Chlamydia evasion of neutrophil host defense results in NLRP3 dependent myeloid-mediated sterile inflammation through the purinergic P2X7 receptor.

Chlamydia trachomatis infection causes severe inflammatory disease resulting in blindness and infertility. The pathophysiology of these diseases remains elusive but myeloid cell-associated inflammation has been implicated. Here we show NLRP3 inflammasome activation is essential for driving a macrophage-associated endometritis resulting in infertility by using a female mouse genital tract chlamydial infection model. We find the chlamydial parasitophorous vacuole protein CT135 triggers NLRP3 inflammasome activation via TLR2/MyD88 signaling as a pathogenic strategy to evade neutrophil host defense. Paradoxically, a consequence of CT135 mediated neutrophil killing results in a submucosal macrophage-associated endometritis driven by ATP/P2X7R induced NLRP3 inflammasome activation. Importantly, macrophage-associated immunopathology occurs independent of macrophage infection. We show chlamydial infection of neutrophils and epithelial cells produce elevated levels of extracellular ATP. We propose this source of ATP serves as a DAMP to activate submucosal macrophage NLRP3 inflammasome that drive damaging immunopathology. These findings offer a paradigm of sterile inflammation in infectious disease pathogenesis.

Cultural Aspects of End-of-Life Advance Care Planning for African Americans: An Ethnonursing Study.

INTRODUCTION: Advance directive completion rates among the general population are low, with even lower completion rates among African Americans (AAs). This study's purpose was to identify culturally based meanings, expressions, and traditions of end-of-life (EOL) advance care planning (ACP) and decision making in order to promote culturally congruent nursing care among African Americans. METHODOLOGY: Leininger's Culture Care Theory and Ethnonursing Research Method guided the study. A convenience sample of 21 informants were interviewed in community settings. Data analysis was guided using Leininger's phases of ethnonursing data analysis for qualitative data. RESULTS: Three themes emerged that affect EOL decision making: (a) faith in God and belief in life after death, (b) a strong matriarchal family structure, and (c) fear of talking about death and mistrust of the U.S. health care system. DISCUSSION: AA culture, beliefs, and traditions influence EOL ACP and practices, and must be considered while providing culturally congruent care.

Antimicrobial Peptide Resistance Mechanism Contributes to Staphylococcus aureus Infection.

Antimicrobial peptides (AMPs) constitute an important part of innate host defense. Possibly limiting the therapeutic potential of AMPs is the fact that bacteria have developed AMP resistance mechanisms during their co-evolution with humans. However, there is no direct evidence that AMP resistance per se is important during an infection. Here we show that the Staphylococcus aureus Pmt ABC transporter defends the bacteria from killing by important human AMPs and elimination by human neutrophils. By showing that Pmt contributes to virulence during skin infection in an AMP-dependent manner, we provide evidence that AMP resistance plays a key role in bacterial infection.

Cultural Aspects of End-of-Life Care Planning for African Americans: An Integrative Review of Literature.

Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are affected by demographic variables, cultural distinctives related to patient autonomy, mistrust of the health care system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. An integrative review was conducted to synthesize nursing knowledge regarding cultural perspectives of end-of-life and advance care planning among African Americans. Twenty-four articles were reviewed. Nurses educate patients and families about end-of-life planning as mandated by the Patient Self-Determination Act of 1991. Implementation of advance directives promote patient and family centered care, and should be encouraged. Clinicians must be sensitive and respectful of values and practices of patients of diverse cultures, and initiate conversations with open-ended questions facilitating patient trust and sharing within the context of complex beliefs, traditions, and lifeways.

Antioxidant capacity, lipid peroxidation, and lipid composition changes during long-term and short-term thermal acclimation in Daphnia.

Examples of phenotypic plasticity-the ability of organisms of identical genotypes to produce different phenotypes in response to the environment-are abundant, but often lack data on the causative physiology and biochemistry. Phenotypes associated with increased protection against or reduced damage from harmful environments may, in fact, be downstream effects of hidden adaptive responses that remain elusive to experimental measurement or be obscured by homeostatic or over-compensatory effects. The freshwater zooplankton crustacean Daphnia drastically increases its heat tolerance as the result of acclimation to high temperatures, an effect often assumed to be based on plastic responses allowing better protection against oxidative stress. Using several geographically distant Daphnia magna genotypes, we demonstrate that the more heat tolerant individuals have a higher total antioxidant capacity (TAC) both in the comparison of heat-acclimated vs. non heat-acclimated females and in the comparison of females to age- and body size-matched males, which show lower heat tolerance than females. However, experimental manipulations of hypothesized antioxidant pathways by either glutathione addition or glutathione synthesis inhibition had no effect on heat tolerance. Lipid peroxidation (LPO), contrary to expectations, did not appear to be a predictive measure of susceptibility to thermal damage: LPO was higher, not lower, in more heat tolerant heat-acclimated individuals after exposure to a lethally high temperature. We hypothesize that LPO may be maintained in Daphnia at a constant level in the absence of acute exposure to elevated temperature and increase as a by-product of  a possible protective antioxidant mechanism during such exposure. This conclusion is corroborated by the observed short-term and long-term changes in phospholipid composition that included an increase in fatty acid saturation at 28 °C and up-regulation of certain long-chain polyunsaturated fatty acids. Phospholipid composition was more strongly affected by recently experienced temperature (4-day transfer) than by long-term (2 generations) temperature acclimation. This is consistent with partial loss of thermal tolerance after a short-term switch to a reciprocal temperature. As predicted under the homeoviscous adaptation hypothesis, the more heat tolerant Daphnia showed lower membrane fluidity than their less heat tolerant counterparts, in comparison both between acclimation temperatures and among different genotypes. We conclude that thermal tolerance in Daphnia is influenced by total antioxidant capacity and membrane fluidity at high temperatures, with both effects possibly reflecting changes in phospholipid composition.

