Using Pet Therapy to Decrease Patients' Anxiety on Two Diverse Inpatient Units.

BACKGROUND: The physical benefits for patients who spend time with a therapy dog have been reported, including decreased anxiety. Pet therapy has decreased anxiety in various hospitalized patient populations. The human-animal bond is the foundation for the positive interaction therapy dogs create. AIMS: This study's purpose was to explore the use of pet therapy as an intervention to decrease patients' anxiety levels on two diverse inpatient units: Behavioral Health (BHU) and Pediatrics (PEDS). METHODS: This was a quantitative study using a convenience sample, with systematic assignment to the experimental and control group. The State Anxiety Scale (SAS), a 6-item, Likert-type Short Form version of the State-Trait Anxiety Inventory, was used with adults and children; a Pediatric Emoji Method was constructed to assist children with the SAS. After consent, both groups completed the SAS pretest. Intervention patients then spent up to 15 minutes with a therapy dog and handler. The SAS posttest was completed 1 hour later by the experimental and control group. Descriptive and inferential statistics were used, including an independent samples t test, paired-sample t test, Wilcoxon signed rank tests, and Spearman correlation coefficients. RESULTS: Findings revealed that the therapy dog visitations had a positive effect on lowering anxiety supporting the hypothesis. Both the PEDS and BHU participants experienced a significant decrease in their anxiety level following the dog visits. CONCLUSION: Patients on the BHU and PEDS units benefitted from their visit with a therapy dog by experiencing a decrease in their anxiety level.

Formation of an Airway Lead Network: an essential patient safety initiative.

We outline the history, implementation and clinical impact of the formation of an Airway Lead Network. Although recommendations to improve patient safety in airway management are published and revised regularly, uniform implementation of such guidelines are applied sporadically throughout the hospital and prehospital settings. The primary roles of an Airway Lead are to ensure supply, quality and storage of airway equipment, promote the use of current practice guidelines as well as the organisation of training and audits. Locally, the Airway Lead may chair a multi-disciplinary airway committee within their organisation; an Airway Lead Network enables Airway Leads to share common problems and solutions to promote optimal airway management on a national level. Support from governing bodies is an essential part of this structure.

Spiritual well-being as predictor of quality of life for adults with paraplegia.

PURPOSE: The promotion of quality of life (QOL) and healthy development across the person's life span can result in long and meaningful lives. The purpose of this study was to examine relationships between spiritual well-being (SWB), depression, and QOL for adults with paraplegia. DESIGN: A descriptive correlational design was used for this study. METHODS: A purposive sample of 75 participants completed the Ellison's SWB Scale, the Center for Epidemiologic Studies-Depression Scale, and a QOL scale. FINDINGS: Quality of life was significantly associated with SWB (r = .47, p = .01), and depression (r = -.59, p = .01), 43% of the variance in QOL was explained by age, gender, length of stay, SWB, and depression (F[5,69] = 10.45, p < .001). CONCLUSIONS: Participants with a strong sense of purpose or meaning in life were more likely to experience a higher QOL. CLINICAL RELEVANCE: Rehabilitation nurses can help guide patients to the discovery of what brings purpose and meaning to their lives.

Magnetic resonance myocardial perfusion imaging at 3.0 Tesla for the identification of myocardial ischaemia: comparison with coronary catheter angiography and fractional flow reserve measurements.

AIMS: To assess image quality and diagnostic performance of 3.0 Tesla (3T) cardiac magnetic resonance (CMR) myocardial perfusion imaging with a dual radiofrequency source to detect functional relevant coronary artery disease (CAD), using coronary angiography and invasive pressure-derived fractional flow reserve (FFR) as reference standard. METHODS AND RESULTS: We included 116 patients with suspected or known CAD, who underwent 3T adenosine myocardial perfusion CMR (resolution 2.97 × 2.97 mm) and coronary angiography plus FFR measurements in intermediate lesions. Image quality of myocardial perfusion CMR was graded on a 4-point scale (1 = poor to 4 = excellent). Diagnostic accuracy was assessed by ROC analyses using a 16-myocardial segment-based summed perfusion score (0 = normal to 3 = transmural perfusion defect) and by determining sensitivity, specificity, positive and negative predictive value on the coronary vessel territory and the patient level. Diagnostic image quality was achieved for all stress myocardial perfusion CMR studies with an average quality score of 2.5, 3.1, and 3.0 for LAD, LCX, and RCA territories. The ability of the myocardial perfusion CMR perfusion score to detect significant coronary artery stenosis yielded an area under the curve of 0.93 on ROC analysis. Values for sensitivity, specificity, positive and negative predictive value on a vessel territory level and the patient level were 89, 95, 87, 96% and 85, 87, 77, 92%, respectively. CONCLUSION: In patients with suspected or known significant CAD, 3T myocardial perfusion CMR with standard perfusion protocols provides consistently high image quality and an excellent diagnostic performance.

