Determining the Clinical Utility of the Short Child Occupational Profile (SCOPE)

Objective:

The purpose of this study was to propose a process for the study of clinical utility and to illustrate its implementation in the development of an assessment.

Method:

A mixed methods approach was used to understand the clinical utility of an assessment in development. An exploratory qualitative/quantitative (QUAL?QUANT) approach was used to identify perspectives of the clinical utility of the assessment. The design placed equal status on the two methods used: focus groups and surveys.

Results:

The proposed process for the study of clinical utility resulted in targeted revisions based upon data obtained from 21 practitioners in three focus groups during a systemised examination of clinical utility.

Conclusion:

A mixed methods process can be used to ensure the clinical utility of assessments during the development process.

Striving for Shared Understandings: Therapists' Perspectives of the Benefits and Dilemmas of Using a Child Self-Assessment

Pediatric client-centered intervention planning is particularly complex because children, parents, and professionals must form a “tridactic” partnership and reach a shared understanding for therapy. Therapists may use child self-reports to facilitate children's involvement in this process. The purpose of this study was to understand how therapists used and interpreted a child self-report to achieve a shared understanding in the context of a tridactic relationship, using the Children's Occupational Self-Assessment (COSA) as an exemplar. Thirty-three pediatric therapists participated in five focus groups and qualitative analysis was conducted in four iterative phases. Therapists' decision to use the COSA led to either “good” responses or unexpected tensions between the therapist's, child's, and parent's perspectives. Therapists used demonstration, negotiation, or reflection to shift beliefs to achieve a shared understanding for therapy. Findings suggest that although therapists valued children's voices, professional knowledge usually took precedence over child and parent self-knowledge during intervention planning.

An improved model of the Aspergillus fumigatus CYP51A protein

Azole resistance is an increasing clinical problem for Aspergillus fumigatus, with the majority of published resistance arising from mutations in the azole target gene CYP51A. Previous structural studies of this protein have suffered from a nonorthologous, low-homology template for homology modeling. Here we present a new model based on the human CYP51A orthologue that provides a higher-quality model for A. fumigatus CYP51A.

How Interdisciplinary Pediatric Practitioners Choose Assessments

Background. The assessment process affects the direction and quality of the services children and youth with disabilities receive. However, little is known about how practitioners choose tools and strategies to assess clients. Purpose. To identify processes practitioners use to gather information and choose methods of assessment in pediatric practice. Methods. Three focus groups were held with teams of interdisciplinary pediatric practitioners. Key themes were identified. Findings. Two primary themes emerged: “Things practitioners want to know” and “Choosing what and how to assess.” Practitioners began the assessment process wanting to gather information about children and their environment. Practitioners then used the initial information to decide what and how to further assess as described by three subthemes: “fitting” the child, balancing formal and informal information, and professional context. Implications. Practitioners generally made individualized assessment choices for each child based on the initial information they gathered and then used a balance of formal and informal assessments. However, they were more likely to formally assess children at the level of body structures and function rather than participation, and continued to rely upon such standardized assessments to meet reimbursement and policy requirements.

Examining Rater Behavior on a Revised Version of the Short Child Occupational Profile (SCOPE)

A previous study of the Short Child Occupational Profile (SCOPE), an assessment of occupational participation, supported the psychometric soundness of the instrument overall, but pointed to some potential problems in practitioners' use of the SCOPE in practice. Specific revisions were made to the SCOPE to address the rating behaviors of leniency/severity, halo effect, and restriction of range. A many-faceted Rasch model analysis was conducted after 39 practitioners working in eight practice sites learned to administer the SCOPE using a variety of methods and rated 168 clients using the SCOPE (version 2.1). Practitioners exhibited three significantly different levels of leniency/severity, 35 practitioners did not exhibit any halo effects, and the top three rating categories were used 91% of the time. Findings suggest that a variety of methods can be used to learn to administer and rate the SCOPE in an appropriate manner to assess the personal and environmental factors affecting the occupational participation of children.

