bluuebunny/crossref_metadata_2025_split huggingface dataset:
Marek's Disease Viral Interleukin-8 Promotes Lymphoma Formation through Targeted Recruitment of B Cells and CD4
+
CD25
+
T Cells
Authors: Engel Annemarie T. , Selvaraj Ramesh K. , Kamil Jeremy P. , Osterrieder Nikolaus , Kaufer Benedikt B. 
Published: May 2012

ABSTRACT

Marek's disease virus (MDV) is a cell-associated and highly oncogenic alphaherpesvirus that infects chickens. During lytic and latent MDV infection, a CXC chemokine termed viral interleukin-8 (vIL-8) is expressed. Deletion of the entire vIL-8 open reading frame (ORF) was shown to severely impair disease progression and tumor development; however, it was unclear whether this phenotype was due to loss of secreted vIL-8 or of splice variants that fuse exons II and III of vIL-8 to certain upstream open reading frames, including the viral oncoprotein Meq. To specifically examine the role of secreted vIL-8 in MDV pathogenesis, we constructed a recombinant virus, vΔMetvIL-8, in which we deleted the native start codon from the signal peptide encoding exon I. This mutant lacked secreted vIL-8 but did not affect Meq–vIL-8 splice variants. Loss of secreted vIL-8 resulted in highly reduced disease and tumor incidence in animals infected with vΔMetvIL-8 by the intra-abdominal route. Although vΔMetvIL-8 was still able to spread to naïve animals by the natural route, infection and lymphomagenesis in contact animals were severely impaired.
In vitro
assays showed that purified recombinant vIL-8 efficiently binds to and induces chemotaxis of B cells, which are the main target for lytic MDV replication, and also interacts with CD4
+
CD25
+
T cells, known targets of MDV transformation. Our data provide evidence that vIL-8 attracts B and CD4
+
CD25
+
T cells to recruit targets for both lytic and latent infection.
Efficient Human Cytomegalovirus Reactivation Is Maturation Dependent in the Langerhans Dendritic Cell Lineage and Can Be Studied using a CD14+Experimental Latency Model
Authors: Huang Margaret M. , Kew Verity G. , Jestice Kevin , Wills Mark R. , Reeves Matthew B. 
Published: May 2012

ABSTRACTStudies from a number of laboratories have shown that the myeloid lineage is prominent in human cytomegalovirus (HCMV) latency, reactivation, dissemination, and pathogenesis. Existing as a latent infection in CD34+progenitors and circulating CD14+monocytes, reactivation is observed upon differentiation to mature macrophage or dendritic cell (DC) phenotypes. Langerhans' cells (LCs) are a subset of periphery resident DCs that represent a DC population likely to encounter HCMV early during primary infection. Furthermore, we have previously shown that CD34+derived LCs are a site of HCMV reactivationex vivo. Accordingly, we have utilized healthy-donor CD34+cells to study latency and reactivation of HCMV in LCs. However, the increasing difficulty acquiring healthy-donor CD34+cells—particularly from seropositive donors due to the screening regimens used—led us to investigate the use of CD14+monocytes to generate LCs. We show here that CD14+monocytes cultured with transforming growth factor β generate Langerin-positive DCs (MoLCs). Consistent with observations using CD34+derived LCs, only mature MoLCs were permissive for HCMV infection. The lytic infection of mature MoLCs is productive and results in a marked inhibition in the capacity of these cells to promote T cell proliferation. Pertinently, differentiation of experimentally latent monocytes to the MoLC phenotype promotes reactivation in a maturation and interleukin-6 (IL-6)-dependent manner. Intriguingly, however, IL-6-mediated effects were restricted to mature LCs, in contrast to observations with classical CD14+derived DCs. Consequently, elucidation of the molecular basis behind the differential response of the two DC subsets should further our understanding of the fundamental mechanisms important for reactivation.
Parenteral Pethidine for labour pain relief and substance use disorder: 20-year follow-up cohort study in offspring
Authors: Pereira Robert Rodrigues , Kanhai Humphrey , Rosendaal Frits , van Dommelen Paula , Swaab Dick , Rodrigues Pereira Erik , van de Wetering Ben 
Published: May 2012

