When Stigma, Disclosure, and Access to Care Collide: An Ethical Reflection of mpox Vaccination Outreach

Experiences of stigma in health care encounters among LGBTQ+ populations (lesbian, gay, bisexual, transgender, and queer and questioning) have long been a barrier to care. Marginalization and historically grounded fears of stigmatization have contributed to a reluctance to disclose sexual behavior and/or gender identity to health care providers. We reflect on how student nurses grappled with the ethics of patient disclosure while providing mobile outreach in Chicago for mpox (formerly monkeypox) from fall 2022 to spring 2023. Student nurses addressed how requiring disclosure of sexual behavior or sexual orientation may serve as a barrier to accessing preventive care, such as mpox vaccination. Accounts of stigma and criminalization experienced by LGBTQ+ people provide insight on challenges historically associated with disclosure in health care.

"It Was a Different Environment": Evaluating a Cultural Exchange Program

BACKGROUND

As nursing colleges seek to respond to the demands of the profession for nurses who are globally engaged and of the students for global health educational experiences, Riner's Globally Engaged Nursing Education framework is an effective tool for developing and evaluating an experience.

METHOD

Using Riner's framework, faculty and students at a nursing college evaluate an inaugural cultural exchange program between their U.S.-based college and a partner in India.

RESULTS

The framework helps the team identify the strengths of the program, as well as areas for improvement for future global endeavors. The framework as an evaluation tool is also critiqued in light of this process.

CONCLUSION

Overall, this inaugural program was a success and with this evaluation will inform future cultural exchanges between these institutions. [J Nurs Educ. 2019;58(12):704-711.].

Impact of joint impairment on disability-specific domains at four years

The objective of this study was to assess the longitudinal impact of joint impairment on overall disability and crossing domain-specific thresholds for physical activity, mobility, dexterity, instrumental activities of daily living (IADL), and activities of daily living (ADL) that are associated with use of long-term care. This 4-year longitudinal study observed 484 persons older than age 60. Logistic regression assessed the contribution of demographics, psychological mediators, lower- and upper-extremity joint impairment, and comorbidities to increased domain-specific self-reported disability above a threshold associated with use of long-term care. Lower-extremity joint impairment and age predicted crossing thresholds by year 4 in physical activity, mobility, IADL, and ADL disability that were associated with use of long-term care. Lower-extremity joint impairment is a strong risk factor for future disability that is associated with use of long-term care.

Snowblower injuries to the hand

We retrospectively reviewed the records of 62 patients who sustained serious hand injuries caused by snowblowers between 1981 and 1990. Frequency of injuries to digits tended to correlate with length (i.e., middle, index, ring, or small finger or thumb). Damage to tendons did not seem to follow any particular pattern. The majority of victims sustained multiple digital involvement. Complete versus partial amputation followed the same length distribution as did injured digits. Most of the injuries occurred to the dominant hand. When patients were further questioned regarding the circumstances and events leading to their injury, a recurring pattern was found. Most patients described a wet, heavy snow having recently fallen. The majority of the patients who were injured by placing their hands into the exit chute admitted that they were aware the machine was running, but thought that they had a greater clearance to the rotating impeller blade.

Activity of Procanbid, procainamide twice-daily formulation, to suppress ventricular premature depolarizations. The Study Group Investigators

Procainamide is a class IA antiarrhythmic drug indicated for the treatment of life-threatening or symptomatic ventricular arrhythmias. The current sustained-release formulation requires 6-hour dosing (qid). To improve patient compliance, a new sustained-release formulation for twice-daily (bid) administration has been developed (Procanbid, Parke-Davis). This study assesses the pharmacologic equivalence of the bid and qid formulations in the suppression of symptomatic ventricular premature depolarizations (VPDs). Fourteen centers enrolled a total of 99 patients with frequent symptomatic VPDs (average > or = 20 VPDs/hr) who previously responded to and tolerated the procainamide qid formulation. During the first week of the double-blind phase, patients were randomized to either placebo or procainamide dosages of 1000, 2000, or 4000 mg/d (bid or qid formulations). In the second week, the patients were crossed over to the alternate formulation. Seventy-seven patients qualified for the primary activity analysis. The bid and qid formulations showed comparable effectiveness in the suppression of mean VPDs with a linear dose-response relationship. The VPD suppression was not attenuated towards the end of the dosing interval for either formulation. Sixty-eight of these patients entered an optional 1-year extension to receive the bid formulation. Thirty-seven (54%) patients had adverse effects. Of those, 15 (22%) had side effects considered treatment related. Most of the adverse events occurred during the first 6 weeks of treatment. Only a few patients (8%) withdrew as a consequence of treatment with the bid formulation. The overall safety profile of the bid formulation was similar to other formulations, and the procainamide bid formulation has a low proarrhythmic rate (< 3%). In conclusion, the effectiveness of the twice-daily formulation of procainamide in the suppression of VPDs is comparable to the currently available qid formulation.

