Expression, purification and metal utilization of recombinant SodA from Borrelia burgdorferi

Borrelia are microaerophilic spirochetes capable of causing multisystemic diseases such as Lyme disease and Relapsing Fever. The ubiquitous Fe/Mn-dependent superoxide dismutase (SOD) provides essential protection from oxidative damage by the superoxide anion. Borrelia possess a single SOD enzyme - SodA that is essential for virulence, providing protection against host-derived reactive oxygen species (ROS). Here we present a method for recombinant expression and purification of Borrelia burgdorferi SodA in E. coli. Metal exchange or insertion into the Fe/Mn-SOD is inhibited in the folded state. We therefore present a method whereby the recombinant Borrelia SodA binds to Mn under denaturing conditions and is subsequently refolded by a reduction in denaturant. SodA purified by metal affinity chromatography and size exclusion chromatography reveals a single band on SDS-PAGE. Protein folding is confirmed by circular dichroism. A coupled enzyme assay demonstrates SOD activity in the presence of Mn, but not Fe. The apparent molecular weight determined by size exclusion corresponds to a dimer of SodA; a homology model of dimeric SodA is presented revealing a surface Cys distal to the dimer interface. The method presented of acquiring a target metal under denaturing conditions may be applicable to the refolding of other metal-binding proteins.

The Role of Early Immersive Culture Mixing in Cultural Identifications of Multiculturals

Becoming multicultural through early immersive culture mixing (EICM)—i.e., growing up with a mix of cultures that coexist and interact to form an emergent hybrid culture within one’s home—is a rapidly rising phenomenon in many parts of the world. This phenomenon calls for new research that recognizes the possibility of identification with a hybrid culture as well as the distinct cultures from which the hybrid culture derives. This article extends previous research into psychological variation among multiculturals based on the process of EICM, by investigating how EICM influences hybrid cultural identification and distinct cultural identification. In addition, we examine how EICM relates to the components of identity integration—blendedness and harmony. Across two studies of Chinese-Australian multiculturals, we found that whereas EICM was positively associated with multicultural participants’ identification with a hybrid culture and Australian culture, it was not related to their identification with Chinese culture. Findings also indicated that EICM positively predicted identity blendedness, but EICM did not show a clear link with identity harmony. We discuss the implications of our research for advancing EICM theory and helping to forge new research directions in cultural identification.

How the phagocyte NADPH oxidase regulates innate immunity

The phagocyte NADPH oxidase is a multi subunit protein complex that generates reactive oxygen species at cell membranes and within phagosomes. It is essential for host defence as evidenced by the severe immunodeficiency syndrome caused by a loss of one of the subunits. This is known as chronic granulomatous disease (CGD). However, the phagocyte NADPH oxidase also has a key role to play in regulating immunity and it is notable that chronic granulomatous disease is also characterised by autoimmune and autoinflammatory manifestations. This is because reactive oxygen species play a role in regulating signalling through their ability to post-translationally modify amino acid residues such as cysteine and methionine. In this review, I will outline the major aspects of innate immunity that are regulated by the phagocyte NADPH oxidase, including control of transcription, autophagy, the inflammasome and type 1 interferon signalling.

Antibody repertoire analysis in polygenic autoimmune diseases

High-throughput sequencing of the DNA/RNA encoding antibody heavy- and light-chains is rapidly transforming the field of adaptive immunity. It can address key questions, including: (i) how the B-cell repertoire differs in health and disease; and (ii) if it does differ, the point(s) in B-cell development at which this occurs. The advent of technologies, such as whole-genome sequencing, offers the chance to link abnormalities in the B-cell antibody repertoire to specific genomic variants and polymorphisms. Here, we discuss the current research using B-cell antibody repertoire sequencing in three polygenic autoimmune diseases where there is good evidence for a pathological role for B-cells, namely systemic lupus erythematosus, multiple sclerosis and rheumatoid arthritis. These autoimmune diseases exhibit significantly skewed B-cell receptor repertoires compared with healthy controls. Interestingly, some common repertoire defects are shared between diseases, such as elevated IGHV4-34 gene usage. B-cell clones have effectively been characterized and tracked between different tissues and blood in autoimmune disease. It has been hypothesized that these differences may signify differences in B-cell tolerance; however, the mechanisms and implications of these defects are not clear.

