Activation of the ras-mitogen-activated protein kinase pathway and phosphorylation of ets-2 at position threonine 72 in human ovarian cancer cell lines

The activation status of the ras pathway was studied in eight ovarian tumor cell lines. Three biochemical parameters indicative of ras activation were tested: (a) the ratio of the ras-GTP:ras-GDP complex; (b) the activity of mitogen-activated protein kinases p42/p44; and (c) ets-2 phosphorylation at position threonine 72, a mitogen-activated protein kinase phosphorylation site in vivo. Four of the ovarian tumor cell lines had an activated ras pathway by these three parameters, whereas only one of these contained a mutated ras gene. In addition, ras/ets-2 responsive genes such as the urokinase plasminogen activator (uPA) were activated in these four cell lines. Transient transfection assays indicated that the compound ets-AP1 oncogene responsive enhancer present in the uPA gene was the target of ras signaling in ovarian tumor cells and that the combination of activated ras and ets-2 could superactivate the uPA enhancer element. Coexpression of the dominant-negative ras-Asn17 cDNA gene abrogated activity of this uPA element in ovarian tumor cells. These data indicate that ets-2 is a nuclear target of ras action in ovarian tumor cell lines and that ras signaling pathways may be activated in ovarian cancer by mechanisms independent of direct genetic damage to ras genes.

Bridging the discharge process

Current mental health initiatives are decreasing the number of psychiatric beds and thus increasing the number of clients with serious mental illness who are being served in the community. Such changes have implications for clients' quality of life and health care economics. To implement the changes while addressing the unique needs of psychiatric clients, appropriate models of discharge planning and community integration are critical.

Factors influencing movement of chronic psychiatric patients from the orientation to the working phase of the nurse-client relationship on an inpatient unit

PROBLEM

To identify factors influencing movement of nurse-patient dyads from Peplau's orientation phase to the working phase of the nurse-client relationship in a tertiary care psychiatric setting.

METHODS

Ten nurse-client dyads were interviewed after the initial nurse-client assignment until a consensus was reached between client, nurse, and investigator/CNS that the relationship was in the working phase.

FINDINGS

Factors causing the relationship to progress, from the clients' perspective, were the perceived attitude of the nurse, the nature of the planned therapeutic sessions, and what happened between therapeutic sessions. Factors hindering the development of the relationship included a nurse's or client's unavailability, a sense of distance/inequity, differences in realities/values, and mutual withdrawal. The relationship was perceived as supportive and "powerful" when it progressed to the working phase, but as very negative and like "limbo" if instead it moved to a phase of mutual withdrawal.

CONCLUSIONS

Nurses can help clients move from the orientation phase to the working phase by remaining available, consistent, and acting in a way that promotes trust. When the relationship does not progress to the working phase within 6 months, a therapeutic transfer should be considered.

Physical activity and health promotion for older adults in public housing

INTRODUCTION

Designing health promotion and disease prevention (HPDP) programs for older residents of public housing is hampered by a lack of information about residents' needs and interests. This study addressed whether residents have greater needs for lifestyle modification or for preventive care and assessed interest in programs emphasizing physical activity.

METHODS

Older residents (n = 199) of public housing facilities in Seattle were surveyed to assess HPDP needs. A comparison of residents with older HMO enrollees (n = 2,289) identified which needs were relatively greater in residents of public housing. Residents' interest in physical activity programs was assessed by interviewing residents and by observing their interest in an exercise class.

RESULTS

The majority of residents could benefit from physical activity programs (75% of residents reported less than 60 minutes per week of exercise); fewer residents could benefit from smoking cessation programs (21%) and alcohol counseling (4%). The largest difference between residents and HMO enrollees was the greater need of residents for physical activity promotion. Residents and HMO enrollees reported similar use of preventive care services. Though residents seldom identified physical inactivity as a major concern, residents demonstrated interest in physical activity programs. Eighteen (41%) of 44 residents participated regularly or irregularly in an exercise class offered at their facility. When the class was scheduled to be discontinued, residents successfully lobbied city government to sustain the class.

CONCLUSIONS

The results suggest promoting physical activity should be a major goal of HPDP programs for older residents of public housing.

