The Good Behaviour Game: Maintaining students' physical distancing in physical education classes during the COVID-19 pandemic

Background

Maintaining physical distancing is one of the most important steps to enforce in educational institutions to reduce the risk of transmission of COVID-19. However, close proximity and physical contact between students are often considered 'normal' during physical education (PE) classes, making it challenging for PE teachers to ensure physical distancing.

Objectives

The aim of this study was to assess the effect of the implementation of the Good Behaviour Game (GBG) in maintaining physical distancing in PE settings in times of the COVID-19 pandemic.

Method

In a quasi-experimental design, two groups were separately designated as an experimental group (20 classes involving 220 students) and a control group (20 classes involving 231 students). They were all enrolled in the eighth grade of the Tunisian education system. In the experimental group, the PE teacher managed physical distancing by administering the GBG. Physical distancing was evaluated by direct observation of videos of filmed PE sessions using a code grid. It was measured twice for the two groups using Kinovea software.

Results

Quantitative data analyses showed that the level of maintaining physical distancing increased after the GBG intervention in the experimental group (p < .001). Furthermore, greater percent changes between pre- and post-intervention were identified in the experimental group compared to the control group (120% vs 1%, respectively).

Conclusion

The GBG was effective in ensuring students' physical distancing when implemented in PE settings.

Digitally enabled flash glucose monitoring for inpatients with COVID-19: Feasibility and pilot implementation in a teaching NHS Hospital in the UK

BACKGROUND

COVID-19 placed significant challenges on healthcare systems. People with diabetes are at high risk of severe COVID-19 with poor outcomes. We describe the first reported use of inpatient digital flash glucose monitoring devices in a UK NHS hospital to support management of people with diabetes hospitalized for COVID-19.

METHODS

Inpatients at University Hospitals Coventry & Warwickshire (UHCW) NHS Trust with COVID-19 and diabetes were considered for digitally enabled flash glucose monitoring during their hospitalization. Glucose monitoring data were analysed, and potential associations were explored between relevant parameters, including time in hypoglycaemia, hyperglycaemia, and in range, glycated haemoglobin (HbA1c), average glucose, body mass index (BMI), and length of stay.

RESULTS

During this pilot, digital flash glucose monitoring devices were offered to 25 inpatients, of whom 20 (type 2/type 1: 19/1; mean age: 70.6 years; mean HbA1c: 68.2 mmol/mol; mean BMI: 28.2 kg/m2) accepted and used these (80% uptake). In total, over 2788 h of flash glucose monitoring were recorded for these inpatients with COVID-19 and diabetes. Length of stay was not associated with any of the studied variables (all p-values >0.05). Percentage of time in hyperglycaemia exhibited significant associations with both percentage of time in hypoglycaemia and percentage of time in range, as well as with HbA1c (all p-values <0.05). The average glucose was significantly associated with percentage of time in hypoglycaemia, percentage of time in range, and HbA1c (all p-values <0.05).

DISCUSSION

We report the first pilot inpatient use of digital flash glucose monitors in an NHS hospital to support care of inpatients with diabetes and COVID-19. Overall, there are strong arguments for the inpatient use of these devices in the COVID-19 setting, and the findings of this pilot demonstrate feasibility of this digitally enabled approach and support wider use for inpatients with diabetes and COVID-19.

The Mechanism of Physical Activity-induced Amelioration of Parkinson's Disease: A Narrative Review

Physical activity, together with its ameliorative effects on Parkinson's disease (PD) symptoms, remains a relatively unappreciated factor which may be beneficial for the treatment outcome. Contemporary evidence supports the positive effects of non-pharmacological approaches to PD symptom management, in particular the effects of the exercise on both, motor and non-motor symptoms. The aim of the study was to review the mechanisms of exercise-induced amelioration of PD symptoms. Methods: Electronic databases (PubMed, Web of Science and Google Scholar) were searched using the following key words: "Parkinson and physical activity" OR "Parkinson disease and exercise" OR "Parkinson disease and lifestyle factors" OR "Parkinson disease and longevity". A total of 97 studies which investigated PD genetics and various forms of exercise and their etiologic impact on PD were reviewed. The studies were subdivided into four topic groups: 1) genetics of PD, 2) exercise and the brain, 3) physical activity and PD, 4) mind-body interventions, and discussed accordingly. Adequate levels of physical activity are associated with higher quality of life in PD patients. Physical activity may have protective and stimulatory effects for better functional efficiency in higher-level cognitive networks. It can also improve balance and motor functions by improving muscle strength. Given the etiologic evidence of the beneficial effects of physical activity on PD, albeit tentative, a concerted effort to elucidate the processes and outcomes of physical activity on ameliorating symptoms of PD must be undertaken.

A primary care physician’s approach to a child with meningitis

Background: Paediatric meningitis remains a common cause of childhood morbidity and mortality in developing countries. In children the peak age for meningitis is six to 12 months old, with 90% of cases occurring in children younger than five years. It is imperative that a primary healthcare physician be aware of and is capable of managing this life-threatening condition as most caregivers first present to a primary healthcare physician with their sick child.Discussion: Common symptoms are headaches, photophobia, drowsiness, fatigue, unexplained crying, convulsions, irritability, and lethargy. Signs include fever, vomiting, neck stiffness and signs of increased intracranial pressure. Acute bacterial meningitis, especially meningococcal meningitis can present with petechiae and/or purpura. Cranial nerve palsy occurs commonly in cryptococcal meningitis, which can occur as part of immune reconstitution inflammatory syndrome (IRIS) after initiation of antiretroviral therapy. Older children may present with behavioural changes and localising signs such as hemiparesis and coma.Conclusion: This paper discusses the lumbar puncture technique and findings, drug and non-drug management, information on chemoprophylaxis for bacterial meningitis, and the possible complications of meningitis in children. This is an important area for the primary care physician as they are usually the first port of call by caregivers.

