Medicine and Health Sciences Commons^™

Characterisation Of Amyloid Fibril Formation By Small Heat-Shock Proteins, Human Alphaa-, Alphab- And R120g Alphab-Crystallins, Sarah Meehan, Tuomas Knowles, Andrew Baldwin, Jeffrey Smith, Adam Squires, Phillip Clements, Teresa Treweek, Heath Ecroyd, Gian Tartaglia, Michele Vendruscolo, Cait Macphee, Christopher Dobson, John Carver

Heath Ecroyd

AlphaB-Crystallin is a ubiquitous small heat-shock protein (sHsp) renowned for its chaperone ability to prevent target protein aggregation. It is stress-inducible and its up-regulation is associated with a number of disorders, including those linked to the deposition of misfolded proteins, such as Alzheimer's and Parkinson's diseases. We have characterised the formation of amyloid fibrils by human alphaB-crystallin in detail, and also that of alphaA-crystallin and the disease-related mutant R120G alphaB-crystallin. We find that the last 12 amino acid residues of the C-terminal region of alphaB-crystallin are predicted from their physico-chemical properties to have a very low propensity to aggregate. (1)H …

Implementing Evidence-Based Practices: Considerations For The Hospice Setting, S. Sanders, Melissa Lehan Mackin, J. Reyes, Keela Herr, M. Titler, P. Fine, C. Forcucci

Melissa Lehan Mackin

No abstract provided.

Hand Problems Among Endourologists., Kelly A Healy, Raymond W Pak, Ryan C Cleary, Arturo Colon-Herdman, Demetrius H Bagley

Department of Urology Faculty Papers

BACKGROUND AND PURPOSE: Endourology has evolved rapidly for the management of both benign and malignant disease of the upper urinary tract. Limited data exist, however, on the occupational hazards posed by complex endourologic procedures. The aim of this study was to determine the prevalence and possible causes of hand problems among endourologists who routinely perform flexible ureteroscopy compared with controls.

MATERIALS AND METHODS: An online computer survey targeted members of the Endourological Society and psychiatrists in academic and community settings. A total of 600 endourologists and 578 psychiatrists were contacted by e-mail. Invited physicians were queried regarding their practice settings …

Functional Genomics Reveals An Essential And Specific Role For Stat1 In Protection Of The Central Nervous System Following Herpes Simplex Virus Corneal Infection, Tracy J. Pasieka, Cristian Cilloniz, Victoria S. Carter, Pamela Rosato, Michael G. Katze, David A. Leib

Dartmouth Scholarship

Innate immune deficiencies result in a spectrum of severe clinical outcomes following infection. In particular, there is a strong association between loss of the signal transducer and activator of transcription (Stat) pathway, breach of the blood-brain barrier (BBB), and virus-induced neuropathology. The gene signatures that characterize resistance, disease, and mortality in the virus-infected nervous system have not been defined. Herpes simplex virus type 1 (HSV-1) is commonly associated with encephalitis in humans, and humans and mice lacking Stat1 display increased susceptibility to HSV central nervous system (CNS) infections. In this study, two HSV-1 strains were used, KOS (wild type [WT]), …

Buffered Memory: A Hypothesis For The Maintenance Of Functional, Virus-Specific Cd8(+) T Cells During Cytomegalovirus Infection., Christopher M Snyder

Department of Microbiology and Immunology Faculty Papers

Chronic infections have been a major topic of investigation in recent years, but the mechanisms that dictate whether or not a pathogen is successfully controlled are incompletely understood. Cytomegalovirus (CMV) is a herpesvirus that establishes a persistent infection in the majority of people in the world. Like other herpesviruses, CMV is well controlled by an effective immune response and induces little, if any, pathology in healthy individuals. However, controlling CMV requires continuous immune surveillance, and thus, CMV is a significant cause of morbidity and death in immune-compromised individuals. T cells in particular play an important role in controlling CMV and …

We Can Do It Together: Par1/Par2 Heterodimer Signaling In Vsmcs., Rafal Pawlinski, Michael Holinstat

Department of Medicine Faculty Papers

In this issue, Sevigny and colleagues demonstrate that a protease-activated receptor 1 (PAR1)-PAR2 heterodimer regulates vascular smooth muscle cell (VSMC) hyperplasia following vascular injury ¹. PARs belong to a family of G-protein coupled receptors that are proteolytically activated by a variety of proteases ^{2, 3}. Cleavage of PARs results in intracellular signaling mediated by activation of various G proteins including G_12/13, G_q, and G_i ^{2, 4-6}. The PAR family consists of 4 members, PAR1-PAR4, with PARs 1, 3, and 4 being primarily activated by thrombin, while PAR2 is activated by trypsin and …

Practice Theory Development: A Model For Person-Centered Care, S. Cumbie, Virginia Conley, M. Burman, C. Weinert

Virginia M. Conley

No abstract provided.