Smoking and schizophrenia

Individuals with schizophrenia have a high prevalence of smoking compared with the general population and little is known about why so many people with schizophrenia smoke. This paper reviews suggestions of differences in motivation for smoking. Possible explanations for smoking include psychological reasons, together with possible effects on positive and negative symptoms of schizophrenia and reduced side-effects of neuroleptics. Understanding complex issues related to smoking and schizophrenia is important prior to developing health promotion strategies.

Isolation, genetic diversity, and geographic distribution of Bayou virus (Bunyaviridae: hantavirus)

Bayou hantavirus, previously implicated in human hantavirus pulmonary syndrome in Louisiana, was isolated from a rice rat (Oryzomys palustris) captured in Georgia. The presence of antibody among rice rats captured throughout the southeastern United States and the extent of diversity among the genetic variants of Bayou viruses suggest that the rice rat is the most likely natural reservoir of the virus and that both virus and host have probably co-evolved for some years.

Characterization of human telomerase complex

Telomerase, a ribonucleoprotein complex, adds hexameric repeats called "telomeres" to the growing ends of chromosomal DNA. Characterization of mammalian telomerase has been elusive because of its low level of expression. We describe a bioinformatics approach to enrich and characterize the human telomerase complex. Using local sequence homology search methods, we detected similarity of the Tetrahymena p80 subunit of telomerase with the autoantigen Ro60. Antibodies to Ro60 immunoprecipitated the telomerase activity. Ro60 and p80 proteins were cross-recognizable by antibodies to either protein. Telomerase activity and the RNA component of telomerase complex were localized to a doublet in a native gel from the Ro60 antibody-precipitated material. The enriched material showed specific binding to a TTA GGG probe in vitro in an RNA template-dependent manner. Polyclonal antibodies to the doublet also immunoprecipitated the telomerase activity. These results suggest an evolutionary conservation of the telomerase proteins.

The experience of thought-disordered individuals preceding an aggressive incident

The purpose of this qualitative study was to increase the understanding of the experiences of individuals with thought disorders, which precede incidents of aggression. Twelve individuals, from two hospitals, who had a nursing diagnosis of thought disorder and a history of aggression were interviewed, between one and four times, to collect baseline information and information about particular aggressive incidents. The participants described in their own words their thoughts, feelings and experiences preceding the aggressive incidents. Three themes emerged. First, participants perceived themselves to be strongly affected by the external environment; their responses to aspects of the environment were influential in precipitating the aggressive incident. Second, participants perceived themselves, paradoxically, to be both powerful and powerless; the act of aggression becomes an incident of brief self-empowerment. Third, the aggressive incident occurred in spite of the participants' acknowledgement and previous use of anger-controlling strategies; the participants' perceptions of themselves as powerless in an oppressive environment may have mitigated against the success of these strategies. Nurses need to know what triggers aggressiveness in psychiatric patients, in order to intervene effectively. Mental health professionals must also reexamine the psychiatric hospital environment, to make sure they are not needlessly exacerbating their patients' powerlessness with policies that are unjustifiably controlling.

Fos-Jun dimerization promotes interaction of the basic region with TFIIE-34 and TFIIF

The regulation of RNA polymerase II-mediated transcription involves both direct and indirect interactions among regulatory proteins and the general transcription factors (GTFs) that assemble at TATA-containing promoters. Here we show that the oncogenic transcription factors Fos and Jun make direct physical contacts with three proteins of the basal transcription apparatus, TFIIE-34 (TFIIE-beta), TFIIF-30 (RAP30), and TFIIF-74 (RAP74). The interactions among the activator proteins and these three GTFs were not detected with other transcription factors, including some bZIP protein family members. Both coimmunoprecipitation and protein blotting experiments demonstrated that the interactions were strongly favored by dimerization of Fos and Jun and that they involved the basic region and basic region-proximal domain of both proteins. Mutations within the DNA-binding domains of Fos and Jun abolished binding to GTFs, although the presence of DNA was not required for the association. Surprisingly, only a single basic region in the context of a protein dimer was sufficient for the interaction. Squelching of AP-1-dependent transcription in vitro by an excess of Fos-Jun dimers was relieved by the addition of TFIIE, indicating that it is a direct functional target of Fos and Jun. These results suggest that dimerization induces a conformational alteration in the basic region of Fos and Jun that promotes an association with TFIIE-34 and TFIIF, thus contributing to transcription initiation.