Signal transduction in electrically stimulated articular chondrocytes involves translocation of extracellular calcium through voltage-gated channels

OBJECTIVE

To ascertain, using specific inhibitors, the potential role of calcium-related signal transduction pathways in the mechanism of cartilage matrix protein gene induction and metalloproteinase gene suppression by capacitively coupled electric fields.

METHODS

Articular chondrocytes were isolated from adult bovine patellae and cultured in high density for 7 days. To study matrix protein expression, cells cultured in the absence or presence of specific calcium pathway inhibitors were exposed to a capacitively coupled electrical field (60 kHz, 20 mV/cm): for aggrecan 1h at 50% duty cycle and for type II collagen 6h at 8.3% duty cycle. To study metalloproteinase expression in the presence of interleukin 1 beta (IL-1beta), cells were cultured as above but exposed for only 30 min to a 100% duty cycle signal. At harvest, total mRNA was isolated and aggrecan, type II collagen, matrix metalloproteinase (MMP-1, -3 and -13) and aggrecanase [a disintegrin and metalloproteinase with thrombospondin repeats (ADAMTS-4 and -5)] mRNA expression were measured by quantitative real-time polymerase chain reaction (qPCR).

RESULTS

(1) In the absence of inhibitors, appropriate electrical stimulation induces a 3-4-fold up-regulation of both aggrecan and type II collagen mRNA and a 3.7-9.6-fold down-regulation of IL-1beta-induced metalloproteinases; (2) the presence of inhibitors alone does not affect any target mRNA levels; (3) inhibitors of intracellular calcium regulation and inositol 1,4,5-triphosphate (IP(3)) formation [8-(diethylamino)octyl-3,4,5,-trimethoxybenzoate hydrochloride (TMB-8) and neomycin, respectively] have no effect on regulation of target mRNA levels by electrical stimulation; and (4) inhibitors of voltage-gated calcium channels (verapamil), calmodulin activation (N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide hydrochloride, W-7), calcineurin activity (cyclosporin A), phospholipase C activity (bromophenacyl bromide, BPB) and prostaglandin E(2) (PGE(2)) synthesis (indomethacin) completely inhibit the effects of electrical stimulation.

CONCLUSIONS

The results are consistent with the effects of electrical stimulation involving a pathway of extracellular Ca(2+) influx via voltage-gated calcium channels rather than from intracellular Ca(2+) repositories; and with downstream roles for calmodulin, calcineurin and nuclear factor of activated T-cells (NF-AT) rather than for phospholipase C and IP(3).

Basement membrane zone type XV collagen is a disulfide-bonded chondroitin sulfate proteoglycan in human tissues and cultured cells

Type XV collagen has a widespread distribution in human tissues, but a nearly restricted localization in basement membrane zones. The alpha1(XV) chain contains a highly interrupted collagenous region of 577 residues, and noncollagenous amino- and carboxyl-terminal domains of 530 and 256 residues, respectively. Cysteines are present in each domain and consensus sequences for O-linked glycosaminoglycans are situated in the amino terminus and in two large, noncollagenous interruptions. We now report that type XV collagen is a chondroitin sulfate proteoglycan in human tissues and cultured cells, and that the alpha chains are covalently linked by interchain disulfide bonds only between the two cysteines in the collagenous region. Western blotting of tissue extracts revealed a diffuse smear with a mean size >/=400 kDa, which after chondroitinase digestion resolved into a 250-kDa band in umbilical cord, and 250- and 225-kDa bands in placenta, lung, colon, and skeletal muscle. The latter two bands were also directly visualized by alcian blue/silver staining of a purified placenta extract. In a human rhabdomyosarcoma cell line, almost all of the newly synthesized type XV collagen was secreted into the medium and upon chondroitinase digestion just the 250-kDa alpha chain was generated. Chondroitinase plus collagenase digestion of tissue and medium proteins followed by Western blotting using domain-specific antibodies revealed a 135-kDa amino-terminal fragment containing glycosaminoglycan chains and a 27-kDa fragment representing the intact carboxyl terminus. However, a truncated carboxyl peptide of approximately 8-kDa was also evident in tissue extracts containing the 225-kDa form. Our data suggest that the 225-kDa form arises from differential carboxyl cleavage of the 250-kDa form, and could explain the approximately 19-kDa endostatin-related fragments (John, H., Preissner, K. T., Forssmann, W.-G., and Ständker, L. (1999) Biochemistry 38, 10217-10224), which may be liberated from the alpha1(XV) chain.

A preliminary study of the effects of electroconvulsive therapy on regional brain glucose metabolism in patients with major depression

Animal studies have shown that a course of electroconvulsive shock (ECS) leads to a significant reduction in glucose metabolism in rat brains 1 day after the last ECS. In humans, of the two positron emission tomography (PET) studies that assessed the effects of a course of electroconvulsive therapy (ECT) on brain glucose metabolism in depressed patients, one reported no change while the other found a trend for reduction in glucose metabolism in frontal cortical region 24 hours after last ECT. The changes in glucose metabolism detected 24 hours after the last ECS/ECT treatment might simply be due to subacute effects of a seizure. We hypothesized that the changes in brain metabolism that persist 1 week after a course of ECT are more likely to underlie the therapeutic effects of ECT. We, therefore, investigated the effects of a course of ECT on brain glucose metabolism 1 week after last ECT by using PET and [18F]fluorodeoxyglucose (FDG). Six patients who met DSM-IV criteria for a diagnosis of major depressive disorder (unipolar), and were referred for ECT as the clinically indicated treatment were recruited. They underwent two PET scans, one prior to first ECT and the second a week after last ECT. The number of ECT treatments subjects received ranged from 8 to 12 with a mean of 11. Five out of six patients responded to the ECT treatment. Cerebral metabolic rates for glucose were slightly lower in most regions post treatment compared with pretreatment but the differences were not statistically significant. Similarly, there was no significant correlation between changes in regional cerebral metabolic rates for glucose (rCMRglc) and changes in Hamilton Depression Rating Scale (HAM-D 21-item) scores. Our results might suggest that rCMRglc rates are not altered 1 week after a therapeutic course of ECT in depressed patients. Further studies using new generation PET scanners, which have a higher resolution, in larger numbers of depressed patients, are clearly needed before firm conclusions can be drawn.

