Focal Traumatic Brain Injury Impairs the Integrity of the Basement Membrane of Hindlimb Muscle Fibers Revealed by Extracellular Matrix Immunoreactivity.

Traumatic brain injury (TBI) stands as a prominent global cause of disability, with motor deficits being a common consequence. Despite its widespread impact, the precise pathological mechanisms underlying motor deficits after TBI remain elusive. In this study, hindlimb postural asymmetry (HL-PA) development in rats subjected to focal TBI was investigated to explore the potential roles of collagen IV and laminin within the extracellular matrix (ECM) of selected hindlimb muscles in the emergence of motor deficits following TBI. A focal TBI was induced by ablating the left sensorimotor cortex in rats and motor deficits were assessed by measuring HL-PA. The expression of laminin and collagen IV in eight selected muscles on each side of the hindlimbs from both TBI- and sham-operated rats were studied using immunohistochemistry and semi-quantitatively analyzed. The results indicated that the TBI rats exhibited HL-PA, characterized by flexion of the contralateral (right) hindlimb. In the sham-operated rats, the immunoreactive components of laminin and collagen IV were evenly and smoothly distributed along the border of the muscle fibers in all the investigated muscles. In contrast, in the TBI rats, the pattern was broken into aggregated, granule-like, immunoreactive components. Such a labeling pattern was detected in all the investigated muscles both from the contra- and ipsilateral sides of the TBI rats. However, in TBI rats, most of the muscles from the contralateral hindlimb showed a significantly increased expression of these two proteins in comparison with those from the ipsilateral hindlimb. In comparison to sham-operated rats, there was a significant increase in laminin and collagen IV expression in various contralateral hindlimb muscles in the TBI rats. These findings suggest potential implications of laminin and collagen IV in the development of motor deficits following a focal TBI.

A Comparison of PKD2L1-Expressing Cerebrospinal Fluid Contacting Neurons in Spinal Cords of Rodents, Carnivores, and Primates.

Cerebrospinal fluid contacting neurons (CSF-cNs) are a specific type of neurons located around the ventricles in the brain and the central canal in the spinal cord and have been demonstrated to be intrinsic sensory neurons in the central nervous system. One of the important channels responsible for the sensory function is the polycystic kidney disease 2-like 1 (PKD2L1) channel. Most of the studies concerning the distribution and function of the PKD2L1-expressing CSF-cNs in the spinal cord have previously been performed in non-mammalian vertebrates. In the present study immunohistochemistry was performed to determine the distribution of PKD2L1-immunoreactive (IR) CSF-cNs in the spinal cords of four mammalian species: mouse, rat, cat, and macaque monkey. Here, we found that PKD2L1-expressing CSF-cNs were present at all levels of the spinal cord in these animal species. Although the distribution pattern was similar across these species, differences existed. Mice and rats presented a clear PKD2L1-IR cell body labeling, whereas in cats and macaques the PKD2L1-IR cell bodies were more weakly labeled. Ectopic PKD2L1-IR neurons away from the ependymal layer were observed in all the animal species although the abundance and the detailed locations varied. The apical dendritic protrusions with ciliated fibers were clearly seen in the lumen of the central canal in all the animal species, but the sizes of protrusion bulbs were different among the species. PKD2L1-IR cell bodies/dendrites were co-expressed with doublecortin, MAP2 (microtubule-associated protein 2), and aromatic L-amino acid decarboxylase, but not with NeuN (neuronal nuclear protein), indicating their immature properties and ability to synthesize monoamine transmitters. In addition, in situ hybridization performed in rats revealed PKD2L1 mRNA expression in the cells around the central canal. Our results indicate that the intrinsic sensory neurons are conserved across non-mammalian and mammalian vertebrates. The similar morphology of the dendritic bulbs with ciliated fibers (probably representing stereocilia and kinocilia) protruding into the central canal across different animal species supports the notion that PKD2L1 is a chemo- and mechanical sensory channel that responds to mechanical stimulations and maintains homeostasis of the spinal cord. However, the differences of PKD2L1 distribution and expression between the species suggest that PKD2L1-expressing neurons may receive and process sensory signals differently in different animal species.

The Development of Hindlimb Postural Asymmetry Induced by Focal Traumatic Brain Injury Is Not Related to Serotonin 2A/C Receptor Expression in the Spinal Cord.

