Measuring Gratitude in Children.

Gratitude is a rich socioemotional construct that emerges over development beginning in early childhood. Existing measures of children's gratitude as a trait or behavior may be limited because they do not capture different aspects of gratitude moments (i.e., awareness, thoughts, feelings, and actions) and the way that these facets appear in children. The current study evaluates a battery of new measures assessing children's gratitude to address these limitations. Parent-child dyads (N=101; children aged 6-9) completed a lab-based assessment followed by a 7-day online parental diary and 18-month follow-up survey. In addition to newly developed measures of children's gratitude, the battery included indicators of convergent, concurrent, divergent, and predictive validity. Results demonstrate the complexity of gratitude as a construct and the relative benefits and limits of various assessment modalities. Implications for the measurement of children's gratitude and suggestions for future research on the development of gratitude are discussed.

Anesthetic management of parturients with Arnold Chiari malformation-I: a multicenter retrospective study.

BACKGROUND: Consensus regarding the safest mode of delivery and anesthetic management for parturients with Arnold Chiari malformation-I (ACM-I) remains controversial. This study assessed their anesthetic management and reported anesthetic complications during hospitalization for delivery. METHODS: This was a multicenter, retrospective, cohort study of patients with ACM-I undergoing vaginal or cesarean delivery. Data were obtained from the electronic databases of four United States academic institutions using International Classification of Diseases (ICD) codes from 2007-2017 at three sites and 2004-2017 at one site. The primary outcome was anesthetic complications. RESULTS: Data were analyzed for 185 deliveries in 148 patients. Diagnosis of ACM-I was made prior to delivery in 147 (80%) cases. Pre-delivery neurosurgical consultation for management of ACM-I was performed in 53 (36%) patients. Pre-existing symptoms were recorded for 89 (48%) of the deliveries. Vaginal deliveries occurred in 80 (43%) cases, and 62 women (78%) received neuraxial labor analgesia. Cesarean delivery was performed in 105 (57%) cases, of which 70 women (67%) had neuraxial anesthesia and 34 (32%) received general anesthesia. Post-dural puncture headache was reported in three (2%) patients who had neuraxial anesthesia, and in two (12%) patients with syringomyelia. There was one (3%) reported case of aspiration pneumonia with general anesthesia. CONCLUSIONS: The findings suggest that anesthetic complications occur infrequently in patients with ACM-I regardless of the anesthetic management. Although institutional preference in anesthetic and obstetric care appears to drive patient management, the findings suggest that an individualized approach has favorable outcomes in this population.

Interprofessional provider attitudes toward the initiation of epidural analgesia in the laboring patient: are we all on the same page?

BACKGROUND: The timing of initiation of neuraxial labor analgesia should ultimately depend on patient preference although obstetricians, anesthesiologists and nurses may influence decision-making. We hypothesized that provider groups would have similar attitudes toward the timing of epidural placement, but some identifiable differences could be used to improve understanding and communication among providers. METHODS: Anesthesiologists, nurses and obstetricians completed a survey assessing their knowledge and attitudes on the timing of epidural placement in specified clinical circumstances. RESULTS: Anesthesiologists (100%) and nurses (86.2%) reported being more familiar with epidural management than obstetricians (43.3%, P <0.01). The willingness of providers to advocate epidural placement based on the magnitude of cervical dilation was similar, although at 10 cm dilatation obstetricians (73.3%) were significantly more likely to advocate neuraxial block compared to both nurses (27.6%, P <0.01) and anesthesiologists (36.7%, P <0.01). The impact of patient factors and clinical circumstances on the timing of neuraxial block placement showed significant differences among provider groups in five of 24 areas assessed, including patient desire for an epidural, primigravid patients without membrane rupture, oxytocin infusion initiated, labor epidural in a previous pregnancy, and a difficult airway. CONCLUSIONS: There were differences between providers in factors that may impact the timing of epidural placement and in their self-perceived familiarity with epidural management. These present an opportunity for furthering interprofessional education and collaboration.

Transversus abdominis plane and ilioinguinal/iliohypogastric blocks for cesarean delivery in a patient with type II spinal muscular atrophy.

While neuraxial and general anesthetic techniques are most commonly utilized for cesarean delivery, there are rare instances in which alternative techniques may be considered. We report a patient with type II spinal muscular atrophy who had relative contraindications to both neuraxial and general anesthesia, and had experienced significant discomfort during two previous cesarean deliveries performed with local anesthetic infiltration. We describe the successful use of bilateral ultrasound-guided transversus abdominis plane and ilioinguinal/iliohypogastric blocks, in addition to intravenous sedation, for cesarean delivery anesthesia.

BMI-based body size guides for women and men: development and validation of a novel pictorial method to assess weight-related concepts.