Laceration and ejection dangers of automotive glass, and the weak standards involved. The strain fracture test

Glazing types are historically described, with the laceration injuries and ejection deaths associated with present glazing. Sixty tempered glass windows manufactured at nominally four temper levels were tested for uncracked fracture fragment size and weight and length by the American and European standards, which fracture the glass without strain, and our preliminary strain fracture test, which produces longer uncracked fragments and heavier clusters of fragments. Our study relates the results by the three methods to the temper measurements using birefringence, with a discussion of alternate safer glazing and the inadequacy of present standards for reducing laceration and ejection dangers.

Up-regulation of type XIX collagen in rhabdomyosarcoma cells accompanies myogenic differentiation

Rhabdomyosarcomas are known to recapitulate some of the early events in skeletal muscle embryogenesis, and cultures derived from these tumors have been extensively used to elucidate processes associated with the differentiation of primitive mesenchymal cells. These neoplasms have also provided important systems for studying different collagen types. This aspect is particularly relevant to type XIX collagen, which was originally identified from rhabdomyosarcoma cDNA clones. Although this collagen has been localized in vivo to basement membrane zones in a wide variety of tissues, including skeletal muscle, the tumor cells appear to be a unique source of its expression in vitro. We have found that one particular cell line-derived from a peritesticular embryonal rhabdomyosarcoma-produced relatively large amounts of type XIX collagen, especially in those rare instances in which these cells appear to spontaneously differentiate. To characterize this phenomenon, tumor cells were grown under conditions known to induce differentiation in normal myoblast cultures. In response to this treatment, the typical tumor cell morphology consistently and reproducibly switched from polygonal to round/spindle-shaped with the subsequent appearance of some structures resembling myotubes. Concurrently, the cultures commenced a dramatic up-regulation of type XIX collagen and skeletal muscle myosin heavy chain and alpha-actinin in a time-dependent fashion, whereas protein and mRNA levels of other matrix proteins were either decreased or unchanged. Moreover, immunocytochemical analysis revealed that only a subpopulation of the cells was responsible for the increased synthesis of type XIX collagen, alpha-actinin, and myosin, and that the same cells which stained positive for the collagen also stained positive for the muscle proteins. Taken together, the results suggested that type XIX collagen may be involved in the initial stages of skeletal muscle cell differentiation.

Effects of client interviewers on client-reported satisfaction with mental health services

A study at two outpatient facilities compared two methods of collecting data on client satisfaction with mental health services provided by case managers and by physicians. A satisfaction survey instrument was developed with input from clients. A total of 120 clients were randomly assigned to be interviewed by either a staff member or a client. Clients from both facilities reported high levels of satisfaction regardless of the type of interviewer. Clients gave a significantly greater number of extremely negative responses when they were interviewed by client interviewers. No difference between the two groups was found in overall satisfaction with services received from case managers or physicians.

Wellness self-care by healthy older adults

PURPOSE

To examine self-care behaviors in healthy older adults. The number of older adults continues to increase. Nurses need a framework for understanding and supporting healthy behaviors in this population.

DESIGN

Descriptive.

METHOD

Data about self-care behaviors were elicited in 1997 about how healthy older adults stay well. Using a key-informant criterion and critical case approach, a small convenience sample of 28 older adults (ages 57-83) responded to a questionnaire based on a self-care wellness model.

FINDINGS

Age was not related to differences in healthy behaviors. Many informants reported no digestive or sleep difficulties. All were active, regularly kept in touch with family and friends, were confident their environment was safe, obtained sufficient sleep and rest, and managed stress well. All but one attributed their quality of life and zest for living to remaining active, eating healthy food, exercising, pacing themselves, doing preferred activities, and reading the Bible, or "feeding the life of the mind."

CONCLUSIONS

Participant statements of actions can provide inspiration for less-active seniors and a beginning framework for nurses for understanding and supporting wellness self-care behaviors in older adults.

Recognizing spiritual needs of orthopaedic patients

Orthopaedic nurses often are well-educated in dealing with patients' physical and psychologic needs but lack education in caring for the spiritual needs of man. Nurses must realize they, themselves, have spiritual needs and must invest in clarifying their own values and beliefs as well as their patients. To perform a complete spiritual assessment, nurses need to become familiar with the concept of spirituality and what it means in the care of patients. Providing spiritual care is individualized and often complex. The nursing process enables the nurse to plan patient care. Providing spiritual care is a challenge orthopaedic nurses must recognize and assume responsibility for.

Nosocomial and community-acquired Staphylococcus aureus bacteremias from 1980 to 1993: impact of intravascular devices and methicillin resistance

The rate of nosocomial bacteremia due to Staphylococcus aureus has increased over the past decade, but trends in community-acquired S. aureus bacteremia are less certain. This hospital-based observational study compares nosocomial and community-acquired S. aureus bacteremias during 1980-1983 and 1990-1993. The rate of nosocomial S. aureus bacteremia increased from 0.75 to 2.80 cases per 1,000 discharges, while the rate of community-acquired S. aureus bacteremia increased from 0.84 to 2.43 cases per 1,000 discharges. The number of nosocomial device-related bacteremias increased eightfold; 56% of S. aureus bacteremias were associated with devices during 1990-1993. Intravascular devices were associated with no community-acquired S. aureus bacteremias during 1980-1983 but with 22% during 1990-1993. Methicillin-resistant S. aureus (MRSA) seldom caused bacteremia during 1980-1983. From 1990 to 1993, MRSA caused 32% and 18.5% of nosocomial and community-acquired S. aureus bacteremias, respectively. The rates of both community-acquired and nosocomial S. aureus bacteremias have increased significantly since 1980. In addition to their role in nosocomial infections, MRSA and intravascular device-related S. aureus bacteremias are emerging problems in the nonhospital setting.

