Diagnostic couplé des virus grippaux et du SARS-CoV-2 : évaluation de 2 tests moléculaires

Introduction

Matériels et méthodes

Résultats

Conclusion

[Emerging parasitic diseases]

Travels, migration and circulation of goods facilitate the emergence of new infectious diseases often unrecognized outside endemic areas. Most of emerging infections are of viral origin. Muscular Sarcocystis infection, an acute illness acquired during short trips to Malaysia, and Chagas disease, a chronic illness with long incubation period found among Latin American migrants, are two very different examples of emerging parasitic diseases. The former requires a preventive approach for travelers going to Malaysia and must be brought forth when they return with fever, myalgia and eosinophilia, while the latter requires a proactive attitude to screen Latin American migrant populations that may face difficulties in accessing care.

An IgE epitope of Bet v 1 and fagales PR10 proteins as defined by a human monoclonal IgE

BACKGROUND

Analyses of the molecular basis underlying allergenicity and allergen cross-reactivity, as well as improvement of allergy diagnostics and therapeutics, are hampered by the lack of human monoclonal IgE antibodies and knowledge about their epitopes. Here, we addressed the consecutive generation and epitope delineation of a human monoclonal IgE against the prototypic allergen Bet v 1.

METHODS

Phage-display scFv hybrid libraries of allergic donor-derived VH epsilon and synthetic VL were established from 107 mononuclear cells. An obtained scFv was converted into human immunoglobulin formats including IgE. Using variants of Bet v 1, the epitope of the antibody was mapped and extrapolated to other PR10 proteins.

RESULTS

The obtained antibodies exhibited pronounced reactivity with Bet v 1, but were not reactive with the homologous PR10 protein Mal d 1. The epitope as defined by the IgE paratope and a set of chimeric Bet v 1 fusion proteins and fragments could be assigned to a C-terminal helix-structured motif comprised by amino acid residues 132-154, including the critical residue E149. Grafting this motif re-established the reactivity of the per se nonreactive Mal d 1 framework. Cross-reactivities predicted by primary structure analyses of different isoforms and PR10 proteins were verified by allergen chip-based analyses.

CONCLUSIONS

The obtained results demonstrate that hybrid IgE repertoires represent a source for human antibodies with genuine paratopes. The IgE-derived information about the IgE epitope nature of Bet v 1 and homologues allows for detailed insights into molecular aspects of allergenicity and cross-reactivity within the PR10 protein family.

[Pleural plaques: when and how to treat?]

Which course of action should be taken during the incidental finding of pleural thickening on chest X-ray? Aftereffect, without consequence, of an injury of the pleura, or potentially serious subclinical pathology? The differential diagnosis is wide, the radiograph nonspecific and the interobserver variability significant. In the absence of epidemiological studies and guidelines, the history and clinical examination remain the main factors in dictating investigations and management. Apical pleural thickening, which is nonspecific in the absence of parenchymal lesions, does not influence treatment recommendations for tuberculosis. Pleural plaques do not appear to increase the risk of cancer associated with asbestos and, thus, do not modify post-exposure follow-up. Incidental finding of pleural thickening remains a gray zone that opens the door to new studies.

[Pulmonary diseases among returning travelers]

Respiratory tract infections are a frequent cause of travelers' health problems. Tropical diseases are relatively rare compared to common respiratory infections. Nevertheless, due to their potential gravity, they must be systematically considered. The differential diagnosis of tropical pathogens is wide. A targeted travel history taking into account specific epidemiological, geographical and behavioral risk factors helps focusing biological exams to identify the causative diagnosis. The chest radiography remains very helpful in this context; however, more specific exams, such as serologies are often necessary to reach a final diagnosis.

The putative serine protease inhibitor Api m 6 from Apis mellifera venom: recombinant and structural evaluation

BACKGROUND

Immunoglobulin (Ig) E-mediated reactions to honeybee venom can cause severe anaphylaxis, sometimes with fatal consequences. Detailed knowledge of the allergic potential of all venom components is necessary to ensure proper diagnosis and treatment of allergy and to gain a better understanding of the allergological mechanisms of insect venoms.

OBJECTIVE

Our objective was to undertake an immunochemical and structural evaluation of the putative low-molecular-weight serine protease inhibitor Api m 6, a component of honeybee venom.