Brain injury and stroke are leading causes of adult disability. Motor deficits are common problems, and their underlying pathological mechanisms remain poorly understood. The serotoninergic system is implicated in both functional recovery from and the occurrence of spasticity after injuries to the central nervous system. This study, which was conducted on rats, investigated the development of limb postural changes and their relationship to the expression of serotonin (5-HT) 2A and 2C receptors in the spinal cord in the 4 weeks after focal traumatic brain injury (TBI) to the right hindlimb sensorimotor cortex. The limb motor deficits were assessed by measuring gait pattern changes during walking and hindlimb postural asymmetry at different time intervals (3−28 days) after surgery. The expressions of the 5-HT2A and 2C receptors in the lumbar spinal cord were investigated using immunohistochemistry. The results showed that all the rats with TBI, independently of the duration of the interval, displayed postural asymmetry with flexion on the contralateral (left) side (>2 mm), while the sham-operated rats showed no apparent postural asymmetry. The TBI rats also had longer stride lengths during walking in both their hindlimbs and their forelimbs compared with the sham rats. For both the TBI and the sham rats, the hind-paw placement angles were larger on the contralateral side in some of the groups. Compared to the sham-operated rats, the 5-HT2A and 2C receptor expression did not significantly change on either side of the lumbar spinal cords of the TBI rats in any of the groups. These results suggest that focal TBI can induce motor deficits lasting a relatively long time, and that these deficits are not related to the expression of the 5-HT2A and 2C receptors in the spinal cord.

College Students' Responses to Their Sexually Assaulted Friends: Impact of Rape Myth Acceptance, Prior Victimization, and Social Relationships.

College students often confide in their friends following sexual assaults. Friends' reactions may include a variety of emotions and helping behaviors; prior victimization, knowing the accused, and rape myth acceptance may affect these. A sample of 1016 students at a religiously affiliated university completed quantitative surveys measuring their rape myth acceptance, history of sexual assault victimization, disclosures received, and reactions to the most recent disclosure. A subset of 636 students (506 females, 130 males) reported receiving at least one rape disclosure from a friend. Regression analysis of the subset revealed that participants' rape myth acceptance, victimization histories, and relationships to the accused influenced reactions to friends who were sexually assaulted. Students who endorsed rape myths were less likely to lend support to survivors; they were also more likely to experience shame and anger, and to blame their sexually assaulted friends. Students who shared friends with both the survivor and the accused were more likely to offer support to the survivor, experience feelings of divided loyalty, and blame the survivor. Blaming or feeling embarrassed toward survivors was associated with a tendency to advise them on how to avoid revictimization. This suggests that some disclosure recipients focused on their friend's behavior to explain the sexual assault. Cognitive dissonance theory may partially explain the findings.

Placental MRI: Development of an MRI compatible ex vivo system for whole placenta dual perfusion.

PURPOSE: Placental dysfunction plays a key role in diseases that affect the fetus in utero and after birth. Aiming to develop a platform for validating in vivo placental MRI and investigations into placental physiology, we designed and built a prototype MRI-compatible perfusion chamber with an integrated MRI receive coil for high SNR ex vivo placental imaging. PRINCIPAL RESULTS: After optimizing placenta vascular clearing and perfusion protocols, we performed contrast enhanced MR angiography and MR relaxometry on eight carefully selected placentas while they were perfused via the umbilical arteries (UAs). Additionally, two of these placentas underwent maternal perfusion via the intervillous space (IVS). Despite striving for homogenous perfusion across the whole placenta, imaging results were highly heterogeneous for both UA and IVS perfused placentas. By histology, we observed blood congestion in the villi in regions that showed low UA perfusion during MRI. In two placentas prominent chorionic arteries followed by adjacent veins underwent contrast enhancement in the absence of villous capillary blush. The single placenta from a pregnancy affected by IUGR had the most homogeneous villous capillary perfusion. MAJOR CONCLUSIONS: A dual perfusion system for ex vivo placentas compatible with MRI permitted assessment of UA and IVS placental perfusion. We observed spatial UA perfusion heterogeneity and evidence for arteriovenous shunting in placentas from normal pregnancies and deliveries, but relative villous capillary perfusion homogeneity in a single IUGR placenta. Future work will focus on system optimization, followed by physiological manipulation and validation of in vivo placental MRI.

The Rat Homolog of the Schizophrenia Susceptibility Gene ZNF804A Is Highly Expressed during Brain Development, Particularly in Growth Cones.