Promoting Healthy Behaviors Through Process Engagement: Chronic Illness: Clarifying The Concepts Of Information And Information Seeking And Usage... Proceedings Of The Communicating Nursing Research Conference And Win Assembly, "Responding To Societal Imperatives Through Discovery And Innovation", Held April 10-12, 2003, Scottsdale, Arizona, Virginia Conley

Virginia M. Conley

No abstract provided.

The Role Of Values In Caregiver Information-Seeking Behavior, Virginia Conley

Virginia M. Conley

Significance of findings include important relationships noted between values, actions, outcomes, and assigned meaning. Providers' awareness and understanding of involved values may clarify perceived erratic or noncompliant behaviors and provide the means for providing caregivers with information that will enable terminal values to be fulfilled, thereby facilitating the assignment of meaning to their experiences and the death of their loved ones.

Family Caregiver Provided Massage For Rural-Dwelling Chronically Ill Persons, D. Kempson, Virginia Conley

Virginia M. Conley

Family caregivers attending to chronically ill family members within the community are vulnerable to psychological and medical health issues. Rural caregivers may be at increased risk because of fewer resources. This pilot study explored whether rural caregivers would learn and provide gentle massage to their chronically ill loved ones, would find study participation burdensome, and would realize benefits from providing the massage. Positive results in each of the three areas suggest that providing caregivers with instruction on gentle massage techniques for their chronically ill loved ones may support and enhance rural caregivers' perceptions of self-efficacy and self-agency and thus possibly …

Iowa Case Management For Rural Drug Abuse, J. Hall, Msv Sarrazin, Diane Huber, T. Vaughn, R. Block, A. Reedy, M. Jang

Diane Huber

Objective: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. Results: Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to …

Psychometric Evaluation Of The Structured Clinical Interview For Dsm-Iv Childhood Diagnoses (Kid-Scid), D. Smith, Diane Huber, J. Hall

Diane Huber

The purpose of this study was to evaluate the reliability and validity of selected modules of the Structured Clinical Interview for DSM IV (KID-SCID, Version 1.0). The Disruptive Behavior Disorders (i.e., ADHD, ODD, CD) and Substance Related Disorders modules of the KID-SCID were administered to 50 adolescents receiving residential treatment for substance abuse and severe behavioral problems. This study examined available evidence for inter-rater reliability and convergent validity. Convergent validity was demonstrated for the Disruptive Behavior Disorders module, however, the Substance Abuse Disorders module failed to converge with frequency of use for most substances. Inter-rater reliability was generally high. This …

Molecular Diagnostics In Periprosthetic Joint Infection., Javad Parvizi, Lesley Walinchus, Bahar Adeli

Department of Orthopaedic Surgery Faculty Papers

Periprosthetic joint infection (PJI) is a significant and costly challenge to the orthopedic community. The lack of a gold standard for diagnosis remains the biggest obstacle in the detection and subsequent treatment of PJI. Molecular markers in the serum and joint fluid aspirate hold immense promise to enhance the development of a firm diagnostic criterion. The primary goal is one marker with high sensitivity and specificity. Here, we review our current research efforts in the field of molecular markers: C-reactive protein, erythrocyte sedimentation rate, white blood cells, and leukocyte esterase. Each marker has been studied to determine its sensitivity, specificity, …

Catastrophic Reactions And Other Behaviors Of Alzheimer's Residents: Special Unit Compared With Traditional Units, Elizabeth Swanson, Meridean Maas, Kathleen Buckwalter

Elizabeth A. Swanson

Using a quasi-experimental pretest/posttest design, the effects of a Special Care Unit (SCU) on the incidence of catastrophic reactions and other behaviors of nursing home residents with Alzheimer's disease (AD) were examined. Findings indicate significantly fewer catastrophic reactions and other selected behavior changes occurred during the posttest period for subjects in the experimental group compared with the subjects in the control group. Implications for psychiatric consultation/liaison nurses (PCLNs) working with this vulnerable population are discussed.

Outcomes Of Family Involvement In Care Intervention For Caregivers Of Individuals With Dementia, Meridean Maas, D. Reed, M. Park, Janet Specht, D. Schutte, Lisa Skemp Kelley, Elizabeth Swanson, Toni Tripp-Reimer, Kathleen Buckwalter

Elizabeth A. Swanson

BACKGROUND: Despite the increasing number of individuals with dementia relocated from caregiving at home to a nursing home, there is only a small body of literature examining the influence of institutional family-oriented practices on family member perceptions of care and family-staff relationships. OBJECTIVE: The study tested the effects of the Family Involvement in Care partnership intervention on family members' perceptions of their caregiving role, relationships with staff, and satisfaction with the care of relatives with dementia residing in special care units as well as the effects on staff attitudes toward families and staff satisfaction with a caregiving role. METHODS: A …

