Dental Hygiene Educators' Perspectives Towards Manikin Testing for Clinical Licensure Examination

Purpose The use of manikin testing was recently introduced for dental hygiene licensure examinations. There is currently a lack of research about the efficacy and accuracy of manikin testing for clinical licensure. The purpose of this study is to identify perceptions of dental hygiene educators regarding the use of manikins for the dental hygiene clinical licensure exam.Methods This qualitative study used an exploratory, online, focus group design with 20 dental hygiene educator participants recruited through purposive sampling. Pseudonyms were used to protect participants confidentiality. Two groups of educators were from institutions that did not use manikin testing during COVID-19, and two groups of educators were from institutions that did use manikin testing during the same time period. Themes were analyzed using the classic analysis strategy. Validity was established using investigator triangulation, member checks, and saturation.Results Lack of knowledge including preconceived assumptions regarding manikin examinations; testing considerations with benefits and concerns regarding manikins versus live patients; and perceptions regarding the value of single point in time clinical licensure examinations were the three major themes identified by the participants.Conclusion The manikin exam appeared to address ethical concerns, however, there were limitations in relation to assessing critical thinking and decision-making skills. Some participants expressed that graduation from an accredited dental hygiene program was considered sufficient for licensure. Future studies should include comparisons of recent graduates who complete a clinical licensure examination versus those who do not complete a clinical licensure examination.

Optimization of routine transformation of Escherichia coli with plasmid DNA

Methods to optimize resources and transformation efficiency of routine daily transformations of DH1 Escherichia coli prepared by three calcium chloride methods were investigated and compared with polyethylene glycol and Hanahan methods. The benefit of a heat-shock step, a preplating incubation step to allow expression of antibiotic resistance, use of log phase bacteria and prolonged storage of bacteria were investigated using pBR322 and pUC18 plasmid DNAs. Bacteria prepared by CaCl2 methods consistently gave efficiencies of 4 x 10(6) transformants/microgram of plasmid DNA or better and were overall the most labor- and resource-efficient methods. Use of log phase bacteria, a heat shock and an incubation step were found to be beneficial for freshly prepared bacteria for all methods. Prolonged storage of up to 30 days of bacteria prepared by the CaCl2 methods was beneficial, resulting in a sustained increase in transformation efficiency when selection was by ampicillin but not when by tetracycline resistance. Also found when using bacteria stored three days or longer was an increased transformation efficiency of stationary vs. log phase bacteria and an unchanged or even increased efficiency when the preplating incubation step was omitted. The Hanahan methods were the most labor and resource intensive and routinely gave efficiencies of 2 x 10(7). Higher efficiencies of 10(8) were obtained only with repeated trial and error and were not consistently reproducible. The polyethylene glycol method consistently gave efficiencies of 2 x 10(7), and bacteria could easily be prepared daily or frozen with a minimal decrease in efficiency.

Correlates between autoantibodies to nucleolar antigens and clinical features in patients with systemic sclerosis (scleroderma)

Immunofluorescence on rat liver sections was used to select high-titer antinucleolar antibodies (ANoA) in the sera of patients with systemic sclerosis (scleroderma). In 646 patients, 53 ANoA sera (8%) were identified, and of these, 46 were available in sufficient quantities for further analysis. The complex of RNA polymerase I was immunoprecipitated by 7 sera (15%), which uniformly produced punctate nucleolar staining. The PM-Scl antigen, a particle consisting of 11 polypeptides, was immunoprecipitated by 8 sera (17%), all of which displayed homogeneous nucleolar staining. A 34-kd nucleolar protein (fibrillarin) of the U3 RNP complex was positive in immunoblotting of 22 sera (48%), which characteristically produced clumpy nucleolar staining. Antibodies against RNA polymerase I were associated with diffuse scleroderma of short duration, which was characterized by a high prevalence of internal organ involvement, including renal crisis. Anti-U3 RNP antibodies had a high prevalence in men with significantly less joint involvement, compared with ANoA-negative patients. Anti-PM-Scl antibodies identified a group of scleroderma patients with a high prevalence of concomitant myositis and renal involvement.