Transfer of the trapezius for flail shoulder after brachial plexus injury

Shoulder arthrodesis is often used to treat flail shoulder after a brachial plexus injury, but has a high complication rate and entails loss of passive mobility. We have reviewed 27 patients with brachial plexus injury treated by transfer of the trapezius to the proximal humerus at an average time from injury of 31.3 months. Pre-operatively, all 27 shoulders were subluxated, with an average abduction of 3.5 degrees. Postoperatively, shoulder abduction averaged 45.4 degrees, and subluxation was abolished. All patients were satisfied with their improvement in function. Trapezius transfer is recommended as a simple procedure that requires only a brief period in hospital, allows early rehabilitation, and gives a satisfactory outcome, while retaining passive mobility of the shoulder.

Purpura fulminans

Purpura fulminans is a rare disease that typically begins as a benign infectious process and subsequently progresses to severe sepsis, hypotension, purpura ecchymosis, and disseminated intravascular coagulation. We present an unusual case of an adult who was seen initially with pneumococcal sepsis that subsequently developed into purpura fulminans with major extremity involvement. A multidisciplinary approach is needed in the treatment of this often catastrophic disease.

Detection of Epstein-Barr virus in CNS lymphomas by in-situ hybridization

We used an optimized in-situ hybridization technique employing a biotinylated Epstein-Barr (EB) virus sequence, BamH1V (3.1 kb), to detect this sequence in 2 EB virus-infected cell lines (B95-8 and Namalwa) and 8 CNS lymphomas. We obtained a good hybridization signal from cytospins of B95-8 (EB virus productively infected) and Namalwa (EB virus latently infected, 1 copy per cell) cell lines. We were able to detect signal from both cell lines after overnight fixation in 10% formalin and paraffin embedding, but development time in the detection chromogen required longer incubation and the signal intensity was lower than in cytospin cells. We then used the technique to examine formalin-fixed, paraffin-embedded primary CNS lymphoma tissue from 4 patients who were immunocompromised (1 renal transplant, 3 acquired immune deficiency syndrome) and 4 patients who were not. All 4 CNS lymphomas from immunocompromised patients hybridized well with BamH1V, exhibiting a pattern of staining similar to Namalwa cells and nonlytically infected B95-8 cells. There was no relationship between the intensity and degree of reaction and the patients' survival. None of the 4 CNS lymphomas in immunocompetent patients or uninvolved brain showed any reactivity with BamH1V. We suggest that low-abundance targets are detectable in paraffin-embedded tissue by in-situ hybridization using biotinylated probes. Detection of EB viral sequences in CNS lymphomas in immunocompromised patients suggests a role for the virus in the pathogenesis of this tumor.

Skeletal traction for fractures of the femoral shaft in children. A long-term study

Fifty-four children who had been treated with 90-90 skeletal traction for a fracture of the femoral shaft were examined after an average follow-up of 4.3 years. All of the patients were functioning normally and had a symmetrical range of motion of both hips and knees. A limb-length discrepancy of more than thirteen millimeters was found in three of thirty-nine children who were less than eleven years old and in eight of fifteen who were more than eleven years old. Traction pins that were placed obliquely were associated with a statistically significant (p less than 0.01) and predictable difference in the intercondylar angle (axis of the knee joint) as compared with pins that were placed horizontally. The study showed that pins for skeletal traction should be placed parallel to the axis of the knee joint and that fractures in children who are more than eleven years old should be reduced without overriding.