Except in emergencies: AMA ethics and physician autonomy

In this paper I will argue that in emergency cases, physician autonomy is soci-etally constrained under Principle VI of the American Medical Association's (AMA) “Principles of Medical Ethics”1 The issue will be seen to turn on whether the contextual use of “emergency” should be construed narrowly or broadly; I argue for a broadened rendering. Although a societal emergency is not defined here, I recommend that the condition of inner city healthcare presents a paradigm “patient” for such emergency care. I further urge that because societal constraints on physician autonomy are ambiguous and only derived indirectly in the AMA document, further AMA comment on physician autonomy and societal responsibility would advance clarity on the profession's commitment to the public trust.

Cellular responses to chemical and morphologic aspects of biomaterial surfaces. II. The biosynthetic and migratory response of bone cell populations

The biosynthetic and migratory response of bone cells to changes in both surface composition and morphology of polystyrene (PS) substrates was examined. A system was devised wherein micromachined silicon wafers were used as templates to solvent-cast PS replicas [using 0, 1, or 2 wt % styrene (S) monomer additions] with either 0.5- or 5.0- microns-deep surface grooves. Smooth replicas (0% S) served as the control surfaces. The chemical and morphologic characteristics of the nine unique model biomaterial surfaces (MBSs) produced using this system were documented and were found to be distinct. For the biosynthetic studies, bone cells isolated from neonatal rat calvaria were plated onto the MBSs and labeled at postconfluence with [14C]proline for 24 h. Total DNA per surface, total newly synthesized collagenous (CP), and noncollagenous protein (NCP) (cell associated and secreted) were determined. Cell-associated CP was found to increase significantly for the bone cells cultured on the substrates with 0.5-micron grooves and 2% S (P < .05). Cell-associated NCP was found to be elevated for all 2% S substrates and for the 0.5-micron grooves substrates with 1% S. For the migration studies, bone cells were plated first onto 5-mm nitrocellulose disks that were attached to standard Petri dishes using a plasma clot. At confluence, the disks were removed aseptically and placed on the replicas. The cellular area occupied as a result of the outward migration of the bone cells was measured after 4 days of culture using an image analysis system. An average velocity for the leading edge of bone cell populations on each of the nine MBSs was calculated: Cells on surfaces with either 1% S or 5.0-microns grooves displayed significantly higher velocities than did the control cultures. A significant interaction effect between chemistry and morphology was observed. The biosynthetic and migratory responses of in vitro cultures of bone cells were not predictable from the observations of the cellular responses to the individual features, but appeared to depend on cellular responses to more than one substrate factor.

Microvessel endothelial cells and pericytes increase proliferation and repress osteoblast phenotypic markers in rat calvarial bone cell cultures

To investigate the influence of microvessel cells on osteoblasts, we exposed osteoblast-enriched cultures of rat calvarial cells to cultured endothelial cells and pericytes using feeder-layer co-cultures, co-culture dish inserts, and conditioned media experiments. When co-cultured with growth-arrested feeder-layers of endothelial cells or pericytes for 10 days, bone cell cultures showed an increase in cell number and reduction in alkaline phosphatase activity. The response of bone cells to endothelial cells was nearly twice their response to pericytes. A similar response was demonstrated by exposure to microvessel cells in co-culture dish inserts and by exposure to media conditioned by microvessel cells. In long-term cultures of bone cells, the levels of osteocalcin and the number of mineralized nodules both were reduced by exposure to media conditioned by the microvessel cells. Transient exposure to conditioned media from the microvessel cell cultures for 3 days, during the period from initial plating to cell confluence, produced nearly the same effect on the cultures of bone cells as did continuous exposure to these conditioned media. The influence of isolated microvessel cells on osteoblast-enriched calvarial cells was found to be primarily mitogenic, mediated by soluble factors, independent of cell contact, and a cause of prolonged reduction in the expression of early and late markers of the osteoblast phenotype.

Occupational therapists as case managers: responding to current approaches to community mental health service delivery

Case management has been identified as an effective approach to service delivery which can assist persons with severe psychiatric disabilities to live in the community. The conceptualization and development of case management services have been the focus of much discussion. Occupational therapists are attempting to define their role in relation to case management. The purpose of this paper is to explore the relationship between occupational therapy and the case management approach to service delivery. The case management approach will be described including its objectives, models, functions and training requirements for case managers. A discussion of some of the philosophical, educational and professional issues facing occupational therapists in the role of case manager will be examined.

Serum fractions and related agonists with calcium-mobilizing activity in the bovine growth plate chondrocyte

Longitudinal growth of bone involves a complex sequence of cellular events in the cartilaginous epiphysis. Whole blood serum has been shown previously to be a potent stimulus to the cells of the growth plate, as demonstrated by its ability to activate the inositol phosphate-calcium second messenger system, resulting in a rise in intracellular Ca2+. By manipulating the preparation of serum to functionally separate it into its constituent parts, we have shown that the processes of platelet lysis and activation of the clotting cascade are responsible for the generation of factors that stimulate this signaling mechanism in isolated bovine growth plate chondrocytes. Through a subsequent trial of bioactive agents generated in these processes, we identified and partially characterized several novel agonists of growth plate chondrocytes:adenosine triphosphate and adenosine diphosphate, the purine energy substrates, and bradykinin, the bioactive peptide generated in a side reaction of the clotting cascade, each induces a rise in intracellular Ca2+ via release from intracellular ion stores. Additionally, the three distinct isoforms of platelet-derived growth factor (AA, AB, and BB), also released on platelet lysis, were compared with respect to their ability to stimulate the inositol phosphate-calcium second messenger system in growth plate chondrocytes.