Mulinia lateralis (Mollusca: Bivalvia) die-off in South Carolina: discovery of a vector for two elasmobranch cestode species.

Unexplained and episodic die-offs of the dwarf surf clam, Mulinia lateralis , have been reported on the West Atlantic coast, with such an occurrence in South Carolina in June 2010. A sample of live clams from the 2010 South Carolina event was collected, and 200 clams were measured and necropsied. Two species of tapeworm larvae were observed. Plerocercoids (Duplicibothrium sp.) occupied the digestive gland ducts, and merocercoids (Rhodobothrium sp.) were found beneath the mantle. Specimens of both species were sequenced to obtain partial 28S rRNA gene sequences, and they were identified as the tetraphyllidean D. minutum and the rhinebothriidean R. paucitesticulare, based on an NCBI Standard Nucleotide BLAST search. Of the 200 clams, 2.1% were infected with merocercoids (mean intensity 1.3 ± 0.2) and 75% with plerocercoids (mean intensity 4.3 ± 3.7). Intensity of infection by plerocercoids increased significantly with individual shell length. The presence of plerocercoids was associated with enlargement of the digestive gland ducts, but no other pathology was observed. Because uninfected clams were abundant among the stranded molluscs, these parasites are not considered to be the causative agent of the die-off. This is a new host record for both elasmobranch tapeworms.

Endangered North Atlantic right whales (Eubalaena glacialis) experience repeated, concurrent exposure to multiple environmental neurotoxins produced by marine algae.

The western North Atlantic population of right whales (Eubalaena glacialis) is one of the most critically endangered of any whale population in the world. Among the factors considered to have potentially adverse effects on the health and reproduction of E. glacialis are biotoxins produced by certain microalgae responsible for causing harmful algal blooms. The worldwide incidence of these events has continued to increase dramatically over the past several decades and is expected to remain problematic under predicted climate change scenarios. Previous investigations have demonstrated that N. Atlantic right whales are being exposed to at least two classes of algal-produced environmental neurotoxins-paralytic shellfish toxins (PSTs) and domoic acid (DA). Our primary aims during this six-year study (2001-2006) were to assess whether the whales' exposure to these algal biotoxins occurred annually over multiple years, and to what extent individual whales were exposed repeatedly and/or concurrently to one or both toxin classes. Approximately 140 right whale fecal samples obtained across multiple habitats in the western N. Atlantic were analyzed for PSTs and DA. About 40% of these samples were attributed to individual whales in the North Atlantic Right Whale Catalog, permitting analysis of biotoxin exposure according to sex, age class, and reproductive status/history. Our findings demonstrate clearly that right whales are being exposed to both of these algal biotoxins on virtually an annual basis in multiple habitats for periods of up to six months (April through September), with similar exposure rates for females and males (PSTs: ∼70-80%; DA: ∼25-30%). Notably, only one of 14 lactating females sampled did not contain either PSTs or DA, suggesting the potential for maternal toxin transfer and possible effects on neonatal animals. Moreover, 22% of the fecal samples tested for PSTs and DA showed concurrent exposure to both neurotoxins, leading to questions of interactive effects. Targeted studies employing both in vivo and in vitro model systems represent the next logical step in assessing how and to what extent these algal biotoxins might compromise the health and reproduction of this endangered population.

An inducible and reversible mouse genetic rescue system.

Inducible and reversible regulation of gene expression is a powerful approach for uncovering gene function. We have established a general method to efficiently produce reversible and inducible gene knockout and rescue in mice. In this system, which we named iKO, the target gene can be turned on and off at will by treating the mice with doxycycline. This method combines two genetically modified mouse lines: a) a KO line with a tetracycline-dependent transactivator replacing the endogenous target gene, and b) a line with a tetracycline-inducible cDNA of the target gene inserted into a tightly regulated (TIGRE) genomic locus, which provides for low basal expression and high inducibility. Such a locus occurs infrequently in the genome and we have developed a method to easily introduce genes into the TIGRE site of mouse embryonic stem (ES) cells by recombinase-mediated insertion. Both KO and TIGRE lines have been engineered for high-throughput, large-scale and cost-effective production of iKO mice. As a proof of concept, we have created iKO mice in the apolipoprotein E (ApoE) gene, which allows for sensitive and quantitative phenotypic analyses. The results demonstrated reversible switching of ApoE transcription, plasma cholesterol levels, and atherosclerosis progression and regression. The iKO system shows stringent regulation and is a versatile genetic system that can easily incorporate other techniques and adapt to a wide range of applications.

