Examining Motivation of First-Year Undergraduate Anatomy Students Through the Lens of Universal Design for Learning (UDL): A Single Institution Study

Motivation is critical for meaningful learning among healthcare students studying anatomy. Learners are highly variable, and it is important to ensure learners are equally supported in the diverse aspects of an anatomy curriculum. The implementation of the educational framework, Universal Design for Learning (UDL), in anatomy curricula could potentially enhance student motivation. The multiple means of engagement principle of UDL refers to the enhancement of motivation among students. This study aimed to identify healthcare students' motivation levels at the start and end of their anatomy module and whether there was any change in motivation. The Motivated Strategies for Learning Questionnaire (MSLQ) was distributed to gather the self-reported motivation levels of first-year undergraduate medical, dental and occupational therapy (OT) and speech and language therapy (SLT) students studying anatomy at the start of their respective anatomy modules and again at the end of the module. The overall response rate was 74% and 69%, at the start and end of the study, respectively. Responses were analysed by the respective programme of study. Motivation to study anatomy among medical, dental, OT and SLT students ranged from medium to high on the MSLQ at the start of their respective anatomy modules. By the end of the anatomy modules, dental students reported high levels of motivation to study anatomy, whereas motivation among medical, OT and SLT students ranged from medium to high. A change in students' self-reported motivation levels while studying anatomy was identified. The study emphasises the benefits of UDL and its flexible nature to enhance motivation.

Delusions of parasitosis and delusions of parasitosis by proxy in a mother and her children

Delusions of parasitosis by proxy is an uncommon entity wherein an individual projects a delusional belief onto another person who lacks capacity to hold the same belief. We report a case of delusions of parasitosis by proxy in a mother who believed that she was infested with scabies and projected her fixed, delusional belief of scabies infestation onto her children. She subjected her children to numerous home remedies and medical treatments as well as removing them from school in an effort to cure them of the supposed infestation. Child maltreatment can be a concern in such cases with a low threshold for involving child protective services if harm to the children is suspected.

A feasibility study on a novel well-being intervention for university students

OBJECTIVES

Challenging transitions, increased stress and mental ill health can affect students' academic performance and their capacity to remain in higher education. Prevention and early treatment of mental health problems in college students is therefore a key public health priority, nationally and internationally. Developing a range of evidence-based interventions targeting the mental health of students is critical. We examined the feasibility and acceptability of a new universal time use and well-being intervention, the 'Everyday Matters: Healthy Habits for University Life' digital badge (EMDB), a co-curricular micro-credential for first-year college students.

METHODS

This study used a single-arm, pre-post design for first-year undergraduate students. The EMDB comprised eight 1-hour lunchtime sessions on brain development and time-use habits across the 24 hours of the day including sleep, self-care, leisure, study and work. Validated measures of occupational competence and value, mental well-being, sleep health, mindset, self-compassion and gratitude were completed, along with an evaluation questionnaire.

RESULTS

Eight first-year undergraduate students completed the demographic questionnaire and pre- and post- measures, with one additional student completing only the evaluation questionnaire. There was significantly improved levels of well-being, self-compassion and growth mindset following the intervention. Many of the challenges reported by participants related to occupational issues such as managing finances and having a satisfying routine. Participants appreciated the practical relevance and scientific underpinnings of the programme content. The sense of belonging within the group and having insightful conversations with other group members were particularly valued by participants.

CONCLUSIONS

This study offers preliminary evidence that an occupational therapy based universal time-use and well-being intervention was feasible to deliver and acceptable to first-year undergraduate students. The results of this study and the participant acceptability support further development and evaluation of the EMDB intervention.

1595 Instituting Rapid and Semi-rapid COVID-19 Testing Pathways to Facilitate Emergency Surgery

Aim

Defining a patient’s COVID-19 status on admission is essential for optimised patient management, safe bed-placement, and flow across the hospital. Perioperative COVID-19 infection is associated with significantly poorer outcomes and may influence a patient's and/or surgeon's decision to proceed. Rapid PCR tests (1-2 hours) for COVID-19 remain the gold-standard, however most NHS Trust’s either do not have, or have severely limited access to such testing modalities. Our aim was to introduce a surgical triaging algorithm to conserve rapid testing for immediate surgery, whilst developing a semi-rapid pathway with results available in 12-15 hours for surgery within 24-48 hours.

