Registered nurse intent to promote physical activity for hospitalised liver transplant recipients.

AIM: To describe how registered nurse work motivation, attitudes, subjective norm and perceived behavioural control influence intention to promote physical activity in hospitalised adult liver transplant recipients. DESIGN: Descriptive study of clinical registered nurses caring for recipients of liver transplant at a tertiary medical centre. METHODS: Intent to Mobilise Liver Transplant Recipient Scale, Work Extrinsic and Intrinsic Motivation Scale, and demographics were used to explore registered nurses' work motivation, attitudes, subjective norms, perceived behavioural control and intention to promote physical activity of hospitalised adult liver transplant recipients during the acute postoperative phase. Data analysis included demographics, comparison between scale items and analysis of factors predicting intent to mobilise. RESULTS: Factors predictive of intention to promote physical activity after liver transplant included appropriate knowledge to mobilise patients (R2  = .40) and identification of physical activity as nursing staff priority (R2  = .15) and responsibility (R2  = .03). DISCUSSION/IMPLICATIONS FOR NURSING MANAGEMENT: When implementing an early mobilisation protocol after the liver transplant, education on effects of physical activity in the immediate postoperative period are essential to promote implementation in practice. Nursing care environment and leadership must be supportive to ensure mobility is a registered nurse priority and responsibility. Nursing managers can leverage results to implement a mobility protocol.

Median nerve somatosensory evoked potential monitoring during carotid endarterectomy: does reference choice matter?

Median nerve somatosensory evoked potential monitoring is commonly used during carotid endarterectomy to permit selective shunting in only those patients who are determined to have inadequate collateral flow after carotid cross-clamping. The N20 component is recorded from the CPc (contralateral centroparietal) electrode; either CPi (ipsilateral centroparietal) or Fpz (forehead) can be used as the reference. Because of the distribution of the subcortically generated N18 component, the CPc-Fpz derivation might record both the N20 and the N18 components and might therefore inadequately detect hemispheric ischemia after carotid cross-clamping. Somatosensory evoked potentials recorded were compared using these 2 derivations during 38 carotid endarterectomies to assess their ability to detect neurophysiologic changes after carotid cross-clamping. Although, as expected, the baseline N20 component was significantly larger when recorded with the CPc-Fpz derivation than with the CPc-CPi derivation (3.1 vs. 2.4 µV in the hemisphere ipsilateral to the clamped carotid, P < 0.001), there was no significant difference in the postclamp amplitude decline between the 2 derivations (8.7% vs. 8.6%, P = 0.82). It is concluded that CPc-Fpz is an acceptable derivation for recording postclamp hemispheric somatosensory evoked potential changes during carotid endarterectomy and may be advantageous because it provides a larger amplitude somatosensory evoked potential than the CPc-CPi derivation.

Low pathogenicity avian influenza viruses infect chicken layers by different routes of inoculation.

In order to develop better control measures against avian influenza, it is necessary to understand how the virus transmits in poultry. In a previous study in which the infectivity and transmissibility of the pandemic H1N1 influenza virus was examined in different poultry species, we found that no or minimal infection occurred in chicken and turkeys intranasally (IN) inoculated with the virus. However, we demonstrated that the virus can infect laying turkey hens by the intracloacal (IC) and intraoviduct (IO) routes, possibly explaining the drops in egg production observed in turkey breeder farms affected by the virus. Such novel routes of exposure have not been previously examined in chickens and could also explain outbreaks of low pathogenicity avian influenza (LPAI) that cause a decrease in egg production in chicken layers and breeders. In the present study, 46-wk-old specific-pathogen-free chicken layers were infected by the IN, IC, or IO routes with one of two LPAI viruses: a poultry origin virus, A/chicken/CA/1255/02 (H6N2), and a live bird market isolate, A/chicken/NJ/12220/97 (H9N2). Only hens IN inoculated with the H6N2 virus presented mild clinical signs consisting of depression and anorexia. However, a decrease in number of eggs laid was observed in all virus-inoculated groups when compared to control hens. Evidence of infection was found in all chickens inoculated with the H6N2 virus by any of the three routes and the virus transmitted to contact hens. On the other hand, only one or two hens from each of the groups inoculated with the H9N2 virus shed detectable levels of virus, or seroconverted and did not transmit the virus to contacts, regardless of the route of inoculation. In conclusion, LPAI viruses can also infect chickens through other routes besides the IN route, which is considered the natural route of exposure. However, as seen with the H9N2 virus, the infectivity of the virus did not increase when given by these alternate routes.