Limiting response alternatives in time-intensity scaling: an examination of the halo-dumping effect

Time-related measurements pose some challenges to psychophysics and to applied sensory testing methods including control of psychological biases which have been found in single-point scaling. This research examined enhancement of ratings when response alternatives were limited in time-intensity scaling tasks using repeated category ratings. Panelists rated a pseudo-beverage containing sweetener and flavor and one with sweetener only over a 90-s period. The aromatic flavor caused an increase in sweetness intensity and especially so when the panelists were limited to sweetness responses only. The odor-induced enhancement of sweetness was smaller when panelists were given both flavor and sweetness response options than when the panelists were given only a sweetness scale. Prior use of both scales in a previous experimental session did not lessen the halo-dumping enhancement effect. In one study, sweetness ratings of sucrose alone were depressed when the additional scale for flavoring was provided, perhaps due to inappropriate partitioning of responses.

Effects of thapsigargin, an intracellular calcium-mobilizing agent, on synthesis and secretion of cartilage collagen and proteoglycan

The calcium-mobilizing agents thapsigargin and 2,5-di-(tert-butyl)-1,4- benzohydroquinone were shown to markedly elevate the intracellular calcium concentration of chick embryo chondrocytes in a dose-dependent manner. Under these conditions, the metabolism of macromolecules was variably affected. The synthesis and secretion of protein in general, and of collagen in particular, were significantly inhibited; in contrast, proteoglycan synthesis (but not glycosaminoglycan synthesis) was inhibited, whereas secretion was unaffected. Flunarizine, which prevented the thapsigargin-induced intracellular calcium elevation, and EGTA, which caused only a transient thapsigargin-induced intracellular calcium elevation, did not reverse these alterations. It was concluded, therefore, that the observed effects of thapsigargin and 2,5-di-(tert-butyl)-1,4-benzohydroquinone on chondrocyte macromolecule metabolism were not related to the ability of these drugs to increase the cytosolic free calcium concentration but may have been due to the specific depletion of the calcium sequestered in the endoplasmic reticulum. The differential effect of these drugs on protein and proteoglycan secretion suggests that the intracellular trafficking of these two classes of macromolecules may be controlled independently.

Factors encouraging and discouraging the use of nursing research findings

A sample of 543 members of Midwest Alliance in Nursing and Midwest Nursing Research Society were surveyed to identify factors encouraging and discouraging research utilization. Lack of time was the factor that most discouraged research utilization. A library containing research journals was available to most service (82 percent) and educator nurses (86 percent). Computer services were more available to educators (85 percent) than service nurses (68 percent). A research newsletter was ranked as more helpful than continuing education or computer networks for keeping abreast of research findings.

Molecular cloning of the human proto-oncogene Wnt-5A and mapping of the gene (WNT5A) to chromosome 3p14-p21

The highly conserved Wnt genes belong to a widely distributed family of presumptive signaling molecules that have been implicated not only in the regulation of normal pattern formation during embryogenesis and differentiation of cell lineages, but also in oncogenic events. All of the known vertebrate Wnt genes encode for 38- to 43-kDa cysteine-rich putative glycoproteins, which have features typical of secreted growth factors: a hydrophobic signal sequence, a conserved asparagine-linked oligosaccharide consensus sequence, and 22 conserved cysteine residues whose relative spacing is maintained. In this study, we report the cloning and sequencing of several overlapping cDNAs encoding approximately 4.1 kb of the human homologue of Wnt-5A. The mature protein contained 343 residues (M(r) approximately 38,000 excluding any post-translational modifications) with a > 93% homology to the reported sequences of other Wnt-5A proteins (> 99% homologous to mouse Wnt-5A). This protein maintained certain features--a hydrophobic signal sequence, the Wnt-1 family "signature sequence" (CKCHGvSGSC), and a number of other conserved amino acid residues: 24 cysteine residues, 4 asparagine-linked oligosaccharide consensus sequences, and a tyrosine sulfation site--that have been found in all other Wnt-5A proteins. Reverse transcriptase PCR analysis of RNA from a variety of human embryonic, neonatal, and adult cells and/or tissues showed that human Wnt-5A expression was detected only in neonatal heart and lung. It may be relevant, however, that the 3'-untranslated region contained numerous AT-rich motifs that could be involved in the rapid degradation of mRNA. Finally, using a combination of Southern blotting, PCR amplification, and in situ hybridization, the human Wnt-5A (WNT5A) gene was mapped to chromosome 3p14-p21.