Method

Using quality improvement methodology, based on a ‘PDSA’ model we introduced a surgical triaging algorithm. Testing options were categorised into rapid, semi-rapid or routine (24 hours). Defined outcomes, as well as primary and secondary drivers were identified. Both the pre-analytical and post-analytical testing pathways were characterised, concentrating on electronic requesting, laboratory transportation and reporting. Five ‘PDSA’ cycles were performed with immediate audit and feed-back to surgeons after each round. A vetting procedure was also introduced to improve compliance with requesting.

Results

Turn-around-times for COVID-19 PCR swabs at our institution improved from 23 hrs:13 minutes at baseline, to 9 hrs:38 minutes for semi-rapids, to < 2 hours for rapid swabs.

Conclusions

Adoption of a surgical triaging algorithm ensured prioritisation of rapid and semi-rapid COVID testing based on clinical need. This ensured optimised patient care, safe theatre and anaesthetic Infection Prevention and Control practices, as well as correct post-operative placement.

Vertigoheel induced psychosis: A patient case report

Objective

To describe a case of a patient who developed psychosis after ingestion of Vertigoheel for treatment of dizziness.

Case Summary

A 28-year-old male with no psychiatric history presented with 5 days of worsening depression and psychosis. He denied current use of prescription medications, alcohol, or illicit substances. Approximately 2 weeks prior, while visiting family in Germany, he developed dizziness. A provider in Germany prescribed Vertigoheel, 1 tablet to be taken every hour until symptom improvement. This did not improve his dizziness but did cause him to feel as if he were "in a dream." He stopped taking the medication after 2 days but continued to feel amotivated with decreased appetite and insomnia. Several days later, he developed ego-dystonic auditory hallucinations. He returned to the United States; was admitted to an inpatient psychiatric unit for 4 days; and given olanzapine 5 mg at bedtime, lorazepam 1 mg every evening, and melatonin 6 mg every evening. He experienced gradual improvement in symptoms and was discharged with olanzapine 5 mg daily and outpatient follow-up.

Discussion

Vertigoheel is a homeopathic preparation containing ambra grisea, Cocculus indicus, Conium maculatum, and petroleum. Psychosis was not reported in any of the randomized controlled trials evaluating the use of Vertigoheel for treatment of vertigo. A literature search revealed no published reports of psychosis as a result of administration of any components of Vertigoheel.

Conclusion

A possible causal relationship was observed between the homeopathic supplement Vertigoheel and an acute episode of psychosis in a young male patient with no comorbidities.

Loneliness and biological responses to acute stress in people with Type 2 diabetes

Loneliness is linked with all-cause mortality and coronary heart disease. Altered neuroendocrine and inflammatory responses to stress constitute potential pathways linking loneliness and ill-health. Stress responsivity is modified in people with Type 2 diabetes, but it is unclear whether loneliness influences biological stress responses in this population. We assessed interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1RA), monocyte chemoattractant protein-1 (MCP-1), and cortisol responses to acute stress in 135 people with Type 2 diabetes. Loneliness was measured used the Revised UCLA Loneliness Scale. Loneliness was inversely associated with cortisol output poststress (B = -4.429, p = 0.019) independent of age, sex, education, marital status, body mass index, and smoking. Lonelier individuals had raised MCP-1 concentrations 75 min poststress independent of covariates (B = 0.713, p = 0.022). No associations between loneliness and IL-6 or IL-1RA concentrations were detected. These results suggest that loneliness is associated with disturbances in stress responsivity in people with diabetes, and the impact of loneliness on health in people with diabetes may be mediated in part through dysregulation of inflammatory and neuroendocrine systems. Future research is required to understand if such changes increase the risk of poorer outcomes in this population.

Molecular phylogenetics of New World searobins (Triglidae; Prionotinae)

Phylogenetic relationships among members of the New World searobin genera Bellator and Prionotus (Family Triglidae, Subfamily Prionotinae) and among other searobins in the families Triglidae and Peristediidae were investigated using both mitochondrial and nuclear DNA sequences. Phylogenetic hypotheses derived from maximum likelihood and Bayesian methodologies supported a monophyletic Prionotinae that included four well resolved clades of uncertain relationship; three contained species in the genus Prionotus and one contained species in the genus Bellator. Bellator was always recovered within the genus Prionotus, a result supported by post hoc model testing. Two nominal species of Prionotus (P. alatus and P. paralatus) were not recovered as exclusive lineages, suggesting the two may comprise a single species. Phylogenetic hypotheses also supported a monophyletic Triglidae but only if armored searobins (Family Peristediidae) were included. A robust morphological assessment is needed to further characterize relationships and suggest classification of clades within Prionotinae; for the time being we recommend that Bellator be considered a synonym of Prionotus. Relationships between armored searobins (Family Peristediidae) and searobins (Family Triglidae) and relationships within Triglidae also warrant further study.