ObjectiveTo determine whether use of intrapartum Pethidine pain analgesia increases the risk for substance use disorder in adult offspring.DesignAnalysis of data from a cohort study.SettingAcademic hospital in Leiden, the Netherlands.Participants133 cases and 164 control individuals, aged 18–20 years at follow-up.Main outcome measureIncidence of substance use disorder or use of alcohol and tobacco.ResultsThe lifetime use of addictive substances in children exposed to intrapartum Pethidine analgesia was 45% of 133 children versus 48% of 164 not-exposed subjects (adjusted OR=0.79, 95% CI 0.48 to 1.29). Recent use of alcohol, tobacco and hard drugs showed no statistical difference either.ConclusionPethidine for labour pain medication appears not to be associated with substance misuse or smoking in later life.
Disability pension among young women in Sweden, with special emphasis on family structure: a dynamic cohort study
Authors: Floderus Birgitta , Hagman Maud , Aronsson Gunnar , Gustafsson Klas , Marklund Staffan , Wikman Anders 
Published: May 2012

ObjectivesThe influence of family structure on the risk of going on disability pension (DP) was investigated among young women by analysing a short-term and long-term effect, controlling for potential confounding and the ‘healthy mother effect’.Design and participantsThis dynamic cohort study comprised all women born in Sweden between 1960 and 1979 (1.2 million), who were 20–43 years of age during follow-up. Their annual data were retrieved from national registers for the years 1993–2003. For this period, data on family structure and potential confounders were related to the incidence of DP the year after the exposure assessment. Using a modified version of the COX proportional hazard regression, we took into account changes in the study variables of individuals over the years. In addition, a 5-year follow-up was used.ResultsCohabiting working women with children showed a decreased risk of DP in a 1-year perspective compared with cohabiting working women with no children, while the opposite was indicated in the 5-year follow-up. Lone working women with children had an increased risk of DP in both the short-term and long-term perspective. The risk of DP tended to increase with the number of children for both cohabiting and lone working women in the 5-year follow-up.ConclusionsThe study suggests that parenthood contributes to increasing the risk of going on DP among young women, which should be valuable knowledge to employers and other policy makers. It remains to be analysed to what extent the high numbers of young women exiting from working life may be counteracted by (1) extended gender equality, (2) fewer work hours among fathers and mothers of young children and (3) by financial support to lone women with children.
Provision of palliative care for life-limiting disease in a low income country national hospital setting: how much is needed?
Authors: Lewington Jane , Namukwaya Elizabeth , Limoges Julie , Leng Mhoira , Harding Richard 
Published: May 2012

ObjectivesThis study aimed to measure the magnitude of palliative care needs among hospital inpatients. Objectives were to: (1) determine the point prevalence of inpatients with active life-limiting disease and (2) describe multidimensional need for palliative care among these patients.MethodsThe study was a hospital inpatient census in Uganda. Patient notes were surveyed and those patients identified as having an active life-limiting disease were interviewed. Multidimensional palliative care need was assessed using the African Palliative Care Association (APCA) African Palliative Outcome Scale (POS).Results122/267 (46%) patient notes were found to indicate an active life-limiting disease. Diagnoses were; HIV/AIDS (74/122, 61%), cancer (22/122, 18%), heart failure (11/122, 9%), renal failure (11/122, 9%), liver failure (3/122, 2%) and chronic obstructive pulmonary disease (1/122, 1%). A total of 78/122 patients consented to be interviewed. Most patients reported multidimensional need in the three most negative of six categories for any APCA African POS question (75/78, 96%). Social problems included an inability to work (72/78, 92%), having unaffordable medical expenses (39/78, 50%) and limited access to food (11/78, 14%). Of those with a faith (76/78), more than a third (29/78, 38%) expressed the need for increased faith support.ConclusionsThe prevalence of active life-limiting disease reported here (46%) is greater than in comparable European studies (5–23%).This reflects the sub-Saharan increased disease prevalence, presentation at a later stage and limited access to curative therapies. There is need for symptom control, food, financial assistance and spiritual support. Service development should be tailored to meet these needs.
Advance care planning discussions among residents of LTC and DAL in Alberta
Authors: Dyason C. , Wityk Martin TL. , Simon J. 
Published: May 2012

