A realist process evaluation of an intervention to promote competencies in interprofessional collaboration among interdisciplinary integrated care teams for older people: Study protocol

Background: International policy is increasingly committed to placing interdisciplinary team-working at the centre of health and social care integration across the lifespan. The National Clinical Programme for Older People in Ireland has a critical role in the design and implementation of the National Older Person's Service Model, which aims to shift the delivery of care away from acute hospitals towards community-based care. Interdisciplinary Community Specialist Teams for older persons (CST-OPs) play an important role in this service model. To support the development of competencies for interprofessional collaboration and an interdisciplinary team-based approach to care integration, a culture shift will be required within care delivery. Design:This study builds upon a collaborative partnership project which co-designed a framework describing core competencies for interprofessional collaboration in CST-OPs. A realist-informed process evaluation of the framework will be undertaken as the competencies described in the framework are being fostered in newly developed CST-OPs under the national scale-up of the service model. Realist evaluation approaches reveal what worked, why it worked (or did not), for whom and under what circumstances. Three iterative and integrated work packages are proposed which combine multiple methods of data collection, analysis and synthesis. Prospective data collection will be undertaken within four CST-OPs, including qualitative exploration of the care experiences of older people and family carers. Discussion: The realist explanatory theory will provide an understanding of how interprofessional collaboration can be fostered and sustained in various contexts of care integration for older people. It will underpin curriculum development for team-based education and training of health and social care professionals, a key priority area in the national Irish health strategy. It will provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and to realise the goals of integrated care for older people.

Psychometric Deficits in Autoimmune Encephalitis: A retrospective study from the Australian Autoimmune Encephalitis Consortium

BACKGROUND

Despite the rapid increase in research examining outcomes in Autoimmune Encephalitis (AE) patients, there are few cohort studies examining cognitive outcomes in this population.

METHODS

This retrospective observational study collected psychometric data from 59 patients across six secondary and tertiary referral centres in metropolitan hospitals in Victoria, Australia between January 2008 and July 2019. Frequency and pattern analysis were employed to define and characterise psychometric outcomes. Univariable logistic regression was performed to examine predictors of intact and pathological psychometric outcomes.

RESULTS

Deficits in psychometric markers of executive dysfunction were the most commonly observed in this cohort, followed by deficits on tasks sensitive to memory. 54.2% were classified as having psychometric impairments across at least two cognitive domains. 29 patterns were observed, suggesting outcomes in AE are complex. None of the demographic data, clinical features, and auxiliary examination variables were predictors of psychometric outcome.

CONCLUSIONS

Cognitive outcomes in AE are complex. Further detailed and standardised cognitive testing in combination with MRI volumetrics and serum/CSF biomarkers is required to provide rigorous assessments of disease outcomes.

63 USING CO-DESIGN TO DEVELOP A CORE COMPETENCY FRAMEWORK FOR INTERPROFESSIONAL COLLABORATION WITHIN INTEGRATED CARE TEAMS FOR OLDER PEOPLE IN IRELAND

Background

Fundamental to the successful delivery of integrated care for older people in Ireland and internationally, is sustainable interprofessional collaboration (IPC). Current evidence, however, offers little guidance in terms of how IPC can be fostered and sustained within the context of integrated care and older people. This research aimed to design a framework that describes core competencies for IPC within integrated care teams (ICTs) for older people, and outline mechanisms by which ICTs could start to develop the necessary knowledge, skills and behaviours to demonstrate proficiency.

Methods

Using a co-design approach, academic health systems researchers, members of the National Integrated Care Programme for Older People in Ireland (IPC subcommittee), and public and patient representatives (nominated by Age Friendly Ireland) collaborated across three studies to devise a core competency framework. Study 1 used co-design workshops to develop and gain consensus on core competencies; study 2 employed semi-structured interviews to explore current working practice within two existing interprofessional ICTs and study 3, combined findings from study 1 and 2, validated the agreed upon competencies and finalised the IPC competency framework.

Results

Six competencies, within three domains, were agreed. Domain one, knowledge of the team, includes the competencies, understanding roles and making referrals. Domain two, communication, includes sharing information and communicating effectively and domain three, shared decision-making, includes the final two competencies, supporting decision making with older people and collective clinical decision-making.

Conclusion

This co-designed framework provides the scaffold for curriculum development for the training of health and social care professionals around interdisciplinary team working for the care of older people. The core competencies prioritise mutual respect and active elicitation of input from all disciplines, thereby empowering disciplinary-specific expertise. Finally, and perhaps most critically, the will and preferences of the older person are deemed central to effective integrated interprofessional working within the developed IPC framework.

A systematic review exploring the impact of focal leader behaviours on health care team performance

AIM

The aim of this study is to understand how the behaviour of focal leaders impacts health care team performance and effectiveness.

BACKGROUND

Despite recent shifts towards more collectivistic leadership approaches, hierarchical structures that emphasize the role of an individual focal leader (i.e., the formal appointed leader) are still the norm in health care. Our understanding of the effect of focal leader behaviours on health care team performance remains unclear.

EVALUATION

A systematic review was conducted. Five electronic databases were searched using key terms. One thousand forty-seven records were retrieved. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

KEY ISSUES

Fifty papers met the criteria for inclusion, were reviewed and synthesized under the following categories: task-focused leadership, directive leadership, empowering leadership and relational focused leadership.

CONCLUSIONS

Categories are discussed in relation to team performance outcomes, safety specific outcomes, individual-level outcomes and outcomes related to interpersonal dynamics. Emerging themes are explored to examine and reflect on how leadership is enacted in health care, to catalogue best practices and to cascade these leadership practices broadly.

IMPLICATIONS FOR NURSING MANAGEMENT

Empowering and relational leadership styles were associated with positive outcomes for nursing team performance. This underscores the importance of training and encouraging nursing leaders to engage in more collaborative leadership behaviours.

Promoting physical health among people with enduring mental illness: a qualitative study of healthcare providers' perspectives

BACKGROUND

People with enduring mental illness (EMI) have higher morbidity and mortality from chronic diseases than the general population, and this results in a significantly reduced relative life expectancy-accounted for primarily by physical illness. This gap may be partly influenced by the reduced likelihood of access to and uptake of regular physical health screening.

AIM

To establish Irish service providers' perspectives regarding the care of the physical health of people with EMI in an effort to inform future service developments aimed at improving the physical health of people with EMI.

DESIGN AND SETTING

Qualitative study of healthcare providers-general practitioners (GPs) and members of the community mental health teams-in Ireland.

PARTICIPANTS

GPs and mental health service providers.

METHODS

Qualitative semi-structured interviews were conducted with 34 service providers. Thematic analysis was undertaken.