OBJECTIVES: To develop and evaluate two BMI-based instruments to determine perceptions of weight status, particularly perceptions of overweight and obesity, using pictorial images of women and men. METHODS: Pictures of adults with known BMI values were used to construct gender-specific body size guides (BSGs) containing 10 bodies that ranged from underweight to class III obesity. Figures were standardized and a composite face was added to each. The BSGs were administered to 400 adults to assess the psychometric properties of the instruments and weight perceptions. RESULTS: High correlations between the BMIs of respondents and the BMIs of the current body selected by respondents provided strong support for the criterion-related validity of the BSGs, and the logical pattern of responses to items assessing perception of weight categories supported construct validity for the scales. Test-retest reliability, assessed by correlations for both current and ideal body, was also high, despite the lengthy 6-month testing interval. Respondents' perceptions of the bodies within specific weight categories indicated that a majority failed to recognize the overweight female as overweight and perceived the overweight male as normal weight. Obese bodies were generally unrecognized as such until the bodies reached the higher levels of obesity (that is, BMI values >39). Perception of weight was influenced by the respondents' weight status and gender. CONCLUSIONS: Psychometric analyses indicated the BSGs are valid and reliable instruments. These results, coupled with the face validity of the scales and the relationship between the bodies and BMI values, indicate the BSGs offer advantages over existing instruments for researchers of weight perception and body image. Administration of the scales to an adult sample confirmed that overweight and obesity are under-recognized. Increased efforts to improve public understanding of these terms are needed and the BSGs may provide useful tools for this purpose.

From critters to cancers: bridging comparative and clinical research on oxygen sensing, HIF signaling, and adaptations towards hypoxia.

The objective of this symposium at the First International Congress of Respiratory Biology (ICRB) was to enhance communication between comparative biologists and cancer researchers working on O(2) sensing via the HIF pathway. Representatives from both camps came together on August 13-16, 2006, in Bonn, Germany, to discuss molecular adaptations that occur after cells have been challenged by a reduced (hypoxia) or completely absent (anoxia) supply of oxygen. This brief "critters-to-cancer" survey discusses current projects and new directions aimed at improving understanding of hypoxic signaling and developing therapeutic interventions.

Protein tyrosine and serine-threonine phosphatases in the sea urchin, Strongylocentrotus purpuratus: identification and potential functions.

Protein phosphatases, in coordination with protein kinases, play crucial roles in regulation of signaling pathways. To identify protein tyrosine phosphatases (PTPs) and serine-threonine (ser-thr) phosphatases in the Strongylocentrotus purpuratus genome, 179 annotated sequences were studied (122 PTPs, 57 ser-thr phosphatases). Sequence analysis identified 91 phosphatases (33 conventional PTPs, 31 dual specificity phosphatases, 1 Class III Cysteine-based PTP, 1 Asp-based PTP, and 25 ser-thr phosphatases). Using catalytic sites, levels of conservation and constraint in amino acid sequence were examined. Nine of 25 receptor PTPs (RPTPs) corresponded to human, nematode, or fly homologues. Domain structure revealed that sea urchin-specific RPTPs including two, PTPRLec and PTPRscav, may act in immune defense. Embryonic transcription of each phosphatase was recorded from a high-density oligonucleotide tiling microarray experiment. Most RPTPs are expressed at very low levels, whereas nonreceptor PTPs (NRPTPs) are generally expressed at moderate levels. High expression was detected in MAP kinase phosphatases (MKPs) and numerous ser-thr phosphatases. For several expressed NRPTPs, MKPs, and ser-thr phosphatases, morpholino antisense-mediated knockdowns were performed and phenotypes obtained. Finally, to assess roles of annotated phosphatases in endomesoderm formation, a literature review of phosphatase functions in model organisms was superimposed on sea urchin developmental pathways to predict areas of functional activity.

Production and purification of refolded recombinant human IL-7 from inclusion bodies.

A recombinant form of human rhIL-7 was overexpressed in Escherichia coli HMS174 (DE3) pLysS under the control of a T7 promoter. The resulting insoluble inclusion bodies were separated from cellular debris by cross-flow filtration and solubilized by homogenization with 6 M guanidine HCl. Attempts at refolding rhIL-7 from solubilized inclusion bodies without prior purification of monomeric, denatured rhIL-7 were not successful. Denatured, monomeric rhIL-7 was therefore initially purified by size-exclusion chromatography using Prep-Grade Pharmacia Superdex 200. Correctly folded rhIL-7 monomer was generated by statically refolding the denatured protein at a final protein concentration of 80-100 microg/ml in 100 mM Tris, 2mM EDTA, 500 mM L-arginine, pH 9.0, buffer with 0.55 g/l oxidized glutathione at 2-8 degrees C for at least 48 h. The refolded rhIL-7 was subsequently purified by low-pressure liquid chromatography, using a combination of hydrophobic interaction, cation-exchange, and size-exclusion chromatography. The purified final product was >95% pure by SDS-PAGE stained with Coomassie brilliant blue, high-pressure size-exclusion chromatography (SEC-HPLC), and reverse-phase HPLC. The endotoxin level was <0.05 EU/mg. The final purified product was biologically active in a validated IL-7 dependent pre-B-cell bioassay. In anticipation of human clinical trials, this material is currently being evaluated for safety and efficacy in non-human primate toxicology studies.