METHODS

We recombinantly produced Api m 6 as a soluble protein in Escherichia coli and in Spodoptera frugiperda (Sf9) insect cells.We also assessed specific IgE reactivity of venom-sensitized patients with 2 prokaryotically produced Api m 6 variants using enzyme-linked immunosorbent assay. Moreover, we built a structural model ofApi m 6 and compared it with other protease inhibitor structures to gain insights into the function of Api m 6.

RESULTS

In a population of 31 honeybee venom-allergic patients, 26% showed specific IgE reactivity with prokaryotically produced Api m 6, showing it to be a minor but relevant allergen. Molecular modeling of Api m 6 revealed a typical fold of canonical protease inhibitors, supporting the putative function of this venom allergen. Although Api m 6 has a highly variant surface charge, its epitope distribution appears to be similar to that of related proteins.

CONCLUSION

Api m 6 is a honeybee venom component with IgE-sensitizing potential in a fraction of venom-allergic patients. Recombinant Api m 6 can help elucidate individual component-resolved reactivity profiles and increase our understanding of immune responses to low-molecular-weight allergens

Api m 10, a genuine A. mellifera venom allergen, is clinically relevant but underrepresented in therapeutic extracts

BACKGROUND

Generalized systemic reactions to stinging hymenoptera venom constitute a potentially fatal condition in venom-allergic individuals. Hence, the identification and characterization of all allergens is imperative for improvement of diagnosis and design of effective immunotherapeutic approaches. Our aim was the immunochemical characterization of the carbohydrate-rich protein Api m 10, an Apis mellifera venom component and putative allergen, with focus on the relevance of glycosylation. Furthermore, the presence of Api m 10 in honeybee venom (HBV) and licensed venom immunotherapy preparations was addressed.

METHODS

Api m 10 was produced as soluble, aglycosylated protein in Escherichia coli and as differentially glycosylated protein providing a varying degree of fucosylation in insect cells. IgE reactivity and basophil activation of allergic patients were analyzed. For detection of Api m 10 in different venom preparations, a monoclonal human IgE antibody was generated.

RESULTS

Both, the aglycosylated and the glycosylated variant of Api m 10 devoid of cross-reactive carbohydrate determinants (CCD), exhibited IgE reactivity with approximately 50% of HBV-sensitized patients. A corresponding reactivity could be documented for the activation of basophils. Although the detection of the native protein in crude HBV suggested content comparable to other relevant allergens, three therapeutical HBV extracts lacked detectable amounts of this component.

CONCLUSION

Api m 10 is a genuine allergen of A. mellifera venom with IgE sensitizing potential in a significant fraction of allergic patients independent of CCD reactivity. Thus, Api m 10 could become a key element for component-resolved diagnostic tests and improved immunotherapeutic approaches in hymenoptera venom allergy.

Fatal acute melioidosis in a tourist returning from Martinique Island, November 2010

We report the fatal case of acute melioidosis in a patient returning from Martinique with fever in November 2010. Gram-negative rods were isolated from a blood culture and Burkholderia pseudomallei identified within 24 hours after first medical contact. The patient died two days after admission to hospital despite intravenous therapy with high doses of imipenem/cilastatin and intensive care. Clinicians seeing travellers returning from the subtropics or tropics with severe pneumonia or septicaemia should consider the possibility of acute melioidosis.

Fatal acute melioidosis in a tourist returning from Martinique Island, November 2010

We report the fatal case of acute melioidosis in a patient returning from Martinique with fever in November 2010. Gram-negative rods were isolated from a blood culture and Burkholderia pseudomallei identified within 24 hours after first medical contact. The patient died two days after admission to hospital despite intravenous therapy with high doses of imipenem/cilastatin and intensive care. Clinicians seeing travellers returning from the subtropics or tropics with severe pneumonia or septicaemia should consider the possibility of acute melioidosis.

[Interpretation of 24h ambulatory blood pressure monitoring by primary care physicians]

Comparatively to office blood pressure measurement, 24h ambulatory blood pressure monitoring (ABPM) provides a more accurate evaluation of the patient's blood pressure and of the burden of the arterial pressure in real life. This measurement is better correlated with cardiovascular risk, with hypertension-related organ damage and its changes with treatment, than does office blood pressure. It allows diagnosis of white coat and masked hypertension, and of alteration in blood pressure's circadian rhythm. This article aims to summarise ABPM's indications, to point out its advantages and give some key practical messages to realize and properly interpret this exam.