Denaturing gradient gel electrophoresis to diagnose multiple endocrine neoplasia type 2

Multiple endocrine neoplasia type 2 (MEN 2) is an autosomal dominant cancer syndrome caused by mutations in the RET protooncogene. Others have already demonstrated the value of genetic testing in known MEN 2 kindreds. Previously described approaches to DNA-level diagnosis, particularly of index cases, are tedious. We developed appropriate denaturing gradient gel electrophoresis (DGGE) conditions for analysis of exons 10, 11, and 16 of this gene, where many of the pathogenic mutations map. We screened 16 members of a three-generation MEN 2 kindred by DGGE and found five affected but still asymptomatic patients, ranging in age from 5 to 67 years. We used DGGE to localize the pathogenic mutations and screen at-risk individuals in several other kindreds. DGGE--which requires no radioactive, fluorescent, or chemiluminescent labeling--is ideally suited to the diagnosis of MEN 2 because of the syndrome's dominant genetics and the rarity of clinically silent variants in the RET gene.

Health care access of poverty-level older adults in subsidized public housing

OBJECTIVE

To assess the health status, access and use of health care and unmet health care needs of poverty-level residents of the Seattle Housing Authority over the age of 62.

METHODS

An in-person interview survey of a quota sample of community residents.

RESULTS

About half of SHA residents reported problems accessing care and sixteen percent reported being denied care. Multivariate analysis showed that encountering barriers of health care use were associated with having insufficient funds for monthly living expenses and lack of transportation. Over 90% of the population knew where to seek health care, so knowledge about sources of care did not appear to be a barrier. SHA residents met or exceeded national goals for completion of six out of nine recommended exams and procedures. SHA residents had unmet needs for services not covered by Medicare or provided by visiting nurse services.

CONCLUSIONS

The results suggest that SHA residents know how to access medical care, and that visiting nurse services may be remarkably effective in meeting some medical care needs of SHA residents. It appears access to care by residents of subsidized housing could be improved by addressing transportation and financial barriers, and by providing more services to residents on site.

Quality of life of persons with urinary incontinence: development of a new measure

OBJECTIVES

Our objective was to develop a self-report quality of life measure specific to urinary incontinence (I-QOL) that could be used as an outcome measure in clinical trials and in patient care centers.

METHODS

The I-QOL was developed from interviews of 20 individuals with urinary incontinence. Refining the questionnaire was accomplished by structured interviews of 17 individuals with urinary incontinence. Testing the I-QOL's psychometric properties involved two administrations (n = 62) along with measures of psychologic well-being and functional status.

RESULTS

The rigorous development process ensured that the measure was complete and understandable. The I-QOL proved to be internally consistent (alpha 0.95) and highly reproducible (r = 0.93; 18 days; SD 4). For discriminant validity, severity of incontinence (P < 0.0001) and number of medical appointments in the past year to treat incontinence (P < 0.0001) significantly predicted I-QOL scores. Convergent validity analyses confirmed our predictions that the I-QOL scores were more closely related to overall well-being than bodily pain.

CONCLUSIONS

The I-QOL proved to be valid and reproducible as a self-administered measure for assessing quality of life of patients with urinary incontinence.

Site-specific isotope fractionation in the characterization of biochemical mechanisms. The glycolytic pathway