Effect of age on the pathogenesis and innate immune responses in Pekin ducks infected with different H5N1 highly pathogenic avian influenza viruses.

The pathogenicity of H5N1 highly pathogenic avian influenza (HPAI) viruses in domestic ducks varies between different viruses and is affected by the age of the ducks, with younger ducks presenting a more severe disease. In order to better understand the pathobiology of H5N1 HPAI in ducks including the role of host responses, 2 and 5-week-old Pekin ducks were infected with three different H5N1 HPAI viruses. Virus-induced pathology ranged from no clinical signs to severe disease and mortality, with the 2-week-old ducks being more severely affected by the more virulent viruses. However, these more virulent viruses induced higher body temperatures in the 5-week-old ducks than in the 2-week-old ducks indicating possible differences in innate immune responses. To analyze the ducks host responses to H5N1 HPAI virus infection, expression of innate immune-related genes was measured in the spleens and lungs of infected ducks at the peak of virus infection. IFN-α, RIG-I, and IL-6 RNA levels were increased in spleens regardless of the virus given and the age of the ducks, however differences were observed in the levels of up-regulation of IFN-α and RIG-I between the 2 and the 5-week-old ducks with the more virulent virus. Differences in IL-2 gene expression were also observed. In the lungs, the levels of expression of innate immune-related genes were lower than in the spleen, with mostly up-regulation of RIG-I and IL-6 and down-regulation of IFN-α and IL-2; no significant difference in expression was found between the 2 and the 5-week-old ducks. The differences observed in the innate immune responses to infection with H5N1 HPAI viruses could explain in part the differences in pathogenicity found between the 2 and 5-week-old ducks, however earlier time points after infection and additional innate immune-related genes should be examined.

Striosome-matrix pathology and motor deficits in the YAC128 mouse model of Huntington's disease.

Huntington's disease is characterized by striatal degeneration and progressive motor deficits. To examine striatal compartment-specific pathology and its relation to motor symptoms, we used immunohistochemistry to identify and measure the striosomes and matrix of 7-13-month-old YAC128 and wild type (WT) mice that were previously tested on motor tasks. Compared to WTs, 13-month-old YAC128s showed volume shrinkage in striosomes, and cell loss in both compartments. The percent cell loss was greater in striosomes than matrix. Striosome volume and cell loss was greatest in the dorsolateral striatum. YAC128 rotarod and balance beam deficits preceded volume and cell loss. At 13 months, YAC128 balance beam slips and striosome cell number were inversely correlated. The results show that pathology in older YAC128s manifests as an abnormal striosome to matrix ratio and suggest that this imbalance can contribute to some motor symptoms.

Urinary incontinence: The Social Health Maintenance Organization's approach (CE).

Urinary incontinence (UI) is a problem that affects more than 16 million Americans, most of them women. Although nearly half of the elderly in America have episodes of UI, it is not a normal consequence of aging. It remains a largely neglected problem despite its considerable prevalence, morbidity, and expense. This article reports on a successful proactive health risk screening process to treat this major problem.

Differential metabolic activity in the striosome and matrix compartments of the rat striatum during natural behaviors.

The striosome and matrix compartments of the striatum are clearly identified by their neurochemical expression patterns and anatomical connections. To determine whether these compartments are distinguishable functionally, we used [14C]deoxyglucose metabolic mapping in the rat and tested whether neutral behavioral states (free movement, gentle restraint, and focal tactile stimulation under gentle restraint) were associated with regions of high metabolic activity in the matrix, in striosomes, or in both. We identified metabolic peaks in the striatum by means of image analysis, striosome-matrix boundaries by [3H]naloxone binding, and primary somatosensory corticostriatal input clusters by injections of anterograde tracer into electrophysiologically identified sites in SI. Peak metabolic activity was primarily confined to the matrix compartment under each behavioral condition. These findings show that during relatively neutral behavioral conditions the balance of activity between the two compartments favors the matrix and suggest that this balance is present in the striatum as part of normal behavior and processing of afferent activity.

Changing managed care to care management: innovations in nursing practice.

This article describes ways to develop a Case Management System that includes the principles of care planning by using an interdisciplinary team across the continuum of health services.