L-selectin is dispensable for T regulatory cell function postallogeneic bone marrow transplantation

In murine models, the adoptive transfer of CD4(+) /CD25(+) regulatory T cells (T(regs) ) inhibited graft-versus-host disease (GvHD). Previous work has indicated a critical role for the adhesion molecule L-selectin (CD62L) in the function of T(regs) in preventing GvHD. Here we examined the capacity of naive wild-type (WT), CD62L(-/-) and ex vivo expanded CD62L(Lo) T(regs) to inhibit acute GvHD. Surprisingly, we found that CD62L(-/-) T(regs) were potent suppressors of GvHD, whereas CD62L(Lo) T(regs) were unable to inhibit disease despite being functionally competent to suppress allo T cell responses in vitro. Concomitant with improved outcomes, WT and CD62L(-/-) T(regs) significantly reduced liver pathology and systemic pro-inflammatory cytokine production, although CD62L(-/-) T(regs) were less effective in reducing lung pathology. While accumulation of CD62L(-/-) T(regs) in GvHD target organs was equivalent to WT T(regs) , CD62L(-/-) T(regs) did not migrate as well as WT T(regs) to peripheral lymph nodes (PLNs) over the first 2 weeks posttransplantation. This work demonstrated that CD62L was dispensable for T(reg) -mediated protection from GvHD.

Post-Welfare employment and psychological well-being

Current public assistance policies are removing many recipients from the welfare rolls, regardless of their income level. This article examines the post-assistance well-being of a stratified probability sample of 426 "able-bodied" women and men who lost cash benefits when Michigan terminated its General Assistance program in 1991. The relationship of demographic, human capital, and psychological resource variables to employment status, depressive symptomatology and life satisfaction is examined utilizing two panels of survey data, collected approximately one and two years after the program ended. Findings demonstrate that personal mastery is related to employment status and risk of depression, and sense of burden is linked to both psychological outcomes, controlling for relevant demographic and human capital variables. Gender is related to risk of depression; however, its relation to employment is dependent on the presence of children in the household. Steady employment is positively associated with psychological well-being. Overall, the findings suggest that the majority of former recipients faced employment difficulties and psychological hardship, and that services should be targeted to subgroups of former recipients with particular risk factors.

Patient satisfaction, use of services, and one-year outcomes in publicly funded substance abuse treatment

OBJECTIVE

This longitudinal study examined the relationships among patient satisfaction with substance abuse services, service use, and clinical and employment outcomes.

METHODS

Interviews were conducted with 502 adults who were beginning outpatient or residential treatment for substance abuse in a managed care plan in Oregon or in fee-for-service plans in Washington State. The participants were reinterviewed after six months and after one year. Measures of satisfaction and use of services were assessed at six months and clinical outcomes at one year with the Addiction Severity Index. Multivariate regression analyses were used to estimate the relationship between satisfaction and service use and the relationships among satisfaction, use, and one-year outcomes when baseline characteristics were held constant.

RESULTS

The final sample included 310 individuals (62 percent) who completed interviews at the three time points. Compared with those who were excluded because of missing data, the patients in the final sample were more likely to be white, to be better educated, to be in outpatient treatment, and to live in Oregon and less likely to be homeless. No significant differences were observed in baseline symptoms between the two groups. Satisfaction with access and effectiveness of services predicted service use at six months. Service use, satisfaction with access, and satisfaction with effectiveness were significantly associated with abstinence from substance use at one year. Neither patient satisfaction nor use of services was related to other outcomes, including employment and the presence of psychiatric symptoms.

CONCLUSIONS

Although causation cannot be determined, the results of this study suggest that patient satisfaction is related to both use of services and abstinence from substance use. Longitudinal research using more detailed measures of satisfaction is needed to sort out the complex relationship between satisfaction and service use and the direct and indirect influences of these variables on outcomes.

Socioeconomic status and dissatisfaction among HMO enrollees

OBJECTIVES

Member satisfaction is commonly used as an indicator of the quality of care delivered by health plans. Yet few contemporary studies have explored the extent to which individual patient characteristics influence dissatisfaction in HMOs. We sought to determine whether socioeconomic status is associated with enrollee dissatisfaction.