Patients, physicians and the health care system are faced with the challenge of determining, and respecting, the medical wishes of an aging population. Patient autonomy and informed decision-making can only be maximised when the decision-making process is better understood. In 2008, Alberta Health Services initiated its “Advance Care Planning: Goals of Care Designation” (ACP:GCD) policy in the Calgary Zone. This policy encouraged discussions about goals of care (GOC) and used a tracking form to capture these conversations. Chart audits were performed at 3 time points: at baseline, at 6 months, and at 18 months post implementation. Recorded data included presence of an advance directive on the chart, indication of a personal representative/agent, and the number, participants and recorded key outcomes of documented ACP conversations.This study will perform a retrospective review of the results of those audits in both Long Term Care (LTC) and Designated Assisted Living sites (DAL). Specifically, we will address what elements of ACP were discussed including: prognosis and anticipated outcomes of treatment, patient's values and understanding/expectation of treatment options, life sustaining measures/degree of benefit, comfort measures, resources available and GOC. 166 charts had documented ACP discussions, representing 81% of LTC charts reviewed and 87% of those in DAL.The limitations of this study are those retrospective data and the reliance on accurate/thorough chart documentation. The study will identify current practice in the advance care planning process in LTC And DAL and potential gaps in that practice.
A clinical decision support tool to improve care planning in end-of-life cancer care
Authors: Elvidge K 
Published: May 2012

In end-of-life cancer care, nurse clinicians strive to deliver an effective care plan to minimise pain, manage debilitating symptoms, and improve patients' quality of life as they approach end of life. Sadly, existing research literature is replete with studies contesting that sub-optimal pain and symptom management remains the reality for many end-of-life cancer patients, resulting in unnecessary suffering and a diminished quality of life.To begin to overcome the chasm between inadequate pain and symptom management currently delivered in end-of-life care, and the excellent standard of care that could be achieved, nurse clinicians need only leverage knowledge from existing knowledge resources. Researchers assert that clinical decision making for care planning in end-of-life cancer care can be improved by ensuring access to contextually relevant, medical knowledge resources at the point-of-care. Collectively, these medical knowledge resources represent a valuable asset which can improve clinical decisions and the delivery of best clinical practice, while reducing medical uncertainty, unnecessary clinical variation, and medical errors.In this research we present a clinical decision support system to bridge the knowledge gap that currently impedes the planning, and delivery, of effective pain and symptom management in end-of-life cancer care. This system enables nurse clinicians to: (a) make informed clinical decisions based upon the patient's presenting situation, care priorities, preferences, and standards of care; and (b) create personalised care plans for effective pain and symptom management in end-of-life cancer care.
Practice and attitude toward advance care planning among Japanese palliative care physicians
Authors: Kizawa Yoshiyuki , Tsuneto Satoru , Abe Yasushi 
Published: May 2012

The aim of this study is to examine physicians' attitude toward ACP in PCU in Japan.We conducted a questionnaire survey to responsible physicians who worked in 203 certified PCU in December 2010. We asked them to complete a questionnaire regarding their attitude toward, and practice of ACP. We used 15 items questionnaire adopted from previous research (Davidson K, JAMA 1989) to investigate physician's attitude toward ACP. The questionnaire was confirmed its content validity by conveniently sampled 10 palliative care specialists.Among 203 physicians contacted, 95 returned the questionnaire (response rate 47%). The percentage of physicians who practicing ACP discussion during admission in PCU regarding implementation of CPR, existing Advance Directives (ADs) and Power of Attorney of health care was 33%, 46% and 40 % respectively.Responses to attitude statements were similar to US study in 1987 except for following three statements; “In a catastrophic situation, I would have greater confidence in my treatment decisions if guided by an AD”, “Widespread use of ADs could help contain medical expenditure” and “Widespread acceptance of ADs will lead to less aggressive treatment even of patients who do not have an AD” (34.4%, 31.4% and 28.6% of Japanese physicians answered agree or strongly agree V.S. 70.9%, 74.1% and 61.2% of US physicians).This study will clarify physicians' practice and attitude toward ACP in PCU in Japan, and provide evidence of the unique cultural diversity toward end-of-life care and ACP among Japanese.
Conversations that matter: using videos to model quality ACP conversations between clinicians and patients
Authors: Vig C , Berg B , Simon J 
Published: May 2012