Correlation between home health resource utilization measures

The study explored the strengths of the correlation between three home health resource utilization measures: number of visits, length of stay, and total direct care time. The setting was four home health agencies in the northwest; 2,788 home health episodes of care were studied. The results showed that although number of visits and total direct care time were highly correlated (r = .96), the strength of the correlation between number of visits and length of stay (r = .65) and total direct care time and length of stay (r = .63) were only moderate. Although visit counts and direct care time were redundant measures in the mostly fee-for-service reimbursement environment of the current study, in a prospective payment environment where visit length may show increased variation, researchers will need to confirm redundancy in the two measures.

Evaluation of 3 quality of life measurement tools in patients with chronic heart failure

OBJECTIVE

The objectives of this study are to (1) Address issues related to selecting a quality of life (QOL) measuring tool; and (2) Present data from a pilot test comparing 3 QOL tools (Medical Outcomes Study Short Form-36 [SF-36], the Minnesota Living with Heart Failure Questionnaire [LHFQ], and a visual analogue scale).

DESIGN

Descriptive comparative.

SETTING

A Southern university-affiliated tertiary medical center outpatient heart failure clinic.

PATIENTS

Thirty adults, randomly selected from those treated in a multidisciplinary, nurse practitioner-managed heart failure clinic.

RESULTS

Significant correlations were found among the global or broader measures of QOL (visual analog scale and LHFQ Total score) and the component scores (LHFQ Emotional, LHFQ Physical, SF-36 Mental [MCS], and SF-36 Physical [PCS]), with the only exception being that of the LHFQ Total and the SF-36 PCS. Mental and physical components of QOL were not related within the SF-36 or between the SF-36 PCS and the LHFQ Emotional score. However, the emotional and physical scores were highly and significantly related within the LHFQ and between the SF-36 MCS and the LHFQ Physical score.

CONCLUSIONS

The SF-36 was better able to differentiate physical and emotional aspects of QOL in this sample. The LHFQ subscales may be less useful in QOL assessment than the total score.

Perceived difficulty of diabetes treatment in primary care: does it differ by patient ethnicity?

PURPOSE

The purpose of this cross-sectional study was to determine the attitudes of internal medicine physicians toward treating diabetes in different patient ethnic groups and compared with treating common chronic medical conditions in primary care.

METHODS

The survey instrument was administered to 55 internal medicine physicians. An e-mail message was sent to each physician with a hyperlink to a site where the survey could be completed. The instrument was a modified, quantitative 10-point scale designed to measure attitudes regarding the difficulty of treating diabetes.

RESULTS

Diabetes was perceived to be more difficult to treat than hyperlipidemia and angina. African Americans with diabetes were perceived to be more difficult to treat than Caucasian patients. Difficulty in treating diabetes was comparable to that for hypertension, arthritis, and congestive heart failure. Physicians were confident about treatment efficacy for diabetes and changing diabetes outcomes, but not about the adequacy of time and resources for diabetes treatment.

CONCLUSIONS

Diabetes was perceived as a difficult disease to treat, African American patients were more difficult to treat, and time and resources were inadequate for diabetes treatment. To improve diabetes care, there is a need to address these attitudes and concerns of internal medicine physicians.

Effect of locale on health status and direct care time of rural versus urban home health patients

OBJECTIVE

The study purpose was to determine if health status differed between rural versus urban home health patients and to identify if locale was a significant predictor of home health direct care time.

BACKGROUND

Implemented in October 2000, the Medicare home health prospective payment system (PPS) made only temporary allowance for differences in cost of delivering home health services in rural versus urban environments. However, past research documented differences in health status and service utilization between rural and urban home health patients.

METHODS

Data were collected retrospectively on a convenience sample of 2,788 patient episodes of care. Patient health status was measured using items form the Outcome Assessment and Information Set (OASIS). Obtained from itinerary records, direct care time was the time clinicians spent in the home.

RESULTS

The results showed significant differences in rural versus urban patients health status, with urban patients being healthier than rural patients. Consistent with poorer health status, rural patients received more RN direct care time. Other study factors being equal, living in a rural locale increased total direct care time by 150 minutes over living in an urban environment.

CONCLUSIONS

Given the poorer health status and increased time requirements for rural patients, the results support assertions that Medicare per episode reimbursement should be higher for rural than for urban home health patients.

Quantification of human cytomegalovirus DNA by real-time PCR

A quantitative real-time PCR assay was developed to measure human cytomegalovirus (HCMV) DNA load in peripheral blood leukocytes (PBLs). The HCMV DNA load in PBLs was normalized by means of the quantification of a cellular gene (albumin). The results of the real-time PCR assay correlated with those of the HCMV pp65-antigenemia assay (P < 0.0001).