Effects of a strategy to improve offender assessment practices: Staff perceptions of implementation outcomes

BACKGROUND

This implementation study examined the impact of an organizational process improvement intervention (OPII) on a continuum of evidence based practices related to assessment and community reentry of drug-involved offenders: Measurement/Instrumentation, Case Plan Integration, Conveyance/Utility, and Service Activation/Delivery.

METHODS

To assess implementation outcomes (staff perceptions of evidence-based assessment practices), a survey was administered to correctional and treatment staff (n=1509) at 21 sites randomly assigned to an Early- or Delayed-Start condition. Hierarchical linear models with repeated measures were used to examine changes in evidence-based assessment practices over time, and organizational characteristics were examined as covariates to control for differences across the 21 research sites.

RESULTS

Results demonstrated significant intervention and sustainability effects for three of the four assessment domains examined, although stronger effects were obtained for intra- than inter-agency outcomes. No significant effects were found for Conveyance/Utility.

CONCLUSIONS

Implementation interventions such as the OPII represent an important tool to enhance the use of evidence-based assessment practices in large and diverse correctional systems. Intra-agency assessment activities that were more directly under the control of correctional agencies were implemented most effectively. Activities in domains that required cross-systems collaboration were not as successfully implemented, although longer follow-up periods might afford detection of stronger effects.

Using a Novel Emotional Skills Module to Enhance Empathic Responding for a Child With Conduct Disorder With Limited Prosocial Emotions

Children with conduct problems benefit less from empirically supported interventions for disruptive behaviors when callous-unemotional (CU) traits (i.e., lack of empathy/guilt) are also present. Traditional “gold-standard” interventions for disruptive behavior disorders that focus primarily on improving parenting skills fail to address the core deficits in emotional processing and empathic responding unique to children with co-occurring conduct problems and CU traits (CP + CU). This case study presents a follow-up of the treatment of a young boy with severe disruptive behavior and pronounced CU traits using a novel, brief adjunctive treatment called Coaching and Rewarding Emotional Skills (CARES). Findings (a) indicate short-term improvements in empathic responding and emotion recognition with CARES and (b) provide preliminary support for supplementing parent training with a brief adjunctive intervention to improve socio-emotional behavior and CU traits. Novel targeted interventions for children with CP + CU are critically needed given their poor prognosis and long-term impairment.

Genetic and environmental overlap between borderline personality disorder traits and psychopathy: evidence for promotive effects of factor 2 and protective effects of factor 1

BACKGROUND

Previous studies have reported strong genetic and environmental overlap between antisocial-externalizing (factor 2; F2) features of psychopathy and borderline personality disorder (BPD) tendencies. However, this line of research has yet to examine etiological associations of affective-interpersonal (factor 1, F1) features of psychopathy with BPD tendencies.

METHOD

The current study investigated differential phenotypic and genetic overlap of psychopathy factors 1 and 2 with BPD tendencies in a sample of over 250 male and female community-recruited adult twin pairs.

RESULTS

Consistent with previous research, biometric analyses revealed strong genetic and non-shared environmental correlations of F2 with BPD tendencies, suggesting that common genetic and non-shared environmental factors contribute to both phenotypes. In contrast, negative genetic and non-shared environmental correlations were observed between F1 and BPD tendencies, indicating that the genetic factors underlying F1 serve as protective factors against BPD. No gender differences emerged in the analyses.

CONCLUSIONS

These findings provide further insight into associations of psychopathic features - F1 as well as F2 - and BPD tendencies. Implications for treatment and intervention are discussed, along with how psychopathic traits may differentially influence the manifestation of BPD tendencies.

Behavioral health treatment history among persons in the justice system: Findings from the Arrestee Drug Abuse Monitoring II Program

OBJECTIVE

Despite the high prevalence of substance use disorders, mental disorders, and co-occurring disorders among persons in the justice system, there is a fairly low rate of treatment utilization among this population. This study explored rates of lifetime behavioral health treatment utilization and factors associated with involvement in treatment.

METHODS

The study examined data from the Arrestee Drug Abuse Monitoring II program from 2007 to 2010, including over 18,000 arrestees in 10 U.S. metropolitan jails. Logistic regression and χ² analyses were used to explore the relationship between self-reported lifetime treatment history and sociodemographic characteristics, self-reported substance use, and severity of substance use.

