The Impact of Organizational Factors and Professional Identity on Turn Over Intent in State Vocational Rehabilitation Agencies

Turnover of staff is an ongoing concern in the state-federal vocational rehabilitation (VR) system. To better understand employee turnover intent, a multiple regression analysis was conducted using professional identity and organizational factors (e.g., pay, work tenure) as predictor variables. An internet-based survey solicited counselor perceptions regarding professional identity, turnover intent, and job satisfaction. Respondents ( n = 351) described their level of satisfaction relevant to several workplace conditions (co-workers, job in general, work assignments, pay, promotion, and supervision), and their current level of professional identity. The outcome variable representing current or future turnover intent was whether participants were actively looking for a new position or planning to look for a new position in the next 5 years. Results indicated that a little over one third of current counselors would look for a new position in the coming year, with half of current counselors seeking a new position within 5 years. Findings suggest that turnover in state-federal VR settings exceeds the national average of 19%. Purposeful pre-hire considerations, goodness of fit, motivation factors (i.e., opportunities for promotion), and hygiene factors (i.e., caseload size, supervision, and pay) identified in this study should be elements of a state-federal VR agency’s plan to mitigate turnover intent.

O-215 Embryo developmental competence of de novo male gametes in a novel three-dimensional culture

Study question

Are de novo gametes generated from mouse embryonic stem cells (mESCs) in a novel three-dimensional (3D) culture system capable of supporting full preimplantation development?

Summary answer

A novel 3D culture system yielded de novo male gametes capable of fertilizing an oocyte and supporting full preimplantation development.

What is known already

In regenerative medicine, several 3D culture systems have been shown to be capable of producing functional tissue implants. In reproductive biology, recent studies have reported preliminary success in generating functional de novo gametes through soft-agar culture and testicular organoids, in the mouse model. However, a heterologous transplantation technique is required to obtain functional gametes.

Study design, size, duration

mESCs were first cultured on a gelatin-coated 6-well plate with fibroblasts in monolayer and later spherified using sodium alginate. Spheres were submerged in specifically designed conditioned media to encourage differentiation of the mESCs into germ-like cells. Over the course of differentiation, cells were assessed for germ cell differentiation biomarkers. Considering that normal spermatogenesis occurs in 30 days, utilization of the de novo gametes was planned for days 15, 22, 29, and 36.

Participants/materials, setting, methods

mESCs were differentiated by submerging the spheres in EpiLC medium containing Activin A, bFGF, and KSR for 3 days followed by PGCLC medium containing BMP4, LIF, SCF, and EGF for up to 36 days. Differentiation was assessed for markers DAZL (spermatogonium), VASA (spermatocyte), BOULE (post-meiotic stage), and acrosin (spermatid). Differentiated cells were then injected into oocytes and activated by calcium ionophore. Embryo development was monitored in a time-lapse incubator.

Main results and the role of chance

Expression of DAZL in 20% and VASA in 15% of the cells at day 3 demonstrated progression into spermatogenesis. On day 10, DAZL and VASA were assessed again, revealing increases to 45% and 18%. A small proportion of cells expressed post-meiotic biomarkers, BOULE (1%) and acrosin (2%). On day 15, VASA expression plateaued at 17%, BOULE expression peaked at 10%, and acrosin reached 5%. On day 22, expression of VASA increased slightly to 19%, BOULE decreased to 8%, and acrosin peaked at 7%. On day 29, VASA expression peaked at 20%, acrosin expression remained stable at 7%, and BOULE expression dropped to 2%. On day 36, VASA was still expressed at 13%, and few cells expressed acrosin (1%); there was complete loss of BOULE expression. 

Our mouse ICSI control achieved 89.2% fertilization and 77.8% blastocyst rates. De novo gametes were injected into oocytes on days 15, 22, 29, and 36, achieving fertilization rates of 35.0%, 61.1%, 81.8%, and 75.0%, respectively. Correspondently, hatching blastocysts were obtained at rates of 5.0%, 16.7%, 36.4%, and 8.3%, respectively.

Limitations, reasons for caution

Despite the ability to fertilize normally, the blastulation rate remained suboptimal. Most importantly, the ability to generate live offspring still needs to be documented.

Wider implications of the findings

Our novel 3D differentiation model can generate functional gametes and is aimed at obviating the need for allo-/xeno-geneic transplantation. If reproducibility and the ability to obtain healthy offspring are confirmed, this method may represent a tool for achieving neogametogensis in mammals.