Characterization of human poly(ADP-ribose) polymerase with autoantibodies

The addition of poly(ADP-ribose) chains to nuclear proteins has been reported to affect DNA repair and DNA synthesis in mammalian cells. The enzyme that mediates this reaction, poly(ADP-ribose) polymerase, requires DNA for catalytic activity and is activated by DNA with strand breaks. Because the catalytic activity of poly(ADP-ribose) polymerase does not necessarily reflect enzyme quantity, little is known about the total cellular poly(ADP-ribose) polymerase content and the rate of its synthesis and degradation. In the present experiments, specific human autoantibodies to poly(ADP-ribose) polymerase and a sensitive immunoblotting technique were used to determine the cellular content of poly(ADP-ribose) polymerase in human lymphocytes. Resting peripheral blood lymphocytes contained 0.5 X 10(6) enzyme copies per cell. After stimulation of the cells by phytohemagglutinin, the poly(ADP-ribose) polymerase content increased before DNA synthesis. During balanced growth, the T lymphoblastoid cell line CEM contained approximately 2 X 10(6) poly(ADP-ribose) polymerase molecules per cell. This value did not vary by more than 2-fold during the cell growth cycle. Similarly, mRNA encoding poly(ADP-ribose) polymerase was detectable throughout S phase. Poly(ADP-ribose) polymerase turned over at a rate equivalent to the average of total cellular proteins. Neither the cellular content nor the turnover rate of poly(ADP-ribose) polymerase changed after the introduction of DNA strand breaks by gamma irradiation. These results show that in lymphoblasts poly(ADP-ribose) polymerase is an abundant nuclear protein that turns over relatively slowly and suggest that most of the enzyme may exist in a catalytically inactive state.

Human autoantibodies to poly(adenosine diphosphate-ribose) polymerase

The chromatin-bound enzyme poly(ADP-ribose) polymerase (ADPRP) is strongly stimulated by DNA with single- or double-stranded breaks, and transfers the ADP-ribose moiety of NAD to nuclear proteins. The activation of ADPRP is important for DNA repair and replication, and also has been postulated to play a role in the pathogenesis of lymphocyte dysfunction associated with chronic inflammatory diseases, and inborn errors of nucleoside metabolism. We have detected high titers of IgG autoantibodies to the ADPRP protein in six patients with rheumatic complaints. No other autoantibodies were detected in any of the six sera. The specificity of the anti-enzyme antibodies was established by (a) immunoprecipitation of ADPRP activity, (b) immunoprecipitation and immunoblotting of both the native 116-kD enzyme and its proteolytic digestion products. ADPRP was purified from human thymus and calf thymus. The autoantibodies reacted equivalently with both enzymes. The anti-ADPRP antibodies had a distinctive immunofluorescent pattern with HEp-2 cells, reacting intensely with nucleoli and metaphase chromosomes, and diffusely with the nucleus. Autoantibodies to ADPRP have not been described previously. The presence of a specific immune response against an enzyme that has been associated with various immunodeficiency syndromes raises intriguing possibilities concerning the relationship between DNA damage, immunodeficiency, and autoimmunity.

Monoclonal autoantibody from a (New Zealand black x New Zealand white)F1 mouse and some human scleroderma sera target an Mr 34,000 nucleolar protein of the U3 RNP particle

A monoclonal IgG2a antinucleolar autoantibody (72B9) was obtained by fusion of spleen cells from a (New Zealand black x New Zealand white)F1 mouse with myeloma cells (P3x63Ag8.653). Antibody 72B9 recognized a highly conserved nucleolar antigen present in both animal and plant cells. The staining pattern produced by antibody 72B9 in different cell substrates was identical with those obtained by scleroderma antibodies reactive with a basic (pI 8.5) nucleolar protein of Mr 34,000, which is associated with the U3 RNP particle. Western blotting further confirmed its reactivity with this scleroderma-related U3 RNP protein.

Antibody-dependent cellular cytotoxicity of human vascular endothelium in systemic lupus erythematosus

Sera from 35 patients with systemic lupus erythematosus were examined for a cytotoxic effect on human umbilical vein endothelium. Although none of these sera produced direct cytotoxicity of 51Cr-labelled endothelial cells, even with added complement, 3 sera regularly produced increased 51Cr release when co-cultured with endothelial cells and normal human peripheral blood mononuclear cells. The effector cells involved in this cytotoxicity possessed Fc-receptors but were non-T and non-adherent while fractionation studies indicated that the responsible serum factor(s) was IgG, probably in the form of immune complexes of small size. Control studies, using sera from both 27 normal controls and 19 patients with either diabetes or extensive atherosclerotic vascular disease failed to reveal any similar cytotoxicity. Two of the 3 patients, whose sera produced this antibody-dependent cellular cytotoxicity, had had clinical episodes of major vascular thrombosis, raising the possibility that the cytotoxicity might provide an additional pathogenic mechanism in certain patients with systemic lupus erythematosus.