Family Visitation On Special Care Units, Lisa Skemp Kelley, Elizabeth Swanson, Meridean Maas, Toni Tripp-Reimer

Elizabeth A. Swanson

With placement of a family member with Alzheimer's disease on a SCU, the family does not relinquish the caregiving role, rather they take on different roles in relation to the residents. Family visitation of the residents on the SCU is an integral part of family involvement in care of individuals with Alzheimer's disease, as well as SCU functioning. Within the context of changing relationships with the residents, family members visited the residents as a sense of duty to "be faithful," to monitor care by "being their eyes and ears," and to foster a sense of family through ongoing relationships and …

Special Care Units For Persons With Alzheimer's Disease: A Successful Intervention?, Kathleen Buckwalter, Meridean Maas, Elizabeth Swanson, G. Hall

Elizabeth A. Swanson

No abstract provided.

Russian Citizens' Trusted Sources Of Health Promotion Information, C. Goody, Elizabeth Swanson, A. Bossen, E. Frolova, O. Kuznetsova, S. Plavinski

Elizabeth A. Swanson

This study examined Russian citizens' trusted sources of health information. A random sample of 906 people, from two villages in St. Petersburg, Russia, responded to a health needs assessment questionnaire. Results suggest that medical professionals and special books, such as informational pamphlets about treating a myriad of illnesses, are significant trusted sources of health information for people in Russia. Further, these data suggest differences between trusted sources of health information exist between villages rather than by gender or age group. This work has implications for health care practitioners in Russia, who are advancing the discipline of family practice, as well …

Prevalence And Risk Factors Of Adverse Reactions To Natural Rubber Latex Among Nursing Personnel, Victoria Steelman

Victoria J. Steelman

Allergic reactions to products containing natural rubber latex (NRL), ranging in severity from contact dermatitis, rhinoconjunctivitis to asthma and anaphylaxis, are becoming increasingly common among healthcare workers. These reactions may be life threatening. Yet, little is known about the prevalence or risk factors for development of sensitization in nursing staff. Specific aims of this study were to: (1) determine prevalence of symptoms resulting from exposure to NRL and (2) identify risk factors (allergic predisposition, air latex content, glove use, frequency of NRL exposure in workplace, non-workplace exposures) for severity of symptoms to NRL contact among nursing staff. Hypotheses were, nursing …

Guiding Inpatient Quality Improvement: A Systematic Review Of Lean And Six Sigma, Justin Glasgow, Jill Scott-Caziewell, Peter Kaboli

Jill Scott-Cawiezell

Background: Two popular quality improvement (QI) approaches in health care are Lean and Six Sigma. Hospitals continue to adopt these QI approaches -- or the hybrid Lean Sigma approach -- with little knowledge on how well they produce sustainable improvements. A systematic literature review was conducted to determine whether Lean, Six Sigma, or Lean Sigma have been effectively used to create and sustain improvements in the acute care setting. Methods: Databases were searched for articles published in the health care, business, and engineering literatures. Study inclusion criteria required identification of a Six Sigma, Lean, or Lean Sigma project; QI efforts …

Technology Innovations. Barriers To Safe Medication Administration In The Nursing Home: Exploring Staff Perceptions And Concerns About The Medication Use Process, A. Vogelsmeier, Jill Scott-Cawiezell, D. Zellmer

Jill Scott-Cawiezell

The purpose of this study was to explore staff perceptions and concerns about the medication use process in the nursing home setting. A total of 76 staff members from 5 nursing homes in 3 Midwestern states participated in key informant interviews and focus groups. Common themes included issues related to communication, competing demands, and the challenges of a paper-based medication administration record. Concerns frequently were associated with the timeliness and accuracy of the medication administration process. Recognition of staff concerns are an important first step in improving the nursing home medication use process. Staff insight provided clarification related to impediments …

Saddle Pulmonary Embolism: Is It As Bad As It Looks? A Community Hospital Experience., Alejandro Sardi, Jill Gluskin, Adam Guttentag, Morris N Kotler, Leonard E Braitman, Michael Lippmann

Division of Pulmonary and Critical Care Medicine Faculty Papers

BACKGROUND: Saddle pulmonary embolism represents a large clot and a risk for sudden hemodynamic collapse. However, the clinical presentation and outcomes vary widely. On the basis of the findings of right heart dysfunction on echocardiograms, computed tomography angiography, or cardiac enzyme elevation, some argue for the use of thrombolytics or catheter thrombectomy even for hemodynamically stable patients.