RESULTS

Over half of arrestees reported no history of behavioral health treatment (62%), and Caucasians were significantly more likely to have received treatment than African Americans and Hispanics. Rates of treatment for substance use disorders or for both substance use and mental disorders were lowest among arrestees reporting marijuana and alcohol use and highest for heroin users. Methamphetamine users were the most likely to have received prior mental health treatment. Severity of alcohol and drug use was the highest among arrestees who had received both substance abuse and mental health treatment.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Considering the high rates of mental and substance use disorders in this population, the overall lack of behavioral health service utilization among offenders is concerning and points to the need to engage offenders in mental health and substance abuse treatment and to expand these services in jails, prisons, diversionary programs, and community corrections settings. (PsycINFO Database Record

Psychopathy factor interactions and co-occurring psychopathology: Does measurement approach matter?

The 2 dimensions of psychopathy as operationalized by various measurement tools show differential associations with psychopathology; however, evidence suggests that the statistical interaction of Factor 1 (F1) and Factor 2 (F2) may be important in understanding associations with psychopathology. Findings regarding the interactive effects of F1 and F2 are mixed, as both potentiating and protective effects have emerged. Moreover, approaches to measuring F1 (e.g., clinical interview vs. self-report) are based on different conceptualizations of F1, which may influence the interactive effects. The current study aims to (a) elucidate the influence of F1 and F2 on psychopathology by using both variable-centered and person-centered approaches and (b) determine whether the measurement of F1 influences the interactive effects of F1 and F2 by comparing the strength of interactive effects across F1 measures in a sample of over 1,500 offenders. Across analytic methods, there were very few cases in which F1 statistically influenced the association between F2 and psychopathology, such that F1 failed to evidence either potentiating or protective effects on F2. Furthermore, the conceptualization of F1 across psychopathy measures did not impact the interactive effects of F1 and F2. These findings suggest that F2 is probably driving the relations between psychopathy and other forms of psychopathology and that F1 may play less of a role in interacting with F2 than previously believed.

Understanding the relative contributions of direct environmental effects and passive genotype-environment correlations in the association between familial risk factors and child disruptive behavior disorders

BACKGROUND

Previous work reports an association between familial risk factors stemming from parental characteristics and offspring disruptive behavior disorders (DBDs). This association may reflect (a) the direct effects of familial environment and (b) a passive gene-environment correlation (r(GE)), wherein the parents provide both the genes and the environment. The current study examined the contributions of direct environmental influences and passive r(GE) by comparing the effects of familial risk factors on child DBDs in genetically related (biological) and non-related (adoptive) families.

METHOD

Participants were 402 adoptive and 204 biological families. Familial environment was defined as maternal and paternal maladaptive parenting and antisociality, marital conflict and divorce; offspring DBDs included attention deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD). Mixed-level regressions estimated the main effects of familial environment, adoption status and the familial environment by adoption status interaction term, which tested for the presence of passive r(GE).

RESULTS

There was a main effect of maternal and paternal maladaptive parenting and marital discord on child DBDs, indicating a direct environmental effect. There was no direct environmental effect of maternal or paternal antisociality, but maternal and paternal antisociality had stronger associations with child DBDs in biological families than adoptive families, indicating the presence of a passive r(GE).

CONCLUSIONS

Many familial risk factors affected children equally across genetically related and non-related families, providing evidence for direct environmental effects. The relationship of parental antisociality and offspring DBDs was best explained by a passive r(GE), where a general vulnerability toward externalizing psychopathology is passed down by the parents to the children.

Exploring positive pathways to care for members of the UK Armed Forces receiving treatment for PTSD: a qualitative study

OBJECTIVE

To examine the factors which facilitate UK military personnel with post-traumatic stress disorder (PTSD) to engage in help-seeking behaviours.

METHODS

The study recruited active service personnel who were attending mental health services, employed a qualitative design, used semi-structured interview schedules to collect data, and explored these data using interpretative phenomenological analysis (IPA).

RESULTS

Five themes emerged about how participants were able to access help; having to reach a crisis point before accepting the need for help, overcoming feelings of shame, the importance of having an internal locus of control, finding a psychological explanation for their symptoms and having strong social support.

CONCLUSIONS

This study reported that for military personnel who accessed mental health services, there were a number of factors that supported them to do so. In particular, factors that combated internal stigma, such as being supported to develop an internal locus of control, appeared to be critical in supporting military personnel to engage in help-seeking behaviour.