Fate and distribution of brevetoxin (PbTx) following lysis of Karenia brevis by algicidal bacteria, including analysis of open A-ring derivatives.

Flavobacteriaceae (strain S03) and Cytophaga sp. (strain 41-DBG2) are algicidal bacteria active against the brevetoxin (PbTx)-producing, red tide dinoflagellate, Karenia brevis. Little is known about the fate of PbTx associated with K. brevis cells following attack by such bacteria. The fate and distribution of PbTx in K. brevis cultures exposed to these algicidal strains were thus examined by receptor binding assay and liquid chromatography/mass spectrometry (LC/MS) in three size fractions (>5, 0.22-5, <0.22microm) over a 2-week time course. In control cultures, brevetoxin concentrations in the >5microm particulate size fraction correlated with changes in cell density, whereas significant increases in dissolved (i.e., <0.22microm) toxin were observed in the later stages of culture growth. Exposure of K. brevis to either of the two algicidal bacteria tested caused cell lysis, coinciding with a rapid decline in the >5microm PbTX size fraction and a simultaneous release of dissolved toxin into the growth medium. Upon cell lysis, dissolved brevetoxin accounted for ca. 60% of total toxin and consisted of 51-82% open A-ring derivatives. Open A-ring PbTx-2 and PbTx-3 derivatives bound with lower affinity (approximately 22- and 57-fold, respectively) to voltage-gated sodium channels and were considerably less cytotoxic (86- and 142-fold, respectively) to N2A cells than their individual parent toxins (i.e., PbTx-2 and PbTx-3). These novel findings of changes in PbTx size-fractioned distribution and overall reduction in K. brevis toxicity following attack by algicidal bacteria improve our understanding of potential trophic transfer routes and the fate of PbTx during red tide events. Moreover, this information will be important to consider when evaluating the potential role of algicidal bacteria in harmful algal bloom (HAB) management strategies involving control of bloom populations.

Large-scale, saturating insertional mutagenesis of the mouse genome.

We describe the construction of a large-scale, orderly assembly of mutant ES cells, generated with retroviral insertions and having mutational coverage in >90% of mouse genes. We also describe a method for isolating ES cell clones with mutations in specific genes of interest from this library. This approach, which combines saturating random mutagenesis with targeted selection of mutations in the genes of interest, was successfully applied to the gene families of G protein-coupled receptors (GPCRs) and nuclear receptors. Mutant mouse strains in 60 different GPCRs were generated. Applicability of the technique for the GPCR genes, which on average represent fairly small targets for insertional mutagenesis, indicates the general utility of our approach for the rest of the genome. The method also allows for increased scale and automation for the large-scale production of mutant mice, which could substantially expedite the functional characterization of the mouse genome.

Long-lasting decrease in viremia in macaques chronically infected with simian immunodeficiency virus SIVmac251 after therapeutic DNA immunization.

Rhesus macaques chronically infected with highly pathogenic simian immunodeficiency virus (SIV) SIVmac251 were treated with antiretroviral drugs and vaccinated with combinations of DNA vectors expressing SIV antigens. Vaccination during therapy increased cellular immune responses. After the animals were released from therapy, the virus levels of 12 immunized animals were significantly lower (P = 0.001) compared to those of 11 animals treated with only antiretroviral drugs. Vaccinated animals showed a persistent increase in immune responses, thus indicating both a virological and an immunological benefit following DNA therapeutic vaccination. Several animals show a long-lasting decrease in viremia, suggesting that therapeutic vaccination may provide an additional benefit to antiretroviral therapy.

Dimensions of quality in long-term care facilities in Taiwan.