Effects of short-term cast immobilization on equine articular cartilage

Hexosamine concentration (an index of proteoglycan content), DNA content (an index of cellularity), and [35S]sulfate incorporation (an index of proteoglycan synthesis) of articular cartilage were measured in biopsy specimens from medial proximal sesamoid bone, medial condyle of the third metacarpal bone, and proximal dorsal rim of the proximal phalanx in both metacarpophalangeal joints of 6 adult horses. One limb was then placed in a fiberglass cast that extended down from the proximal portion of the metacarpus and enclosed the hoof; the other limb was not casted. After 30 days of stall confinement, additional specimens were taken from the medial proximal sesamoid bone, medial condyle of the third metacarpal bone, midproximal portion of the proximal phalanx, distal portion of the proximal phalanx, and proximal portion of the middle phalanx of both limbs for comparison. Immobilization resulted in an apparent decrease in the hexosamine content of the cartilage when the 30-day immobilized vs 30-day mobilized specimens were analyzed. This decrease was accentuated by opposing trends in the 2 limbs. The immobilized cartilage tended to lose hexosamine, whereas the mobilized limb tended to gain hexosamine during the 30-day period; a similar trend also was seen with [35S] incorporation, but this trend was not statistically significant. The largest change was a significant increase in glycosaminoglycan synthesis in the mobilized limb, compared with little change in the immobilized joint cartilage. We concluded that contralateral limbs are unsuitable for controls in immobilization studies because of their biological response to increased weight bearing.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro bone-cell response to a capacitively coupled electrical field. The role of field strength, pulse pattern, and duty cycle

Newborn rat calvarial bone cells were grown to confluence and subjected to a matrix of sine wave 60-kHz capacitively coupled electrical signals of various field strengths, pulse-burst patterns, and duty cycles. Both [3H] thymidine incorporation into DNA and alkaline phosphatase activity were evaluated in field strengths ranging from 0.0001 to 20 mV/cm, with pulse-burst patterns ranging from continuous to 5 milliseconds ON/495 milliseconds OFF, with daily duty cycles ranging from 0.25% to 25%. A significant increase in proliferation occurred in field strengths of 0.1, 1, and 20 mV/cm when the signal was applied continuously for six hours. Significant proliferation also occurred when the 20-mV/cm field was pulsed for six hours at 5 milliseconds ON/495 milliseconds OFF and at 5 milliseconds ON/245 milliseconds OFF. No change in alkaline phosphatase activity occurred in the 20-mV/cm field with any signal. At 1 mV/cm, there was a significant decrease in alkaline phosphatase activity in the continuous signal and in the 5 milliseconds ON/62 milliseconds OFF signal; in the lower fields evaluated, there was an actual decrease in alkaline phosphatase activity with some of the signals. The field strength plays a dominant role in determining the bone-cell's proliferative response, and to a lesser extent the alkaline phosphatase activity response, to a capacitively coupled electric field. The pulse configuration and the duty cycle are also important, but only if the proper field strength is being applied to the cell.

Proliferation and macromolecular synthesis by rat calvarial bone cells grown in various oxygen tensions

Perinatal rat calvarial bone cells were isolated by sequential collagenase digestion and grown in oxygen tensions ranging from 1 to 60% O2. Cell proliferation as determined by automated cell counting and DNA content was greatest in the lower oxygen tensions (less than or equal to 9% O2), whereas alkaline phosphatase activity and [35S]sulfate and [14C]proline incorporation were greatest in the higher oxygen tensions (greater than or equal to 13% O2). It is concluded that lower oxygen concentrations favor bone cell proliferation, whereas higher oxygen concentrations favor macromolecular synthesis. These findings, when related to the known pO2 of the fracture callus, suggest the following sequence of events: first, at the time of fracture an ingrowth of osteoprogenitor cells, capillary buds, and primitive mesenchymal cells occurs in the fracture site, a region of low pO2; second, a great increase in cellular proliferation accompanied by an initiation of macromolecular synthesis follows; finally, as the pO2 levels begin to increase, cellular proliferation decelerates, accompanied by an increase in macromolecular synthesis.

Proteoglycan synthesis and content in articular cartilage and cartilage repair tissue in horses

Hexosamine concentration, DNA concentration, and [35S]sulfate incorporation for articular cartilage obtained from various sites in the metacarpophalangeal and carpal joints of horses were measured. The same measurements were made on the repair tissue filling full-thickness articular defects in the intermediate carpal bone and on cartilage surrounding partial-thickness defects 6 weeks after the defects were created arthroscopically. Cellularity (measured as DNA concentration), proteoglycan content (measured as hexosamine concentration), and proteoglycan synthesis (measured as [35S]sulfate incorporation) varied according to the site sampled. Cartilage from the transverse ridge of the head of the third metacarpal bone and the radial facet of the third carpal bone had the lowest hexosamine concentration, whereas rate of proteoglycan synthesis was lowest in cartilage from the transverse ridge of the head of the third metacarpal bone and the distal articular surface of the radial carpal bone. Repair tissue filling a full-thickness cartilage defect at 6 weeks was highly cellular. It was low in proteoglycan content, but was actively synthesizing these macromolecules. In contrast, the cartilage surrounding a partial-thickness defect was unchanged 6 weeks after the original defect was made.

The effect of oxygen tension on proteoglycan synthesis and aggregation in mammalian growth plate chondrocytes

Growth plate chondrocytes isolated from the proliferative and hypertrophic zones of bovine costochondral junctions were grown in vitro in the presence of various oxygen tensions ranging from 3 to 60%. Using [35S] sulfate as an index of glycosaminoglycan synthesis, incorporation was found to be maximal at 21% O2. In contrast, proteoglycan aggregation under the same conditions was found to be maximal at 3% O2. There were no consistent differences in response between cells from the different morphologic zones even though they are exposed to different oxygen tensions in situ. These results show that proteoglycan synthesis and aggregation in growth plate chondrocytes in vitro are differentially affected by the ambient oxygen environment.

Spirituality: integral to quality care

Caring is the medium through which nursing knowledge, skill, and touch are operationalized. Caring is a profound act of hope (White T. 1986. Unpublished data) that contributes to the spiritual well-being of others. In order to assure quality care, the impact of identifying and meeting patient spiritual needs must be taken into account.