TRiM: an organizational response to traumatic events in Cumbria Constabulary

BACKGROUND

A major incident involving multiple fatalities occurred in Cumbria, England on 2 June 2010. The Cumbrian Constabulary deployed an organizational peer support response for personnel involved known as trauma risk management (TRiM).

AIMS

To examine data routinely gathered during the TRiM process to evaluate the relationship of the intervention to sickness absence.

METHODS

Using incident databases, details were gathered regarding exposure to the murders and type of TRiM intervention, including an assessment of the psychological risk to the individual of developing a trauma-related mental health problem. Sociodemographic information was collated by the occupational health department. Cumulative sickness absence data in the 2 months following the murders were used as a proxy for mental health status.

RESULTS

A total of 717 police officers and civilian support staff were identified. High levels of traumatic exposure were associated with subsequent receipt of a TRiM intervention. The majority of psychological risk indices reduced between the initial and subsequent evaluation. Greater traumatic exposure was associated with longer sickness absence lengths. Engagement in the TRiM process was associated with a reduction in sickness absence especially in more junior ranks.

CONCLUSIONS

In this study, we found that TRiM deployed within a police force responding to a major event offered a way of structuring a response for those involved. Our data suggest that TRiM may offer a way of assessing psychological risk so that officers can be offered early supportive interventions. Our data suggest that TRiM may help to ameliorate some of the negative effects of high trauma exposure.

Time doesn't change everything: the longitudinal course of distress tolerance and its relationship with externalizing and internalizing symptoms during early adolescence

Although distress tolerance is an emerging construct of empirical interest, we know little about its temporal change, developmental trajectory, and prospective relationships with maladaptive behaviors. The current study examined the developmental trajectory (mean- and individual-level change, and rank-order stability) of distress tolerance in an adolescent sample of boys and girls (N = 277) followed over a four-year period. Next we examined if distress tolerance influenced change in Externalizing (EXT) and Internalizing (INT) symptoms, and if EXT and INT symptoms in turn influenced change in distress tolerance. Finally, we examined if any of these trends differed by gender. Results indicated that distress tolerance is temporally stable, with little mean- or individual-level change. Latent growth models reported that level of distress tolerance is cross-sectionally associated with both EXT and INT symptoms, yet longitudinally, only associated with EXT symptoms. These results suggest that distress tolerance should be a focus of research on etiology and intervention.

Iraq and Afghanistan veteran presentations to combat stress, since 2003

BACKGROUND

Recently, proposals have been made to improve mental health care for U.K. military veterans. Combat stress (CS), a veteran's charity, has provided mental health services for veterans since 1919. Since 2003, service users have included veterans from the Iraq and Afghanistan conflicts; however, their pattern of help-seeking has not been evaluated.

AIMS

To describe the characteristics of the veteran population of the recent Iraq or Afghanistan conflicts who sought help from CS between 2003 and May 2011.

METHODS

CS Iraq and Afghanistan veteran clinical and welfare records were evaluated.

RESULTS

Nine hundred and eighty-eight records were evaluated. The median time for veterans of recent conflicts to seek help from CS since discharge from military service was ~2 years, considerably shorter than the mean time of 14 years previously estimated by CS. Approximately, three-quarters of the veterans receiving a full clinical assessment (n = 114), received a diagnosis of post traumatic stress disorder (PTSD) (n = 87). Approximately half of the clinically assessed veterans self-referred to CS (51%); their most frequent diagnosis was PTSD.

CONCLUSIONS

Veterans who have served in Iraq and Afghanistan are presenting to Combat stress sooner, and at a younger age, than veterans of previous conflicts and operations.

The influence of depression on the progression of HIV: direct and indirect effects

The authors suggest a theoretical model of pathways of HIV progression, with a focus on the contributions of depression-as well as secondary, behavioral and emotional variables. Literature was reviewed regarding (a) comorbid depression and the direct physiological effects on HIV progression and (b) intermediary factors between HIV and disease progression. Intermediary factors included (a) substance use, (b) social support, (c) hopelessness, (d) medication nonadherence, and (e) risky sexual behavior and the contraction of secondary infections. The authors suggest direct physiological pathways from depression to HIV progression and indirect pathways (e.g., behavioral, social, and psychological). In addition to depression, substance use, poor social support, hopelessness, medication nonadherence, and risky sexual behavior seem to be integral in HIV progression. Based on the individual relationships of these variables to depression and HIV progression, a comprehensive multipath model, incorporating all factors, serves to explain how severe emotional distress may lead to accelerated progression to AIDS.