The extended effects of the life review in nursing home residents

To date, there is little information on the therapeutic effects of the life review beyond one year. This analysis followed fifty-two of 256 subjects who lived for at least three years in a nursing home. These participants received either a life review or friendly visit and took part in four repeated testings to determine the lasting effects of the life review at two and three years. Measures of integrity (life satisfaction, psychosocial well being, self-esteem) and despair (depression, hopelessness, and suicide intent) were used as pretest, posttest, and retest. Results showed a trend toward continued and by year three significant improvement over time in those who received the life review on measures of depression (t = -2.20, p < .03), life satisfaction (t = 2.51, p < .02), and self-esteem (t = -2.31, p < .03).

Service utilization and outcomes in rural home health agencies

As home health reimbursement moves from fee-for-service to prospective payment, data describing the relationship between service utilization and patient outcomes will be the basis for planning services. The investigators measured the relationship between service utilization and generic patient outcomes for 1,704 home health episodes of care. Few significant relationships were found. The average study patient received 17 visits, well below the average number for the state and nation. Investigators suggested the possibility that visit numbers were too low to stimulate improvement in outcomes and that when services are curtailed, home health staff may do well to focus quality improvement efforts on condition-specific patient outcomes rather than generic outcomes.

[Evaluation of the diagnosis of pigmented tumors of the skin and factors leading to a decision to excise. Dermatologists of the Postgraduate Association of Haute-Normandie]

INTRODUCTION

The necessity of excising melanomas characterized by a slight thickness at an early stage, leads dermatologists to remove pigmented lesions which do not correspond to melanomas. The aims of this study were: a) to prospectively assess the accuracy of melanoma diagnosis, b) to quantify the number of excisions performed according to the degree of melanoma suspicion, c) to determine the specific clinical sign or signs of relevant diagnostic value.

PATIENTS AND METHODS

This study was conducted prospectively from January 1996 to August 1997 by dermatologists in private practice and dermatologists from a University Hospital staff. When it was decided to excise a pigmented lesion, a form was filled out choosing the most appropriate clinical diagnosis, the degree of melanoma suspicion, and clinical signs which lead to surgery. Based on histological findings as the reference, the sensitivity, specificity, accuracy of melanoma diagnosis and the kappa test that evaluates the concordance between clinical and histological diagnosis, were performed. The diagnostic value of clinical signs was assessed by variance analysis.

RESULTS

Of the 353 excised lesions, 38 (10.7 p. 100) were identified as melanoma on histologic examination. The sensitivity, the specificity and diagnostic accuracy were: 79 p. 100, 94 p. 100 and 53 p. 100 respectively. The kappa test concordance between clinical and histological diagnosis was 0.66. Two hundred and two lesions (57 p. 100) were excised even though the clinical suspicion of melanoma was poorly considered. Only one of these 202 lesions was identified histologically as a true melanoma. Thirty seven (24.5 p. 100) of the 151 remaining excised lesions with an "average" or "strong" suspicion were true melanomas. The clinical signs considered, alone or associated, had a poor predictive positive value (< 38 p. 100). An analytical approach performed with a logistic model permitted the identification of two associated signs suggesting a best diagnostic value.

DISCUSSION

This is the only study, to our knowledge, reported in the literature which prospectively assesses the sensitivity, specificity and concordance between clinical and histological diagnosis of melanoma. Results were considered from average to good. The originality of this study was to assess the number of pigmented lesions excised according to the degree of melanoma suspicion, suggesting the possibility of reducing the number of nevi removed when the melanoma risk was considered clinically poor. Finally, this study emphasizes the limits of clinical semiology and the need for future diagnostic methods in the assessment of melanoma.

Life review: preventing despair in newly relocated nursing home residents short- and long-term effects

Relocation to a nursing home places frail elders at risk for developing depression and suicide ideation. This study followed two hundred and fifty-six newly relocated nursing home residents for five years. Using a Solomon Four research design, participants were divided into four groups, two control and two experimental, one each with pretesting and all with posttesting. Participants in the control groups received a friendly visit and those in the experimental groups received the intervention of life review. Immediate short-term results showed the life review to be an effective preventive intervention for clinical depression (p = .05). Additionally, when looking at long-term effects at one year, there were significant decrease in depression (p = .05), hopelessness (p = .01), and psychological well-being (p = .02) with measurable increases in life satisfaction (p = .08). These findings support the hypothesis that life review prevents despair in frail elders newly admitted to a nursing home.