In 2008, the “Advance Care Planning: Goals of Care Designation (ACP/GCD) (Adult)” policy was systematically implemented across all sectors within Alberta Health Services, Calgary Zone. A critical component for successful implementation of the policy was clinician development of skills with engaging in quality advance care planning (ACP) conversations. Pre and post policy evaluation has consistently identified ongoing barriers with initiating and engaging in the quality conversations required for successful outcomes with policy adoption.Key challenges reported by clinicians are lack of confidence and competency with approaching patients for the purpose of engaging in ACP conversations. Clinicians frequently identify similar themes found in ACP literature; fear of diminishing hope, lack of skills in initiating and sustaining conversations and fear of causing harm to patients in this process.This presentation will present a series of clinician education videos modelling key components of ACP conversations. The videos provide clinicians with a ‘tool box’ of phrases and questions they might consider saying in different situations or at different stages of the process of conversations, and provide clear examples of communication techniques such as clarifying, maintaining eye contact and open body language.These videos can be used as a basis for role modelling-based education for all clinicians to practice and improve communicating about advance care planning. Additionally, utilising videos as a teaching methodology can assist with timely and flexible education reducing some of the barriers with accessing skill development and training.
Documentation of do not attempt cardiopulmonary resuscitation (DNACPR) orders – do electronic DNACPR order (eDNACPR) forms make a clinical difference over standardised paper DNACPR order (sDNACPR) forms?
Authors: Kayode O , Pabla G , Downing C , Speakman J 
Published: May 2012

DNACPR orders are important in sparing patients from inappropriate resuscitation attempts. Accurate documentation of a DNACPR order is required to ensure the decision is clear and understood by those involved. The clarity of documentation is central to NHS Trust guidelines, which suggest specific aspects of the decision need recording.To determine whether the introduction of eDNACPR forms improve documentation when compared to the standard practice of sDNACPR forms.A retrospective service evaluation of DNACPR documentation 2 months prior to and 2 months after the introduction of eDNACPR forms (July - November 2011). Subjects were in-patients on the 4 main geriatric/general medicine wards of Queen Elizabeth Hospital Birmingham, Foundation Trust. Documented aspects of the decision were examined and compliance with Trust guidelines assessed.200 DNACPR orders were documented: 99 sDNACPR forms and 101 eDNACPR forms. Demographics (sex, ethnicity and mean age) were comparable between patients in each documentation method. 31% of sDNACPR forms and 3% of eDNACPR forms proved non-compliant with Trust guidelines.Analysis of the sDNACPR forms revealed 12% of relatives and 15% of patients were not informed of the DNACPR decision.eDNACPR forms showed 82% of relatives and 91% of patients were not informed.eDNACPR forms improve the compliance of DNACPR order documentation with Trust guidelines. However, fewer DNACPR decisions are discussed with patients and relatives. eDNACPR forms do not process until all fields are completed. Therefore some reasons for sDNACPR form non-compliance, e.g. no review date stated, were removed through the design of eDNACPR forms.
Advance care planning needs, which is expected to end of life care teams in Japan
Authors: Yokoe Y , Nishikawa M , Miura H , Hong Y , Kubokawa N , Shibasaki M , Takamichi K , Kitamura S , Endo H , Nakashima K 
Published: May 2012