Production and purification of a recombinant Staphylococcal enterotoxin B vaccine candidate expressed in Escherichia coli.

An attenuated, recombinant form of Staphylococcus enterotoxin B (rSEB) was overexpressed in Escherichia coli under transcriptional control of the T7 promoter. The 28-kDa rSEB was partially purified from soluble, intracellular protein by tangential flow filtration and differential ammonium sulfate precipitation. The intermediate product was then further purified using low-pressure liquid chromatography including hydrophobic interaction, cation exchange, and size-exclusion matrices. The final vialed product was >95% pure as determined by Coomassie blue-stained sodium dodecyl sulfate-polyacrylamide gel electrophoresis, high-pressure size-exclusion chromatography, and capillary zonal electrophoresis. The endotoxin level was <0.6 EU/mg. Final estimated yield of purified rSEB was 147 mg/L of starting culture. Purified rSEB was stable, elicited an immune response in mice, and protected mice against a lethal challenge with the native toxin.

Racial/ethnic disparities in nursing.

The racial and ethnic composition of the registered nurse (RN) workforce in California is not at parity with the composition of the population. We find that the underrepresentation of African Americans in nursing in California appears to be due to lower overall educational attainment among African Americans. Underrepresentation of Latinos is due to lower overall educational attainment and, to a lesser extent, a lower percentage of college-educated Latinos pursuing careers in nursing. Improving the overall educational attainment of minority students is critical to increasing the number of minorities in nursing.

Hospital registered nurse shortages: environmental, patient, and institutional predictors.

OBJECTIVE: To examine the characteristics of acute-care hospitals that report registered nurse shortages when a widespread shortage exists and when a widespread shortage is no longer evident. DATA SOURCE: Secondary data from the American Hospital Association's Nursing Personnel Survey from 1990 and 1992 were used. The study population was all acute-care hospitals in the United States. STUDY DESIGN: Outcome variables included whether a hospital experienced a shortage in 1990, when many hospitals reported a nursing shortage, or whether a hospital reported a shortage in both 1990 and 1992. Predictor variables included environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using probit analyses. PRINCIPAL FINDINGS: Location in the South, a high percentage of nonwhite county residents, a high percentage of patients with Medicaid or Medicare as payer, a higher patient acuity, and use of team or functional nursing care delivery consistently predicted hospitals reporting shortages both when there was a widespread shortage and when there was no widespread shortage. CONCLUSIONS: Although some characteristics under the direct control of hospitals, such as nursing care delivery model, are associated with their reporting a shortage of nurses, shortage is also strongly associated with broader population characteristics such as minority communities and a public insurance payer mix. Awareness of these broader factors may help inform policies to improve the distribution of nurse supply.

The Caenorhabditis elegans hif-1 gene encodes a bHLH-PAS protein that is required for adaptation to hypoxia.

Hypoxia-inducible factor, a heterodimeric transcription complex, regulates cellular and systemic responses to low oxygen levels (hypoxia) during normal mammalian development or tumor progression. Here, we present evidence that a similar complex mediates response to hypoxia in Caenorhabditis elegans. This complex consists of HIF-1 and AHA-1, which are encoded by C. elegans homologs of the hypoxia-inducible factor (HIF) alpha and beta subunits, respectively. hif-1 mutants exhibit no severe defects under standard laboratory conditions, but they are unable to adapt to hypoxia. Although wild-type animals can survive and reproduce in 1% oxygen, the majority of hif-1-defective animals die in these conditions. We show that the expression of an HIF-1:green fluorescent protein fusion protein is induced by hypoxia and is subsequently reduced upon reoxygenation. Both hif-1 and aha-1 are expressed in most cell types, and the gene products can be coimmunoprecipitated. We conclude that the mechanisms of hypoxia signaling are likely conserved among metazoans. Additionally, we find that nuclear localization of AHA-1 is disrupted in an hif-1 mutant. This finding suggests that heterodimerization may be a prerequisite for efficient nuclear translocation of AHA-1.

Evaluation of intermittent pneumatic compression devices.