International efforts to disseminate and develop the model of human occupation

This paper documents efforts in Canada, France, Finland, Germany, Hispanoamerica, Israel, Japan, The Netherlands, and Taiwan to disseminate the Model of Human Occupation (MOHO). We aim to characterize the challenges involved, the strategies used, and the impact of these efforts in diverse cultural and social conditions.

Aspergillus flavus: human pathogen, allergen and mycotoxin producer

Aspergillus infections have grown in importance in the last years. However, most of the studies have focused on Aspergillus fumigatus, the most prevalent species in the genus. In certain locales and hospitals, Aspergillus flavus is more common in air than A. fumigatus, for unclear reasons. After A. fumigatus, A. flavus is the second leading cause of invasive aspergillosis and it is the most common cause of superficial infection. Experimental invasive infections in mice show A. flavus to be 100-fold more virulent than A. fumigatus in terms of inoculum required. Particularly common clinical syndromes associated with A. flavus include chronic granulomatous sinusitis, keratitis, cutaneous aspergillosis, wound infections and osteomyelitis following trauma and inoculation. Outbreaks associated with A. flavus appear to be associated with single or closely related strains, in contrast to those associated with A. fumigatus. In addition, A. flavus produces aflatoxins, the most toxic and potent hepatocarcinogenic natural compounds ever characterized. Accurate species identification within Aspergillus flavus complex remains difficult due to overlapping morphological and biochemical characteristics, and much taxonomic and population genetics work is necessary to better understand the species and related species. The flavus complex currently includes 23 species or varieties, including two sexual species, Petromyces alliaceus and P. albertensis. The genome of the highly related Aspergillus oryzae is completed and available; that of A. flavus in the final stages of annotation. Our understanding of A. flavus lags far behind that of A. fumigatus. Studies of the genomics, taxonomy, population genetics, pathogenicity, allergenicity and antifungal susceptibility of A. flavus are all required.

Aspergillus flavus: human pathogen, allergen and mycotoxin producer

Aspergillus infections have grown in importance in the last years. However, most of the studies have focused on Aspergillus fumigatus, the most prevalent species in the genus. In certain locales and hospitals, Aspergillus flavus is more common in air than A. fumigatus, for unclear reasons. After A. fumigatus, A. flavus is the second leading cause of invasive aspergillosis and it is the most common cause of superficial infection. Experimental invasive infections in mice show A. flavus to be 100-fold more virulent than A. fumigatus in terms of inoculum required. Particularly common clinical syndromes associated with A. flavus include chronic granulomatous sinusitis, keratitis, cutaneous aspergillosis, wound infections and osteomyelitis following trauma and inoculation. Outbreaks associated with A. flavus appear to be associated with single or closely related strains, in contrast to those associated with A. fumigatus. In addition, A. flavus produces aflatoxins, the most toxic and potent hepatocarcinogenic natural compounds ever characterized. Accurate species identification within Aspergillus flavus complex remains difficult due to overlapping morphological and biochemical characteristics, and much taxonomic and population genetics work is necessary to better understand the species and related species. The flavus complex currently includes 23 species or varieties, including two sexual species, Petromyces alliaceus and P. albertensis. The genome of the highly related Aspergillus oryzae is completed and available; that of A. flavus in the final stages of annotation. Our understanding of A. flavus lags far behind that of A. fumigatus. Studies of the genomics, taxonomy, population genetics, pathogenicity, allergenicity and antifungal susceptibility of A. flavus are all required.