RESULTS

Participants considered that the physical health of people with EMI is not currently regularly addressed by the patient's GP or the mental health team. Factors associated with this include patient compliance with attendance, time constraints in consultations to adequately support patient self-management, communication difficulties with the patient and between primary and secondary care, and lack of clarity as to whose responsibility it is to ensure physical health is monitored. In participants' view, a barrier to improvement is the present funding approach.

CONCLUSION

The evidence from this study has the potential to form the basis for innovation and change in service delivery for people with an EMI in Ireland and internationally, specifically in countries where it is not clear who has the overall responsibility to monitor the physical health of patients with EMI. This role requires time and regular contact, and both the organisation and the funding of the health system need to support it.

JMJD6 promotes self-renewal and regenerative capacity of hematopoietic stem cells

Lifelong multilineage hematopoiesis critically depends on rare hematopoietic stem cells (HSCs) that reside in the hypoxic bone marrow microenvironment. Although the role of the canonical oxygen sensor hypoxia-inducible factor prolyl hydroxylase has been investigated extensively in hematopoiesis, the functional significance of other members of the 2-oxoglutarate (2-OG)-dependent protein hydroxylase family of enzymes remains poorly defined in HSC biology and multilineage hematopoiesis. Here, by using hematopoietic-specific conditional gene deletion, we reveal that the 2-OG-dependent protein hydroxylase JMJD6 is essential for short- and long-term maintenance of the HSC pool and multilineage hematopoiesis. Additionally, upon hematopoietic injury, Jmjd6-deficient HSCs display a striking failure to expand and regenerate the hematopoietic system. Moreover, HSCs lacking Jmjd6 lose multilineage reconstitution potential and self-renewal capacity upon serial transplantation. At the molecular level, we found that JMJD6 functions to repress multiple processes whose downregulation is essential for HSC integrity, including mitochondrial oxidative phosphorylation (OXPHOS), protein synthesis, p53 stabilization, cell cycle checkpoint progression, and mTORC1 signaling. Indeed, Jmjd6-deficient primitive hematopoietic cells display elevated basal and maximal mitochondrial respiration rates and increased reactive oxygen species (ROS), prerequisites for HSC failure. Notably, an antioxidant, N-acetyl-l-cysteine, rescued HSC and lymphoid progenitor cell depletion, indicating a causal impact of OXPHOS-mediated ROS generation upon Jmjd6 deletion. Thus, JMJD6 promotes HSC maintenance and multilineage differentiation potential by suppressing fundamental pathways whose activation is detrimental for HSC function.

A sensitive and affordable multiplex RT-qPCR assay for SARS-CoV-2 detection

With the ongoing COVID-19 (Coronavirus Disease 2019) pandemic, caused by the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), there is a need for sensitive, specific, and affordable diagnostic tests to identify infected individuals, not all of whom are symptomatic. The most sensitive test involves the detection of viral RNA using RT-qPCR (quantitative reverse transcription PCR), with many commercial kits now available for this purpose. However, these are expensive, and supply of such kits in sufficient numbers cannot always be guaranteed. We therefore developed a multiplex assay using well-established SARS-CoV-2 targets alongside a human cellular control (RPP30) and a viral spike-in control (Phocine Herpes Virus 1 [PhHV-1]), which monitor sample quality and nucleic acid extraction efficiency, respectively. Here, we establish that this test performs as well as widely used commercial assays, but at substantially reduced cost. Furthermore, we demonstrate >1,000-fold variability in material routinely collected by combined nose and throat swabbing and establish a statistically significant correlation between the detected level of human and SARS-CoV-2 nucleic acids. The inclusion of the human control probe in our assay therefore provides a quantitative measure of sample quality that could help reduce false-negative rates. We demonstrate the feasibility of establishing a robust RT-qPCR assay at approximately 10% of the cost of equivalent commercial assays, which could benefit low-resource environments and make high-volume testing affordable.

Real world implementation of a group-based memory rehabilitation program into stroke services: A knowledge translation evaluation

BACKGROUND

Support for memory difficulties remains a significant unmet need for survivors of stroke. Memory skills group training of compensatory strategies can be effective for improving everyday memory function. However, access to these services remains limited.

OBJECTIVES

We aimed to evaluate the fidelity, acceptability, and effectiveness of implementing an evidence-based memory group in real-world clinical settings, to establish a potentially scalable implementation model.

METHODS

The program was facilitated at one acute and one community-based rehabilitation health service. Three clinical neuropsychologists received comprehensive training in facilitating the program. Implementation followed the Knowledge to Action framework, and implementation outcome measures included fidelity monitoring of adherence and competence, as well as clinician and participant reports of acceptability. The clinical effectiveness outcome was attainment of memory-specific goals using Goal Attainment Scaling at post-intervention and six-week follow-up.

RESULTS

The training process resulted in full adherence to the program content and demonstration of all essential clinical competencies. The program was acceptable and enjoyable for the clinicians and participants (n= 19, 63% male, 73% ischemic stroke). Participants demonstrated high levels of goal attainment (>80% at follow-up), comparable in magnitude to previous controlled trials.

CONCLUSIONS

The stroke memory skills program has the potential to be implemented successfully in real-world clinical settings using the Knowledge to Action framework, incorporating comprehensive clinician training.

Teleneuropsychology in the time of COVID-19: The experience of The Australian Epilepsy Project

PURPOSE

Traditional neuropsychological testing carries elevated COVID-19 risk for both examinee and examiner. Here we describe how the pilot study of the Australian Epilepsy Project (AEP) has transitioned to tele-neuropsychology (teleNP), enabling continued safe operations during the pandemic.

METHODS

The AEP includes adults (age 18-60) with a first unprovoked seizure, new diagnosis of epilepsy or drug resistant focal epilepsy. Shortly after launching the study, COVID-related restrictions necessitated adaptation to teleNP, including delivery of verbal tasks via videoconference; visual stimulus delivery via document camera; use of web-hosted, computerised assessment; substitution of oral versions for written tests; online delivery of questionnaires; and discontinuation of telehealth incompatible tasks.

RESULTS

To date, we have completed 24 teleNP assessments: 18 remotely (participant in own home) and six on-site (participant using equipment at research facility). Five face-to-face assessments were conducted prior to the transition to teleNP. Eight of 408 tests administered via teleNP (1.9 %) have been invalidated, for a variety of reasons (technical, procedural, environmental). Data confirm typical patterns of epilepsy-related deficits (p < .05) affecting processing speed, executive function, language and memory. Questionnaire responses indicate elevated rates of patients at high risk of mood (34 %) and anxiety disorder (38 %).

CONCLUSION

Research teleNP assessments reveal a typical pattern of impairments in epilepsy. A range of issues must be considered when introducing teleNP, such as technical and administrative set up, test selection and delivery, and cohort suitability. TeleNP enables large-scale neuropsychological research during periods of social distancing (and beyond), and offers an opportunity to expand the reach and breadth of neuropsychological services.