NBEAL2 is required for neutrophil and NK cell function and pathogen defense

Mutations in the human NBEAL2 gene cause gray platelet syndrome (GPS), a bleeding diathesis characterized by a lack of α granules in platelets. The functions of the NBEAL2 protein have not been explored outside platelet biology, but there are reports of increased frequency of infection and abnormal neutrophil morphology in patients with GPS. We therefore investigated the role of NBEAL2 in immunity by analyzing the phenotype of Nbeal2-deficient mice. We found profound abnormalities in the Nbeal2-deficient immune system, particularly in the function of neutrophils and NK cells. Phenotyping of Nbeal2-deficient neutrophils showed a severe reduction in granule contents across all granule subsets. Despite this, Nbeal2-deficient neutrophils had an enhanced phagocyte respiratory burst relative to Nbeal2-expressing neutrophils. This respiratory burst was associated with increased expression of cytosolic components of the NADPH oxidase complex. Nbeal2-deficient NK cells were also dysfunctional and showed reduced degranulation. These abnormalities were associated with increased susceptibility to both bacterial (Staphylococcus aureus) and viral (murine CMV) infection in vivo. These results define an essential role for NBEAL2 in mammalian immunity.

The phagocyte respiratory burst: Historical perspectives and recent advances

When exposed to certain stimuli, phagocytes (including neutrophils, macrophages and eosinophils) undergo marked changes in the way they handle oxygen. Firstly, their rate of oxygen uptake increases greatly. This is accompanied by (i) the production of large amounts of superoxide and hydrogen peroxide and (ii) the metabolism of large quantities of glucose through the hexose monophosphate shunt. We now know that the oxygen used is not for respiration but for the production of powerful microbiocidal agents downstream of the initial production of superoxide. Concomitantly, glucose is oxidised through the hexose monophosphate shunt to re-generate the NADPH that has been consumed through the reduction of molecular oxygen to generate superoxide. This phagocyte respiratory burst is generated by an NADPH oxidase multi-protein complex that has a catalytic core consisting of membrane-bound gp91phox (CYBB) and p22phox (CYBA) sub-units and cytosolic components p47phox (NCF1), p67phox (NCF2) and p40phox (NCF4). Finally, another cytosolic component, the small G-protein Rac (Rac2 in neutrophils and Rac1 in macrophages) is also required for full activation. The importance of the complex in host defence is underlined by chronic granulomatous disease, a severe life-limiting immunodeficiency caused by mutations in the genes encoding the individual subunits. In this review, I will discuss the experimental evidence that underlies our knowledge of the respiratory burst, outlining how elegant biochemical analysis, coupled with study of patients deficient in the various subunits has helped elucidate the function of this essential part of innate immunity. I will also discuss some exciting recent studies that shed new light on how the abundance of the various components is controlled. Finally, I will explore the emerging role of reactive oxygen species such as superoxide and hydrogen peroxide in the pathogenesis of major human diseases including auto-inflammatory diseases.

A model for integrating the assessment and management of geriatric syndromes into internal medicine continuity practice: 5-year report

A geriatric ambulatory curriculum was created to improve internal medicine residents' care of geriatric patients. Second-year residents met for a 3-hour session weekly for 4 consecutive weeks during a block rotation with faculty geriatricians for a curriculum focused on dementia, falls, and urinary incontinence. After a 1-hour case-based didactic session, residents applied learned content and concepts to patient consultations. Consultative encounters were precepted by faculty and shared with the team. After completing our curriculum, residents reported knowledge acquired and enhanced evaluation and management skills of these three syndromes and were more likely to use all recommended screening tests in future practice. This article describes the process and strategies guiding development of a successful ambulatory geriatric curriculum model that can be embedded into preexisting internal medicine clinics to help future internists to better manage these and other common geriatric syndromes.