The link between fungi and severe asthma: a summary of the evidence

There is current evidence to demonstrate a close association between fungal sensitisation and asthma severity. Whether such an association is causal remains to be confirmed, but this is explored by means of a detailed literature review. There is evidence from two randomised controlled trials that, in the example of allergic bronchopulmonary aspergillosis (ABPA), treatment with systemic antifungal therapy can offer a therapeutic benefit to approximately 60% of patients. ABPA is only diagnosed if a combination of clinical and immunological criteria is achieved. It is not known whether such cases are a discrete clinical entity or part of a spectrum of the pulmonary allergic response to fungi or fungal products. This paper describes the epidemiological evidence that associates severity of asthma with fungi and discusses possible pathogenetic mechanisms. Many airborne fungi are involved, including species of Alternaria, Aspergillus, Cladosporium and Penicillium, and exposure may be indoors, outdoors or both. The potential for a therapeutic role of antifungal agents for patients with severe asthma and fungal sensitisation is also explored. Not only are many patients with severe asthma desperately disabled by their disease, but, in the UK alone, asthma accounts for 1,500 deaths per yr. The healthcare costs of these patients are enormous and any treatment option merits close scrutiny. Within this report, the case for the consideration of a new term related to this association is put forward. The current authors propose the term "severe asthma with fungal sensitisation". However, it is recognised that enhanced and precise definition of fungal sensitisation will require improvements in diagnostic testing.

Relative reactivity of Aspergillus allergens used in serological tests

Aspergillus is a common disease-causing agent, both as an allergen causing ABPA and severe asthma with fungal sensitization (SAFS) and as a pathogen causing invasive aspergillosis in immunocompromised individuals and chronic cavitating disease (CCPA) in apparently immune competent individuals. Currently detection of Aspergillus is problematic and some of the most useful tests rely on detection of antibody response to Aspergillus allergens. Here we examine the IgE antibody response to crude and recombinant allergen tests (Asp f 1, Asp f 2, Asp f 4 and Asp f 6) in individuals with allergic conditions ABPA, SAFS and in individuals with CCPA. Additionally we use recently obtained genomic information to examine the possibility of cross reaction to these allergens and show that possible cross reactive epitopes occur in several species of Aspergillus.

Interdisciplinary staff perceptions of an occupational therapy return to work program for people living with AIDS

The purpose of this qualitative study was to identify the perception of interdisciplinary staff members regarding the impact of a model work and independent living oriented program for residents in supportive living facilities. This study used focus groups and individual interviews to collect these perceptions. Staff members identified four areas of impact: utilization of a holistic and process-oriented approach, an ability to identify and work with the strengths of clients, emphasis on the learning of practical skills, and creating an intersection for all aspects of services. These findings point to the fact that staff members found the value that occupational therapy has to offer their overall programming by improving participation of clients with HIV in learning practical skills for use in their daily lives and in developing work related skills.

Ornithine decarboxylase knockout in Tapesia yallundae abolishes infection plaque formation in vitro but does not reduce virulence toward wheat

A knockout strain of Tapesia yallundae lacking the single ornithine decarboxylase (ODC) allele has been created by targeted gene replacement. A central region of the ODC gene was isolated by polymerase chain reaction with degenerate oligonucleotides and used to probe a lambda genomic library. The gene was sequenced, and the encoded ODC protein sequence was shown to be similar to those from other fungi. The functionality of the T. yallundae ODC was confirmed by complementation of an Aspergillus nidulans mutant (puA) strain devoid of ODC activity, restoring growth in the absence of exogenous polyamines. Transformation-mediated gene replacement was used to create strains that were auxotrophic for putrescine and lack ODC coding sequences. ODC knockout strains were unable to differentiate infection structures after in vitro induction and showed an abnormal hyphal branching phenotype. Pathogenicity studies on these mutants showed that, surprisingly, they are not reduced in virulence compared with nondisrupted transformants. This suggests that the strains carrying an ODC disruption can obtain sufficient polyamines from the host plant for normal growth and differentiation and, therefore, that fungal ODC may not be a suitable target for fungicides.