Biochemical changes in articular cartilage opposing full- and partial-thickness cartilage lesions in horses

Using arthroscopic technique, identical diameter defects were created in the proximal articular surface of both intermediate carpal bones of 6 horses. One of each pair of defects was deepened to penetrate the subchondral plate. Removed cartilage was assayed for [35S] sulfate incorporation, total hexosamine content, and DNA content. Six weeks later, cartilage was harvested and similarly analyzed from the distolateral portion of the radius directly opposite the created lesions and the distomedial portion of the radius distant from the lesion. The repair tissue filling the full-thickness defect and the cartilage at the periphery of the partial-thickness lesion also were analyzed. There was a marked increase in synthetic activity (35S sulfate incorporation) opposite the full-thickness defect, compared with the cartilage opposite the partial-thickness defect. A marked decrease in glycosaminoglycan content in the cartilage opposite the full-thickness defect was found as compared with that opposite the partial-thickness defect. The repair tissue filling the full-thickness defect was highly cellular, high in synthetic activity, but low in glycosaminoglycan content. Insignificant changes occurred in the cartilage adjacent to the partial-thickness defect. On the basis of these results, we suggest that full-thickness defects at 6 weeks result in more detrimental change to the cartilage opposite it than do partial-thickness lesions of the same diameter.

The effect of ascorbic acid on the metabolism of rat calvarial bone cells in vitro

Addition of 50 micrograms/ml sodium ascorbate to confluent cultures of isolated rat calvarium bone cells resulted in a 21% increase in DNA production, a 50-60% increase in incorporation of [14C]proline into collagenous and noncollagenous proteins, and a 200% increase in alkaline phosphatase activity; under identical conditions, [35S]sulfate incorporation into proteoglycans (glycosaminoglycans) was not affected. These results suggest that ascorbate may be important in maintaining or stimulating the osteogenic phenotype of normal bone cells.

Proliferative and synthetic response of bovine growth plate chondrocytes to various capacitively coupled electrical fields

In vitro monolayer cultures of growth plate chondrocytes isolated from newborn calf costochondral junctions were subjected to capacitively coupled electrical fields for 48 h. In part A, the electrical signal was a 60-kHz sine wave applied at different voltages so as to produce electrical fields at the pericellular level of 7, 20, 50, and 126 mV/cm. Incorporations of [3H]thymidine and [35S]sulfate were assayed to determine the effect of the above fields on cells proliferation and matrix synthesis, respectively. Proliferation was increased by 47% in the 20 mV/cm field whereas the same field decreased [35S]sulfate incorporation by 21%. These changes were significant at p less than 0.05 in both instances. In part B, the 20 mV/cm field was applied in a pulsed fashion to produce daily duty cycles of 100, 25, 2, and 0.25%. Incorporation of [3H]thymidine, [35S]sulfate, and [14C]proline per DNA were assayed. Results indicated that the 100, 25, and 0.25% percent duty cycles showed significantly (p less than 0.01-0.05) increased proliferation, whereas the 0.25% signal (5 ms on/495 ms off for 6 h/day) significantly decreased [14C]proline incorporation. We conclude that the biologic response of cells in vitro is signal specific, and that the total amount of electrical energy required to stimulate the growth plate chondrocyte to increased proliferation is very small since the total time the 0.25% duty cycle signal was only 3.6 min of a 24-h period.

Underhydroxylated minor cartilage collagen precursors cannot form stable triple helices

Matrix-free cells from chick-embryo sterna were incubated with various concentrations of 2,2'-bipyridyl, an iron chelator that inhibits prolyl hydroxylase and lysyl hydroxylase. At concentrations in the region of 0.1 mM, significant effects on cartilage collagen hydroxylation and secretion were observed. When the underhydroxylated collagens were subsequently digested with chymotrypsin or chymotrypsin plus trypsin at 4 degrees C for 15 min, the minor cartilage collagen precursors (namely types IX and XI) were extensively degraded; type II procollagen was only partially susceptible and was converted into underhydroxylated collagen. The results demonstrate that there were significant differences in triple-helix stability among cartilage collagens such that the underhydroxylated minor collagen precursors were unable to attain a native structure under conditions where type II procollagen was successful.

Release of corrosion products by F-75 cobalt base alloy in the rat. III: Effects of a carbon surface coating

A pyrolytic carbon coating was applied to F-75 chromium-cobalt-molybdenum alloy in an effort to reduce the release of corrosion products in vivo. After intramuscular implantation in the rat, a complex pattern of serum and urine concentration elevations of chromium, cobalt, and nickel was seen. The carbon-coated implants released more chromium and cobalt than uncoated controls, as seen by significantly elevated metal concentrations in serum and urine. Animals receiving carbon-coated implants showed a high rate of recurrent implant site inflammation. Neoplastic infiltration of 24 animals with coated implants, but not in any of the 16 animals which received either uncoated F-75 microsphere or poly(ethylene) particulate implants.

Modulation of heparan sulfate biosynthesis. Effects of 6-diazo-5-oxo-L-norleucine and low glutamine on the synthesis of heparan sulfate proteoglycan by human colon carcinoma cells

We have investigated the biosynthesis of heparan sulfate proteoglycan in human colon carcinoma cells cultured in either the absence of L-glutamine or the presence of 6-diazo-5-oxo-L-norleucine (DON), a glutamine analogue. Following a 24-h incubation with 100 micrograms/ml DON (0.58 mM) or without L-glutamine, the incorporation of [35S]sulfate was maximally inhibited to about 50%, whereas the incorporation of [3H]leucine or [3H]serine and their specific activity were not significantly affected. Several lines of evidence indicate that the inhibition of [35S]sulfate incorporation was mediated by a reduction in the intracellular pool of UDP-N-acetylhexosamine: the intracellular hexosamine levels were reduced by about 50%; taking into account the changes in specific activity, the incorporation of [3H]glucosamine was also significantly inhibited; and exogenous D-glucosamine (2.3 mM) was capable of substantially reversing the inhibitory effects of DON. This decrease in endogenous sugar supply resulted in the generation of an underglycosylated, lower buoyant density proteoglycan which contained significantly fewer heparan sulfate chains of otherwise normal size and sulfation and even fewer O-linked oligosaccharides. These biochemical changes were corroborated ultrastructurally by the appearance of smaller ruthenium red-stained proteoglycans on the surface of the cells. DON also caused a marked inhibition of cell proliferation and profound morphological changes, both of which were reversible upon culturing in DON-free medium. These results demonstrate that perturbations in glutamine metabolism have profound effects on the structure of heparan sulfate proteoglycan and on the phenotype of human colon carcinoma cells and indicate that DON treatment could be useful for studying post-translational modifications of proteoglycans in various cell systems.