Regulation of human B19 parvovirus promoter expression by hGABP (E4TF1) transcription factor

The genetic expression of human B19 parvovirus is only dependent on one promoter in vivo and in vitro. This is the P6 promoter, which is located on the left side of the genome and is a single-stranded DNA molecule. This led us to investigate the regulation of the P6 promoter and the possible resulting variability of the nucleotide sequence. After analysis of the promoter region of 17 B19 strains, only 1.5% variability was found. More exciting was the finding of mutations that were clustered around the TATA box and defined a highly conserved region (nucleotides 113-210) in the proximal part of the P6 promoter. HeLa and UT7/Epo cell extracts were found to protect this region, which contained a core motif for Ets family proteins, with YY1 and Sp1 binding sites on either side. Gel mobility shift assays performed with nuclear proteins from HeLa and UT7/Epo cells identified DNA-binding proteins specific for these sites. By supershift analysis, we demonstrated the binding of the hGABP (also named E4TF1) protein to the Ets binding site and the fixation of Sp1 and YY1 proteins on their respective motifs. In Drosophila SL2 cells, hGABPalpha and -beta stimulated P6 promoter activity, and hGABPalpha/hGABPbeta and Sp1 exerted synergistic stimulation of this activity, an effect diminished by YY1.

The effect of psychosocial nursing intervention on the mood state of patients with implantable cardioverter defibrillators and their caregivers

This study sought to determine whether mood state and psychosocial adjustment four months after implantable cardioverter defibrillator (ICD) placement were better for patients and caregivers who received a program of psychosocial interventions than for those who received usual postoperative care and follow-up. Thirty-four adult ICD recipients (17 experimental and 17 control) and their significant other (SO) caregivers were randomly assigned to an experimental or control group. The intervention consisted of weekly, postoperative telephone follow-up, evaluation and counseling by a psychiatric liaison nurse, and participation in an ICD support group. There were no significant differences between treatment and control groups on the outcome measures of adjustment (Profile of Mood States, Psychosocial Adjustment to Illness Scale). Outcomes were not associated with age, ejection fraction, length of hospital stay or family income, and there were no differences in outcomes based on gender, employment status, thoracotomy versus non-thoracotomy procedure, or shocked versus unshocked status. The results do not indicate that the extra time spent to provide individualized attention to these ICD recipients and their SOs was advantageous for the outcomes measured. Adaptation to the device may occur over time regardless of intervention.

Stress-induced immunosuppression and therapeutic touch

OBJECTIVE

The specific aim of this study was to evaluate the effectiveness of therapeutic touch in reducing the adverse immunological effects of stress in a sample of highly stressed students. Long-term goals are to develop methods by which a variety of stress-reduction techniques can be tested for efficacy.

DESIGN

Experimental.

SETTING

A large urban medical university in a southern coastal city.

SUBJECTS

Healthy medical and nursing students who are taking professional board examinations.

INTERVENTION

Therapeutic touch.

MAIN OUTCOME MEASURES

T-lymphocyte function (CD25) and immunoglobulin levels.

RESULTS

Subjects who received therapeutic touch and subjects who did not had significantly different levels of IgA and IgM; CD25 (mitogen-stimulated T-lymphocyte function) and IgG levels differed in the expected direction between the two groups, but the differences were not statistically significant. Apoptosis (programmed cell death) was significantly different between the two groups.

CONCLUSIONS

The small sample size requires cautious interpretation of the results. This is a pilot study designed to provide evidence to show that further study of therapeutic touch as an intervention that may be useful in reducing the adverse immunologic consequences of anxiety related to stress in otherwise healthy students is warranted. Change in immune function related to anxiety and the relief of anxiety can be measured. Subsequent power analysis suggests sample sizes of 90 subjects per group are required to confirm the conclusions.

Long-term exercise patterns and immune function in healthy older women. A report of preliminary findings

The purpose of this study was to examine the relationship between active versus inactive lifestyle and immunocompetence in older women. A sample of 46 independently dwelling, ambulatory and mentally alert women 60-98 years was examined, 25 who rated themselves as 'active' and 21 who rated themselves as 'inactive'. Lymphocyte subpopulations were analyzed by flow cytometry using selected monoclonal antibodies. The self-reported active subjects (also validated by their current unsolicited participation in a formal exercise class) demonstrated significantly higher percent change in CD25 mitogen stimulated lymphocytes (P = 0.0335) than those who reported themselves to be sedentary.

