Engaging patients and families to transform heart failure care.

For patients with advanced heart failure involvement as a member of the healthcare team is critical to safe, high-quality and goal-directed care. While recognized as an important aspect of care, patient engagement is not yet a standard practice. This presents an opportunity for professional education and development in team-based care. This short report describes the development of a Community and Patient Advisory Team (CPAT) formed to support patient involvement in interprofessional collaborative practice. The CPAT, composed of patient and family advisors, researchers, care team members, and grant operations staff, served as a core team within the structure of a project to shape a new vision of care delivery. This was accomplished through participation in quarterly leadership workshops and facilitation of team training focused on patient-provider communication strategies to improve patient safety. The advisory team led the co-development of patient materials to support patient engagement during the new implementation of structured interprofessional bedside rounds. Involving community members as partners helped shape our work to more effectively and directly address gaps in current patient care.

Using a GIS model to assess terrestrial salamander response to alternative forest management plans.

A GIS model predicting the spatial distribution of terrestrial salamander abundance based on topography and forest age was developed using parameters derived from the literature. The model was tested by sampling salamander abundance across the full range of site conditions used in the model. A regression of the predictions of our GIS model against these sample data showed that the model has a modest but significant ability to predict both salamander abundance and mass per unit area. The model was used to assess the impacts of alternative management plans for the Hoosier National Forest (Indiana, USA) on salamanders. These plans differed in the spatial delineation of management areas where timber harvest was permitted, and the intensity of timber harvest within those management areas. The spatial pattern of forest openings produced by alternative forest management scenarios based on these plans was projected over 150 years using a timber-harvest simulator (HARVEST). We generated a predictive map of salamander abundance for each scenario over time, and summarized each map by calculating mean salamander abundance and the mean colonization distance (average distance from map cells with low predicted abundance to those with relatively high abundance). Projected salamander abundance was affected more by harvest rate (area harvested each decade) than by the management area boundaries. The alternatives had a varying effect on the mean distance salamanders would have to travel to colonize regenerating stands. Our GIS modeling approach is an example of a spatial analytical tool that could help resource management planners to evaluate the potential ecological impact of management alternatives.

Intracellular detection of sense and antisense enteroviral RNA by in situ hybridization.

We prepared sense (S) and anti-sense (AS) 3H-labelled single-stranded RNA probes by polymerase-directed in vitro transcription of a coxsackievirus B3-derived cDNA fragment cloned in the PGEM2 plasmid vector. The probes detected, by in situ hybridization, both S and AS forms of viral RNA in the cytoplasm of coxsackievirus-infected tissue culture cells. More S (genomic and messenger) RNA was present than AS (negative and replicative intermediate) RNA. We confirmed and quantitated this observation with slot-blot hybridization of lysates of infected cells in which the ratio of detectable S to AS RNA was 40:1. The selective detection and localization of both forms of RNA in infected cells with sensitive and specific bi-directional probes advances the applicability of in situ hybridization to the study of viral pathogenesis.

RNA target loss during solid phase hybridization of body fluids--a quantitative study.

Recent applications of nucleic acid hybridization to the diagnosis of viral infections are limited by the sensitivity of the assay system and, hence, by the amount of target viral nucleic acid in the specimen. In the case of single-stranded RNA viruses, RNase activity in body fluids poses a potential obstacle to optimizing sensitivity. We added radioactively labelled, purified, single-stranded enteroviral RNA to various body fluids and noted significant loss of this 'target' RNA during the course of routine hybridization procedures. We confirmed that RNase activity was responsible for much of the target loss. Further characterization of the RNase activity found it to be rapidly acting (less than 15 s), concentrated (equally active at 10-fold dilution of body fluid) and potent--resulting in RNA breakdown products too small to be retained by any of six commercially available membrane filters. The RNase was active only in solution and was effectively inhibited by treatment of the body fluid with inhibitors prior to contact of the fluid with RNA. In contrast, when RNA within virions was added to body fluids, it was largely retained by membrane filters during the hybridization procedure. We conclude that detection of single-stranded RNA viruses in body fluids will depend upon the quantity of intact virions in the specimen. RNase inhibitors should be immediately added to body fluid specimens after collection to minimize the loss of RNA which will occur if virions are disrupted in transport and handling of the specimen.