Understanding the impact of a collective leadership intervention on team working and safety culture in healthcare teams: a realist evaluation protocol

There is accumulating evidence for the value of collective and shared approaches to leadership across sectors and settings. However, relatively little research has explored collective leadership in healthcare and thus, there is little understanding of what works for healthcare teams, why, how and to what extent. This study describes the approach that will be adopted to the realist evaluation of a collective leadership intervention with four heterogenous healthcare teams in four different settings. A realist evaluation will be conducted. Realist evaluation is a theory-based approach to evaluation. It enables the use of mixed-methods to explore the research question of interest. Development of an initial programme theory (IPT) constitutes the first phase of the approach. This IPT will be informed by interviews with members of teams identified as working collectively, an examination of extant literature using realist synthesis, and will be refined through consultation with an expert panel. A multiple case study design will be adopted to explore the impact of the intervention, including quantitative scales on teamworking, leadership and safety culture, realist interviews with key informants and observations of teams during intervention sessions. Analysis of data will be guided by the IPT to refine the theory and context-mechanism-outcome configurations. Findings from the cases will be compared to identify patterns or demi-regularities and to explore if the intervention operates differently in different contexts. This analysis and synthesis of findings across the teams will inform the development of a middle range theory that will not only add to our understanding of how collective leadership influences teamwork and patient safety, but also provide guidance for future collective leadership interventions.  Favourable ethical opinion has been received from the University College Dublin Ethics Committee. Results will be disseminated via publication in peer-review journals, national and international conferences and to stakeholders/interest groups.

Embedding collective leadership to foster collaborative inter-professional working in the care of older people (ECLECTIC): Study protocol

Background: The National Integrated Care Programme for Older People (NICPOP), formerly NCPOP aims to support older people to live well in their homes by developing primary and secondary care services for older people, especially those with complex needs. The programme develops integrated intermediate care which traverses both hospital and community settings through multidisciplinary and interagency teams. This team-based approach to the integration of health services is a novel innovation in Irish health service delivery and will require, over time, a shift in cultures of care to allow for the development of competencies for inter-professional collaboration across the care continuum.

The ECLECTIC project will develop an implementation framework for achieving, maintaining and monitoring competencies for interprofessional collaboration among multi-disciplinary teams charged with delivering care for older people across the continuum from acute to community settings.

Design: The ECLECTIC research design has been developed in collaboration with the NICPOP. In phase one of the project, a co-design team will collaborate to define and shape competencies for interprofessional collaboration. Phase two will involve the delivery of a collective leadership intervention over a 10-month period with multidisciplinary professionals working with older people across two geographical regions (Mullingar/Midlands and Beaumont/Dublin North). Each group will comprise of members of two multidisciplinary teams charged with coordinating and delivering care to older people across the continuum of acute to community care. Observations of collaborative inter-professional working will take place before, during, and after intervention. In phase three of the study, analysis of the interview and observation data will be presented to the co-design team in order to develop an implementation framework for future teams.

Discussion: The co-design process will develop core competencies and performance indicators for collaborative interprofessional working. The resulting implementation framework will be implemented nationally as part of the NICPOP.

171 Programme Theory to Guide the Adoption of Assisted Decision Making with Older People in Acute Healthcare: Realist Evaluation

Background

In Ireland, the Assisted Decision-Making (ADM) (Capacity) Act and emerging Codes of Practice provide a legal framework for Healthcare Professionals (HCPs) to enable ADM for patients with impaired capacity. ADM ensures that a person’s will and preference is at the centre of all decisions related to their care. This study conducted a realist evaluation and developed a Programme Theory (PT) to highlight how ADM for older people can be operationalised within an Acute Care (AC) context.

Methods

Key informants with interest in ADM informed this evaluation. Interviews were conducted in two Acute Care (AC) sites with multidisciplinary HCPs working within older person services (n=20). Interviews with informants that recently received care within an AC setting involved older people (n=3) people with dementia (n=4) and family carers (n=5). Ethnographic observations from AC multidisciplinary team meetings also informed the review. The framework that guided the qualitative analysis was from a PT informed by literature on ADM implementation in healthcare (O'Donnell, Ní Shé, Davies et al.2018).

Results

The refined PT is supported by credible evidence that is informed by authentic experiences of decision making support in the AC setting. Validation groups (n=4) with the key informants verified the PT. Three mechanisms were identified as a positive climate and receptive environment for the adoption of formal ADM. These are:

AC settings that adopt inter-professional accountability and shared responsibility for patient care that is guided by a clear policy process. Acute care and practice that is informed by a shared commitment to person-centred care and shared decision making. HCPs that operate within an AC setting where organisational learning informs practice through inter-professional training, mentorship and peer support.

Conclusion

Involving stakeholders in PT development enhances the utility, feasibility and applicability of the results. This PT provides a framework for those planning ADM implementation within the AC settings.

153 Barriers and Enablers of Assisted Decision-making for Older People in Acute Care Hospitals: A Multi-Stakeholder Inquiry

Background

Ireland’s Assisted Decision-Making (Capacity) Act 2015 breaks from traditional views of capacity to consider the uniqueness of each decision with relation to topic, time and place for those with impaired or fluctuating capacity. It has yet to be commenced, however codes of practice and educational strategies are in development to support health and social care professionals (HSCPs) to practice in accordance with the Act. This study set out to examine barriers and enablers to the adoption of assisted decision making (ADM) involving older people in acute hospitals from multiple perspectives. It describes a pre-implementation formative evaluation informed by the perspectives of relevant stakeholders in ADM practice.

Methods

In total, 12 key informant interviews and two validation groups were conducted with family carers and older people with and without a diagnosis of dementia in two acute hospitals. In addition, 20 interviews and two validation groups were conducted with HSCPs. Interviews focused on contextual characteristics as well as barriers and enablers of ADM.

Results

Barriers and enablers included supporting capacity through adopting a functional approach, the physical environment where decision-making takes place, meeting information and support needs, methods of communication, upholding will and preferences, relationships and trust. Time and timing were consistently identified as a critical factor. HSCPs also highlighted the need for specialised education and training on ADM practice.

Conclusion

The issues identified around ADM will inform the development of a serious discussion game on acute care scenarios, which will be deployed for awareness raising and educational purposes. Findings will also help focus attention on how those working within complex health systems and organisations can practically implement changes to practice in line with ADM legislation.