Transcription factor CCAAT enhancer-binding protein beta (C/EBPbeta) regulates the formation of a unique extracellular matrix that controls uterine stromal differentiation and embryo implantation

During implantation, the uterine stromal cells undergo terminal differentiation into decidual cells, which support the proper progression of maternal-embryo interactions to successful establishment of pregnancy. The decidual cells synthesize extracellular matrix (ECM) components, such as laminins and collagens, which assemble into a unique basal lamina-like network that surrounds these cells. The functional significance of this matrix during implantation is unknown. We previously showed that the transcription factor CCAAT enhancer-binding protein β (C/EBPβ) critically regulates decidualization in the mouse. We now provide evidence that C/EBPβ directly controls the Lamc1 gene, which encodes a predominant laminin constituent of the ECM produced by the decidual cells. Suppression of Lamc1 expression in mouse primary endometrial stromal cells prevented the assembly of this ECM and impaired stromal differentiation. Attenuation of expression of integrin β1, a major constituent of the integrin receptors targeted by decidual laminins, also inhibited this differentiation process. Disruption of laminin-integrin interactions led to impaired activation of the focal adhesion kinase, an integrin-mediated regulator of cytoskeletal remodeling during decidualization. To further analyze the role of the decidual ECM in modulating maternal-embryo interactions, we monitored trophoblast invasion into differentiating uterine stromal monolayers, using a co-culture system. Silencing of stromal Lamc1 expression, which prevented formation of the basal lamina-like matrix, resulted in marked reduction in trophoblast outgrowth. Collectively, our findings identified C/EBPβ as a critical regulator of the unique ECM that controls decidual cell architecture and differentiation, and it provided new insights into the mechanisms by which the uterine stromal microenvironment controls the progression of embryo implantation.

Creating high reliability in health care organizations

OBJECTIVE

The objective of this paper was to present a comprehensive approach to help health care organizations reliably deliver effective interventions.

CONTEXT

Reliability in healthcare translates into using valid rate-based measures. Yet high reliability organizations have proven that the context in which care is delivered, called organizational culture, also has important influences on patient safety. MODEL FOR IMPROVEMENT: Our model to improve reliability, which also includes interventions to improve culture, focuses on valid rate-based measures. This model includes (1) identifying evidence-based interventions that improve the outcome, (2) selecting interventions with the most impact on outcomes and converting to behaviors, (3) developing measures to evaluate reliability, (4) measuring baseline performance, and (5) ensuring patients receive the evidence-based interventions. The comprehensive unit-based safety program (CUSP) is used to improve culture and guide organizations in learning from mistakes that are important, but cannot be measured as rates.

CONCLUSIONS

We present how this model was used in over 100 intensive care units in Michigan to improve culture and eliminate catheter-related blood stream infections--both were accomplished. Our model differs from existing models in that it incorporates efforts to improve a vital component for system redesign--culture, it targets 3 important groups--senior leaders, team leaders, and front line staff, and facilitates change management-engage, educate, execute, and evaluate for planned interventions.

Cycles of chromosome instability are associated with a fragile site and are increased by defects in DNA replication and checkpoint controls in yeast

We report here that a normal budding yeast chromosome (ChrVII) can undergo remarkable cycles of chromosome instability. The events associated with cycles of instability caused a distinctive "sectoring" of colonies on selective agar plates. We found that instability initiated at any of several sites on ChrVII, and was sharply increased by the disruption of DNA replication or by defects in checkpoint controls. We studied in detail the cycles of instability associated with one particular chromosomal site (the "403 site"). This site contained multiple tRNA genes known to stall replication forks, and when deleted, the overall frequency of sectoring was reduced. Instability of the 403 site involved multiple nonallelic recombination events that led to the formation of a monocentric translocation. This translocation remained unstable, frequently undergoing either loss or recombination events linked to the translocation junction. These results suggest a model in which instability initiates at specific chromosomal sites that stall replication forks. Forks not stabilized by checkpoint proteins break and undergo multiple rounds of nonallelic recombination to form translocations. Some translocations remain unstable because they join two "incompatible" chromosomal regions. Cycles of instability of this normal yeast chromosome may be relevant to chromosome instability of mammalian fragile sites and of chromosomes in cancer cells.