The effects of 6-diazo-5-oxo-L-norleucine, a glutamine analogue, on the structure of the major cartilage proteoglycan synthesized by cultured chondrocytes

Incubation of embryonic chick chondrocytes with 6-diazo-5-oxo-L-norleucine (DON), a glutamine analogue, led to a dose-dependent inhibition of [35S]sulfate incorporation into proteoglycan. In the absence of exogenous L-glutamine, a maximal inhibition of 50-60% was achieved with DON concentrations greater than or equal to 1 microgram/ml (6 microM); the ED50 was approximately 0.2 microM. This inhibitory effect could be partially restored by the addition of 100-fold molar excess of either exogenous L-glutamine or M-glucosamine. The quantitative changes were due neither to inhibition of protein core synthesis nor to undersulfation of glycosaminoglycan chains. Rather, the proteoglycan synthesized in the presence of DON contained substantially fewer (approximately 50% of control) and smaller (10-15% of control, on the average) chondroitin sulfate chains as well as a paucity of keratan sulfate chains. The result of these structural changes was a proteoglycan with significantly lower molecular weight, buoyant density, and anionic charge. In spite of these modifications, the altered proteoglycan synthesized in the presence of DON was secreted normally and retained the ability to interact with exogenous hyaluronic acid and link proteins. The results of our experiments also indicate that DON substantially diminished the pool of hexosamine precursors required for glycosaminoglycan synthesis. We conclude that this decrease was responsible for the molecular alterations described above; and these, in turn, can account for the morphological changes previously seen in cartilage matrix synthesized in the presence of DON.

The specificity of electron impact mass spectroscopy for the identification of N-ethyl-1-phenylcyclohexylamine (PCE)

The electron impact mass spectrum of N-ethyl-1-phenylcyclohexylamine (PCE) was studied using both deuterium-labeled compounds and structurally related analogs. The deuterium-labeled compounds used were d2 . PCE with two deuterium atoms on the methylene carbon of the N-ethyl group, d3 . PCE with three deuterium atoms on the methyl carbon of the N-ethyl group, d4 . PCE with four deuterium atoms on the beta carbons of the cyclohexyl rings, and d5 . PCE with five deuterium atoms on the phenyl ring. Structurally related compounds used included the N,N-dimethyl, N-propyl, and cyclopentyl analogs. The identities of some major fragments and possible pathways leading to their formation are shown. Electron impact mass spectroscopy is shown to be a definitive test for the identification of PCE.

Surface distribution of flash-evoked and pattern reversal-evoked potentials in hooded rats

Simultaneous recording from 21 electrode sites in a 4 X 4 mm area over the posterior cortex was used to determine the surface distribution of all major peaks which constitute flash-evoked potentials (FEPs) and pattern reversal evoked-potentials (PREPs) in hooded rats. Topographical maps were constructed with respect to Bregma and midline reference points. The data indicate that not all of the peaks which constitute either evoked potential have their greatest amplitude within the classically defined primary visual cortex. Further, since the FEPs were produced by uniform stimulation, the data suggest that surface regions of the rat visual cortex differ in ways other than simply the portion of the visual field from which information is received.

Chondroitin sulfate proteoglycan is a constituent of the basement membrane in the rat embryo parietal yolk sac

In addition to containing Type IV collagen, laminin and entactin, basement membranes contain small amounts of proteoglycans substituted primarily with heparan sulfate chains. We have previously shown, however, that parietal yolk sacs in organ culture synthesize predominantly chondroitin sulfate proteoglycan. In the present study, we have used histochemical and immunohistochemical techniques coupled with chondroitinase ABC digestion to provide evidence for the presence of chondroitin sulfate proteoglycan in the basement membrane (Reichert's membrane) of the 14.5-day rat embryo parietal yolk sac. The results revealed numerous cuprolinic blue-positive filaments and granules, 20-30 nm in greater length or diameter, dispersed throughout the thickness of the basement membrane. Both structures were removed by preincubating freshly isolated parietal yolk sacs with chondroitinase ABC. A similar labeling pattern was also obtained with immunoelectron microscopy using gold-labeled monoclonal antibodies directed against the three major isomers of protein-bound chondroitin sulfate. In contrast, coarser cuprolinic blue granules, 40-100 nm in diameter, were neither sensitive to chondroitinase ABC digestion nor labeled by the monoclonal antibodies. These results thus indicate that Reichert's membrane contains chondroitin sulfate proteoglycan in addition to heparan sulfate proteoglycan.

Electron impact mass spectroscopy for identification of phencyclidine

The electron impact mass spectrum of phencyclidine (PCP) was studied using both deuterium-labeled analogs and high-resolution mass spectroscopy. The deuterium-labeled compounds used were d5.PCP having 5 deuterium atoms on the phenyl ring, d10.PCP having 10 deuterium atoms on the cyclohexyl ring, and d15.PCP having deuterium atoms on both the phenyl and cyclohexyl rings. The identities of some major fragments and some possible pathways for their formation are shown. Electron impact mass spectroscopy is shown to be a definitive test for the identification of PCP.