Profiling the Membrane and Glycosaminoglycan-Binding Proteomes of Moraxella catarrhalis.

Moraxella catarrhalis, a Gram-negative bacterium, is an important respiratory pathogen causing acute otitis media and exacerbations of chronic obstructive pulmonary disease. Adhesion of the pathogen to human epithelial cells is mediated via bacterial membrane adhesin proteins. To identify the surface proteome of Moraxella catarrhalis, we applied different membrane protein extraction methods in combination with different proteomic technologies. Proteins from preparations of outer membrane vesicles and from carbonate extractions were analyzed using either a gel-based nano-HPLC-MS/MS technique or 2D-LC-MS/MS. Furthermore, because glycosaminoglycans (GAGs) play an important role for microbial entry into human cells, the GAG-binding membranome of Moraxella catarrhalis was investigated using a glycan-based pull-down approach. By these means, potential vaccine protein candidates that were previously selected by the ANTIGENome technology were confirmed, but importantly also novel proteins were identified as candidates.

The neurotransmitter serotonin interrupts α-synuclein amyloid maturation.

Indolic derivatives can affect fibril growth of amyloid forming proteins. The neurotransmitter serotonin (5-HT) is of particular interest, as it is an endogenous molecule with a possible link to neuropsychiatric symptoms of Parkinson disease. A key pathomolecular mechanism of Parkinson disease is the misfolding and aggregation of the intrinsically unstructured protein α-synuclein. We performed a biophysical study to investigate an influence between these two molecules. In an isolated in vitro system, 5-HT interfered with α-synuclein amyloid fiber maturation, resulting in the formation of partially structured, SDS-resistant intermediate aggregates. The C-terminal region of α-synuclein was essential for this interaction, which was driven mainly by electrostatic forces. 5-HT did not bind directly to monomeric α-synuclein molecules and we propose a model where 5-HT interacts with early intermediates of α-synuclein amyloidogenesis, which disfavors their further conversion into amyloid fibrils.

The effect of problem-based learning in patient education after an event of CORONARY heart disease--a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study.

BACKGROUND: Even though there is convincing evidence that self-care, such as regular exercise and/or stopping smoking, alters the outcomes after an event of coronary heart disease (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention programmes are structurally and pedagogically applied using adult learning principles e.g. problem-based learning (PBL). Until now, most education programs for patients with CHD have not been based on such principles. The basic aim is to discover whether PBL provided in primary health care (PHC) has long-term effects on empowerment and self-care after an event of CHD. METHODS/DESIGN: A randomised controlled study is planned for patients with CHD. The primary outcome is empowerment to reach self-care goals. Data collection will be performed at baseline at hospital and after one, three and five years in PHC using quantitative and qualitative methodologies involving questionnaires, medical assessments, interviews, diaries and observations. Randomisation of 165 patients will take place when they are stable in their cardiac condition and have optimised cardiac medication that has not substantially changed during the last month. All patients will receive conventional care from their general practitioner and other care providers. The intervention consists of a patient education program in PHC by trained district nurses (tutors) who will apply PBL to groups of 6-9 patients meeting on 13 occasions for two hours over one year. Patients in the control group will not attend a PBL group but will receive home-sent patient information on 11 occasions during the year. DISCUSSION: We expect that the 1-year PBL-patient education will improve patients' beliefs, self-efficacy and empowerment to achieve self-care goals significantly more than one year of standardised home-sent patient information. The assumption is that PBL will reduce cardiovascular events in the long-term and will also be cost-effective compared to controls. Further, the knowledge obtained from this study may contribute to improving patients' ability to handle self-care, and furthermore, may reduce the number of patients having subsequent CHD events in Sweden. TRIAL REGISTRATION: NCT01462799.

Embodied reflection in practice--'touching the core of caring'.

A study was performed with the aim of clarifying the integration of the caring act of touch with reflection on caring theory. Seven participant nurses in elderly care volunteered as 'coresearchers' and performed a caring act called Rhythmical Embrocation, together with reflective dialogues on caring theory. The project lasted for 6 months and at the end qualitative interviews with participants were used to evaluate the study. The findings showed an opening of awareness, embodied moments of presence and an extended ability to act creatively in caring. In this study, the movement between theory and practice was the integration of the caring act with reflection on basic caring concepts. Implications for praxis development are that implementation and reflection by teams over certain caring acts might open the door to an expanded view of one's own caring ability that in the long run will benefit the patient.

Gastrointestinal symptoms and well-being of adults living on a gluten-free diet: a case for nursing in celiac disease.