Trial registration number

N/A

Esophageal distensibility measurement: impact on clinical management and procedure length

Luminal distensibility measurement has demonstrated relevance to various disease processes, though its effects on clinical decision-making have been less well understood. This study aims to characterize the clinical impact of impedance planimetry measurement as well as the learning curve associated with its use in the esophagus. A single provider performed distensibility measurement in conjunction with upper endoscopy for a variety of clinical indications with the functional lumen imaging probe (FLIP) over a period of 21 months. Procedural data were prospectively collected and, along with medical records, retrospectively reviewed. Seventy-three procedures (70 patients) underwent esophageal distensibility measurement over the timeline of this study. The most common procedural indications were known or suspected achalasia (32.9%), dysphagia with connective tissue disease (13.7%), eosinophilic esophagitis (12.3%), and dysphagia with prior fundoplication (9.6%). FLIP results independently led to a change in management in 29 (39.7%) cases and supported a change in management in an additional 15 (20.5%) cases. The most common change in management was a new or amended therapeutic procedure (79.5%). Procedural time added by distensibility measurement was greater among earlier cases than among later cases. The median time added overall was 5 minutes and 46 seconds. Procedural time added varied significantly by procedural indication, but changes in management did not. Distensibility measurement added meaningful diagnostic information that impacted therapeutic decision-making in the majority of cases in which it was performed. Procedural time added by this modality is typically modest and decreases with experience.

Sensing textile seam-line for wearable multimodal physiological monitoring

This paper investigates a novel multimodal sensing method by forming seam-lines of conductive textile fibers into commercially available fabrics. The proposed ultra-low cost micro-electro-mechanical sensor would provide, wearable, flexible, textile based biopotential signal recording, wetness detection and tactile sensing simultaneously. Three types of fibers are evaluated for their array-based sensing capability, including a 3D printed conductive fiber, a multiwall carbon nanotube based fiber, and a commercially available stainless steel conductive thread. The sensors were shown to have a correlation between capacitance and pressure; impedance and wetness; and recorded potential and ECG waveforms.

Immunoglobulin repertoire of B lymphocytes infiltrating breast medullary carcinoma

Tumor specific peptides recognized by T lymphocytes infiltrating solid tumors, as well as the corresponding T cell receptor (TcR) repertoire usage, have been extensively investigated. By contrast, tumor infiltrating B cells and their immunoglobulin (Ig) repertoire have been studied only in a limited number of tumors. The objective of the present study was to determine, whether DNA sequence analysis of the expressed immunoglobulin variable regions of B cells that infiltrate breast cancer, could be used to reveal a potential specific tumor binding capacity of the antibodies. To answer this question, about 200 expressed Ig heavy (VH) and light chain variable gene (VL) regions were cloned, sequenced and comparatively analysed from a typical medullary beast carcinoma (MBC), where the massive B and plasma cell infiltration correlates with favourable prognosis despite of its high grade. The tumor infiltrating B cell Ig heavy and light chain sequences could be classified into clusters, families and subgroups, based on the identity level to germline, showing a pattern of oligoclonality. Some overrepresented clusters could be determined. In the course of a detailed analysis and search in Blastn database, a number of VH and VL sequences showed more than 99% homology to DNA sequences of Ig VH region, with proved tumor antigen binding capacity. Our data suggest, that potential tumor binder Ig VH and VL sequences might be selected using a detailed immunoglobulin variable region analysis. This new approach might have a benefit for further antibody engineering, as difficulties in search for tumor binders by phage library selection might be reduced and the time for selection shortened.

Health care providers' information seeking: recent research

Recent research studies describe typical information-seeking behavior of doctors, nurses, and other health care providers. This review identifies and analyzes thirty-nine studies and nine reviews published since 1990. The researchers are from many disciplines and often work in multi-disciplinary teams. They have used both quantitative and qualitative methods to gather self-report and observational data. In spite of the increased availability of online bibliographic and full-text sources in this decade, health care providers are using the same sources they used twenty years ago. Self-report studies usually show a higher use of published literature than of advice from colleagues; observational studies usually show the opposite.

An assistive device for the treatment of positional plagiocephaly

An assistive device (AD) was used to treat 122 infants with moderate-to-severe positional plagiocephaly. Clinical evaluations indicate that the AD provided the most benefit when applied to 2- to 8-month-old children. Our results suggest that the AD may join molding helmets and physical therapy as a treatment for moderate-to-severe positional plagiocephaly in infants under the age of 1 year.

Identification of the immunoreactive peptide sequence for AgSK1, an adenocarcinoma-restricted antigen

SK1, a human immunoglobulin M (IgM) monoclonal antibody was derived from regional nodal lymphocytes of a Dukes B colon carcinoma patient. The antigen recognized by the human monoclonal antibody (HuMab) SK1, termed AgSK1, was shown to be a two-chain glycoprotein with an apparent molecular weight range of 42-46 kDa and preferentially expressed by human adenocarcinomas, particularly human gastrointestinal malignancies. To identify the gene encoding the AgSK1 antigenic epitope, a cDNA expression library constructed in lambda gt22A using mRNA from the colon carcinoma cell line HT29 was screened and one of the isolated clones encoding a 1.5-kb cDNA, which showed strong immunoreactivity with HuMab SK1, was selected for further analysis. This clone consisted of an amino terminal open reading frame of 54 amino acids and the carboxyl terminal 20 amino acids of this protein coding region contained the antigenic epitope recognized by HuMab SK1.