Direct role of a viroid RNA motif in mediating directional RNA trafficking across a specific cellular boundary

The plasmodesmata and phloem form a symplasmic network that mediates direct cell-cell communication and transport throughout a plant. Selected endogenous RNAs, viral RNAs, and viroids traffic between specific cells or organs via this network. Whether an RNA itself has structural motifs to potentiate trafficking is not well understood. We have used mutational analysis to identify a motif that the noncoding Potato spindle tuber viroid RNA evolved to potentiate its efficient trafficking from the bundle sheath into mesophyll that is vital to establishing systemic infection in tobacco (Nicotiana tabacum). Surprisingly, this motif is not necessary for trafficking in the reverse direction (i.e., from the mesophyll to bundle sheath). It is not required for trafficking between other cell types either. We also found that the requirement for this motif to mediate bundle sheath-to-mesophyll trafficking is dependent on leaf developmental stages. Our results provide genetic evidence that (1) RNA structural motifs can play a direct role in mediating trafficking across a cellular boundary in a defined direction, (2) the bundle sheath-mesophyll boundary serves as a novel regulatory point for RNA trafficking between the phloem and nonvascular tissues, and (3) the symplasmic network remodels its capacity to traffic RNAs during plant development. These findings may help further studies to elucidate the interactions between RNA motifs and cellular factors that potentiate directional trafficking across specific cellular boundaries.

When to give blood

With increased public awareness of the risks of blood transfusion and the decreased availability of blood products, the decision to transfuse a patient should be considered carefully. Most patients require a blood transfusion when haemoglobin levels fall below 8 g=dl or when there is greater than 30% loss of blood volume. However, the main indication for transfusing a patient is to increase their oxygen-carrying capacity and through invasive monitoring provide evidence of inadequate tissue oxygenation. Blood transfusions should be based on the patient’s risks of developing complications of inadequate oxygenation rather than on a single haemoglobin ‘trigger’.

Glutamine transporter in crypts compensates for loss of villus absorption in bovine cryptosporidiosis

Cryptosporidium parvum infection represents a significant cause of diarrhea in humans and animals. We studied the effect of luminally applied glutamine and the PG synthesis inhibitor indomethacin on NaCl absorption from infected calf ileum in Ussing chambers. Infected ileum displayed a decrease in both mucosal surface area and NaCl absorption. Indomethacin and glutamine or its stable derivative alanyl-glutamine increased the net absorption of Na(+) in infected tissue in an additive manner and to a greater degree than in controls. Immunohistochemical and Western blot studies showed that in control animals neutral amino acid transport system ASC was present in villus and crypts, whereas in infected animals, ASC was strongly present only on the apical border of crypts. These results are consistent with PGs mediating the altered NaCl and water absorption in this infection. Our findings further illustrate that the combined use of a PG synthesis inhibitor and glutamine can fully stimulate Na(+) and Cl(-) absorption despite the severe villous atrophy, an effect associated with increased expression of a Na(+)-dependent amino acid transporter in infected crypts.

Subcortical hypoperfusion following surgery for aneurysmal subarachnoid haemorrhage: implications for cognitive performance?

The incidence and severity of cognitive deficits after surgery for aneurysmal subarachnoid haemorrhage and their relationship to aneurysm site remains controversial. The aim of this study was to investigate the pattern of regional cerebral blood flow which exists in patients one year post-surgery and to identify whether different patterns exist which may be related to the type of cognitive deficit or the location of the aneurysm. 62 patients underwent cognitive assessment and HMPAO SPECT imaging at a mean time of 12 months following surgery. Results were compared to those from healthy control subjects (n = 55 for neuropsychological testing; n = 14 for SPECT imaging). In the patient group, significant stable cognitive deficits occurred in all cognitive domains but no cognitive measure differentiated aneurysm site. On SPECT images, statistical parametric mapping identified a large common area of subcortical hypoperfusion in the patient group as a whole. The findings of this study suggest a possible link between reduced subcortical function and the extent and severity of cognitive deficits.

Pleuromutilins. Part 1. The identification of novel mutilin 14-carbamates

A novel series of mutilin 14-carbamates has been discovered as a result of structure-activity studies on the naturally occurring antibiotic pleuromutilin (1). In particular, the 4-methoxybenzoylcarbamate, SB-222734 (15o) displays potent antibacterial activity against a number of bacterial pathogens which are resistant to currently used agents and shows enhanced metabolic stability when compared to earlier pleuromutilin derivatives. Such derivatives therefore have the potential to provide a new class of antibacterial agents for human therapy which address the threat of bacterial resistance.