A single nucleotide polymorphism in the ZNF804A gene, rs1344706, is associated with schizophrenia. The polymorphism has been suggested to alter fetal expression of ZNF804A. It has also been reported to be associated with altered cortical functioning and neural connectivity in the brain. Since developmental mechanisms are suggested in the pathophysiology for schizophrenia, expression of Zfp804A, the rat homolog of ZNF804A, was investigated in the developing rat brain. We found that expression of Zfp804A in most brain regions is developmentally regulated and peaks around birth, where after it decreases towards adult levels. This time point is developmentally the equivalent to the second trimester of fetal development in humans. An exception to this expression pattern is the hippocampus where the expression of Zfp804A appears to increase again in the adult brain. Using laser capture and quantitative PCR we found that Zfp804A mRNA expression in the adult rat hippocampus is highest in the CA1 sub region, where the overall firing rates of neurons is higher than in the CA3 region. In cultured cortical neurons Zfp804A mRNA expression peaked at day 4 and then decreased. The ZFP804A protein expression was therefore investigated with immunochemistry in such cultures. Interestingly, before day 4, the protein is mostly found in the perinuclear region of the cell but at day 4, ZFP804A was instead found throughout the cell and particularly in the growth cones. In conclusion we demonstrate that Zfp804A increases in the rat brain at the time of birth, coinciding with neuronal differentiation. We also show that ZFP804A is localized to growth cones of growing neurites. These data implicate ZFP804A in growth cone function and neurite elongation. The polymorphism rs1344706 lowers expression of ZNF804A during prenatal brain development. This may affect ZNF804A's role in cone function and neurite elongation leading to synaptic deficits and altered neural connectivity.

Infection prevention needs assessment in Colorado hospitals: rural and urban settings.

BACKGROUND: The purpose of our study was to conduct a needs assessment for infection prevention programs in both rural and urban hospitals in Colorado. METHODS: Infection control professionals (ICPs) from Colorado hospitals participated in an online survey on training, personnel, and experience; ICP time allocation; and types of surveillance. Responses were evaluated and compared based on hospital status (rural or urban). Additionally, rural ICPs participated in an interview about resources and training. RESULTS: Surveys were received from 62 hospitals (77.5% response); 33 rural (75.0% response) and 29 urban (80.6% response). Fifty-two percent of rural ICPs reported multiple job responsibilities compared with 17.2% of urban ICPs. Median length of experience for rural ICPs was 4.0 years compared with 11.5 years for urban ICPs (P = .008). Fifty-one percent of rural ICPs reported no access to infectious disease physicians (0.0% urban) and 81.8% of rural hospitals reported no antimicrobial stewardship programs (31.0% urban). Through the interviews it was revealed that priorities for rural ICPs were training and communication. CONCLUSIONS: Our study revealed numerous differences between infection prevention programs in rural versus urban hospitals. An infection prevention outreach program established in Colorado could potentially address the challenges faced by rural hospital infection prevention departments.

Police officers' collaboration with rape victim advocates: barriers and facilitators.

Secondary victimization may occur when rape victims make police reports. This can compromise the quality of official statements and jeopardize criminal cases. Rape reporters receive better treatment by police officers when advocates are involved and best practice police work includes such collaboration. Studies of advocates have described tension, role confusion, and poor communication with police officers. Many variables, including rape myth acceptance (RMA) and training on sexual assault dynamics, may affect officers' collaboration with advocates. There were 429 police officers who responded to a survey measuring their victim interviewing skill, formal training about rape, years on the job, number of victims known personally, number of recent rape cases, RMA, and collaboration with advocates. Results suggest that officers' interviewing skill, years on the job, and specific training are related to collaboration with victim advocates on rape cases. Professional, rather than personal, variables were most predictive of collaboration. Implications for officer selection and training are explored.

Assessment of the quality of publicly reported central line-associated bloodstream infection data in Colorado, 2010.

BACKGROUND: Validation of self-reported health care-associated infection data is essential to verify correct understanding of definition criteria, surveillance practices, and reporting integrity. Recent studies have found significant under-reporting of central line-associated bloodstream infections (CLABSI) leading Colorado Department of Public Health and Environment to examine the quality of Colorado's CLABSI data. METHODS: Trained Colorado Department of Public Health and Environment staff members performed onsite validation visits that included interviews with infection preventionists to assess surveillance practices and retrospective chart reviews of patients with positive blood cultures in specific intensive care units (adult and neonatal) and long-term acute care hospitals during the first quarter of 2010. RESULTS: Fifty-five CLABSIs from the original sample were identified; 33 (60%) in the adult intensive care unit, 7 (12.7%) in the neonatal intensive care unit, and 15 (27.3%) in the long-term acute care hospital. Of the 55 CLABSIs identified by reviewers, 18 (32.7%) were not reported by the hospitals, 37 CLABSIs (67.3%) were reported correctly into the National Healthcare Safety Network, and 1 CLABSI was over-reported. CONCLUSIONS: There was wide variation noted in surveillance practices as well as in application of definition criteria. With 33% under-reported cases, it was concluded that ongoing validation of health care-associated infection data is necessary.

Police interviews of sexual assault reporters: do attitudes matter?