For a given biochemical transformation, such as the fermentation reaction, the redistribution coefficients, which relate the natural site-specific isotope contents in end products to those of their precursors, are a source of mechanistic information. These coefficients characterize the traceability of specific hydrogens in the products (ethanol and water) to their parent hydrogens in the starting materials (glucose and water). In conditions of complete transformation, they also enable intermolecular exchanges with the water medium to be estimated. Thus it is directly confirmed that hydrogens 1, 2, 6, and 6' of glucose are strongly connected to the methyl site I of ethanol obtained by fermentation by Saccharomyces cerevisiae. However, whereas hydrogens 6 and 6' are transferred to a great extent, transfer is only partial for hydrogen 2, and it is even less for hydrogen 1. Because the two moieties of glucose corresponding to carbons 1-2-3 and 4-5-6 are scrambled by the aldolase and triosephosphate isomerase reactions, additional exchange of hydrogens at positions 1 and 2 must have occurred before these steps. The value of the coefficient that relates site 2 of glucose to site I of ethanol in particular can be used to quantify the contribution of intermolecular exchange occurring in the course of the transfer from site 2 of glucose 6-phosphate to site 1 of fructose 6-phosphate mediated by phosphoglucoisomerase. The average hydrogen isotope effects associated with the transfer of hydrogen from the water pool to the methyl or methylene site of ethanol are estimated. In contrast to conventional experiments carried out in strongly deuterium-enriched media where metabolic switching may occur, the NMR investigation of site-specific natural isotope fractionation, which operates at tracer isotopic abundance, faithfully describes the unperturbed metabolic pathways.

Isolation of black creek canal virus, a new hantavirus from Sigmodon hispidus in Florida

Numerous rodents were trapped for serologic and virologic studies following the identification of a hantavirus pulmonary syndrome (HPS) case in Dade County, Florida. Cotton rats (Sigmodon hispidus) were the most frequently capture rodent and displayed the highest seroprevalence to a variety of hantavirus antigens. Hantavirus genome RNA was detected in all the seropositive cotton rats tested, using a reverse transcriptase-polymerase chain reaction (RT-PCR) assay. A virus was isolated from tissues of two seropositive cotton rats by cultivation of lung and spleen homogenates on Vero E6 cells. Nucleotide sequence information obtained by direct RT-PCR and the serologic relationships of this virus with the other hantaviruses indicate that this virus, Black Creek Canal virus, represents a new hantavirus distinct from the previously known serotypes.

Sexual knowledge interview schedule: reliability

The Sexual Knowledge Interview Schedule (SKIS) is a 46-item interview schedule with an abuse scale and knowledge scale. The knowledge scale includes feelings, body parts identification, body parts function and general sexual knowledge. The reliability of the SKIS is reported. Internal consistency for scales/subscales ranges from 0.78 to 0.96. Inter-rater reliability was 95.3% agreement and test-retest reliability was 70.1%.

Linking research and practice

Although nurses are expected to incorporate research findings into their practice and be accountable for their actions, they often lack support to carry out these professional responsibilities. Below, how a service agency facilitated the linkage between nursing research and practice at a Canadian hospital.

Increased risk of small intestinal atresia among twins in the United States

OBJECTIVE

To compare the prevalence of small intestinal atresia among twins and singletons in the United States.

DESIGN

Descriptive analysis.

MEASUREMENTS

The McDonnell Douglas Health Information System (MDHIS), a national registry of newborn diagnoses, 1982 through 1988; and the Metropolitan Atlanta Congenital Defects Program (MACDP), a registry of defects among infants in Atlanta, 1968 through 1989.

PATIENTS

Live-born infants with small intestinal atresia.

INTERVENTIONS

None.

MAIN RESULTS

In both systems, the rate of small intestinal atresia was higher among twins than singletons (MDHIS: 5.5 per 10,000 vs 2.0, relative risk [RR] = 2.8, 95% confidence interval [CI] = 1.9 to 4.0; MACDP: 7.3 vs 2.5, RR = 2.9, 95% CI = 1.5 to 5.7). The increase was more notable among same-sex twins than opposite-sex twins, suggesting an increase among monozygotic twins. It was also more notable among twins with jejunoileal atresia than those with duodenal atresia, suggesting a vascular cause in many cases.

CONCLUSION

Twins have a higher rate of small intestinal atresia than singletons, possibly due to vascular disruption in monozygotic twins.

Effects of estrogen on free fatty acid metabolism in humans

To determine whether estrogen directly affects effective adipose lipolysis, palmitate rate of appearances ([14C]palmitate) was measured in 15 postmenopausal women. Each volunteer was studied after > or = 2 mo of estrogen treatment and again after > or = 2 mo of estrogen deficiency. Plasma hormone concentrations were controlled and identical on the 2 study days with use of the pancreatic clamp technique, and the lipolytic response to epinephrine and epinephrine + phentolamine was assessed. Results showed that overall palmitate flux was greater (10-20%, P < 0.05) during the estrogen-deficient than during the estrogen-replete study. Adrenergic stimulation of lipolysis was not specifically influenced by estrogen treatment, and control of plasma hormone concentrations did not eliminate the difference in palmitate flux between the estrogen-deficient and estrogen-replete study days. We conclude that estrogen deficiency is associated with increased plasma free fatty acid availability and that estrogen likely has direct, albeit small, effects on adipose tissue lipolysis.