Understanding the impact of a collective leadership intervention on team working and safety culture in healthcare teams: a realist evaluation protocol

There is accumulating evidence for the value of collective and shared approaches to leadership across sectors and settings. However, relatively little research has explored collective leadership in healthcare and thus, there is little understanding of what works for healthcare teams, why, how and to what extent. This study describes the approach that will be adopted to the realist evaluation of a collective leadership intervention with four heterogenous healthcare teams in four different settings. A realist evaluation will be conducted. Realist evaluation is a theory-based approach to evaluation. It enables the use of mixed-methods to explore the research question of interest. Development of an initial programme theory (IPT) constitutes the first phase of the approach. This IPT will be informed by interviews with members of teams identified as working collectively, an examination of extant literature using realist synthesis, and will be refined through consultation with an expert panel. A multiple case study design will be adopted to explore the impact of the intervention, including quantitative scales on teamworking, leadership and safety culture, realist interviews with key informants and observations of teams during intervention sessions. Analysis of data will be guided by the IPT to refine the theory and context-mechanism-outcome configurations. Findings from the cases will be compared to identify patterns or demi-regularities and to explore if the intervention operates differently in different contexts. This analysis and synthesis of findings across the teams will inform the development of a middle range theory that will not only add to our understanding of how collective leadership influences teamwork and patient safety, but also provide guidance for future collective leadership interventions.  Favourable ethical opinion has been received from the University College Dublin Ethics Committee. Results will be disseminated via publication in peer-review journals, national and international conferences and to stakeholders/interest groups.

A Best Evidence in Medical Education systematic review to determine the most effective teaching methods that develop reflection in medical students: BEME Guide No. 51

INTRODUCTION

Reflection is thought to be an essential skill for physicians. Although much has been written about it, there is little concurrence about how to best teach reflection in medical education. The aim of this review was to determine: (i) which educational interventions are being used to develop reflection, (ii) how is reflection being assessed, and (iii) what are the most effective interventions.

METHODS

Inclusion criteria comprised: (i) undergraduate medical students, (ii) a teaching intervention to develop reflection, and (iii) assessment of the intervention. A review protocol was developed and nine databases were searched. Screening, data extraction, and analysis procedures were performed in duplicate. Due to the heterogeneity of studies, a narrative synthesis approach was performed for the study analysis.

RESULTS

Twenty-eight studies met the inclusion criteria. The interventions in these studies had at least of two of the following components related to reflection: (i) introduction, (ii) trigger, (iii) writing, (iv) guidelines, (v) small group discussion, (vi) tutor and (vii) feedback. Three validated rubrics were used to assess reflective writing in these studies.

CONCLUSIONS

The strongest evidence from studies in this review indicates that guidelines for, and feedback on, reflective writing improve student reflection.

Spatial-Temporal Analysis of PM2.5 and NO₂ Concentrations Collected Using Low-Cost Sensors in Peñuelas, Puerto Rico

The U.S. Environmental Protection Agency (EPA) is involved in the discovery, evaluation, and application of low-cost air quality (AQ) sensors to support citizen scientists by directly engaging with them in the pursuit of community-based interests. The emergence of low-cost (<$2500) sensors have allowed a wide range of stakeholders to better understand local AQ conditions. Here we present results from the deployment of the EPA developed Citizen Science Air Monitor (CSAM) used to conduct approximately five months (October 2016⁻February 2017) of intensive AQ monitoring in an area of Puerto Rico (Tallaboa-Encarnación, Peñuelas) with little historical data on pollutant spatial variability. The CSAMs were constructed by combining low-cost particulate matter size fraction 2.5 micron (PM2.5) and nitrogen dioxide (NO₂) sensors and distributed across eight locations with four collocated weather stations to measure local meteorological parameters. During this deployment 1 h average concentrations of PM2.5 and NO₂ ranged between 0.3 to 33.6 µg/m³ and 1.3 to 50.6 ppb, respectively. Peak concentrations were observed for both PM2.5 and NO₂ when conditions were dominated by coastal-originated winds. These results advanced the community's understanding of pollutant concentrations and trends while improving our understanding of the limitations and necessary procedures to properly interpret measurements produced by low-cost sensors.

Staphylococcus pseudintermedius Surface Protein L (SpsL) Is Required for Abscess Formation in a Murine Model of Cutaneous Infection

Staphylococcus pseudintermedius is the leading cause of pyoderma in dogs and is often associated with recurrent skin infections that require prolonged antibiotic therapy. High levels of antibiotic use have led to multidrug resistance, including the emergence of epidemic methicillin-resistant clones. Our understanding of the pathogenesis of S. pseudintermedius skin infection is very limited, and the identification of the key host-pathogen interactions underpinning infection could lead to the design of novel therapeutic or vaccine-based approaches for controlling disease. Here, we employ a novel murine cutaneous-infection model of S. pseudintermedius and investigate the role of the two cell wall-associated proteins (SpsD and SpsL) in skin disease pathogenesis. Experimental infection with wild-type S. pseudintermedius strain ED99 or a gene-deletion derivative deficient in expression of SpsD led to a focal accumulation of neutrophils and necrotic debris in the dermis and deeper tissues of the skin characteristic of a classical cutaneous abscess. In contrast, mice infected with mutants deficient in SpsL or both SpsD and SpsL developed larger cutaneous lesions with distinct histopathological features of regionally extensive cellulitis rather than focal abscessation. Furthermore, comparison of the bacterial loads in S. pseudintermedius-induced cutaneous lesions revealed a significantly increased burden of bacteria in the mice infected with SpsL-deficient mutants. These findings reveal a key role for SpsL in murine skin abscess formation and highlight a novel function for a bacterial surface protein in determining the clinical outcome and pathology of infection caused by a major canine pathogen.

Using Co-Design to Develop a Collective Leadership Intervention for Healthcare Teams to Improve Safety Culture

While co-design methods are becoming more popular in healthcare; there is a gap within the peer-reviewed literature on how to do co-design in practice. This paper addresses this gap by delineating the approach taken in the co-design of a collective leadership intervention to improve healthcare team performance and patient safety culture. Over the course of six workshops healthcare staff, patient representatives and advocates, and health systems researchers collaboratively co-designed the intervention. The inputs to the process, exercises and activities that took place during the workshops and the outputs of the workshops are described. The co-design method, while challenging at times, had many benefits including grounding the intervention in the real-world experiences of healthcare teams. Implications of the method for health systems research are discussed.

Prisoners perceptions of a mental health wellness workshop

Purpose The purpose of this paper is to report on the evaluation of a one-day mental health wellness workshop which was delivered to male prisoners in an urban prison in the Republic of Ireland. Design/methodology/approach A mixed methods approach was used to evaluate the workshop. This paper presents the findings of the qualitative arm of the evaluation. Qualitative data were collected using semi-structured telephone interviews with ten participants who had completed the programme. Findings The participants were overwhelmingly positive about the wellness workshop and the qualitative interviews articulated the ways that the workshop impacted on their ability to manage their own and other peoples mental health. Originality/value As prisons attempt to limit the negative impact of prison life, implementing recovery orientated approaches such as the wellness workshop can have a positive impact on prisoners' mental health as well as raising their awareness and improving their attitudes towards mental distress and suicide. The concepts of self-help and peer support, espoused by the workshop offer a real opportunity to equip interested prisoners with skills to support themselves and other prisoners who are in distress.