Eros is a novel transmembrane protein that controls the phagocyte respiratory burst and is essential for innate immunity

The phagocyte respiratory burst is crucial for innate immunity. The transfer of electrons to oxygen is mediated by a membrane-bound heterodimer, comprising gp91phox and p22phox subunits. Deficiency of either subunit leads to severe immunodeficiency. We describe Eros (essential for reactive oxygen species), a protein encoded by the previously undefined mouse gene bc017643, and show that it is essential for host defense via the phagocyte NAPDH oxidase. Eros is required for expression of the NADPH oxidase components, gp91phox and p22phox Consequently, Eros-deficient mice quickly succumb to infection. Eros also contributes to the formation of neutrophil extracellular traps (NETS) and impacts on the immune response to melanoma metastases. Eros is an ortholog of the plant protein Ycf4, which is necessary for expression of proteins of the photosynthetic photosystem 1 complex, itself also an NADPH oxio-reductase. We thus describe the key role of the previously uncharacterized protein Eros in host defense.

Interpreter training for medical students: pilot implementation and assessment in a student-run clinic

BACKGROUND

Trained medical interpreters are instrumental to patient satisfaction and quality of care. They are especially important in student-run clinics, where many patients have limited English proficiency. Because student-run clinics have ties to their medical schools, they have access to bilingual students who may volunteer to interpret, but are not necessarily formally trained.

METHODS

To study the feasibility and efficacy of leveraging medical student volunteers to improve interpretation services, we performed a pilot study at the student-run clinic at the Icahn School of Medicine at Mount Sinai. In each fall semester in 2012-2015, we implemented a 6-h course providing didactic and interactive training on medical Spanish interpreting techniques and language skills to bilingual students. We then assessed the impact of the course on interpreter abilities.

RESULTS

Participants' comfort levels, understanding of their roles, and understanding of terminology significantly increased after the course (p < 0.05), and these gains remained several months later (p < 0.05) and were repeated in an independent cohort. Patients and student clinicians also rated participants highly (averages above 4.5 out of 5) on these measures in real clinical encounters.

CONCLUSIONS

These findings suggest that a formal interpreter training course tailored for medical students in the setting of a student-run clinic is feasible and effective. This program for training qualified student interpreters can serve as a model for other settings where medical students serve as interpreters.

Item-Difficulty Sequence in Achievement Examinations: Examinees' Preferences and Test-Taking Strategies

Elementary, secondary school, and university students were asked for the test-taking strategy usually used in taking an achievement test and for the sequence of difficulty preferred for achievement test items. The majority preferred an easy-to-hard strategy with items in order-presented as second choice, and the hard-to-easy strategy chosen least often. No conclusions were drawn as to the effect of students' usual test-taking strategies on research with various item-difficulty sequences. The data on students' preferences for item sequences support the use of the easy-to-hard or random arrangement over the hard-to-easy.

What Is Implementation Science and What Forces Are Driving a Change in Medical Education?

Evidence-based interventions to improve health care and medical education face multiple complex barriers to adoption and success. Implementation science focuses on the period following research dissemination, which is necessary but insufficient to address important gaps in clinician performance and patient outcomes. This article describes the forces on health care institutions, medical schools, physician clinicians, and trainees that have created the imperative to design educational interventions to address the gap between evidence and practice. These forces include accreditation, certification, licensure, and regulatory and research funding initiatives focused on improving the quality of health professions education and clinical practice. Medical educators must expand their focus on "what to change" to include "how to change" in order to prepare health care professionals and institutions to effectively adopt new evidence-based practices to improve patient, and ultimately population, outcomes.

Communication In Intercultural Interaction

This study examined the communication styles of East Asians and Anglo-European New Zealanders (Pakeha). Results indicated that in general, Asians exhibited more sociocentric communication behavior whereas Pakeha exhibited more idiocentric behavior. In intercultural interactions, both the frequency and intensity of these behavior styles were exacerbated. Results further indicated that task accomplishment required more time in the intercultural condition as compared to homogeneous conditions. Implications for international management research and practice are discussed.

Effect of Culture on Situational Determinants of Exchange Behavior in Organizations

This study examined the moderating effect of national culture on the relationship between a key situational indicator (job satisfaction) and the exchange behaviors of employees. The main effect of job satisfaction on the outcome behaviors of exit, voice, loyalty, and neglect was consistent in Indonesia and New Zealand suggesting a possible universal relationship. However, the cultural group of participants (Indonesia or New Zealand) moderated the influence of job satisfaction on all outcomes with the exception of voice. The implications of these results for theory and practice are discussed.