Sexual assault is underreported in the United States. Survivors are often reluctant to make police reports for various reasons; one is fear of revictimization by criminal justice professionals. Conversely, police officers often lack skills for interviewing crime victims. Posttraumatic stress reactions among victims can exacerbate the problem. Although some victims prefer female interviewers, it is not known whether they are more skilled. A sample of 429 police officers completed a written survey testing their rape myth acceptance and knowledge of how to interview rape reporters. A significant relationship between rape myth acceptance and interviewing skill was discovered. Although officer gender was related to interviewing skill, the effect was mediated by rape myth acceptance. Specific officer behaviors related to high rape myth acceptance were identified. Implications for selection of police to conduct victim interviews were discussed.

No essence no self: using a Buddhist perspective to characterize the nature of nursing.

A fresh perspective is needed on the historical roots and contemporary politics of the essentials of nursing. In the 21st century, the profession needs to move past separatist thinking and the pursuit of identifying what can be called a professional self. Two ways that nurses have tried to characterize a professional self is through claiming caring as the essence of nursing and using the esoteric taxonomy system of nursing diagnoses. The Buddhist teaching of nonself (anatman) is proposed as an alternative way of viewing the nature of the profession.

A United States perspective on the challenges in nursing education.

Nursing education in the US today is at crossroads. The profession has made great strides in gaining public respect and recognition for the work that nurses do. Nurses' voices are being heard in important political debates about revolutionary changes in the problematic US health care system. Advanced practice nurses are becoming valued providers of primary care to US citizens. It is innovative educational programs and educators that have provided the foundation to help nursing use its voice and to propel the profession forward. However, nurse educators are finding that they face major challenges in keeping nursing on track to be in the forefront of health care in the future. Some of these challenges include confronting nursing and faculty shortages, eliminating inconsistent and confusing educational choices, taking responsibility for mandates to stay on the cutting edge of quality initiatives, providing excellent clinical experiences for students and being willing to step out of old comfort zones to engage in designing imaginative and innovative ways to educate nurses in the future. Nurse educators must be successful in turning these challenges into opportunities if nursing is to command a key role in an evolving US health care system.

Using a Buddhist Sangha as a model of communitarianism in nursing.

In spite of a continuing long and rich history of caring for patients, many nurses have not been satisfied with their work. One cause among others for this dissatisfaction is that nurses often do not care for one another. The philosophy of a Buddhist Sangha, or community, is similar to the philosophy of western communitarian ethics. Both philosophies emphasize the importance of people working together harmoniously towards a common good. In this article, unsatisfactory nurse-nurse relationships have been considered and a model for communitarian nursing practice has been suggested based on a Buddhist Sangha.

Acknowledging dependence: a MacIntyrean perspective on relationships involving Alzheimer's disease.

As people living with Alzheimer's disease experience their lifetime of memories slowly slipping away, they become dependent on society's independent practical reasoners family, health care professionals and society. Many people grow accustomed to the cognitive decline and begin to view the person with dementia as less than a person. In Dependent rational animals, Alasdair MacIntyre emphasized a moral framework that encompasses two sets of virtues needed for human beings to flourish in society and to achieve genuine common goods--the virtues of independent practical reasoners and the virtues of acknowledged dependence. Virtues of acknowledged dependence are discussed ethically in terms of benevolence towards those who are disabled or dependent upon people who are strong and independent. The authors propose that using MacIntyre's perspective of the two sets of virtues is valuable in the care of persons with Alzheimer's disease. According to MacIntyre, independent reasoners who understand and practice these two sets of virtues will help those people in communities who are dependent and vulnerable, and, subsequently, human flourishing can occur.

Rational suicide: uncertain moral ground.

BACKGROUND: The ambiguities involving end-of-life issues, such as physician-assisted suicide and voluntary stopping of eating and drinking, have caused a blurring of the definition of rational suicide and have prompted rich dialogue with moral deliberations that seem to be on disparate paths among bioethicists and other health care professionals. With the evolution of advanced medical technology extending life expectancy in older, disabled, and terminally ill people, rational suicide has become a critical issue of debate. AIM: The purpose of this article is to address the ethical positions supporting and opposing rational suicide and to consider whether coherence can be achieved through an ethic of care. FINDINGS: Attitudes towards suicide have been controversial, varying from acceptance to non-acceptance depending on social, political and religious influences. Nursing attitudes are no different from general societal attitudes and, consequently, nurses are treading on uncertain moral ground. CONCLUSION: Nurses who have not reflected on the moral issues involved with rational suicide may be unprepared psychologically and professionally when working with patients who may be contemplating such actions.

Performance improvement in higher education: adapting a model from health care agencies.

Because a nationwide nursing shortage continues to affect consumers of nursing education, it is currently more important than ever for nurse educators to continue to define and evaluate the quality of their programs. The authors propose that a model used by an industry leader in health care accreditation, the Joint Commission on Accreditation of Healthcare Organizations, can be adapted to evaluate the quality of nursing programs. This model is improvement oriented and data driven, targeting program functions and processes, rather than being problem focused.