CI-926 (3-[4-[4-(3-methylphenyl)-1-piperazinyl]butyl]-2,4-imidazolinedione): antihypertensive profile and pharmacology

CI-926 (10(-7)-10(-6) M) selectively antagonized the contraction of isolated rabbit aortae to phenylephrine and displaced the alpha-1 adrenoceptor ligand WB4101 (IC50: 82 nM) in rat brain. In the spontaneously hypertensive rat, single oral doses of either CI-926 (0.3-10 mg/kg) or prazosin (0.3-100 mg/kg) caused dose-related reductions in blood pressure; however, CI-926 was more efficacious. The maximal antihypertensive response to CI-926 was unchanged with three consecutive days of oral dosing in the spontaneously hypertensive rat, whereas a first dose effect was noted with prazosin. In two-kidney, one-clip, renal hypertensive rats, CI-926 and prazosin (1-10 mg/kg) lowered blood pressure; however, prazosin was more efficacious. In perinephritic hypertensive dogs, CI-926 (10 mg/kg) lowered blood pressure 20%. In anesthetized dogs, CI-926 in the presence of supermaximal blood pressure-lowering doses of prazosin caused an additional reduction in pressure. With equivalent alpha-1 blockade in anesthetized rats, CI-926 tended to have greater hypotensive activity than prazosin. These results demonstrate that CI-926 is a potent, orally active antihypertensive agent in renin-dependent and -independent hypertension. The profile of CI-926 suggests that it lowers blood pressure in part by interacting with peripheral alpha-1 adrenoceptors and in part via an additional mechanism(s). Although weak relative to its affinity for alpha-1 adrenoceptors, CI-926 was found in preliminary experiments to interact with alpha-2 adrenoceptors, serotonergic receptors and dopaminergic receptors. The importance of these interactions to the blood pressure response of CI-926 remains to be elucidated.

Neurobehavioral changes among shipyard painters exposed to solvents

Painters in three shipyards, exposed to a wide variety of solvents, were examined. A short battery of performance tests, a detailed occupational history, and a special questionnaire to assess acute (prenarcotic, transitory) and chronic (persistent) neurologic symptoms was administered. The results of the neurobehavioral performance tests demonstrated decrements in central nervous system function in painters when compared with a control group matched for age, sex, race, and education. The prevalence of reported acute neurological symptoms among painters was increased significantly compared to other occupational groups in the same yards; for chronic, persistent symptoms the difference was not statistically significant. Performance test scores were significantly, negatively correlated with chronic symptoms but not with acute symptoms. No significant correlations between performance test scores and duration of solvent exposure or between symptoms and duration of solvent exposure were observed. The reversibility of such symptoms and of decrements in central nervous system function after cessation of exposure is still uncertain.

Antihypertensive profile of the angiotensin-converting enzyme inhibitors CI-906 and CI-907

CI-906 and CI-907, new orally active nonsulfhydryl angiotensin-converting enzyme inhibitors, were examined for antihypertensive effects in unanesthetized hypertensive rats and dogs. In two-kidney, one-clip Goldblatt hypertensive rats, single oral daily doses (0.03-30 mg/kg) produced dose-dependent decreases in blood pressure; a single 3 mg/kg oral dose lowered blood pressure to normotensive levels. In spontaneously hypertensive rats, 30 mg/(kg X day) orally administered for 5 consecutive days achieved the same blood pressure decrease as that obtained on the first day in the renal hypertensive rats. In diuretic-pretreated renal hypertensive dogs, a 10 mg/kg oral dose decreased blood pressure by 25%. No adverse side effects were observed with CI-906 and CI-907 in any of the conscious animals. These studies indicate that CI-906 and CI-907 are potent, orally active antihypertensive agents without any apparent limiting side effects.