Women with celiac disease (CD) living on a gluten-free diet (GFD) show a lower health-related quality of life and report a higher rate of gastrointestinal (GI) symptoms than men with CD. Uncertainty exists as to whether GI symptoms may explain the poorer treatment outcome of women with CD. This study was designed to explore relationships of GI symptoms and psychological well-being in men and women with long-standing CD. Patients with CD (n = 108; 59% women), aged 45-64 years, treated with a GFD for at least 8 years were evaluated by the Gastrointestinal Symptom Rating Scale and the Psychological General Well-Being index. The results show that women with a high rate of GI symptoms have no lower level of psychological well-being than corresponding men with CD and that women with CD with reduced psychological well-being have no more GI symptoms than corresponding men. Our results fail to support the notion that the reduced subjective health in CD is explained by GI symptoms. They may be secondary to perceived difficulties in managing everyday life, suggesting that launching a nurse-led follow-up may be helpful, as has been proven to be useful in other lifelong disorders.

Conceptions on treatment and lifestyle in patients with coronary heart disease--a phenomenographic analysis.

Twenty-three patients with an acute event of coronary heart disease (CHD) received routine care including information about medication and lifestyle changes. They were interviewed after 1 year about their conceptions concerning drug treatment and lifestyle changes. The interviews were taped, transcribed and analysed using the phenomenographic approach. Conceptions were hierarchically categorised with regard to level of understanding. The results showed that the patients' understanding of the effects and health benefits of their treatment was superficial as judged on an informed layman level. The knowledge was fragmentary and mechanistic. Several misconceptions were revealed. Few answers related to prognostic benefits. However, a conception about effects of stopping drug intake was risk of relapse. Some patients considered fate and heredity as the main causes of CHD. Thus, our patients had not achieved an adequate understanding of CHD treatment. The level of knowledge was lower than anticipated.

Superior in vitro stimulation of human CD8+ T-cells by whole virus versus split virus influenza vaccines.

Pandemic and seasonal influenza viruses cause considerable morbidity and mortality in the general human population. Protection from severe disease may result from vaccines that activate antigen-presenting DC for effective stimulation of influenza-specific memory T cells. Special attention is paid to vaccine-induced CD8+ T-cell responses, because they are mainly directed against conserved internal influenza proteins thereby presumably mediating cross-protection against circulating seasonal as well as emerging pandemic virus strains. Our study showed that influenza whole virus vaccines of major seasonal A and B strains activated DC more efficiently than those of pandemic swine-origin H1N1 and pandemic-like avian H5N1 strains. In contrast, influenza split virus vaccines had a low ability to activate DC, regardless which strain was investigated. We also observed that whole virus vaccines stimulated virus-specific CD8+ memory T cells much stronger compared to split virus counterparts, whereas both vaccine formats activated CD4+ Th cell responses similarly. Moreover, our data showed that whole virus vaccine material is delivered into the cytosolic pathway of DC for effective activation of virus-specific CD8+ T cells. We conclude that vaccines against seasonal and pandemic (-like) influenza strains that aim to stimulate cross-reacting CD8+ T cells should include whole virus rather than split virus formulations.

Caring theory and practice--entering a simultaneous concept analysis.

PROBLEM: To better understand the approach of caring in nursing and the role of theory in practice, we wanted to consolidate the caring theory of Watson with the empirical findings from the three studies performed to reveal nurses' caring intentions and their lived experience of reflecting caring theory in practice. METHOD: Through a simultaneous concept analysis of nine concepts, caring science theory was consolidated with the findings of the three empirical studies to reveal the dynamics of caring theory and caring practice. FINDINGS AND CONCLUSION: These nine concepts were found to be interrelated with the advanced concept of mediating care, which emphasizes that mediating care calls for an authenticity of being and ability--an ability to be present to self and others in the dynamism of openness and frames of thought.

Eliciting reflections on caring theory in elderly caring practice.

Caring theories are the description and conceptualization of the care that is given in caring practise by nurses and other professional caregivers with the aim of verbalizing and communicating caring phenomena. Intermittently, a theory -practice gap is given expression- that theory does not go along with clinical practice in caring.The aim of this study was an investigation into the possible disparity between theory and practice in caring by analysing nurses' lived experience of the understanding of caring theory in practice in the context of municipal elderly care.Hermeneutical phenomenology was the research approach used to explore the lived experience of caring science theories in caring practice from the perspective of 12 nurses working in municipal care for elderly.The findings shows that the nurses Impulsively described their experience of detachment to caring theory, but when describing their caring intentions, the relationship to theory became apparent, and even confirmed their practice. As such, a seedbed exists for caring theory to be reflected on and cultivated in caring praxis. However, as the nurses describe, the caring theory must be sensitive enough for the nursing practitioners to accept.The gap revealed itself on an organisational level, as the nurses' commission in municipal care did not correspond with their caring intention.We believe it is important to seriously consider what we want to achieve as a caring profession. We have to reflect on our responsibility as culture carriers and knowledge developers. We must make the disparate forces of intention and organisation become one intertwining force.