Quality and cost outcomes of transitional care

Longitudinal analysis of the outcomes of a transitional care program documented success in discharging patients home with remarkable compliance to discharge plans and sustained improvement in mental status and functional independence. Inpatient costs were significantly reduced.

The influence of stress intrusion on immunodepression in generalized anxiety disorder patients and controls

Previous work from our group has examined the relationship between stress and immunodepression in medical students taking National Boards, Part I, and has described a relationship between stress intrusion scores (SIS) and immunodepression. We have also shown that a high proportion of individuals with generalized anxiety disorders (GAD) and panic disorders (PD) exhibit enhanced stress intrusion (SI) and are more prone to upper respiratory infections (URI). In the present preliminary study, we sought to establish a model to evaluate further the role of SI level on the extent of immunodepression. This would serve to assess in further studies the mechanism(s) of stress-induced immunodepression, its relationship to morbidity, and the role of therapeutic interventions. In 14 GAD patients and 14 controls, we correlated the expression of interleukin-2 receptors (CD25) on T lymphocytes stimulated with anti-CD3 in short term cultures and the frequency of URI and the SIS to assess the relationships among these parameters. A decreased expression of CD25 correlates linearly with increasing SIS and with a higher number of sick days with URI. These results support our previous observations that GAD patients are more susceptible to URI. Moreover, they suggest that there may be a direct relationship between immunodepression and morbidity and between SIS and immunodepression.

Studying multidimensional constructs through cluster analysis

The analysis of multidimensional constructs presents a challenge. The challenge is to combine the information from the dimensions relating to the construct in a meaningful way. This article examines a complex construct known as the nursing practice environment and describes the use of cluster analysis to combine information from three dimensional measurements to operationalize the construct.

Coordination as a critical element of managed care

Although the concept of coordination is not new to nursing, little is known about how it contributes to cost-effective patient care outcomes. The authors examined the mechanisms used by staff nurses to coordinate patient care services in practice environments characterized by low, moderate, and high levels of uncertainty. Regardless of practice environment conditions, nurses used the same mechanisms to coordinate patient care. These findings suggest a potential for inadequate communication among providers, poor coordination of services, and lost efficiency. Strategies to improve coordination of patient care services are discussed.

During HIV infection, CD4+ CD38+ T-cells are the predominant circulating CD4+ subset whose HLA-DR positivity increases with disease progression and whose V beta repertoire is similar to that of CD4+ CD38- T-cells

Three-color automated flow cytometry was carried out on peripheral blood CD4+ and CD8+ T-lymphocytes of 42 HIV-positive patients using tri-color anti-CD4 or anti-CD8, phycoerythrin-anti-CD38, and fluorescein-anti-HLA-DR, mAbs to elucidate further the T-cell activation hypothesis recently proposed to explain CD4+ T-cell abnormalities observed during HIV infection. CD4+ CD38+ T-cells constituted the major part of circulating CD4+ T-cells in HIV-infected patients and their HLA-DR molecule positivity increased as their disease progressed. The level of CD38 and HLA-DR expression on CD4+ T-cells was positively correlated to that of CD8+ T-cells and to the level of beta 2-microglobulin. Next, to determine whether CD38 expression was associated with a selective expansion or deletion of V beta gene-defined subsets, we compared the V beta gene frequencies between CD38+ and CD38- T-cells from HIV-infected CDC stage II patients using 13 mAbs specific to V beta families. While selective expansion of certain V beta families was observed in CD4+ and CD8+ T-cells the T-cell receptor V beta subset distribution was similar among CD38+ and CD38-, CD4+ and CD8+ T-cells, suggesting that CD38+ expression was either independent of an HIV-encoded antigen-driven process or rather indicative of T-cell immaturity. It is proposed that the phenotype of circulating CD4+ and CD8+ T-cells of HIV-infected patients is a feature of two different mechanisms: (i) an in vitro activation state responsible for increased DR expression and selective expansion of V beta gene-defined subsets, and (ii) T-cell immaturity due to an increased turnover of these cells and accounting for increased CD38 expression.