Promoting assisted decision-making in acute care settings for care planning purposes: Study protocol

Background: The Assisted Decision-Making (ADM) (Capacity) Act 2015 was enacted by Dáil Éireann in December 2015. The purpose of the act, as it applies to healthcare, is to promote the autonomy of persons in relation to their treatment choices, to enable them to be treated according to their will and preferences, and to provide healthcare professionals with important information about persons and their choices in relation to treatment. In practice, those patients with cognitive impairment, particularly dementia, and those with complex needs requiring composite decisions present the greatest challenge to healthcare professionals practicing in accordance with this legislation. Patients with complex needs requiring multifaceted decisions are often over 70 years of age and present in acute hospitals experiencing some form of cognitive impairment. Objectives: The aim of this project is to develop an educational tool which will promote understanding of ADM among healthcare professionals working in acute care settings, and encourage their adoption of this understanding into their care planning with older people. Research design: The study design for this project is mapped out over four consecutive work packages combining a multimethod approach including rapid realist review, qualitative exploration, participatory learning and action sets and intervention trialling and revision. This incremental and context sensitive approach to research design is appropriate for the exploration, development and evaluation of a complex behaviour change intervention. Conclusion: The targeted beneficiaries of this project are healthcare professionals working within acute care settings as well as older people and their family carers who are interacting with the acute care system. The potential impact is improved communication between healthcare professionals and their patients in relation to assisted decision-making and care planning. This educational intervention will be embedded into the pedagogic strategies of the RCPI in their postgraduate education curricula as well as the continuous professional development scheme.

Abstract P1-10-08: Development of a first-in-class oral selective ERα covalent antagonist (SERCA) for the treatment of ERαWT and ERαMUT breast cancer

Mutations in estrogen receptor alpha (ERα) are detected in up to 30% of breast cancer patients who have relapsed during endocrine therapy. ERα mutations functionally confer resistance to existing classes of endocrine therapies, likely through gaining constitutive activity. The fact that current ER-directed therapies are only partially effective in the ERα mutant setting, and that a significant proportion of resistant breast cancer metastases continue to remain dependent on ERα signaling for growth/survival, highlights the critical need to develop the next generation of ERα antagonists that can overcome aberrant ERα activity. Using structure-based drug design approaches we have identified a novel class of ERα antagonist referred to as Selective ERα Covalent Antagonist (SERCA) that inactivate both wild-type and mutant ERα by targeting a unique cysteine residue that is not conserved among other steroid hormone receptors. Biophysical, biochemical and cellular analyses confirm the covalent mechanism of action, specific binding to ER and selective inhibition of ERα-dependent transcription of SERCAs. H3B-6545 is a highly selective SERCA that potently antagonizes wild-type and mutant ERα in biochemical and cell based assays demonstrating increased potency over standard of care and other experimental agents. In vivo, H3B-6545 shows superior efficacy to fulvestrant in the MCF-7 xenograft model with once daily oral dosing, achieving maximal antitumor activity at doses &gt;10x below the maximum tolerated dose in mice. In addition, H3B-6545 shows superior antitumor activity to both tamoxifen and fulvestrant in patient derived xenograft models of breast cancer carrying estrogen receptor mutations. In summary, H3B-6545 is a first-in-class, orally available and selective ER covalent antagonist with a compelling pre-clinical profile that is being developed for the treatment of ERα positive breast cancer.

Citation Format: Korpal M, Puyang X, Furman C, Zheng GZ, Banka D, Wu J, Zhang Z, Thomas M, Mackenzie C, Yao H, Rimkunas V, Kumar P, Caleb B, Karr C, Subramanian V, Irwin S, Larsen N, Vaillancourt F, Nguyen T-V, Davis A, Chan B, Hao MH, O'Shea M, Prajapati S, Agoulnik S, Kuznetsov G, Kumar N, Yu Y, Lai G, Hart A, Eckley S, Fekkes P, Bowser T, Joshi JJ, Selvaraj A, Wardell S, Norris J, Smith S, Reynolds D, Mitchell L, Wang J, Yu L, Kim A, Rioux N, Sahmoud T, Warmuth M, Smith PG, Zhu P. Development of a first-in-class oral selective ERα covalent antagonist (SERCA) for the treatment of ERαWT and ERαMUT breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-10-08.

Jmjd6, a JmjC Dioxygenase with Many Interaction Partners and Pleiotropic Functions

Lysyl hydroxylation and arginyl demethylation are post-translational events that are important for many cellular processes. The jumonji domain containing protein 6 (JMJD6) has been reported to catalyze both lysyl hydroxylation and arginyl demethylation on diverse protein substrates. It also interacts directly with RNA. This review summarizes knowledge of JMJD6 functions that have emerged in the last 15 years and considers how a single Jumonji C (JmjC) domain-containing enzyme can target so many different substrates. New links and synergies between the three main proposed functions of Jmjd6 in histone demethylation, promoter proximal pause release of polymerase II and RNA splicing are discussed. The physiological context of the described molecular functions is considered and recently described novel roles for JMJD6 in cancer and immune biology are reviewed. The increased knowledge of JMJD6 functions has wider implications for our general understanding of the JmjC protein family of which JMJD6 is a member.

A Citizen Science and Government Collaboration: Developing Tools to Facilitate Community Air Monitoring

The U.S. Environmental Protection Agency (EPA) is actively involved in supporting citizen science projects and providing communities with information and assistance for conducting their own air pollution monitoring. As part of a Regional Applied Research Effort (RARE) project, EPA's Office of Research and Development (ORD) worked collaboratively with EPA Region 2 and the Ironbound Community Corporation (ICC) in Newark, New Jersey, to develop and test the "Air Sensor Toolbox for Citizen Scientists." In this collaboration, citizen scientists measured local gaseous and particulate air pollution levels by using a customized low-cost sensor pod designed and fabricated by EPA. This citizen science air quality measurement project provided an excellent opportunity for EPA to evaluate and improve the Toolbox resources available to communities. The Air Sensor Toolbox, developed in coordination with the ICC, can serve as a template for communities across the country to use in developing their own air pollution monitoring programs in areas where air pollution is a concern. This pilot project provided an opportunity for a highly motivated citizen science organization and the EPA to work together directly to address environmental concerns within the community. Useful lessons were learned about how to improve coordination between the government and communities and the types of tools and technologies needed for conducting an effective citizen science project that can be applied to future efforts.

Effects of Resin Rheology on the Extrusion Foaming Characteristics of PET

Extrusion foaming by injection of inert gases (carbon dioxide, nitrogen, argon) in the polymer melt is increasingly finding applications for a wide variety of resins, competing with chemical blowing agents, volatile organic compounds or microcellular foaming. The molecular weight and molecular weight distribution of the resin affect its rheological characteristics (shear and elongational viscosity, melt elasticity, melt strength), its process characteristics and control cell size and stability of the resulting foam. In the present work, a variety of PET resins (including virgin materials, recycled and post-reactor modified) having different rheological characteristics were foamed by direct carbon dioxide injection and through the use of chemical blowing agents. Formability as related to density and cell size and distribution was evaluated and correlated with rheological characteristics of the particular resin, process conditions and type of blowing agent.

