/-) mice to investigate the role of PDE11 in spermatozoa physiology. Ejaculated sperm from PDE11-/- mice displayed reduced sperm concentration, rate of forward progression, and percentage of live spermatozoa. Pre-ejaculated sperm from PDE11-/- mice displayed increased premature/spontaneous capacitance. These data are consistent with human data and suggest a role for PDE11 in spermatogenesis and fertilization potential. This is the first phenotype described for the PDE11-/- mouse and the first report of a physiological role for PDE11.

Improving glycemic control: can techniques used in a managed care setting be successfully adapted to a rural fee-for-service practice?

The objective of this work was to improve glycemic control using case management supported by electronic diabetes care monitoring. Information for patients with diagnosed diabetes in a rural community was maintained in the Diabetes Care Monitoring System. In September 1998, counseling and medication management for glycemic control was intensified during individual office visits. And, from September 1998 to February 1999, 2-hour cluster visits modeled after a successful urban program were offered for groups of patients with elevated HbA1c values. The median (and 75th percentile) HbA1c values for the patient population decreased from 8.7% (10.9%) in March 1998 (N = 173) to 7.5% (9.3%) in March 1999 (N = 182) and was maintained at 7.5% (9.1%) through March 2000 (N = 182). Case management, including cluster visits, can be accomplished in a rural physician's office with the support of an electronic diabetes care monitoring system. This intensified approach decreased and sustained the HbA1c level by more than a percentage point for the patient population.

Effects of supplemental methionine on antiserum-induced dysmorphology in rat embryos cultured in vitro.

BACKGROUND: Heterologous antiserum to the visceral yolk sac (AVYS) is teratogenic, inducing a spectrum of malformations in vivo and producing similar effects in vitro. Numerous studies support the concept that AVYS-induced malformations result from embryonic nutritional deficiency, without affecting the maternal nutritional status. This has provided a useful model with which to investigate the nutritional requirements of the early embryo, as well as the role of various nutrients in the etiology of congenital defects. METHODS: In the current investigation, we examined the effects of methionine and other nutrients on AVYS-induced embryotoxicity in vitro. For these experiments, we cultured rat embryos (9.5 p.c) for 48 hr with AVYS and/or methionine at several concentration levels. RESULTS: The addition of L-methionine to AVYS-exposed cultures reduced dysmorphology and open neural tube; this effect was concentration dependent. AVYS-induced dysmorphology was completely prevented at a concentration of L-methionine corresponding to 50-fold the basal serum concentration. Utilization of D-methionine, L-leucine, or folic acid (5-methyltetrahydrofolate, MTHF) instead of L-methionine had no protective effects. CONCLUSIONS: These results suggest that, although AVYS limits the supply of all amino acids to the embryo, embryopathy largely results from a deficiency of methionine. Furthermore, although endocytosis and degradation of proteins by the VYS supplies most amino acids to the embryo, free amino acids may be compensatory when this source is reduced. These results support those of previous investigations that suggest methionine is required for normal NT closure and that methionine is a limiting nutrient for embryonic development.

Molecular cloning and characterization of a distinct human phosphodiesterase gene family: PDE11A.

We report here the cloning, expression, and characterization of human PDE11A1, a member of a distinct cyclic nucleotide phosphodiesterase (PDE) family. PDE11A exhibits

Oncology nursing education within a supportive care framework: an evidence-based undergraduate course.

Addressing supportive care needs of individuals affected by cancer is a crucial role for oncology nurses. If these needs are not identified and addressed, then individuals and their families risk experiencing biopsychosocial distress. This paper describes how a group of interested nurses with research and/or cancer knowledge developed, implemented and evaluated an evidence-based university undergraduate course in oncology nursing. The purposes of this course are to provide nurses with specialized knowledge about supportive care in oncology throughout the cancer care continuum and to assist registered nurses in preparing for oncology nursing certification. Theoretical, practical and research-based issues related to the scope of supportive care are incorporated into the assessment, nursing diagnosis, planning and evaluation of client care.

Limb reduction defects in the A/J mouse strain associated with maternal blood loss.

We previously described a high incidence of digit/limb anomalies in the offspring of A/J mice subjected to surgery on day 12.5 postconception (p.c.), but not in the offspring of untreated control mice. To investigate the cause of these defects, we compared the offspring of mice in experimental groups involving adrenalectomy, sham adrenalectomy, blood sampling, and anesthesia with the offspring of control mice. All treatments significantly reduced fetal weight and increased resorptions as compared with the controls. The highest incidence of digit anomalies occurred in the offspring of dams from which blood samples had been drawn on days 12.5, 14.5, and 15.5 p.c. The incidence of isolated cleft palate was also increased in the offspring of mice that had been subjected to blood sampling. We conclude that digit anomalies in the offspring of A/J mice result from fetal vascular disruptive phenomena subsequent to maternal blood loss induced hypovolemia and hypoperfusion to the uterus and placenta as has been suggested for uterine vascular clamping, misoprostol, chorionic villus sampling, and cocaine teratogenesis. The etiology for cleft lip in these mice may involve mechanisms unrelated to uterine/placental hypoperfusion.