Use of an isocitrate lyase promoter-GFP fusion to monitor carbon metabolism of the plant pathogen Tapesia yallundae during infection of wheat

Abstract Green fluorescent protein (GFP) has been used as a vital marker in a variety of species. Here, we present the use of a GFP-promoter fusion to visualize carbon metabolism in a pathogenic fungus during growth on defined medium and during infection of plants. Isocitrate lyase (ICL), a key enzyme in carbon metabolism, is tightly regulated at the transcriptional level, with high levels of expression during 2-carbon growth and no expression during growth on glucose. A GFP-ICL promoter fusion was used to visualize carbon metabolism in the plant pathogenic fungus Tapesia yallundae during growth in vitro and in the host plant. The ICL promoter from Neurospora crassa retained its native induction and repression characteristics in T. yallundae. Loss of GFP fluorescence from hyphae after repression of the ICL promoter suggested a rapid turnover rate for GFP in T. yallundae. Regulation of this promoter was observed during infection, with expression occurring only on the plant surface, suggesting that 2-carbon metabolism occurs during this phase. These data suggest that GFP is a useful vital marker for the in planta imaging of fungal metabolism.

Ornithine decarboxylase of Stagonospora (Septoria) nodorum is required for virulence toward wheat

A knockout strain of Stagonospora (Septoria) nodorum lacking the single ornithine decarboxylase (ODC) allele has been created by targeted gene replacement. A central region of the S. nodorum ODC gene was isolated by polymerase chain reaction using degenerate oligonucleotides and used to probe a lambda genomic library. The gene was sequenced and the encoded ODC protein sequence was shown to be similar to those from other fungi. The functionality of the S. nodorum ODC was confirmed by complementation of an Aspergillus nidulans mutant (puA) strain devoid of ODC activity, restoring growth in the absence of exogenous polyamines. Sporulation of the transformants was reduced suggesting abberant regulation of the S. nodorum gene in A. nidulans. Transformation-mediated gene replacement was used to create strains which were auxotrophic for putrescine and lack ODC coding sequences. Pathogenicity studies on these mutants showed that they are greatly reduced in virulence compared with non-disrupted transformants. This confirms that the strains carrying an ODC disruption cannot obtain sufficient polyamines from the host plant for normal growth and, thus, that fungal ODC may be a suitable target for chemical intervention.

Characterization of SNP1, a cell wall-degrading trypsin, produced during infection by Stagonospora nodorum

Stagonospora (= Septoria) nodorum when grown in liquid culture with wheat cell walls as the sole carbon and nitrogen source secretes numerous extracellular depolymerases, including a rapidly produced, alkaline, trypsin-like protease (SNP1). The enzyme was purified 417-fold by cation exchange chromatography and has a molecular mass of 25 kDa on sodium dodecyl sulfate gels, pI 8.7, and pH optimum of 8.5. It cleaved peptide bonds on the carboxyl side of lysine or arginine, was strongly inhibited by the trypsin inhibitors aprotinin and leupeptin and weakly by phenylmethylsulfonyl fluoride, and its activity was stimulated by calcium. SNP1 has the characteristic, conserved, fungal, trypsin N terminus. Polymerase chain reaction (PCR) primers based on this sequence and the conserved trypsin active site were used to amplify a DNA fragment that facilitated isolation of the corresponding genomic clone from a lambda library of S. nodorum. The full-length sequence confirmed its identity as a trypsin-like protease containing the N-terminal sequence of the previously purified enzyme. Infected leaf tissue contained a protease, not present in controls, that coeluted with the fungal trypsin from cation exchange, and had properties (pI and inhibitor characteristics) similar to those of the fungal trypsin. SNP1 expression in planta was detected by Northern (RNA) blotting, reverse transcription PCR, and green fluorescent protein confocal microscopy. SNP1 released hydroxyproline from wheat cell walls. The release of hydroxyproline, together with its early expression in planta, suggests that SNP1 participates in the degradation of host cell walls during infection.