A 2-year review of the general internal medicine admissions to the British Role 3 Hospital in Camp Bastion, Afghanistan

BACKGROUND

Detailed knowledge of the likely volume and nature of the diseases presenting to deployed secondary care facilities aids operational planning. Now the British operation in Afghanistan has ended and a record of the experience is useful to preserve the lessons learned.

METHODS

Over a 2-year period from April 2011, prospective demographic and clinical data were collected on consecutive general internal medicine admissions to the Role 3 Hospital in Camp Bastion, Afghanistan. Up to four different symptoms and diagnoses were coded using the WHO International Classification of Disease, V.10 for each patient.

RESULTS

A total of 1368 medical patients were admitted. Of 1131 military admissions, 612 were from the UK (54.1%) and the remainder from 13 allied countries; 237 civilians came from 23 countries. Civilians were older than the military patients (p<0.001) but included five children. The 20 most frequent presenting symptoms were identified and there were 1626 diagnoses made. The 10 most frequent diagnoses were infectious gastroenteritis (12.6%), heat illness (4.3%), pneumonia (3.6%), epilepsy (2.6%), cellulitis (2.7%), migraine (1.8%), peptic ulcer disease (1.2%), myocardial infarction (1.2%), venous thromboembolism (1.2%) and pericarditis (0.7%). In 252 cases (18.4%) a firm diagnosis was not reached and a symptom was recorded. The five most frequent of these were undifferentiated febrile illnesses (4.6%), syncope (3.7%), chest pain (2.8%), headache (0.8%) and palpitations (0.7%). The mean hospital length of stay was 1.59 days and 72.2% of UK military patients were 'returned to unit'. Three civilian patients died in hospital or following aeromedical evacuation and there were no deaths of any military patients.

DISCUSSION

This study demonstrates the wide variety of presentations seen by physicians at an established military field hospital. This information informs the core syllabus of military physician training and will help facilitate planning for future medical support to similar military operations.

TRIAL REGISTRATION NUMBER

RCDM/Res/Audit/1036/12/0305.

Salmonella transforms follicle-associated epithelial cells into M cells to promote intestinal invasion

Salmonella Typhimurium specifically targets antigen-sampling microfold (M) cells to translocate across the gut epithelium. Although M cells represent a small proportion of the specialized follicular-associated epithelium (FAE) overlying mucosa-associated lymphoid tissues, their density increases during Salmonella infection, but the underlying molecular mechanism remains unclear. Using in vitro and in vivo infection models, we demonstrate that the S. Typhimurium type III effector protein SopB induces an epithelial-mesenchymal transition (EMT) of FAE enterocytes into M cells. This cellular transdifferentiation is a result of SopB-dependent activation of Wnt/β-catenin signaling leading to induction of both receptor activator of NF-κB ligand (RANKL) and its receptor RANK. The autocrine activation of RelB-expressing FAE enterocytes by RANKL/RANK induces the EMT-regulating transcription factor Slug that marks epithelial transdifferentiation into M cells. Thus, via the activity of a single secreted effector, S. Typhimurium transforms primed epithelial cells into M cells to promote host colonization and invasion.

Does aggressive phototherapy increase mortality while decreasing profound impairment among the smallest and sickest newborns?

OBJECTIVE

Aggressive phototherapy (AgPT) is widely used and assumed to be safe and effective for even the most immature infants. We assessed whether the benefits and hazards for the smallest and sickest infants differed from those for other extremely low-birth-weight (ELBW; ≤ 1000 g) infants in our Neonatal Research Network trial, the only large trial of AgPT.

STUDY DESIGN

ELBW infants (n=1974) were randomized to AgPT or conservative phototherapy at age 12 to 36 h. The effect of AgPT on outcomes (death, impairment, profound impairment, death or impairment (primary outcome), and death or profound impairment) at 18 to 22 months of corrected age was related to BW stratum (501 to 750 g; 751 to 1000 g) and baseline severity of illness using multilevel regression equations. The probability of benefit and of harm was directly assessed with Bayesian analyses.

RESULT

Baseline illness severity was well characterized using mechanical ventilation and FiO(2) at 24 h age. Among mechanically ventilated infants ≤ 750 g BW (n=684), a reduction in impairment and in profound impairment was offset by higher mortality (P for interaction <0.05) with no significant effect on composite outcomes. Conservative Bayesian analyses of this subgroup identified a 99% (posterior) probability that AgPT increased mortality, a 97% probability that AgPT reduced impairment, and a 99% probability that AgPT reduced profound impairment.

CONCLUSION

Findings from the only large trial of AgPT suggest that AgPT may increase mortality while reducing impairment and profound impairment among the smallest and sickest infants. New approaches to reduce their serum bilirubin need development and rigorous testing.

Review of acute cancer beds

A review of admissions to cancer services at University Hospital Galway (UHG) was undertaken to assess the appropriateness of hospital usage. All cancer specialty patients admitted from 26-28 May 2009 were reviewed (n = 82). Chi square tests, Exact tests, and One-way ANOVA were utilised to analyse key issues emerging from the data. Fifty (61%) were classified as emergencies. Twenty three (67%) occupied a designated cancer bed with 24 (30%) in outlying non-oncology wards. The mean length of stay was 29.3 days. Possible alternatives to admission were identified for 15 (19%) patients. There was no evidence of discharge planning for 50 (60%) admissions. There is considerable potential to make more appropriate utilisation of UHG for cancer patients, particularly in terms of reducing bed days and length of stay and the proportion of emergency cancer admissions, and further developing integrated systems of discharge planning.

Improving the ability of mental health nurses to give second opinion in Judicial Reviews: an evaluation study

In New Zealand, concern has been expressed regarding the variable quality of second opinions given by health professionals assisting judicial decisions on the use of compulsory assessment and treatment under mental health legislation. This second opinion is mostly given by registered mental health nurses. An innovative education programme based on experiential learning and adult learning principles was developed to assist health professionals to effectively undertake this role. A mixed method pre-post test intervention research design was developed to evaluate the effectiveness of the programme in assisting health professionals to feel more competent in undertaking the role. Data from the participants (n= 112) was subjected to descriptive statistical analysis and a thematic analysis of open-ended questions. The findings suggested gains in all competencies following the education programme, although there was room for further improvement. These changes were sustained over time at the next occasion when the health professionals undertook the role. There is a need to nationally disseminate such educational innovations to assist more mental health nurses to maximize their input into judicial decisions, which have a marked impact on the lives of those service users involved.