AIM: This article presents the results of a qualitative study designed to explore the perceptions of Taiwanese elders about the quality of their care while in residence at a long-term care facility. BACKGROUND: As the population of elders in Taiwan is increasing rapidly, quality long-term care has become both a necessity and social responsibility. Research related to quality of care has focused on structure, process and outcomes as well as perceptions of quality of care and life satisfaction. Few authors have considered residents' perspectives within a cultural context. METHOD: A convenience sample of 22 residents, aged between 61 and 86 years and living in four Taiwanese care facilities, participated in semi-structured interviews. The data were generated during 2001/2002 and were analysed using content analysis. RESULTS: Six key dimensions of quality care were elicited. The dimensions were: a caring attitude, respect for individual differences, emotional support, social interaction, a supportive environment, and accessible care. These dimensions are discussed within a cultural context supportive of family connectedness and filial piety, values underpinning care expectations of elders. CONCLUSIONS: The findings provide a foundation for increased understanding of the perceived gaps between residents' aspirations about quality care and priorities identified in other studies. Additional studies based on these data are planned in order to generate a culturally relevant, psychometrically sound resident assessment tool to evaluate the quality of care from a resident perspective in long-term care facilities in Taiwan.

DNA vaccines expressing different forms of simian immunodeficiency virus antigens decrease viremia upon SIVmac251 challenge.

We have tested the efficacy of DNA immunization as a single vaccination modality for rhesus macaques followed by highly pathogenic SIVmac251 challenge. To further improve immunogenicity of the native proteins, we generated expression vectors producing fusion of the proteins Gag and Env to the secreted chemokine MCP3, targeting the viral proteins to the secretory pathway and to a beta-catenin (CATE) peptide, targeting the viral proteins to the intracellular degradation pathway. Macaques immunized with vectors expressing the MCP3-tagged fusion proteins developed stronger antibody responses. Following mucosal challenge with pathogenic SIVmac251, the vaccinated animals showed a statistically significant decrease in viral load (P = 0.010). Interestingly, macaques immunized with a combination of vectors expressing three forms of antigens (native protein and MCP3 and CATE fusion proteins) showed the strongest decrease in viral load (P = 0.0059). Postchallenge enzyme-linked immunospot values for Gag and Env as well as gag-specific T-helper responses correlated with control of viremia. Our data show that the combinations of DNA vaccines producing native and modified forms of antigens elicit more balanced immune responses able to significantly reduce viremia for a long period (8 months) following pathogenic challenge with SIVmac251.

Structural and functional analysis of the RNA transport element, a member of an extensive family present in the mouse genome.

We previously identified an RNA transport element (RTE), present in a subclass of rodent intracisternal A particle retroelements (F. Nappi, R. Schneider, A. Zolotukhin, S. Smulevitch, D. Michalowski, J. Bear, B. Felber, and G. Pavlakis, J. Virol. 75:4558-4569, 2001), that is able to replace Rev-responsive element regulation in human immunodeficiency virus type 1. RTE-directed mRNA export is mediated by a still-unknown cellular factor(s), is independent of the CRM1 nuclear export receptor, and is conserved among vertebrates. Here we show that this RTE folds into an extended RNA secondary structure and thus does not resemble any known RTEs. Computer searches revealed the presence of 105 identical elements and more than 3,000 related elements which share at least 70% sequence identity with the RTE and which are found on all mouse chromosomes. These related elements are predicted to fold into RTE-like structures. Comparison of the sequences and structures revealed that the RTE and related elements can be divided into four groups. Mutagenesis of the RTE revealed that the minimal element contains four internal stem-loops, which are indispensable for function in mammalian cells. In contrast, only part of the element is essential to mediate RNA transport in microinjected Xenopus laevis oocyte nuclei. Importantly, the minimal RTE able to promote RNA transport has key structural features which are preserved in all the RTE-related elements, further supporting their functional importance. Therefore, RTE function depends on a complex secondary structure that is important for the interaction with the cellular export factor(s).

Fires from the interaction of anesthetics with desiccated absorbent.

Rarely, fire and patient injury have resulted from the degradation of sevoflurane by desiccated carbon dioxide absorbent. Desiccated absorbent also can degrade desflurane and isoflurane, and in the present investigation we sought to determine whether a danger of fire also arose with their use in the presence of desiccated absorbent. Baralyme was desiccated by heating and directing a 10 L/min flow of oxygen through the absorbent. Approximately 1200 g of this desiccated absorbent was used to fill a standard absorber placed in a standard anesthetic circuit to which we directed a 6 L/min flow of oxygen containing 1.5 or 3.0 MAC desflurane, isoflurane, or sevoflurane. A 3-L reservoir bag served as a surrogate lung, and we ventilated this lung with a minute ventilation of 10 L/min. With desflurane or isoflurane, at both 1.5 MAC and 3.0 MAC, temperatures increased in 30 to 70 min to a peak of approximately 100 degrees C and then decreased. With 1.5 MAC sevoflurane (3.0 MAC was not studied), temperatures increased to over 200 degrees C, and in 2 of 5 studies, flames appeared in the anesthetic circuit. In a separate study, we found that concurrent delivery of carbon dioxide and desflurane did not increase peak temperatures. We conclude that the interaction of desflurane or isoflurane with desiccated absorbent is not likely to produce the conflagrations possible with sevoflurane.