The membrane-permeabilizing effect of avenacin A-1 involves the reorganization of bilayer cholesterol

Avenacin A-1 is a member of a group of naturally occurring compounds called saponins. It is found in oat plants, where it protects against fungal pathogens. A combined electrical and optical chamber was used to determine the interaction of avenacin A-1 with Montal-Mueller planar lipid bilayers. This system allowed simultaneous measurement of the effect of avenacin A-1 on the fluorescence and lateral diffusion of a fluorescent lipid probe and permeability of the planar lipid bilayer. As expected, cholesterol was required for avenacin A-1-induced bilayer permeabilization. The planar lipid bilayers were also challenged with monodeglucosyl, bis-deglucosyl, and aglycone derivatives of avenacin A-1. The results show that the permeabilizing activity of the native avenacin A-1 was completely abolished after one, two, or all three sugar residues are hydrolyzed (monodeglucosyl, bis-deglucosyl, and aglycone derivatives, respectively). Fluorescence recovery after photobleaching (FRAP) measurements on cholesterol-containing planar lipid bilayers revealed that avenacin A-1 caused a small but significant reduction in the lateral diffusion of the phospholipid probe N-(7-nitrobenzoyl-2-oxa-1,3-diazol-4-yl)-1, 2-dihexadecanoyl-sn-glycero-3-phosphoethanolamine (NBD-PE). Similarly, with the sterol probe (22-(N-(7-nitrobenz-2-oxa-1, 3-diazol-4-yl)amino)-23,24-bisnor-5-cholen-3beta-ol (NBD-Chol), avenacin A-1, but not its derivatives, caused a more pronounced reduction in the lateral diffusion than that observed with the phospholipid probe. The data indicate that an intact sugar moiety of avenacin A-1 is required to reorganize membrane cholesterol into pores.

Fungal pathogens of oat roots and tomato leaves employ closely related enzymes to detoxify different host plant saponins

Antifungal saponins are produced by many plants and have been implicated as preformed determinants of resistance to fungal attack. The importance of saponin detoxification in fungal pathogenesis has recently been demonstrated for the fungus Gaeumannomyces graminis var. avenae, which produces the enzyme avenacinase. Avenacinase detoxifies the triterpenoid oat root saponin avenacin A-1, and is essential for pathogenicity of G. graminis var.avenae to oats. Here we demonstrate an unexpected relatedness between avenacinase and the tomatinase enzyme produced by Septoria lycopersici (a tomato leaf-infecting fungus), which acts on the steroidal glycoalkaloid alpha-tomatine. The two enzymes share common physicochemical properties and are immunologically cross-reactive; however, there are critical differences in their substrate specificities which reflect the host preferences of the fungi from which the enzymes were purified. The DNA encoding tomatinase was isolated from a S. lycopersici cDNA library using avenacinase DNA as a probe. Comparison of the predicted amino acid sequences of avenacinase and tomatinase revealed that the enzymes are clearly similar.

Host range of a plant pathogenic fungus determined by a saponin detoxifying enzyme

Antifungal saponins occur in many plant species and may provide a preformed chemical barrier to attack by phytopathogenic fungi. Some fungal pathogens can enzymatically detoxify host plant saponins, which suggests that saponin detoxification may determine the host range of these fungi. A gene encoding a saponin detoxifying enzyme was cloned from the cereal-infecting fungus Gaeumannomyces graminis. Fungal mutants generated by targeted gene disruption were no longer able to infect the saponin-containing host oats but retained full pathogenicity to wheat (which does not contain saponins). Thus, the ability of a phytopathogenic fungus to detoxify a plant saponin can determine its host range.

An "instant gene bank" method for heterologous gene cloning: complementation of two Aspergillus nidulans mutants with Gaeumannomyces graminis DNA

We present a novel technique for gene cloning by complementation of mutations in Aspergillus nidulans with DNA from a heterologous organism, Gaeumannomyces graminis. This technique bypasses the time-consuming and difficult construction of gene libraries, making it both rapid and simple. The method relies on recombination between a fungal replicating vector pHELP1 and linear G. graminis genomic DNA during co-transformation. We were able to complement two out of seven A. nidulans mutants tested and to rescue transforming DNA from both in Escherichia coli. Complementation of the A. nidulans argB mutation resulted from integration of 8-10 kb segments of G. graminis DNA into pHELP1. The complementation of the A. nidulans pyrG mutation resulted from a complex rearrangement. Complementing DNA was shown to originate from G. graminis, and was capable of retransforming the original mutants to give the expected phenotype.