Antihypertensive effects of CI-907 (indolapril): a novel nonsulfhydryl angiotensin converting enzyme inhibitor

CI-907 is a new orally active nonsulfhydryl angiotensin converting enzyme (ACE) inhibitor. Monoester (prodrug) and diacid forms produced concentration related ACE inhibition in guinea-pig serum (IC50 for monoester, 1.7 X 10(-7) M and for diacid, 2.6 X 10(-9) M). In isolated rabbit aortic rings and in rat and dog autonomic studies, CI-907 is highly specific in suppressing the contractile or pressor responses to angiotensin I. In two-kidney, one-clip Goldblatt hypertensive rats, single daily doses (0.03-30 mg/kg p.o.) produced dose-dependent decreases in blood pressure; 3 mg/kg lowered blood pressure to normotensive levels. In the spontaneously hypertensive rat, subacute administration of CI-907 (30 mg/kg/day for 5 days) produced the same decrease in blood pressure as that obtained in the renal hypertensive rat. In diuretic-pretreated renal hypertensive dogs, 10 mg/kg normalized blood pressure. For equivalent drops in blood pressure, heart rate increases were less in CI-907 than in enalapril-treated renal hypertensive dogs. No side effects were observed with CI-907 in any of the conscious animals. The antihypertensive response to CI-907 (0.03-1.0 mg/kg p.o.) was found to correlate with inhibition of vascular tissue ACE, but not plasma or brain ACE in two-kidney, one-clip renal hypertensive rats. These studies indicate that CI-907 is a potent antihypertensive agent with a heart rate profile different from enalapril.

Survey of new antihypertensive drugs: 1982

Over 500 compounds reported to have antihypertensive activity have been cataloged from the world literature (1979-1982). The agents were classified according to mechanism: 1) drugs interacting at alpha-adrenoceptor sites; 2) beta-adrenoceptor antagonists; 3) drugs interacting with the autonomic nervous system by mechanisms other than 1 and 2; 4) inhibitors of the renin-angiotensin system; 5) diuretics; 6) vasodilator antihypertensives; and 7) drugs with miscellaneous mechanisms and/or sites of action. Within each class the drugs were subclassified and compounds that best fit the prototypes identified. The scheme is subjective, largely because of conflicting information cited in the literature. It is clear that many new drugs are at various stages of development. Whether or not these drugs will survive the scrutiny of rigorous and lengthy preclinical and clinical development, and in fact prove to be better antihypertensive agents than the currently marketed agents, remains to be established.

Induction of alkaline phosphatase activity in cultured human intracranial tumor cells

Alkaline phosphatase activity in several cultured primary human intracranial tumor cells varied over a relatively wide range, and there was no correlation between specific activity and the type of tumor from which the cultures were derived. The enzyme was thermolabile, and its activity was strongly inhibited by l-bromotetramisole, levamisole, and L-homoarginine but not by L-phenylalanine and L-phenylalanyglycylglycine. These are the characteristics of the liver-bone-kidney form of alkaline phosphatase. Prednisolone induced increased levels of enzyme activity in most cultures, and sodium butyrate acted as an inducer in cultures of pituitary adenoma and hemangioblastoma cells. The increase was most pronounced when response cells were exposed to both stimuli simultaneously. The induced alkaline phosphatase had the same properties as the enzyme of cells grown in the absence of inducers. Increased alkaline phosphatase activity was not induced by osmolality changes of the culture medium; this feature appears to be characteristic of cells producing the liver-bone-kidney enzyme form.

Fetal isoenzyme expression of heterotransplanted HeLa cells in nude mice

The nude mouse has been successfully employed for the propagation of human tumors, without the need for immunosuppression. In light of the limited data on embryonic gene expression in such tumors, we undertook a study of fetal isoenzyme expression during tumor growth. HeLa TCRC-1 which has been shown to produce the placental Regan isoenzyme was used in these studies. The isoenzyme produced by these cells in culture is initially replaced by an isoenzyme referred to as chorionic. In the later stages of tumor growth, the so-called oncoamniotic (FL) isoenzyme then becomes the dominant enzyme form. The chorionic isoenzyme is produced by the early chorionic membranes of the developing conceptus, while the oncoamniotic (FL) isoenzyme is most similar to that found in the fetal human intestine. The alteration in the expression of fetal isoenzymes in tumors growing in the nude mouse is similar to that seen in the immunosuppressed rat and hamster host animals, indicating that the phenomenon is not related to immunosuppression per se.