OBJECTIVE: To investigate the outcomes and management of patients with saddle pulmonary embolism, including radiographic appearance (estimate of clot burden) and echocardiographic features.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: This study is a retrospective evaluation of all patients with computed tomography angiography positive …

Psychometric Properties Of The Beginning Breastfeeding Survey, Pamela Mulder

Pamela J. Mulder

The Beginning Breastfeeding Survey is a reliable and valid measure of breastfeeding effectiveness during the postpartum hospitalization. Providing an accurate assessment of a mother's perception of breastfeeding effectiveness, the Beginning Breastfeeding Survey will guide targeted interventions to increase breastfeeding effectiveness and duration.

A Concept Analysis Of Effective Breastfeeding, Pamela Mulder

Pamela J. Mulder

OBJECTIVE: To provide a concept analysis of effective breastfeeding. DATA SOURCES: Medline and CINAHL electronic databases, reference lists from selected articles, and 7 breastfeeding assessment tools. Search terms included the following: breastfeeding and effective, adequate, successful. STUDY SELECTION: Literature was selected according to whether the concept of effective breastfeeding was defined or described. DATA EXTRACTION: Literature was reviewed and data organized as definitions or descriptions, with descriptions grouped into categories sharing similar characteristics. DATA SYNTHESIS: Four characteristics were chosen as essential attributes of effective breastfeeding: positioning, latch, sucking, and milk transfer. CONCLUSIONS: The concept of effective breastfeeding requires further concept …

An Epidemiologic Analysis Of Pain In The Elderly: The Iowa 65+ Rural Health Study, Paula Mobily, Keela Herr, M. Clark, R. Wallace

Paula Mobily

No abstract provided.

Reliability Of The 60+ Functional Fitness Test Battery For Older Adults, K. E. Mobily, Paula R. Mobily

Paula Mobily

The primary purpose of this investigation was to determine the internal consistency of the 60+ functional fitness test battery for older adults. A secondary purpose was to determine whether the number of trials recommended in the testing manual was optimal. Subjects were used from an ongoing study of a fitness program for community-dwelling older adults. Internal consistency coefficients for subtests of flexibility, agility, coordination, and strength were excellent. Post hoc analysis across trials indicated significant differences in means between early trials and later trials. Mean scores stabilized after two or three trials, depending on the subtest of interest. Data provided …

Geriatric Mental Health: Staff Stress On An Alzheimer's Unit, Paula Mobily, Meridean Maas, Kathleen Buckwalter, Lisa Skemp Kelley

Paula Mobily

Nurses who work with patients with Alzheimer's disease (AD) are especially vulnerable to the effects of stress and burnout. Many are poorly trained to cope with the emotional and behavioral problems of these residents and are repeatedly frustrated by their inability to manage these recurrent problems. Specialized care units (SCUs) reduced stress in the areas of staff knowledge, abilities, and resources. The SCU was designed specifically to provide the special environmental structures, support, and service systems required for the care of persons with AD that would enhance functioning and decrease associated behavioral problems. Support groups can assist nurses to recognize …

Practice Concepts. Unit-Based Acute Confusion Resource Nurse: An Educational Program To Train Staff Nurses, C. Rapp, L. Onega, Toni Tripp-Reimer, N. Morrow-Howell, Paula Mobily, B. Wakefield, M. Kundrat, J. Akins, K. Wadle, J. Mentes, Kennith Culp, J. Meyer, J. Waterman

Paula Mobily

No abstract provided.

Strength Training And Falls Among Older Adults: A Community-Based Tr Intervention, K. Mobily, Paula Mobily, R. Raimondi, K. Walter, L. Rubenstein

Paula Mobily

The purpose of this study was to determine the effectiveness of a community-based strength training program for older adults in decreasing falls. Subjects who completed a strength training program and an age and gender matched comparison group of older adults who did not participate in the strength training program were questioned about falls during the preceding year. Functional fitness measures for coordination, balance, and strength significantly improved in strength training subjects after completion of a six week program. Furthermore, after controlling for gender effects, the findings revealed that the strength training group reported significantly fewer falls in the preceding year …

Acute Confusion Assessment Instruments: Clinical Versus Research Usability, C. Rapp, B. Wakefield, M. Kundrat, J. Mentes, Toni Tripp-Reimer, Kennith Culp, Paula Mobily, J. Akins, L. Onega

Paula Mobily

Acute confusion (AC), also referred to as delirium (AC/delirium), is a common problem seen by health professionals who work in a variety of care settings. This is an evaluative report on the clinical usability of instruments to assess AC/delirium as a part of nursing practice. Specifically, five instruments [the Confusion Assessment Method (CAM), Delirium Rating Scale (DRS), Delirium Symptom Inventory (DSI), Mini-Mental State Examination (MMSE), and Neelon/Champagne (NEECHAM) Confusion Scale] are discussed. The work demonstrates how the cooperation of nurses in practice, education, and research can improve both patient and staff outcomes.