Venous blood flow rate in the lower extremity after applying different pneumatic compression devices was evaluated. Five healthy individuals, aged 21-35, were recruited for this study. The ability of six different pneumatic compression devices to increase femoral venous blood flow velocity was analyzed and compared to that of active and passive foot dorsiflexion. Baseline venous blood flow velocity was measured using an ATL Duplex Doppler before leg compression. Venous blood flow velocity was then monitored before, during, and after each compression cycle. Average peak venous velocity increased >200% on dorsiflexion of the ankle. Among the investigated devices, the increase in venous velocity varied significantly. Design of compression chambers enabling compression on the lateral and medial aspects of the calf produced an increase in venous velocity closest to active foot dorsiflexion. Foot compression devices produced the smallest increase in venous velocity. The relative effectiveness of pneumatic compression devices, particularly with respect to increasing venous blood flow in the lower extremity, may correlate well with how closely the device simulates the physiologic contraction of the calf muscles. Clinical trials are needed to further compare the effectiveness of these devices, as other less readily measured factors play a role in thromboprophylaxis.

Oral-aboral axis specification in the sea urchin embryo. I. Axis entrainment by respiratory asymmetry.

In embryos of indirectly developing echinoids, the secondary (oral-aboral) larval axis is established after fertilization by an as yet undiscovered process. One of the earliest manifestations of this axis is an asymmetry in mitochondrial respiration, with the prospective oral side of the embryo exhibiting a higher rate of respiration than the prospective aboral side. We show here that respiratory asymmetry can be experimentally induced within embryos by immobilizing them in tight clusters of four ("rosettes"). Within such clusters a redox gradient is established from the inside to the outside of the rosette. Vital staining of clustered embryos demonstrates that the side of the embryo facing the outside of the rosette (i.e., the most oxidizing) tends to become the oral side, while the side facing the inside tends to become the aboral side. Effective entrainment of the oral-aboral axis requires that the embryos remain immobilized in rosettes until the hatching blastula stage. To begin to investigate the molecular mechanisms underlying this effect we made use of P3A2, a transcriptional regulatory protein whose activity is spatially modulated along the oral-aboral axis. When synthetic mRNA encoding P3A2 fused to the VP16 activation domain is injected into eggs, it activates embryonic expression of a green fluorescent protein reporter gene containing a basal promoter and a single strong P3A2 target site. In embryo rosettes, such activation occurs predominantly on the outside of the rosette, suggesting that the activity of the P3A2 protein is spatially regulated by the respiratory asymmetry established by clustering the embryos. These findings are discussed with reference to earlier work on both oral-aboral axis specification and P3A2 and used to develop a testable model of the mechanism of oral-aboral axis specification in the sea urchin embryo.

Characterizing the performance of industrial-scale columns.

The performance of a large commercial chromatographic column was investigated using a short pulse of a tracer and an extension of the reverse-flow technique. This technique permits separate determination of the unavoidable irreversible microscopic processes and the reversible effects of flow maldistribution, and allows for the separation of flow maldistribution in the flow distributors from flow maldistribution inside the packed bed. This analysis was performed on a 0.44 m Millipore IsoPak column using Cellufine GC 700, cellulosic-based media with an average particle diameter of 75 microm, for the stationary phase. The column efficiency was quantified by analysis of the effluent curve from a short pulse of a 5% aqueous acetone tracer. The study examined behavior of beds of different lengths (10-24 cm) and beds packed from different slurry concentrations (10-75% v/v). The slurry-packed columns were very uniform, and no significant macroscopic flow maldistribution was observed inside the column. The observed bed plate heights conformed to the predictions of available one-dimensional continuum models. Dispersion in the flow distributors was significant, corresponding to 15-25% of the intracolumn dispersion when the full 24 cm available bed length was used and a proportionally larger increase for shorter bed lengths. Thus, the headers are shown to produce a significant increase in the observed plate height.

Public policies to promote community-based and interdisciplinary health professions education.

CONTEXT: Many rural and inner-city communities in the United States have persistent shortages of health professionals. In addition, health services are increasingly delivered in community-based settings by interdisciplinary teams. Yet, health professions students in the US continue to receive most of their training in urban hospitals. OBJECTIVE: To assess the extent to which national and state government programs in the US that fund health professions education provide financial resources for community-based and interdisciplinary education in the health professions. METHODS: Literature review. FINDINGS: Most national and state government funding provided to health professions schools and clinical training sites in the US is not targeted to community-based and interdisciplinary education. Nationally, the Bureau of Health Professions, however, does administer some targeted grant programs. In addition, a number of states are addressing these needs through targeted appropriations to health professions schools and Medicaid payments to clinical training sites. RECOMMENDATIONS: The US experience with government funding of health professions education suggests several questions that policymakers in other nations should consider and several principles for developing effective policies to promote community-based and interdisciplinary education.