Lithium dosage and leukocyte counts in psychiatric patients

OBJECTIVE

To evaluate differences in leukocyte counts among patients treated with either lithium alone, antipsychotic medications alone, or a combination of both.

DESIGN

Retrospective study.

SETTING

Long-stay psychiatric hospital.

PATIENTS

Patients admitted between 1990 and 1993, and treated with lithium for at least 1 week and/or with antipsychotic medication for at least 2 weeks. Excluded from the study were those patients for whom complete blood counts at baseline and during therapy were not available, and those patients whose blood picture could primarily be accounted for by extraneous factors. Included in the study were 38 patients treated with lithium alone, 207 patients receiving antipsychotic medications alone, and 71 patients receiving both.

OUTCOME MEASURES

Leukocyte, lymphocyte and granulocyte counts.

RESULTS

Patients treated with lithium alone had significantly higher mean leukocyte and granulocyte counts than those treated with antipsychotic medication alone (analysis of variance, p < 0.05). None of the patients receiving lithium alone showed leukopenia. The dosage of lithium was significantly correlated with leukocyte count (r = 0.25, 95% confidence interval [CI] 0.14 to 0.35, p < 0.001,) and granulocyte count (r = 0.27, 95% CI 0.16 to 0.38, p < 0.001), but not with lymphocyte count (r = 0.06, p = 0.286, 95% CI -0.05 to 0.17).

CONCLUSIONS

Lithium therapy is associated with higher leukocyte and granulocyte levels in psychiatric patients. This leukocytotic effect of lithium may be dose dependent.

Characterization of human IgG1 monoclonal antibody against gangliosides expressed on tumor cells

A human IgG1.k monoclonal antibody (MAb) designated GMA1 was developed by fusing pooled lymph node lymphocytes from cancer patients with the human lymphoblastoid cell line, SHFP-1. The GMA1 MAb reacted with several melanoma and neuroblastoma cell lines. Normal tissue derived from human brain and tumor-cell lines derived from colon, ovary, and breast were not reactive. FACS analysis performed using live cells demonstrated that the antibody recognizes a cell-surface antigen. Enzyme immunoassay (EIA) and thin layer chromatography (TLC) immunostaining with purified gangliosides indicated that the antibody has specificity for the major tumor associated gangliosides GD3, GM3, and GD2. GMA1 heavy and light chain genes were isolated by RT-PCR and a recombinant derivative of this human antibody was expressed in Chinese hamster ovary (CHO) cells. High-level antibody synthesis and secretion was achieved using a vector designed to maximize expression. FACS analysis and TLC immunostaining indicated recombinant GMA1 reacted with human tumor cell lines and gangliosides GD3, GM3, GD2 in a manner similar to the antibody produced by the hybridoma cell line, demonstrating that the specificity of the antibody was not altered during molecular cloning.

Cloning and expression of the human tumor-specific antibody GM4

The human monoclonal antibody GM4 was generated by fusing pooled lymphocytes from cancer patients with the lymphoblastoid cell line SHFP-1. Immunohistochemical staining of tumor and normal tissue indicated that this human IgG4 antibody preferentially reacted with melanomas and neuroblastomas. In this study, we demonstrate that GM4 recognizes a "vimentin-like" peptide sequence that we have termed AgGM4. To generate a recombinant derivative of this human antibody, we isolated and expressed the complete heavy and light chain genes. The entire coding sequence for both the heavy and light chains was isolated by RT-PCR using a set of degenerate 5' signal sequence specific primers and a 3' constant region primer. High level antibody synthesis and secretion was achieved in Chinese hamster ovary (CHO) cells using a vector designed to maximize expression. Western blot and FACS analysis indicated recombinant GM4 reacted with human tumor cell lines and AgGM4 in a manner similar to the antibody produced by the hybridoma cell line, demonstrating that the specificity of the antibody was not altered during molecular cloning.

Findings in 50 AIDS virus-infected patients with positive oral Candida cultures

Oral candidiasis is a common complication of HIV-infected-individuals. The purpose of this study was to evaluate clinical and laboratory findings to assess the impact and efficacy of antifungal treatment. This preliminary report describes findings in 50 HIV-positive, candida culture-positive subjects (49 males, 1 female; mean age: 39 years). The group had been known HIV-positive for a mean of 28 months, and 19 met the CDC/WHO definition for AIDS (63%, KS, 21% PCP). Thirty-four of the fifty patients had oral signs of candidiasis, with almost half having both atrophic (red) and pseudomembranous (white) components. In quantitating the cultures, the higher colony forming unit counts in general were correlated with clinical signs and pain. The other most common oral manifestations were periodontal disease, hairy leukoplakia and xerostomia. The most common candida species was albicans (84%). Response to initial antifungal therapy was satisfactory clinically, but erratic regarding CFU quantitation, species changes, and bacterial emergence. In summary, oral candidiasis is a complex infection with uncertainties as to the significance of quantitation and achieving control.