Expression of KB cell alkaline phosphatase isoenzymes during growth in immunosuppressed LEW rats

Alkaline phosphatase isoenzyme expression of human tumor xenografts was studied by the growing of KB cells in immunosuppressed neonatal LEW rats. In culture these cells produced the oncoamniotic (FL) isoenzyme as the major form and the Regan isoenzyme as a minor fraction as well as a "hybrid" that shared properties of both of the other isoenzymes. Despite a reduction in specific activity, this isoenzyme pattern was essentially unchanged during in vivo growth. KB cells "pretreated" in culture with the glucocorticoid prednisolone in hyperosmolal medium exhibited a decrease in the levels of the oncoamniotic (FL) isoenzyme and an increase in the Regan isoenzyme. During growth of pretreated cells in vivo, a time-dependent resumption in the expression of the oncoamniotic (FL) isoenzyme was associated with the disappearance of the Regan isoenzyme. This shows that the expression of the oncoamniotic (FL) isoenzyme is not restricted to human tumor cells monophenotypic with respect to alkaline phosphatase.

Multiple effects of glucocorticoids and hyperosmolality on isoenzyme expression in cultured KB cells

The KB cell line, though indicted as a HeLa-contamined line, is a useful in vitro model for the study of the regulation of isoenzyme expression. KB cells produced three isoenzymic forms of alkaline phosphatase. When KB cells were grown in the presence of prednisolone and/or in hyperosmolar medium, the total enzyme activity was reduced. This change in activity was coupled with specific alterations in the proportion of each isoenzyme. The slow-moving form (identified biochemically and immunologically as the heat-stable, placental, Regan isoenzyme) was substantially increased by the steroid hormone and/or hyperosmolality. The fast-moving form [identified as the intestine-like, amnion (FL) isoenzyme] was strikingly diminished by either treatment. The intermediate form (tentatively referred to as "hybrid," inasmuch as it shared properties of the other two isoenzymes) was decreased only when KB cells were grown in hyperosmolar medium containing prednisolone. These results corroborated the notion that these stimuli cause the induction of increased levels of the heat-stable Regan alkaline phosphatase only. They also point out the necessity of performing isoenzyme analysis when one is investigating the regulation of this enzyme.

Evidence for altered gene regulation in HeLa cells returned to culture after growing in immunosuppressed rats

HeLa TCRC-1, is a monophenotypic cell line for the production of the carcinoplacental Regan isoenzyme of alkaline phosphatase. It has been previously reported that, when this cell line is grown in immunosuppressed rats, there is an alteration of phenotypic expression in that an isoenzyme that is referred to as oncoamnion (FL) becomes the dominant enzyme form. This report describes the isoenzyme regulation after these cells are returned to culture for at least three months. These cells in culture demonstrate a density-dependent alteration in isoenzyme profiles. The Regan isoenzyme is the dominant isoenzyme form in new, sparsely populated cultures, while the oncoamnion isoenzyme predominates in the later high-density stages of growth. Prednisolone induction of enzyme activity is found to be most effective in the early stages of growth, and the previously reported specificity of hormone action on isoenzymes produced by cancer cells is maintained. Enzyme induction is restricted to the Regan isoenzyme, while hormone-mediated diminution in enzyme activity is confined to the oncoamnion (FL) isoenzyme.

Regulatory controls of oncotrophoblast proteins and developmental alkaline phosphatases in cancer cells

The two oncotrophoblast proteins, Regan isoenzyme (placental-type alkaline phosphatase) and human chorionic gonadotrophin, are readily studied oncodevelopmantal gene products in human cancer patients and in three experimental model systems. The latter consists of (a) HeLa sublines TCRC-1 and TCRC-2, which produce Regan and non-Regan isoenzymes, (b) HEp-2 and FL amnion cell lines as models for the reciprocal expression of developmental genes, and (c) modulation in vivo of developmental gene expression in HeLa cells. In the case of the third model, for example, HeLa TCRC-1 cells grow in immunosuppressed rats to form a tumor nodule, which expresses a new oncoamnion (FL) isoenzyme, while the Regan isoenzyme disappears. Return of the tumor cells to cell culture medium results in a disappearance of the oncoamnion (FL) species and the reappearance of Regan isoenzyme. This interesting model is expected to bridge the interpretation of experiments done in cell culture with observations made on tumors of cancer patients. Most helpful in interpretation of all these studies has been a chronology of early development. It appears that the counterparts of a number of tumor proteins appear as early as gametogenesis and as late as 10 weeks of gestation.