Causal Attribution in an Intercultural Interaction

Causal attribution for three different levels of adaptive behaviour by a foreign (Japanese) manager to the cultural expectations of host country (United States) subordinates was examined in an experimental setting. Two methods, written descriptions of the intercultural interaction (scripts) and direct observation (videotapes produced from the scripts), were used to present the behaviour. A main effect was found for the level of adaptive behaviour on attribution to internal causes. There was no significant difference in the accuracy of participants' memory of critical behaviours based on the method used to present the behaviours. However, participants' recognition memory was affected by the level of cultural adaptation to which they were exposed. Also, a significant interaction between method of stimulus presentation and level of cultural adaptation on causal attribution indicated that the mode of presentation may have affected the psychological process under investigation. Implications for the study of intercultural interactions are discussed.

Cultural Diversity and Work Group Effectiveness

Changes in workforce demographics resulting from globalization, combined with the rising popularity of team-based management techniques, has resulted in a practical concern with the management of multicultural groups. In this experimental study, three mechanisms that are proposed to influence group effectiveness are examined. Results supported the notion that the cultural diversity of the group, the sociocultural norms of group members, and their relative cultural distance from each other influence work group effectiveness. Culturally homogeneous groups had higher performance than did culturally heterogeneous groups on five group tasks. The degree of collectivist orientations of group members was directly related to their evaluations of group processes, and their relative cultural distance from each other influenced their perceptions of group receptiveness. A comparison of the results of this study with previous research indicates the importance of the group task and process-related feedback on group performance. Implications of these findings are discussed.

Domain and Development of Cultural Intelligence

The potential for defining a reliable measure of a cross-cultural facet of intelligence has enormous implications for explaining and predicting the increasingly prevalent cross-cultural interactions that occur in business settings. In this article, the author presents a definition of cultural intelligence (CQ) that explicitly introduces the concept of mindfulness as a key component that links knowledge with behavioral capability. It builds on previous definitions by grounding the conceptualization in the cognitive domain and differentiating CQ as a capability that includes skilled behavior. However, alternatives to previous conceptualizations with regard to the constituent elements and their relationship to each other are presented with a view toward a tighter specification of the construct. Also, a developmental stage model of CQ is outlined. Implications for the assessment of CQ are discussed.

Residents' Perspectives on Rewards and Challenges of Caring for Ambulatory Care Patients Living With Chronic Illness: Findings From Three Academic Health Centers

PURPOSE

To elicit residents' perspectives on rewards and challenges of caring for ambulatory patients with chronic illness and ways to improve their education in caring for these patients.

METHOD

The authors conducted a qualitative study with internal medicine residents during ambulatory medicine block rotations at three academic health centers from October 2011 through February 2012. Focus group questions covered rewards and challenges of caring for patients with chronic illness and strengths and weaknesses of residency education therein, and the Chronic Care Model provided a framework for interpretation. Qualitative analysis was used to identify themes.

RESULTS

Five focus groups were conducted with 28 residents. Discussions yielded 224 comments, which were categorized into 5 domains and 36 themes. Twelve themes related to perceptions of challenges in providing care, and 3 themes related to perceptions of rewards in providing care. Eight themes focused on strategies to improve the patient experience. Strengths of the residency program were identified in 7 themes. Six themes related to ways for improving learning about caring for patients with chronic disease in the ambulatory setting.

CONCLUSIONS

Residents perceived rewards, challenges, and barriers in caring for patients with chronic illness in the ambulatory setting, from providers' and patients' perspectives. They have developed strategies to provide effective patient care. Residents identified best practices in their residency for resident education and patient care and also made suggestions for improvement. Findings have significant implications for residency education and practice redesign in the 21st century for care of patients with chronic illness.