The effectiveness of the department of defense's field manual 3-11 in detecting, deterring and degrading the breach of a combat base by a human-borne with bioagent (HBBA): perceptions of security personnel.

BACKGROUND: The department of defense's FM 3-11 is among the military's field manuals for preparing for, reacting to and recovering from chemical, biological, radiological and nuclear attacks. Since post 9-11, U.S. military service members have been deployed in the global war on terrorism. This study attempted to determine the effectiveness of the FM 3-11 in detecting, deterring or preventing a human-borne with bioagent (HBBA) terrorist breach at an entry control point (ECP). METHOD: This time-specific, cross-sectional study disseminated a validated survey tool with Cronbach's α > 0.82 to respondents who have had antiterrorism training and combat ECP experience. The return rate was greater than 75.0 %; however, many of the respondents failed to meet the inclusion criteria. Consequently, only 26 questionnaires were included in the sample. RESULTS: The results revealed that while over 60.0 % of the respondents either strongly agreed or agreed that biointelligence, the deployment of biodetectors and the use of biowarning systems could be effective in preventing an ECP breach by a terrorist with a bioagent, the use of protective equipment and immunization to decontaminate service members or other TTPs would never prevent a breach. A large percentage of respondents claimed that soldiers at the ECP lacked the devices or the knowledge to detect an HBBA at an ECP, and 72.0 % suggested modifying current ECP TTPs to include education, training and equipment for security personnel at military base ECPs. CONCLUSION: If obtained from appropriate sources and communicated to the personnel at the ECP in an effective or timely manner, the possible effectiveness of certain TTPs in the FM 3-11, specifically FM 3-11.86 (intelligence), might increase.

The possibility of a human-borne with bioagent (HBBA) terrorist at foreign FOB ECPs: the perceptions of U.S. military or security personnel, a preliminary report.

BACKGROUND: The global war on terrorism has prompted an increase in the deployment of security personnel from multi-national forces on foreign lands, especially in places where known terrorist groups are based. The aim of this study was to obtain U.S. military and security personnel's perceptions of the possibility of encountering a human-borne with bioagent (HBBA) terrorist at an entry control point (ECP). METHODS: This study was a mixed-method, cross-sectional, survey-based, time-limited study. A validated, five-option Likert scale questionnaire with Cronbach's alphas of 0.82 and 0.894 for Constructs 1 and 2 was distributed to over 113 respondents with combat experience. RESULTS: The results indicated that 92.3 % of the respondents thought it was possible for a terrorist to employ a biological agent to cause terror; 61.5 % claimed it was either possible or very possible, and 26.9 % claimed it was somewhat possible for a terrorist carrying a biological agent to successfully breach a combat Forward Operating Bases (FOB) ECP undetected. 26.9 % of the respondents agreed that "ECP soldiers are knowledgeable about bioagents (BA)", only 15.4 % responded that ECP soldiers have effective devices for detecting a BA on a terrorist at an ECP. CONCLUSION: Despite some limitations, this pre-study tends to indicate that while many U.S. military or security personnel acknowledge the possibility of an HBBA terrorist breach and the vulnerability of U.S. combat post ECPs to a BA breach, the soldiers at the ECPs lack adequate knowledge or devices to effectively detect a BA on a terrorist at an ECP.

The neuroscience of learning.

Significant advances have been made in understanding the neurophysiological basis of learning, including the discovery of mirror neurons and the role of cyclic adenosine monophosphate (cAMP) responsive element binding (CREB) protein in learning. Mirror neurons help us visually compare an observed activity with a remembered action in our memory, an ability that helps us imitate and learn through watching. Long-term potentiation, the Hebb rule, and CREB protein are associated with the formation of long-term memories. Conversely, protein phosphatase 1 and glucocorticoids are neurophysiological phenomena that limit what can be learned and cause forgetfulness. Gardner's theory of multiple intelligences contends that different areas of the brain are responsible for different competencies that we all possess to varying degrees. These multiple intelligences can be used as strategies for improved learning. Repeating material, using mnemonics, and avoiding overwhelming stress are other strategies for improving learning. Imaging studies have shown that practice with resultant learning results in significantly less use of brain areas, indicating that the brain becomes more efficient. Experts have advantages over novices, including increased cognitive processing efficiency. Nurses are in a unique position to use their understanding of neurophysiological principles to implement better educational strategies to provide quality education to patients and others.