Carcinoplacental alkaline phosphatase. Base level and hormone-induced activity associated with events in the cell cycle

Using HeLa TCRC-1, a cell line which is monophenotypic with respect to the Regan isoenzyme of alkaline phosphatase, we have examined the factors which influence its expression in relation to events of the cell cycle. DNA synthesis is not required for hormone induction of the Regan isoenzyme as in the presence of hydroxyurea, a specific inhibitor of DNA synthesis, we found induction to occur. Additionally, when partially synchronised cells were allowed to leave the S period prior to hormone treatment, and hydroxyurea was added to prevent cells from entering the next S period, hormone induction of the Regan isoenzyme was still observed. This indicates that initiation of expression of hormone-induced carcinoplacental alkaline phosphatase occur prior to the DNA synthetic phase of the cell cycle. We propose a hypothetical two-step mechanism of hormone induction to interpret the present findings in relation to previous results.

Plasma membrane localization of alkaline phosphatase in HeLa cells

The localization of alkaline phosphatase in HeLa cells was examined by electron microscopic histochemistry and subcellular fractionation techniques. Two monophenotypic sublines of HeLa cells which respectively produced Regan and non-Regan isoenzymes of alkaline phosphatase were used for this study. The electron microscopic histochemical results showed that in both sublines the major location of alkaline phosphatase is in the plasma membrane. The enzyme reaction was occasionally observed in some of the dense body lysosomes. This result was supported by data obtained from a subcellular fractionation study which showed that the microsomal fraction rich in plasma membrane fragments had the highest activity of alkaline phosphatase. The distribution of this enzyme among the subcellular fractions closely paralleled that of the 5'-nucleotidase, a plasma membrane marker enzyme. Characterization of the alkaline phosphatase present in each subcellular fraction showed identical enzyme properties, which suggests that a single isoenzyme exists among fractions obtained from each cell line. The results, therefore, confirm the reports suggesting that plasma membrane is the major site of alkaline phosphatase localization in HeLa cells. The absence of any enzyme reaction in the perimitochondrial space in these cultured tumor cells also indicates that the mitochondrial localization of the Regan isoenzyme reported in ovarian cancer may not be a common phenomenon in Regan-producing cancer cells.

Coproduction of Regan isoenzyme and carcinoembryonic antigen in HCT-8 cells

The presence of the Regan isoenzyme of alkaline phosphatase was demonstrated in the carcinoembryonic antigen-producing human cell line HCT-8 Biochemical, histochemical, immunologic, and electrophoretic methods were used as criteria for the identification and characterization of this isoenzyme.

The release of high-molecular-weight alkaline phosphatase and leucine aminopeptidase into the media of cultured human cells

Using exclusion from Sepharose 4B as our criterion, we have found a high-molecular-weight form of alkaline phosphatase and of leucine aminopeptidase which are released into the culture media by the FL amnion cell line. A low-molecular-weight form of leucine aminopeptidase is also found to contribute to the total levels of this enzyme in the media. The levels of these enzymes increased during the growth cycle of the culture, paralleling the increase in cell density, suggesting that the two events may be related. This phenomen in culture suggests a possible explanation for the appearance of similar enzyme forms in patient serum and fluids originating from diseased tissue.

The psychological differentiation of male myopes and nonmyopes

A comparison of 140 male myopes and 118 male nonmyopes of the entering class of Virginia Military Institute cadets in 1968 demonstrated that there are a number of Strong Vocational Interest Inventory test items which will clearly differentiate myopes from nonmyopes so that it is possible to identify 76% of the individuals falling into either class on the basis of a stepwise discriminant analysis based almost entirely on the Strong Vocational Interest Blank. The items which discriminate in favor of the myopes are essentially those which require academic achievement and individual creative performance, whereas the items which are in favor of the nonmyopes are those which require business and selling skills as well as outdoor types of activities. Further, the myopes are significantly more likely to achieve officer status and win more academic awards than the nonmyopes.