Accountability and competence: occupational therapy practitioner perceptions.

OBJECTIVE: Occupational therapy practitioners must meet ever-increasing accountability demands in all service delivery environments. Accountability is made possible through the ongoing development of continued competence throughout a practitioner's career. Behaviors that demonstrate accountability and reflect competence include commitment, leadership, and professional knowledge. This article discusses issues related to accountability and competence, presents findings from focus group discussions with occupational therapy practitioners regarding professional competence, and identifies actions that will bring about greater understanding of this topic. METHOD: Thirty-nine randomly selected occupational therapy practitioners attended one of two focus groups. Participants responded to a structured discussion guide, including questions addressing the definition, process for sustaining, and outcomes of continued competence. RESULTS: Several themes emerged from these discussions. Views about what constitutes and contributes to continued competence in occupational therapy were diverse, and perceptions of occupational therapy "practice" were broad. Participants believed that the "outcomes" of a practitioner's continued competence were best defined as autonomy in executing the occupational therapy process. CONCLUSIONS: Findings offer potential language to articulate competence in occupational therapy and facilitate a discipline-wide conversation. The findings likewise challenge practitioners to assume new professional behaviors that require both personal and interpersonal skills. Such behaviors are critical to demonstrating accountability and competence.

Nutritional studies of the embryo during early organogenesis with normal embryos and embryos exhibiting yolk sac dysfunction.

In 1961 we reported that heterologous kidney antiserum when injected into pregnant rats resulted in wide spectrum of congenital malformations. Further studies identified that it was the IgG component of the antiserum that was teratogenic and that complement was not necessary to produce the teratogenic effect. Labeled antibody studies demonstrated that the kidney antiserum localized in the kidney and in the visceral yolk sac (VYS) and parietal yolk sac placentas. Preparation of yolk sac (YS) antiserum proved to be more potent than the kidney antiserum. Adsorption studies with VYS and parietal yolk sac antiserum revealed that the site of the teratogenic process was located in the VYS. In vitro embryo culture experiments demonstrated that direct injection of the teratogenic antibody into the amniotic or YS cavity did not injure the embryo, thus indicating that the teratogenic antibody had to come in contact with the absorptive surface of the VYS. Collaboration with Dr. John Lloyd demonstrated that teratogenic antibody interfered with the process of pinocytosis and the delivery of amino acids (AA) to the developing embryo. Our studies into the nature of the source of AA for the embryo indicated that in some instances > 95% of the AA present in the developing embryo were derived from maternal proteins and the remainder from free AA in the maternal serum. We also demonstrated that embryonic methionine was derived primarily from the digestion of maternal serum proteins but that more of the methionine was diverted from the synthesis of embryonic proteins, supporting the view that it has important functions other than the synthesis of proteins. All these studies focus on the role of the YS in human development and whether human YS dysfunction may play a role in the pathogenesis of congenital malformations. Further studies on the delivery of AA to the embryo are warranted to determine whether certain AA are in short supply in maternal serum and place the embryo at risk if nutritional alterations in the maternal environment occurs. Furthermore, the YS may be an organ whose role might offer opportunities for pregnancy control.

Is there a no-effect dose for corticosteroid-induced cleft palate? The contribution of endogenous corticosterone to the incidence of cleft palate in mice.

Teratology and genetic counselors are frequently asked whether very low exposures of drugs and chemicals can cause a child's congenital malformations. One critical factor on which the counseling is based is the dose. Because teratogenic effects follow a toxicologic dose-response curve with a no-effect dose, frequently counselors can refute a causal relationship because the dose was far below the no-observable-effect dose. Recently, some investigators have suggested that some teratogens which are present in physiologic levels such as cortisone, glucose, insulin, or sex steroids may contribute to the background incidence of congenital malformations and, therefore, there is no safe dose. Using corticosteroid-induced cleft palate in mice as the model, we conducted experiments to test this hypothesis. Adrenalectomy of A/J or CD-1 dams resulted in a reduction of endogenous corticosterone, but did not reduce the spontaneous incidence of cleft palate in the offspring. In A/J mice, the incidence of isolated cleft palate increased with adrenalectomy indicating that the spontaneous incidence of this defect is not due to endogenous corticosterone. Adrenalectomy did not affect the susceptibility of CD-1 mice to cortisone induced cleft palate demonstrating that endogenous corticosterone did not contribute significantly to the incidence of cleft palate induced by the exogenous corticosteroid. Finally, results in CD-1 mice clearly indicate that cortisone, like other teratogens, has a no-effect level for teratogenesis. These studies support the concept of a threshold in the dose-response relationship for corticosteroid-induced cleft palate in mice.