An inexpensive, simple, and manual method of CD4 T-cell quantitation in HIV-infected individuals for use in developing countries.

CD4+ T lymphocytes are currently the most common surrogate marker indicating immune status and disease progression with HIV infection. The cost of monitoring disease progression and response to therapy is still prohibitively expensive. Flow cytometry is the gold standard for the estimation of CD4+, but the high initial investment for this technology and expensive reagents makes it unaffordable for developing countries like India. We evaluated the Coulter cytosphere assay for quantifying CD4+ T lymphocytes in comparison with the standard method, flow cytometry, in 122 HIV-infected individuals. The correlation coefficient of the cytosphere assay compared with that of flow cytometry for CD4+ T lymphocytes was 0.97 (P< 0.0001), with a confidence interval of 0.95 to 0.98. The sensitivity, specificity, positive predictive value, and negative predictive value of the cytosphere assay in enumerating absolute CD4+ T-lymphocyte counts of less than 200/microL were 94.9%, 96.4%, 92.5%, and 97.6%, respectively. This is a simple inexpensive method and has a strong correlation with flow cytometry. Hence, the cytosphere assay can be an alternate to flow cytometry for the estimation of CD4+ T-lymphocyte counts, especially in resource-poor settings of developing countries, for monitoring HIV progression and response to therapy.

Left-lateralized fMRI activation in the temporal lobe of high repressive women during the identification of sad prosodies.

We investigated with fMRI whether different lateralization types of cortical activation in prosodic tasks are caused by individually different stress-related coping strategies. After healthy women had been classified as high or low repressive they performed four different identification tasks with acoustically presented speech material while being in the MR scanner. The two materials presented in blocks were emotionally irrelevant CV syllables and adjectives with a mix of different prosodic intonations. Sad and happy intonations had to be targeted by two affective identification tasks in the same adjective mixtures. For testing stimulus-material effects the phoneme /a/ had to be identified both in the syllables and the adjectives. This design allowed us to test influences of coping strategies and affective tasks on cortical activation in both hemispheres. Results showed no differences in global cortical lateralization as a function of high or low repressiveness and no global support for either the valence hypothesis or the right-hemisphere hypothesis of emotional processing. However, we observed differences in auditory and speech cortex. In accordance to the construct of repression/sensitization, high repressive women showed larger left, low repressive women larger right hemisphere activation during the identification of sad intonations. Thus, differences in stress-related coping strategies may not lead to general differences in cortical lateralization, but may depend on specific elicitors and task-relevant brain areas. In contrast, the identification of happy intonations led to strong and right-lateralized global cortical activation independent of coping strategies which complies with the right-hemisphere hypothesis of emotional processing. In addition, this may reflect general cognitive and arousal effects of task difficulty as well as auditory cue-specific attentional effects.

Direct analysis of viral-specific CD8+ T cells with soluble HLA-A2/Tax11-19 tetramer complexes in patients with human T cell lymphotropic virus-associated myelopathy

Human T cell lymphotropic virus-I (HTLV-I) -associated myelopathy is a slowly progressive neurologic disease characterized by inflammatory infiltrates in the central nervous system accompanied by clonal expansion of HTLV-I-reactive CD8+ T-cells. In patients carrying the HLA-A2 allele, the immune response is primarily directed to the Tax11-19 peptide. The frequency, activation state, and TCR usage of HLA-A2/Tax11-19 binding T cells in patients with HTLV-I-associated myelopathy was determined using MHC class I tetrameters loaded with the Tax11-19 peptide. Circulating Tax11-19-reactive T cells were found at very high frequencies, approaching 1:10 circulating CD8+ T cells. T cells binding HLA-A2/Tax11-19 consisted of heterogeneous populations expressing different chemokine receptors and the IL-2R beta-chain but not the IL-2R alpha-chain. Additionally, Tax11-19-reactive CD8+ T cells used one predominant TCR beta-chain for the recognition of the HLA-A2/Tax11-19 complex. These data provide direct evidence for high frequencies of circulating Tax11-19-reactive CD8+ T cells in patients with HTLV-I-associated myelopathy.(Au)