The effect of 6 months supplementation with conjugated linoleic acid on insulin resistance in overweight and obese

BACKGROUND

Contradicting results have been published regarding the effect of conjugated linoleic acid (CLA) on insulin resistance. However, only a few studies have used the euglycemic hyperinsulinemic clamp method, which is considered the standard for measuring insulin resistance.

OBJECTIVE

To evaluate if CLA as a mixture of the main isomers trans-10 cis-12 and cis-9 trans-11 affects the insulin resistance in healthy overweight and obese male and female adults.

DESIGN

The main study was a randomized, double-blind, placebo-controlled trial with change in body composition as primary end point comprising 118 subjects receiving supplementation with either placebo (olive oil) or CLA (Clarinol) for 6 months. A sub-population of 49 subjects agreed additionally to participate in an euglycemic hyperinsulinemic clamp study at baseline and after 6 months of supplementation with study drug. The primary outcome was the change in glucose uptake (M) as measured by the hyperinsulinemic euglycemic glucose clamp method. Secondary outcomes were the correlates between insulin resistance and changes in body composition or blood chemistry parameters. Forty-one subjects completed the clamp test at both time points.

RESULTS

The median M of the CLA group was 11.0 mg min(-1) lean body mass (lbm)(-1) (n=24) at baseline, 10.3 mg min(-1) lbm(-1) (n=24) after 6 months, and the median difference was +0.21 mg min(-1) lbm(-1) (n=24). The median M of placebo group was 8.4 mg min(-1) lbm(-1) at baseline and 9.3 mg min(-1) lbm(-1) after 6 months and the median difference was -0.22 mg min(-1) lbm(-1) (n=17). No significant (P<0.05) differences were found within groups or between groups. Likewise, the glucose uptake insulin concentration ratio during clamp (M/I) was independent of treatment and time. Homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index derived from fasting glucose and insulin were also independent of treatment and time, and HOMA for the clamp population (n=49) corresponded well with HOMA for the per protocol population (n=83). Correlation analysis showed that changes in M were inversely correlated to changes in glucohemoglobin (P=0.002), but did not correlate with changes in either glucose, insulin, insulin c-peptide, leptin, adiponectin or percent body fat.

CONCLUSIONS

CLA does not affect glucose metabolism or insulin sensitivity in a population of overweight or obese volunteers.

Impaired learning in adulthood following neonatal delta9-THC exposure

Cannabis is one of the most commonly used illicit drugs during pregnancy, but little is known about the lasting effects of early-life exposure to this drug. In this study, male Wistar rat pups were treated daily with (-)-delta9-tetrahydrocannabinol (THC; 5 mg/kg, s.c.) or its vehicle between postnatal days (PND) 4 and 14. Drug administration during this early postnatal period in rats is analogous to the third trimester of gestation in humans, which is a major period of synaptogenesis. Rats were subsequently tested drug-free during young adulthood (PND 56) using a two-component food-motivated double Y-maze test. Each trial included distinct spatial discrimination and delayed alternation components, which permitted the simultaneous assessment of reference memory and working memory. Rats were tested for 30 trials/day, 5 days/week for 5 weeks. Results revealed no significant differences between THC- and vehicle-treated rats in the spatial discrimination task. However, compared to vehicle-treated rats, THC-treated rats committed significantly more errors, and required significantly longer to obtain 80% correct over two consecutive days in the delayed alternation task. Results suggest that neonatal THC exposure leads to a specific and lasting deficit in learning in adulthood, which is likely due to impaired working memory function.

Evaluating human embryonic germ cells: concord and conflict as pluripotent stem cells

The realization of cell replacement therapy derived from human pluripotent stem cells requires full knowledge of the starting cell types as well as their differentiated progeny. Alongside embryonic stem cells, embryonic germ cells (EGCs) are an alternative source of pluripotent stem cell. Since 1998, four groups have described the derivation of human EGCs. This review analyzes the progress on derivation, culture, and differentiation, drawing comparison with other pluripotent stem cell populations.

Safety profile of conjugated linoleic acid in a 12-month trial in obese humans

Conjugated linoleic acid (CLA) is marketed in numerous commercially available dietary supplements, but few studies have looked at the long-term safety of this product. The current study evaluated the safety of one CLA product (Clarinol) over a one-year period in obese humans who were generally healthy. This was a randomized, double-blind study consisting of three phases in which subjects were given 6 g/day of CLA or placebo. Phase 1 was a low calorie diet (13 kcal/kg desirable weight) for 12 weeks or until 10-20% of initial body weight was lost. In phase 2, from weeks 12 to 28, subjects were re-fed a diet providing 25-30 kcal/kg of desirable body weight. Phase 3 was open label, with subjects from both groups taking CLA from weeks 28 to 52. At biweekly visits, subjects completed a questionnaire evaluating side effects and adverse events. Blood was taken for assay of liver function, glucose, insulin, serum lipids, blood counts, and general chemistry. Overall, body composition did not differ between groups. Laboratory tests showed no adverse effects of CLA. Adverse events and side effects were less in the CLA group compared to placebo. We conclude that CLA as Clarinol is safe for use in obese humans for at least one year.

Infections in neurosurgical patients admitted to the intensive care unit at the University Hospital of the West Indies

Patients admitted to the Intensive Care Unit (ICU) are at risk of developing life-threatening nosocomial infections, especially with organisms resistant to commonly used antibiotics. Neurosurgical patients are particularly vulnerable because of the serious nature of their illness, the frequency of associated trauma and the presence of invasive devices. Of 120 neurosurgical patients admitted to the ICU of the University Hospital of the West Indies (UHWI) between September 1995 and December 1999, the records of 73 patients were available for analysis. All had prophylactic antibiotics. Twenty-one of these 73 patients (28.8%) developed 22 infections after a mean of five days in the ICU: nine with chest infection, seven with urinary tract infection, four with central nervous system (CNS) infection and one each with wound and skin infection. This is an incidence of 11.6/1000 patient-days. The responsible organisms included Pseudomonas (7/21), Acinetobacter (3/21), E. coli 2/21, Enterobacter (2/21), and Klebsiella (2/21), and one each with Staphylococcus aureus, methicillin resistant Staphylococcus aureus, coagulase negative Staphylococcus, group D Streptococcus and bacteroides (1/21). Infection was significantly related to length of hospital stay, length of ICU stay, duration of intubation, duration of ventilation and the presence of diabetes mellitus. All patients who had surgery after ICU admission developed infection, seven with chest infection, two with urinary tract infection, two with CNS and one with skin infection. The three patients who were admitted with intracranial infections all developed other infections. Infected patients had a significantly longer hospital stay. Five patients died, none directly attributable to infection, while 55 (75.5%) made a good recovery. The problem of ICU infection may be expected to escalate with the increased use of intensive care, increasingly more complex surgical procedures and the growing problem of antibiotic resistance. Since infection is related to the length of ICU stay, earlier discharge of neurosurgical patients to an appropriately staffed high dependency unit is likely to result in reduction of the infection rate. Reinforcement of infection control strategies within the ICU may be expected to further minimize the infection rate.