Pharmacokinetics of teratogenic antibodies administered to rats.

The serum levels of total and visceral yolk sac (VYS)-reactive sheep IgG have been determined following injection of a teratogenic sheep anti-VYS antiserum. After intravenous injection, levels of VYS-reactive IgG fell rapidly, with 75% of the amount in the injection removed in the first 5 min, and 90% by 60 min. By contrast, 90% or more of the total sheep IgG was still present at these times. A similar difference in clearance was seen after intraperitoneal injection, although the serum levels also reflected the presence of a pool of antiserum in the peritoneum and the simultaneous influx and efflux of IgG into and from the circulation. The clearance pattern was similar in pregnant and nonpregnant rats; it is concluded that antibodies against VYS-specific antigens comprise a very small fraction of VYS-reactive antibodies in the antiserum. ELISA and Western blot analysis indicated extensive cross-specificity with antigens present in rat tissues other than the VYS. Similar teratogenic effects were observed after intravenous or intraperitoneal injection of the antiserum at 8.5 days of gestation; we conclude that the proximal effect likely begins within the period immediately after the injection. The results are also considered within the context of published reports that the VYS shows structural and functional damage for several days after intraperitoneal administration of antiserum at 8.5 days.

Synthetic inhibitors of tissue kallikrein: effects in vivo in a model of allergic inflammation.

We have recently developed synthetic low molecular weight inhibitors of both tissue and plasma kallikreins. Several of these were evaluated in vivo in the ovalbumin-sensitised guinea pig for their ability to prevent the bronchoconstriction elicited by antigen challenge. The selective tissue kallikrein inhibitor CH-694 (but not the selective plasma kallikrein inhibitor CH-684) caused highly significant falls in airways resistance when it was administered at 10 mg/kg intraperitoneally 15 min before and 90 min after challenge. There was also a highly significant fall in the tissue kallikrein activity measured in broncho-alveolar lavage fluid. Inhibitors of tissue kallikrein may prove effective in the treatment of allergic inflammation in man.

Chemotaxis of Mercenaria mercenaria hemocytes to bacteria in vitro.

Hemocytes of the hard clam Mercenaria mercenaria migrate toward secreted bacterial products in vitro by chemotaxis (i.e., by detection of an increasing chemical gradient of attractant). The attractants produced by Escherichia coli are peptides or small proteins. Clam hemocytes also migrate toward formyl-methionyl-leucyl-phenylalanine (fMLF), a mammalian neutrophil chemoattractant produced by bacteria, but not toward the related compound formyl-methionyl-valine. Migration of hemocytes to fMLF was blocked with the neutrophil fMLF receptor antagonist, t-Boc-MLF, suggesting that the hemocytes possess this receptor and that the response is receptor-mediated. However, fMLF is not the major bacterial chemoattractant for clam hemocytes, as t-Boc-MLF did not block migration of these cells to secreted bacterial chemoattractants.

Induction of humoral manifestations of autoimmunity following intraperitoneal injection of complete Freund's adjuvant in mice.

Several animal models of arthritis are produced using complete Freund's adjuvant (CFA) alone or with collagen as an arthritogen. Successful induction of arthritis is reported to require that the adjuvant mixture be administered by intradermal or subcutaneous routes. The resulting arthritis is caused by primarily cellular immune responses. Data presented in this paper show that giving CFA by intraperitoneal (I.P.) inoculation results in a humoral autoimmune response, with no obvious signs of arthritis. This humoral autoimmune response is characterized by production of autoantibodies to nuclear and cytoplasmic antigens, elevated levels of circulating immune complexes, and in approximately 25% of mice, rheumatoid factor.

Suppression of malaria-induced autoimmunity by immunization with cryoglobulins.

Cryoglobulins obtained from malaria-infected (Plasmodium berghei berghei) Balb/c mice were administered intraperitoneally to naive Balb/c mice. Ten days or 9 months following cryoglobulin administration, the naive mice were infected with malaria. Comparison of sera from cryoglobulin-treated malaria-infected mice with sera from control infected mice revealed that pretreatment with cryoglobulins resulted in (1) reduced levels of circulating immune complexes; (2) reduced levels of autoantibodies reactive with nuclear and cytoplasmic antigens; and (3) suppressed development of cryoglobulinemia. Furthermore, the effect of cryoglobulins was long lasting, suggesting that recipient mice may have been actively immunized against autoantibody production.