Serum immune complexes in systemic sclerosis: relationship with precipitating nuclear antibodies

In a comparative study of antinuclear antibodies (ANA) and immune complexes in the serum of 43 patients with systemic sclerosis (SS) ANA were detected by indirect immunofluorescence on Hep 2 cells and/or double immunodiffusion in 90% of patients, while immune complex assays were positive in 32% of patients. The immune complex assays were positive only in sera containing antibodies to Scl 70, n-RNP, Ro, and La. The presence of immune complexes in SS sera is therefore related to ANA specificity. This might explain the variable findings of several previous studies of immune complexes in SS.

Antibody-dependent cellular cytotoxicity of human vascular endothelium in systemic sclerosis

Sera from 39 patients with systemic sclerosis were examined for a cytotoxic effect on human umbilical vein endothelium. Although none of the sera produced direct cytotoxicity of 51Cr-labelled endothelial cells, even with added complement, nine sera did produce increased 51Cr release when co-cultured with endothelial cells and normal human peripheral blood mononuclear cells. The effector cells involved in this cytotoxicity possessed Fc receptors but were non-T and non-adherent while the responsible serum factor(s) was present in IgG containing fractions. This cytotoxicity tended to occur in patients with both circulating immune complexes and precipitating antibodies to nuclear and cytoplasmic antigens who, as a group, had more severe and extensive visceral disease than those without such serological abnormalities. Control studies using sera from both 27 normal controls and 19 patients with either diabetes or extensive athero-sclerotic vascular disease failed to reveal any similar cytotoxicity.

The production of antibody-dependent cellular cytotoxicity by immune complexes in systemic lupus erythematosus

Sera from 8 patients with systemic lupus erythematosus (SLE) which induced cytotoxicity of human target cells when co-cultured with normal human peripheral blood mononuclear cells were fractionated by Sepharose 6B chromatography and sucrose density-gradient ultracentrifugation in order to characterise the responsible serum factors. With Sepharose 6B chromatography, cytotoxicity was found in IgG containing fractions between 100,000-450,000 mol.wt. and occurred maximally in fractions containing dimer IgG. With sucrose density-gradient ultracentrifugation, cytotoxicity was found maximally in 7S fractions but also frequently extended into 10S and even 12S fractions. These findings suggest that immune complexes of small size in the sera of some patients with SLE may be an important factor in the production of antibody-dependent cellular cytotoxicity of human target cells.

Serum-induced enhancement of peripheral blood mononuclear cell-mediated cytotoxicity towards human target cells in systemic sclerosis

Sera from 7 of 37 patients with systemic sclerosis (SS) were found to markedly enhance cytotoxicity in several established human target cell lines when co-cultured with normal human peripheral blood mononuclear cells (PBM). Fractionation studies indicated that the cytotoxicity-inducing activity resided in the IgG-containing fractions of serum and that the effector cells were Fc-receptor positive. By contrast, sera from 27 normal controls produced little or no cytotoxicity when co-cultured with the same target cell lines and normal PBM. Any slight enhancement of cytotoxicity that occurred with a single target cell line was, on fractionation, either labile or associated with albumin containing fractions. These findings raise the possibility that antibody-dependent cellular cytotoxicity (ADCC) could provide a pathogenetic mechanism in some patients with SS.

Serum-induced enhancement of peripheral blood mononuclear cell mediated cytotoxicity towards human target cells in systemic lupus erythematosus

Sera from 6 out of 18 patients with systemic lupus erythematosus (SLE) were found to be capable of producing marked increases of cytotoxicity in several established human target cell lines when co-cultured with normal human peripheral blood mononuclear cells (PBM). Fractionation studies indicated that the cytotoxicity-inducing activity resided in IgG containing fractions and that the effector cells were Fc-receptor positive. By contrast, sera from 27 normal controls produced little or no cytotoxicity when similarly co-cultured with the same target cell lines and normal PBM. Any slight reactivity that occasionally occurred against a single cell line was, on serum fractionation, either labile or associated with albumen containing fractions. These findings raise the possibility that antibody-dependent cellular cytotoxicity could provide an additional pathogenetic mechanism in patients with SLE.