Repeated withdrawal from ethanol impairs acquisition but not expression of conditioned fear

Repeated withdrawal from ethanol impairs acquisition of conditioned fear [Stephens, D.N., Brown, G., Duka, T. & Ripley, T.L. (2001) Eur. J. Neurosci., 14, 2023-2031]. This study further examined the effect of repeated withdrawal from ethanol on the expression and acquisition of fear conditioning. Following training, presentation of a cue associated with footshock (CS+) resulted in a suppression of operant responding for food reinforcement. In different groups, shock thresholds were manipulated to give weak or severe behavioural suppression. Rats were subsequently chronically treated with ethanol-containing liquid diet either continuously (single withdrawal) or with three withdrawal periods (repeated withdrawal). Ethanol treatment and withdrawal had no effect on conditioned suppression of responding tested 2 weeks after the final withdrawal, at either shock intensity. Nevertheless, extinction of conditioned fear was impaired in the repeated withdrawal group exposed to the higher shock intensity. In the high intensity group, the stimulus-shock association was then reversed, so that the previously neutral conditioned stimulus (CS-) became the CS+. Acquisition of suppression to the new CS+ was significantly less in the animals previously given repeated experience of withdrawal, confirming our previous finding. Thus, repeated withdrawal from ethanol lead to disruption in the acquisition of fear conditioning but had no effect on retrieval of an association formed prior to the ethanol-withdrawal experiences.

Inhibitory effect of apelin-12 on nocturnal food intake in the rat

Apelin, the endogenous peptide ligand of the APJ receptor, is expressed in brain regions implicated in food and water intake. This study reports for the first time, the effect of apelin-12, one of the most potent apelin peptides, on spontaneous (nocturnal) feeding. Randomised intracerebroventricular injection of 1, 3 and 10 nmol apelin-12 or saline vehicle, 10 min prior to lights out, led to dose-dependent reductions in food intake 2-4 h after injection (n = 7; p < 0.05). This suggests that apelin-12 exerts a delayed inhibitory effect on nocturnal feeding. Relative to saline, no effect was observed on total 24-h food intake post injection. In contrast, day-time administration of 10 nmol apelin-12 to satiated rats stimulated feeding (n = 5-11; p < 0.05); lower doses had no effect. No changes in water intake were observed after apelin-12. These results suggest that apelin is involved in the central control of feeding.

Characterization of a putative nitric oxide synthase in the neuromuscular system of the parasitic nematode, Ascaris suum

In this paper we report on the biochemical presence of nitric oxide synthase (NOS)-like activity in Ascaris suum tissue and examine the pharmacological effect of NO donors on A. suum muscle strip preparation. NOS activity was determined by monitoring the formation of [3H]citrulline from [3H]L-arginine and NO formation via the oxyhaemoglobin assay. Neuromuscular tissue from A. suum which stained positively for NADPH diaphorase, contained NOS activity. Neither NOS activity nor NADPH diaphorase staining was detected in intestinal tissue. The absence of Ca2+, NADPH and other co-factors normally required for mammalian neuronal NOS activity only partially reduced the formation of both citrulline and NO by A. suum neuromuscular homogenate. The results of the biochemical assays indicate the presence of an enzyme capable of producing NO and citrulline, but with a different profile from that of rat neuronal NOS. We also present preliminary evidence for the action of NO (NO donors) in the neuromuscular system of A. suum.

Milk fat conjugated linoleic acid (CLA) inhibits growth of human mammary MCF-7 cancer cells

The relationship between growth and the antioxidant enzyme defence system in human MCF-7 (breast) cancer cells treated with bovine milk fat enriched with conjugated linoleic acid (CLA) was studied. Milk enriched in CLA was obtained from cows on pasture supplemented with full fat rapeseeds and full fat soyabeans (1). Cell number decreased up to 90% (p < 0.05) and lipid peroxidation increased 15-fold (p < 0.05) following incubation of MCF-7 cells for 8 days with increasing levels of milk fat yielding CLA concentrations between 16.9 and 22.6 ppm. Growth suppression and prooxidant effects of milk fat CLA were independent of the variable composition of the milk fat samples, suggesting that CLA was the active ingredient in milk fat responsible for the cytotoxic effect. Mixtures containing isomers of CLA (c9, t11-, t10, c12-, c11, t13- and minor amounts of other isomers) and linoleic acid (LA) at similar concentrations to the milk fat samples were as effective at inhibiting growth and stimulating peroxidation of MCF-7 cells as the milk fatty acids. Incubation of the cells with the c9, t11 CLA isomer (20 ppm) or the mixture of CLA isomers (20 ppm) for 8 days resulted in a 60% decrease (p < 0.05) in viability compared with untreated controls and was significantly (p < 0.05) more effective than incubation with the t10, c12 CLA isomer (20 ppm), which caused only a 15% decrease in cell numbers under similar conditions. A 25% increase (p < 0.05) in cell proliferation occurred when LA (20 ppm) alone was incubated with MCF-7 cells for 8 days. 14C-CLA was preferentially incorporated into the phospholipid fraction of the MCF-7 cell lipids in a dose-dependent manner and CLA accumulated in cell membranes more efficiently when the cells were incubated in the presence of milk fat than the c9, t11 synthetic CLA isomer. Superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx) activities were induced in MCF-7 cells exposed to milk fat (containing 16.9-22.6 ppm CLA) over 8 days. The data indicate that milk fat triglyceride-bound CLA, consisting primarily of the c9, t11 isomer, was cytotoxic towards MCF-7 cells.

Four-dimensional neuronal signaling by nitric oxide: a computational analysis

Nitric oxide (NO) is now recognized as a transmitter of neurons that express the neuronal isoform of the enzyme nitric oxide synthase. NO, however, violates some of the key tenets of chemical transmission, which is classically regarded as occurring at points of close apposition between neurons. It is the ability of NO to diffuse isotropically in aqueous and lipid environments that has suggested a radically different form of signaling in which the transmitter acts four-dimensionally in space and time, affecting volumes of the brain containing many neurons and synapses. Although "volume signaling" clearly challenges simple connectionist models of neural processing, crucial to its understanding are the spatial and temporal dynamics of the spread of NO within the brain. Existing models of NO diffusion, however, have serious shortcomings because they represent solutions for "point-sources," which have no physical dimensions. Methods for overcoming these difficulties are presented here, and results are described that show how NO spreads from realistic neural architectures with both simple symmetrical and irregular shapes. By highlighting the important influence of the geometry of NO sources, our results provide insights into the four-dimensional spread of a diffusing messenger. We show for example that reservoirs of NO that accumulate in volumes of the nervous system where NO is not synthesized contribute significantly to the temporal and spatial dynamics of NO spread.