Identification of a new Escherichia coli She haemolysin homolog in avian E. coli.

Haemolysin is one type of virulence factor that assists in the pathogenesis of Escherichia coli. Currently, hemolytic activity in E. coli has been attributed to haemolysin genes found in either uropathogenic or enterohemorrhagic E. coli. Both haemolysins are classified as RTX toxins because they both have repeats in toxin domains and share similar operon organization, sequence homology, and mechanisms of action. Haemolytic avian E. coli isolates, however, lack either E. coli haemolysin gene. To investigate the avian E. coli haemolysin, a genomic library was made from an avian pathogenic E. coli. A haemolytic clone that was isolated was shown to contain homology with sheA, an E. coli K- 12 gene which causes haemolysis when present in high copy number. The cloned haemolysin gene, hlyE, lacked the conserved amino acid sequence and accessory genes common to all RTX toxins. DNA hybridizations and polymerase chain reaction amplifications showed that the nucleotide sequences homologous to hlyE were not present in a collection of three O157: H7 E. coli, five haemolytic canine uropathogenic E. coli, one haemolytic O26 E. coli, and three haemolytic avian pathogenic E. coli. Thus we have identified a new E. coli haemolysin distinct from the RTX haemolysins and have shown that some avian pathogenic E. coli possess a haemolysin with no apparent homology to hlyE or RTX haemolysins.

Sexual expression and dementia. Views of caregivers: A pilot study.

OBJECTIVE: To measure the attitudes of health professionals in nursing homes towards sexuality and sexual expression in cognitively impaired and cognitively intact residents. DESIGN: Postal survey. PARTICIPANTS: The staff (administrators, clinicians, social workers and others) of 300 randomly selected nursing homes located in three states. Of these, 114 representatives responded. MAIN OUTCOME MEASURE: A measure of attitudes towards resident sexuality developed during a prior study. RESULTS: Results suggest that respondents held a generally positive orientation towards residents' sexual expression which was expressed with respect to cognitively impaired residents as well as to those who were cognitively intact. Possibly because of the small sample size and resulting low statistical power, statistical analyses failed to demonstrate any significant differences among the groups of residents: administrators, clinicians, social workers, and undifferentiated 'others'. However, while non-significant, there was a consistent tendency for administrators to be relatively more conservative than were the other groups. Almost all respondents agreed that additional staff training should focus specifically on dealing with resident sexual expression. CONCLUSIONS: Overall, the sample reported generally positive attitudes towards resident sexuality and sexual expression.

Mental status testing in the elderly nursing home population.

The clinical utility of selected brief cognitive screening instruments in detecting dementia in an elderly nursing home population was examined. One hundred twenty nursing home residents (mean age 87.9) were administered the Mini-Mental State Exam (MMSE) and the Modified Mini-Mental State Exam (3MS). The majority of the subjects (75%) were also administered the Dementia Rating Scale (DRS). Both clinically diagnosed demented (n = 57) and non-demented (n = 63) subjects participated in the study. Dementia was diagnosed in accordance with DSM-III-R criteria by physicians specializing in geriatric medicine. Using standard cutoffs for impairment, the 3MS, MMSE, and DRS achieved high sensitivity (82% to 100%) but low specificity (33% to 52%) in the detection of dementia among nursing home residents. Positive predictive values ranged from 52% to 61%, and negative predictive values from 77% to 100%. Higher age, lower education, and history of depression were significantly associated with misclassification of non-demented elderly subjects. Receiver Operating Characteristic (ROC) curve analyses revealed optimal classification of dementia with cutoff values of 74 for the 3MS, 22 for the MMSE, and 110 for the DRS. The results suggest that the 3MS, MMSE, and DRS do not differ significantly with respect to classification accuracy of dementia in a nursing home population. Elderly individuals of advanced age (i.e., the oldest-old) with lower education and a history of depression appear at particular risk for dementia misclassification with these instruments. Revised cutoff values for impairment should be employed when these instruments are applied to elderly residents of nursing homes and the oldest-old.

Expanding adult day care successfully.

Expanding adult day care services successfully by strengthening recruitment and retention, quality assurance, programming, scheduling and financial management requires strong program leadership. Since the vast majority of day care program directors are educated as registered nurses, social workers and recreation therapists, cultivation of effective leadership skills must be achieved through a combination of additional formal education in management, extensive seminar/workshop attendance, outside readings and on the job guidance and experience. The administrator, to whom the program director reports, should devote considerable time and effort toward the director's management development through instruction, counseling and support. Conflicts may arise in areas such as staff and overtime expenses, and marginally efficient equipment purchases, where the director's clinical background may overshadow an objective cost/benefit analysis. Learning to delegate responsibility for basic programming and clinical services to staff, thus developing their skills, is a significant area for director and program growth. A well-trained and motivated nurse's aide can be quite capable of leading discussion and activity groups, perhaps assisted by volunteers. Social work students, with supervision, do a fine job of cofacilitating caregiver support groups and with additional experience, intake assessments.

The course of life for old people.

Various aspects of institutional living for old people are discussed, particularly the imposition of a lifestyle completely foreign to their previous way of existence. Old people who have been living in one manner for about seventy years cannot be expected to adjust readily to another rhythm. The clash of lifestyles creates maladaptive behavior and adjustment problems that have not been adquately studied. Suggestions are made for approaches to resolve these difficulties. In essence, the techniques include reprogramming of institutional living for old people so that they have an opportunity to maintain their customary lifestyle. Examples of such programming are presented.