In Japan, which has the highest rate of aging worldwide, the study of advance care planning (ACP) requirements, which are expected of end-of-life care teams (EOLCT) for non-cancer patients, has just begun.The purpose of this study was to determine the ACP requirements of clinicians and patients, which were expected of EOLCT, for non-cancer patients in Japan.In total, 240 clinicians in the National Center for Geriatrics and Gerontology in Japan were asked about they expected from EOLCT regarding ACP-related issues. Alternatives of “highly expected,” “somewhat expected,” “expected a little,” and “not expected” were scored as “4,” “3,” “2,” and “1” respectively. In addition, the nature of requests from 44 patients who had contacted EOLCT in the first three months of its operation was investigated.The degree of expectation from EOLCT regarding ACP-related issues was 3.5 points. Of the 44 patient requests, 9 included decision support for cancer patients and 13 for non-cancer patients. Of the latter, there were 6 (46%) requests for ACP for gastric feeding tubes and artificial alimentation, 6 (46%) for mechanical ventilators, and 1 (8%) for artificial dialysis; 12 patients (92%) wished to make their own decisions after the intervention of EOLCT.This result suggested that ACP provision for non-cancer patients by EOLCT is a strong expectation in Japan, particularly ACP for gastric feeding tubes and artificial alimentation for mechanical ventilators. This presentation will demonstrate to other Japanese health professionals the role that EOLCT should play in order to promote ACP for non-cancer patients.
Physician orders for life-sustaining treatment (POLST): unresolved conceptual and ethical questions
Authors: Marckmann G , in der Schmitten J 
Published: May 2012

BackgroundIn the US, physician orders for life-sustaining treatment (POLSTs) are widely distributed. In Europe, on the other hand, emergency orders are still rarely reported from the ambulatory setting short of palliative care. There is a number of challenging conceptual and ethical questions involved in the POLST issue that have received little attention yet.MethodsThis analysis is based on a systematic literature search, and further draws on our experience with introducing a variant of the POLST, the POLST-in-case-of-emergency (POLST-E), into our German regional ACP program beizeiten begleiten® (‘be caring betimes’) that is based on Respecting Choices®.ResultsPOLSTs feature an implicit dual nature: On the one hand, they are a physician's order – on the other, (part of) an advance directive (by proxy). However, the conceptual relation between advance directives (ADs) and POLSTs seems not clear, and neither do the requirements for a skilled facilitation process before a POLST should be signed by all participating parties. A number of other questions deserve consideration, i.e. whether POLSTs are reserved for the terminally ill, or also eligible for the healthy; whether they relate only to the setting where they were originally discussed; and which treatment issues they should (not) cover, with particular consideration of the availability of prognostic information.DiscussionIn summary, the POLST instrument bridges a year-long gap between ADs and emergency requirements. However, unreflected use of the POLST may come along with significant risks and potential side effects, therefore open conceptual and ethical questions deserve debate.
Patient and provider perceptions of advance care planning using electronic health record patient portals
Authors: Bose-Brill S , Kobe C , Pressler T , Wills Celia 
Published: May 2012

The electronic health record (EHR) and EHR-tethered patient portals provide innovative opportunities for patient-provider advance care planning (ACP) communication. Development of patient-centred ACP tools for EHR-tethered patient portals requires investigation of barriers to use. An ongoing survey study in Ohio State University primary care clinics is assessing willingness to use OSUMyChart (an EHR-tethered patient portal) for ACP communication. This is phase one of a multiphase project developing a patient-provider ACP communication framework. 27 of 30 physician respondents (90%) indicate that EHR could improve ACP delivery. 34 of 39 patient respondents (87.2%) would respond positively to a provider-initiated ACP discussion. However, only 20 patients (51.2%) are willing to use EHR to discuss ACP. Patients responding negatively to ACP EHR communication have lower rates of internet access (81% vs. 44%) and OSUMyChart activation (52% vs. 17%) than patients who respond positively. Most unwilling patients without internet cite lack of access as the sole reason for reluctance to EHR-based ACP. Possible solutions are on-site technical support and partnerships subsidising internet connectivity for patients without access.DevelopEH EHR-tethered patient portals for the purposes of facilitating ACP must be coupled with strategies for combating health disparities arising from limitations in electronic connectivity. This presentation will describe: (1) patient and provider responses to potential use of EHR-tethered patient portals in ACP; (2) characteristics of patients conveying reluctance to use electronic resources for ACP communication; (3) strategies for overcoming barriers to EHR-based ACP communication.