Spatial representations of virtual mazes: the role of visual fidelity and individual differences

Twenty-four people learned three versions of a room-sized maze: a wire-frame desktop virtual environment (VE), a normal surface-rendered desktop VE, and a real-world maze. Differences among the mental representations formed from each environment were measured with pointing and distance estimation tasks in a real-world version of each maze. People were more accurate at pointing after having learned the real and wire-frame VE maze than the surface-rendered VE maze; however, this effect was small compared with the effect of individual differences. Differences in gender, spatial ability, and prior computer experience were significantly related to the ability to acquire spatial information from the desktop VE. There was a high correlation between spatial knowledge when it was measured in the VE and spatial knowledge measured in the real world. Actual or potential applications include the design of effective VE training systems.

Relationships among assisted suicide and religiousness, resources available, denial of dying, and autonomy

A nonrandom sample of eligible voters in Michigan (N = 218; mean age 35.7 yr.) anonymously completed a questionnaire during the two weeks prior to voting on a ballot proposal endorsing physician-assisted suicide. Favoring assisted suicide correlated negatively with scores on religiousness, believing that only a troubled mind would favor assisted suicide and that vulnerable individuals would suffer were assisted suicide legal, with denial of dying, and with resources available during one's final years. Favoring assisted suicide correlated positively with indicating this to be a medical rather than moral issue, making one's own decisions on moral issues, and believing that people may have different opinions on assisted suicide. The role of experience with dying needs further study.

Use of blood and blood products

It is sometimes necessary for the practitioner to transfuse the ruminant with whole blood or plasma. These techniques are often difficult to perform in practice, are time-consuming, expensive, and stressful to the animal. Acute loss of 20% to 25% of the blood volume will result in marked clinical signs of anemia, including tachycardia and maniacal behavior. The PCV is only a useful tool with which to monitor acute blood loss after intravascular equilibration with other fluid compartments has occurred. An acutely developing PCV of 15% or less may require transfusion. Chronic anemia with PCV of 7% to 12% can be tolerated without transfusion if the animal is not stressed and no further decline in erythrocyte mass occurs. Seventy-five percent of transfused bovine erythrocytes are destroyed within 48 hours of transfusion. A transfusion rate of 10 to 20 mL/kg recipient weight is necessary to result in any appreciable increase in PCV. A nonpregnant donor can contribute 10 to 15 mL of blood/kg body weight at 2- to 4-week intervals. Sodium citrate is an effective anticoagulant, but acid citrate dextrose should be used if blood is to be stored for more than a few hours. Blood should not be stored more than 2 weeks prior to administration. Heparin is an unsuitable anticoagulant because the quantity of heparin required for clot-free blood collection will lead to coagulation defects in the recipient. Blood cross-matching is only rarely performed in the ruminant. In field situations, it is advisable to inject 200 mL of donor blood into the adult recipient and wait 10 minutes. If no reaction occurs, the rest of the blood can probably be safely administered as long as volume overload problems do not develop. Adverse reactions are most commonly seen in very young animals or pregnant cattle. Signs of blood or plasma transfusion reaction include hiccoughing, tachycardia, tachypnea, sweating, muscle tremors, pruritus, salivation, cough, dyspnea, fever, lacrimation, hematuria, hemoglobinuria, collapse, apnea, and opisthotonos. Intravenous epinephrine HCl 1:1000 can be administered (0.2 to 0.5 mL) intravenously or (4 to 5 mL) intramuscularly (preferable) if clinical signs are severe. Pretreatment with antipyretics and slowing the administration rate may decrease the febrile response. Blood or plasma administered too rapidly will also result in signs of cardiovascular overload, acute heart failure, and pulmonary hypertension and edema. Furosemide and slower administration of blood or plasma should alleviate this problem. Administration rates have been suggested starting from 10 mL/kg/hr; faster rates may be necessary in peracute hemorrhage. Plasma should be administered when failure of absorption of passive maternal antibody has occurred or when protein-loosing enteropathy or nephropathy results in a total protein of less than 3 g/dL or less than 1.5 g albumin/dL. Plasma can be stored at household freezer temperatures (-15 to -20 degrees C) for a year; coagulation factors will be destroyed after 2 to 4 months when stored in this manner. To maintain viability of coagulation factors, plasma must be stored at -80 degrees C for less than 12 months. When administering plasma, a blood donor set with a built-in filter should always be used. When bovine plasma is thawed, precipitants form in the plasma and infusion of these microaggregates may result in fatal reactions in the recipient.