Dissemination and use of research findings in nursing practice

This study built on two previous studies (Brett, 1987; Coyle & Sokop, 1990) that found no significant relationships between use of nursing research and nursing education level. These two studies had fewer than 5 per cent of their subjects with master's degrees in nursing. The new population studied had 49 per cent master's prepared nurses, which provided the necessary foundation to expand the examination of the relationship of higher education and use of research findings among nurses. Whereas the overall extent of dissemination and use of research findings among nurses in the sample was similar to that of the two previous studies, it was found that nurses with a master's degree reported higher utilization than those with a bachelor's degree. This finding suggests a unique and critical role for the master's-prepared nurse in the dissemination and use of research findings in the practice setting.

Immunomodulatory effects of alpha interferon and thymostimulin in patients with neoplasias

In this report, we have evaluated the immunological effects following administration of alpha interferon (IFN-alpha) in combination with thymostimulin (TP-1), as well as of IFN-alpha and TP-1 alone in patients with neoplasias who underwent surgery and were subsequently treated with conventional chemotherapy. Data suggest that the combination of IFN-alpha and TP-1 is the most effective in the up-regulation of some immune parameters such as the CD4(+)-CD8+ cell-dependent antibacterial activity. Since this immune function plays an important role in the host protection against different targets such as invading microorganisms and/or neoplastic cells, the administration of TP-1-IFN-alpha is advisable for patients with neoplasias under chemotherapy.

A cost-effectiveness analysis of acute care case management outcomes

Case management was more cost effective in a moderately uncertain practice environment than in either a low or a high uncertainty environment. The environmental state, case manager role differentiation, and information coordination contributed most strongly to these outcomes.

Control of Listeria monocytogenes in the delicatessen industries: the lessons of a listeriosis outbreak in France

During a recent outbreak of foodborne listeriosis which occurred in France in 1992, investigations were carried out in order to identify the plants associated with the production of contaminated products. These investigations were made in six 'suspect' delicatessen plants following the first epidemiological investigations, and in one 'control plant'. The first visits were made during working operations. Two hundred and seventy samples were taken ('environmental' swabs, air samples, products), with 68% of the swabs being positive for Listeria monocytogenes in raw product areas, and 33% positives in the finished product area. The epidemic phagovar was identified in a single plant preparing pork tongues in aspic. The major causes of contamination identified were contact of cooked products with soiled surfaces, cross-contamination between 'raw' and 'cooked' channels and the inadequacy of cleaning and disinfection procedures. A second visit was also made to five plants to provide validation of their cleaning and disinfection procedures. Among 112 swabs collected, 17% of the samples from raw product surfaces and 7% from finished product surfaces were found to be positive. These results suggest that cleaning and disinfection procedures were unable to eliminate sources of L. monocytogenes when not correctly applied.

Beliefs and perceptions about children in pain: a survey

This survey examined beliefs about pain in children and perceptions of the adequacy of pain management among 228 nursing personnel in a pediatric setting in the Southeast. Nursing education correlated positively with both beliefs and perceptions of current practice. Years of nursing experience, number of years of pediatric nursing experience, and age were not significantly correlated with either factor. Respondents perceived the need for (a) educating physicians about effective pain management, (b) more information about pain management in the neonatal/infant population, (c) more collaboration between nurses and physicians when managing pain in children, and (d) more support for nurses to influence pain management. The overwhelming majority (> 95%) of respondents expressed interest in learning more about assessment and management of pain in children.

Case management: the relationship between structure & environment

In response to increasingly uncertain practice environments, case management structural dimensions of role differentiation, task coordination, and decentralization remained constant, while nurse participation in decision making increased significantly.

Environmental uncertainty: implications for practice model redesign

Analysis of one academic medical center revealed three distinct nursing practice environments distinguished by increasing levels of complexity, change, unpredictability, and uncertainty. Designing practice models to accommodate these conditions will facilitate more efficient and effective patient outcomes.

Case management and preventive services among infants from low-income families

To determine the impact of an experimental approach to case management on use of child health clinic and immunization services, a nonequivalent control group with covariate measures design was employed in a sample of 98 infants from low-income families. The innovative pattern of care featured continuity of care; a single public health nurse (PHN) provided child health care to an infant by integrating case management and preventive services. In contrast, the customary pattern of child health care was characterized by fragmentation of services. Case management was segregated from preventive services, and multiple PHNs delivered care to an infant. As predicted, experimental-group infants (44%) were more likely to achieve adequate child health clinic services than control-group infants (8%) (p < 0.001). Moreover, the cost-effectiveness (C/E) ratio (dollar cost per effective intervention) for adequate child health clinic visits in continuous care ($523) was one-fifth of that in fragmented care ($2,900). The C/E ratio related to adequate immunization was 8% less in continuous care ($359) than in the fragmented approach ($386), although the difference in rates of adequate immunization was nonsignificant (experimental group, 64%; control group, 60%). These findings suggest that continuous PHN care with integrated case management is a more effective, cost-efficient approach to critical child preventive services than the customary, segregated case-management approach.