METHODS

Data are from a cross-sectional, telephone survey of a probability sample of adults enrolled in New Jersey HMOs in 1998 (n = 7,983). Health plan ratings were elicited as part of the Consumer Assessment of Health Plans Study (CAHPS) survey, along with income, education, and race/ethnicity. Other factors known to influence satisfaction (age, gender, health status, extent of plan choice, and payment for plan) were also ascertained.

RESULTS

Socioeconomically advantaged enrollees were more likely to give low ratings to their health plans. In a multivariate logistic regression model, those with incomes exceeding $100,000 had 1.65 times the odds of being dissatisfied compared with those with family incomes less than $25,000 (P <0.001); those with a college education had 2.53 times the odds of being dissatisfied than those who had not completed high school (P <0.001). However, among enrollees in their plans for > or =5 years, those in the lowest income group were significantly more dissatisfied than higher-income enrollees.

CONCLUSIONS

Among New Jersey HMO enrollees, higher socioeconomic status (SES) is associated with greater dissatisfaction. Although based on cross-sectional data and thus preliminary, the evidence presented here also suggests that the SES-dissatisfaction relationship varies as a function of duration of enrollment. Further research using longitudinal data could shed additional light on the SES-dissatisfaction link.

Serum response factor-dependent regulation of the smooth muscle calponin gene

Smooth muscle calponin is a multifunctional, thin filament-associated protein whose expression is restricted to smooth muscle cell lineages in developing and postnatal tissues. Although the physiology of smooth muscle calponin has been studied extensively, the cis-elements governing its restricted pattern of expression have yet to be identified. Here we report on smooth muscle-specific enhancer activity within the first intron of smooth muscle calponin. Sequence analysis revealed a proximal consensus intronic CArG box and two distal intronic CArG-like elements, each of which bound recombinant serum response factor (SRF) as well as immunoreactive SRF from smooth muscle nuclear extracts. Site-directed mutagenesis studies suggested that the consensus CArG box mediates much of the intronic enhancer activity; mutating all three CArG elements abolished the ability of SRF to confer enhancer activity on the smooth muscle calponin promoter. Cotransfecting a dominant-negative SRF construct attenuated smooth muscle-specific enhancer activity, and transducing smooth muscle cells with adenovirus harboring the dominant-negative SRF construct selectively reduced steady-state expression of endogenous smooth muscle calponin. These results demonstrate an important role for intronic CArG boxes and the SRF protein in the transcriptional control of smooth muscle calponin in vitro.

The topomer-sampling model of protein folding

Clearly, a protein cannot sample all of its conformations (e.g., approximately 3(100) approximately 10(48) for a 100 residue protein) on an in vivo folding timescale (<1 s). To investigate how the conformational dynamics of a protein can accommodate subsecond folding time scales, we introduce the concept of the native topomer, which is the set of all structures similar to the native structure (obtainable from the native structure through local backbone coordinate transformations that do not disrupt the covalent bonding of the peptide backbone). We have developed a computational procedure for estimating the number of distinct topomers required to span all conformations (compact and semicompact) for a polypeptide of a given length. For 100 residues, we find approximately 3 x 10(7) distinct topomers. Based on the distance calculated between different topomers, we estimate that a 100-residue polypeptide diffusively samples one topomer every approximately 3 ns. Hence, a 100-residue protein can find its native topomer by random sampling in just approximately 100 ms. These results suggest that subsecond folding of modest-sized, single-domain proteins can be accomplished by a two-stage process of (i) topomer diffusion: random, diffusive sampling of the 3 x 10(7) distinct topomers to find the native topomer ( approximately 0.1 s), followed by (ii) intratopomer ordering: nonrandom, local conformational rearrangements within the native topomer to settle into the precise native state.

Recognition of factitial hand injuries

Facitial injuries with various presentations occur with some frequency to the hand because it is a body part that is easily accessible. Methods used to produce wounds included insertion of porcupine quills, application of constrictive rubber bands, mascara injections and excoriation of healing wounds. It is important to recognize the factitial origin in order to avoid needless repetitive surgery and permanent hand disability. No specific pattern of psychopathology was found in our cases. The patients' attitude toward their lesions was one of bland unconcern and stoicism. The patients were resistant to psychiatric referral and persisted in seeking medical responsibility for cure. Successful management requires early suspicion and prompt recognition as well as establishment of non-accusatory relationship with the primary physician. Confrontation should be avoided if possible. Even if reinforced with collaborative evidence, such confrontation will have limited effect on the patient's subsequent behavior.