Descriptive epidemiology of small intestinal atresia, Atlanta, Georgia

To describe the epidemiology of small intestinal atresia (SIA) in Atlanta, Georgia, from 1968 through 1989, we used the Metropolitan Atlanta Congenital Defects Program, an active, population-based surveillance system for birth defects diagnosed during the first year of life. We identified 176 infants with SIA, a prevalence of 2.8 per 10,000 livebirths. Among black infants, the prevalence was 3.7 per 10,000 livebirths, significantly higher than the prevalence of 2.4 per 10,000 among white infants [relative risk (RR) = 1.6, 95% confidence interval (CI) = 1.1,2.1]. Nine infants were each one member of a unique pair of twins. The prevalence among twin infants was 7.3 per 10,000, significantly higher than the prevalence of 2.8 per 10,000 among singletons (RR = 2.7, 95% CI = 1.4,5.2). Forty-nine percent of the infants had duodenal atresia, 36% had jejunal atresia, and 14% had ileal atresia. Two infants (1%) had atresia at an unspecified site in the small intestine. We grouped the infants by anatomic location of SIA into four categories: isolated SIA (53%), SIA with multiple unrelated defects (21%), sequences (16%), and syndromes (10%). We then compared the isolated and multiple unrelated defects groups by gender, race, maternal age, birth weight and one-year mortality for each location of SIA. Among black infants the prevalence of isolated jejunal atresia was 1.4 per 10,000, significantly higher than the prevalence of 0.2 per 10,000 among white infants (RR = 6.3, 95% CI = 2.9, 13.5). The increased prevalence of these defects among twins was a particularly interesting finding.

Alcohol use before and during pregnancy. PRAMS Working Group

A woman's excessive drinking during pregnancy can cause structural and behavioral abnormalities in her offspring. However, population-based data concerning maternal drinking behaviors are sparse. To describe drinking prevalences and patterns, we analyzed self-reported data from the Pregnancy Risk Assessment Monitoring Systems of Maine, Michigan, Oklahoma, and West Virginia. During 1988 and 1989, 6,319 mothers were surveyed two to six months after delivery; state-specific response rates ranged from 65.6% to 83.5%. We applied statistical weights to the sample from each state; thus, the results estimate state-specific prevalences. State-specific prevalences of drinking during the last three months of pregnancy were low: 6.8% to 15.1% of mothers reported light drinking (one to six drinks per week), 0.06% to 0.30% reported moderate drinking (seven to 13 drinks per week), and 0.03% to 0.13% reported heavy drinking (14 or more drinks per week). In contrast, prevalences of drinking during the three months before pregnancy were much higher: the range was 31.9% to 53.8% for light drinking, 1.6% to 3.0% for moderate drinking, and 0.6% to 1.3% for heavy drinking. State-specific prevalences of mothers who reported receiving prenatal counseling about alcohol's effects ranged from 66.3% to 75.0%. More heavy drinkers than light drinkers received counseling. These findings indicate that moderate and heavy drinking during late pregnancy is relatively rare. However, all levels of drinking near the time of conception are much higher, and these results suggest the need for research into methods of reducing drinking before pregnancy.

Defining and classifying skin tears: need for a common language

Very little has been written about skin tears. A common taxonomy and definition for each type of skin tear can organize teaching, practice, and research in the field. In 1990, Payne and Martin published the results of a descriptive clinical nursing research study on the epidemiology and management of skin tears in older adults. The Payne-Martin Classification System for Skin Tears, definitions, and characteristics of skin tears were presented. The purpose of this article is to critique their classification system and definitions. Criteria for evaluating taxonomies, internal validity, external validity, and utility, are used for the critique. A revision based upon continuing research and work with the classification system is presented. Further testing and modification will refine the classification and advance the science of wound care.