The role of self-concept in cross-cultural communication

Empirical evidence supports the notion that communication behaviors in intercultural encounters are effectively extensions of cultural values as well as epistemologies. Study 1 established communication behaviors of Asians and New Zealanders (NZs) as consistent with vertical collectivism and horizontal individualism, respectively. In particular, argumentativeness is positively related to independent self-construal (SC) and negatively related to interdependent SC. This supports Markus and Kitayama’s SC theory. Study 2 showed that NZs exhibited more idiocentric and argumentative behavior, while Asians displayed more sociocentric and less argumentative behavior during two actual interactions; specifically, participants diverged in their communication styles to be more consistent with their cultural values during intercultural interactions. Analyses of decision outcomes provide support that culture moderates cognitive consistency behaviors such that NZs exhibited more inconsistency-reduction behaviors, which is rooted in adherence to noncontradiction. In contrast, Asians exhibited more inconsistency-support behaviors, suggesting that naive dialecticism rooted in acceptance of contradiction is customary in Asian social interaction.

Society for Academic Continuing Medical Education Intervention Guideline Series: Guideline 2, Practice Facilitation

The Society for Academic Continuing Medical Education commissioned a study to clarify and, if possible, standardize the terminology for a set of important educational interventions. In the form of a guideline, this article describes one such intervention, practice facilitation, which is a common strategy in primary care to help practices develop capacity and infrastructure to support their ability to improve patient care. Based on a review of recent evidence and a facilitated discussion with US and Canadian experts, we describe practice facilitation, its terminology, and other important information about the intervention. We encourage leaders and researchers to consider and build on this guideline as they plan, implement, evaluate, and report practice facilitation efforts. Clear and consistent use of terminology is imperative, along with complete and accurate descriptions of interventions, to improve the use and study of practice facilitation.

Society for Academic Continuing Medical Education Intervention Guideline Series: Guideline 3, Educational Meetings

The Society for Academic Continuing Medical Education commissioned a study to clarify and, if possible, to standardize the terminology for a set of important educational interventions. In the form of a guideline, this article describes one such intervention, educational meetings, which is a common intervention in health professions' education. An educational meeting is an opportunity for clinicians to assemble to discuss and apply important information relevant to patient care. Based on a review of recent evidence and a facilitated discussion with US and Canadian experts, we describe proper educational meeting terminology and other important information about the intervention. We encourage leaders and researchers to consider and to build on this guideline as they plan, implement, evaluate, and report educational meeting efforts. Clear and consistent use of terminology is imperative, along with complete and accurate descriptions of interventions, to improve the use and study of educational meetings.

Society for Academic Continuing Medical Education Intervention Guideline Series: Guideline 4, Interprofessional Education

The Society for Academic Continuing Medical Education commissioned a study to clarify and, if possible, to standardize the terminology for a set of important educational interventions. In the form of a guideline, this article describes one such intervention, interprofessional education (IPE), which is a common intervention in health professions education. IPE is an opportunity for individuals of multiple professions to interact to learn together, to break down professional silos, and to achieve interprofessional learning outcomes in the service of high-value patient care. Based on a review of recent evidence and a facilitated discussion with US and Canadian experts, we describe IPE, its terminology, and other important information about the intervention. We encourage leaders and researchers to consider and to build on this guideline as they plan, implement, evaluate, and report IPE efforts. Clear and consistent use of terminology is imperative, along with complete and accurate descriptions of interventions, to improve the use and study of IPE.

Society for Academic Continuing Medical Education Intervention Guideline Series: Guideline 1, Performance Measurement and Feedback

The Society for Academic Continuing Medical Education commissioned a study to clarify and, if possible, to standardize the terminology for a set of important educational interventions. In the form of a guideline, this article describes one such intervention, performance measurement and feedback, which is a common intervention in health professions education. In the form of a summary report, performance measurement and feedback is an opportunity for clinicians to view data about the care they provide compared with some standard and often with peer and benchmark comparisons. Based on a review of recent evidence and a facilitated discussion with the US and Canadian experts, we describe proper terminology for performance measurement and feedback and other important information about the intervention. We encourage leaders and researchers to consider and build on this guideline as they plan, implement, evaluate, and report efforts with performance measurement and feedback. Clear and consistent use of terminology is imperative, along with complete and accurate descriptions of interventions, to improve the use and study of performance measurement and feedback.