A measure of perceived environmental uncertainty in hospitals

The purpose of this study is to evaluate the preliminary psychometric properties of the Perceived Environmental Uncertainty Questionnaire (PEUQ). Environmental uncertainty (EU) refers to times when within the organization unanticipated events and problems occur with frequency and cannot be predicted by members of the organization due to a lack of critical information. The PEUQ was designed as a measure of EU and was tested with 375 patient-care and nonpatient-care hospital employees. Internal consistency as measured by Cronbach's alpha was .81. Confirmatory factor analysis supported two of the PEUQ's hypothesized three factors: state and effect EU. These two factors accounted for 61.1% of the variance in subjects' level of uncertainty. Factor analysis failed to confirm response uncertainty as a subconstruct of EU. Contrasted group analysis found expected differences in the level of perceived EU between workers on different hospital units (t = -5.02, p < .001). This study provides evidence of the PEUQ's beginning reliability and validity as a measure of EU. Failure to identify response uncertainty as a salient subconstruct of EU warrants further exploration. The design of nursing care delivery structures (NCDS) to minimize EU first requires a means to measure hospital units' EU. The establishment of the PEUQ's psychometric soundness is antecedent to measuring EU and improving the efficacy of our NCDS.

Body size values of white and black women

The purpose of this naturalistic study was to compare values held by 36 white and 31 black women related to body size, and to identify factors that influence these values and linkages between body size values and weight management activities. Black women of lower SES were significantly different from black women of higher SES and white women, regardless of SES, in that they were heavier, viewed themselves as heavier, and perceived attractive body size as heavier. Black lower status women had to become a great deal heavier than the other groups before they defined themselves as overweight. We suggest that black lower social status women have a wider range of "normal" and attractive body size and that this wider range is developed from comparisons of other women in their social milieu and influences the initiation of weight loss activities.

Maternal risk factors in infants with very low birth weight

To determine whether maternal risk factors associated with the delivery of very low birth weight infants under 1501 g are different from those associated with low birth weight infants of 1501 to 2500 g, prenatal data on 12,247 deliveries were evaluated. The sample contained 302 very low birth weight infants. Maternal race, age, height, weight, gravidity, parity, past pregnancy performance, and pregnancy complications were analyzed. Factors related to very low birth weight but not to low birth weight infants were previous abortions, previous fetal deaths, and hypertensive vascular disease. Race, maternal height, and prepregnancy weight were not related to very low birth weight but were associated with an increase in low birth weight. There was no significant difference in the rate of very low birth weight or low birth weight by maternal age from 14 to 40 years. These results contradict the concept of a uniform set of predisposing factors for birth of all infants weighing 2500 g or less.

[Plasmodium falciparum and drepanocytic gene in Popular Republic of Congo. I. Prevalence of malaria and drepanocytic trait among school children in Brazzaville area (author's transl)]

From 1978 to 1979, 5 surveys, among schoolchildren, were carried out during the rainy season in the neighbourhood of Brazzaville (R.P. Congo): 3 in PK 45 village (northern part of the capital), 2 in Djoumouna village (southern part), and 1 in "Talangai" (a suburb of the capital). 868 exams (plasmodic and splenic index fitted with hemoglobin composition [Hb AA or Hb AS]) were done. It appeared that 19,6% of schoolchildren examined were heterozygous sicklers (AS). This percentage confirmed the previous results from other authors in different countries of Central Africa. On the other hand, in spite of an intense transmission, both plasmodic and splenic index were, on the average, relatively low (24,5 and 24,8% respectively). Plasmodium falciparum was largely predominant (95,3% of infections) but P. ovale and P. malariae were also found (1,9% for each species). From our study no obvious "protecting effect" can be attributed to sickle cell trait because plasmodic index of children AA and AS were similar (23,8 and 27,6% respectively). A slight decrease of splenic index was noticed in AS in regard to AA (19,4 and 26.1% respectively). It is difficult to consider this no significative regression as a definitive proof of a premunition stronger in AS than in AA. Effectively some splenic infarctus are well known to be a regular physiopathological process occurring in homozygous SS but often in heterozygous AS too. In such highly endemic and stable malaria area the problem of a suitable antimalaria strategy remains to be solved.