Nurses' conceptions of facilitative strategies of weaning patients from mechanical ventilation--a phenomenographic study.

BACKGROUND: Mechanical ventilator withdrawal can amount up to 40% of total ventilator time. Being on a mechanical ventilator is associated with risk of anxiety, post-traumatic stress syndrome, nosocomial pneumonia and premature mortality. PURPOSE: The purpose of the present study was to describe different conceptions of nurses' facilitating decision-making strategies regarding weaning patients from mechanical ventilations cared for in intensive care unit (ICU). METHOD: Semi-structured interviews were analysed within the phenomenographic framework. Twenty ICU nurses were interviewed. FINDINGS: The findings revealed three main categories of nurses' facilitating decision-making strategies: "The intuitive and interpretative strategy" featured nurses' pre-understandings. "The instrumental strategy" involved analysis and assessment of technological and physiological parameters. "The cooperative strategy" was characterised by interpersonal relationships in the work situation. Absence of a common strategy and lack of understanding of others' strategies were a source of frustration. The main goals were to end mechanical ventilator support, create a sense of security, and avoid further complications. CONCLUSION: Although these findings need to be confirmed by further studies we suggest that nurses' variable use of individual strategies more likely complicate an efficient and safe weaning process of the patients from mechanical ventilation.

Incentives for lifestyle changes in patients with coronary heart disease.

AIM: This paper reports a study exploring how patients in the rehabilitation phase of coronary heart disease experience facilitating and constraining factors related to lifestyle changes of importance for wellbeing and prognosis. BACKGROUND: Lifestyle change is important but complex during rehabilitation after a myocardial infarction or angina pectoris. The intentions to perform behaviours and to experience control over facilitators and constraints are important determinants of behaviour. METHODS: A total of 113 consecutive patients below 70 years of age (84 men and 29 women) were interviewed within 6 weeks of a cardiac event and again after 1 year. Interview transcriptions and notes taken by hand were qualitatively analysed using the phenomenographic framework. The distribution of statements among the categories identified was quantitatively analysed. The data were collected in 1998-2000. FINDINGS: Four main categories portrayed patients' experiences of facilitating or constraining incentives for lifestyle changes. 'Somatic incentives' featured bodily signals indicating improvements/illness. 'Social/practical incentives' involved shared concerns, changed conditions including support/demand from social network, and work/social security issues. Practical incentives concerned external environmental factors in the patients' concrete context. 'Cognitive incentives' were characterized by active decisions and appropriated knowledge, passive compliance with limited insights, and routines/habits. 'Affective incentives' comprised fear of and reluctance in the face of lifestyle changes/disease, lessened self-esteem, and inability to resist temptations. Cognitive incentives mostly facilitated physical exercise and drug treatment. Social/practical incentives facilitated physical exercise and diet change. Physical exercise and diet changes were mainly constrained by somatic, social, and affective incentives. CONCLUSION: The results illustrate important incentives that should be considered in contacts with patients and their families to improve the prospects of positively affecting co-operation with suggested treatment and lifestyle changes.

Patients' conceptions of coronary heart disease--a phenomenographic analysis.

Readjustment after an event of coronary heart disease (CHD) is defined to comprise cognitive, instrumental and affective components. The cognitive dimension refers to understanding of the disease. Twenty-three patients (<60 years) with CHD were interviewed about the nature of their disease and encouraged to use their own words. The study was conducted 1 year after the event of myocardial infarction (MI) and some patients had also been revascularized. The interviews were transcribed in extenso and analysed according to the phenomenographic approach. The main finding was the great variation of conceptions revealed. Six different conceptions were found concerning CHD. Some patients comprehended MI by involving (A) blood and vessels, (B) either blood or vessel or referred to (C) risk factors/symptoms. Angina pectoris was expressed as (A) insufficient heart capacity, (B) atherosclerosis/contracted vessel or as (C) symptoms. Several patients found it difficult to expand their answers and some expressed misconceptions about the course of events. Patients' pre-existing knowledge and their way of reasoning about central phenomena related to their disease should be taken into consideration in patient education and is also applicable in individual encounters with patients.

Rehabilitation after coronary heart disease: spouses' views of support.

BACKGROUND: Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles. AIM: The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes. METHOD: Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework. FINDINGS: The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation. CONCLUSION: Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

Coronary heart disease: causes and drug treatment--spouses' conceptions.

BACKGROUND: Spouses are important in the rehabilitation process of their partner after coronary heart disease event. Their knowledge and attitudes have an impact on their support to the partner concerning lifestyle changes and drug treatment after an event. AIMS AND OBJECTIVES: To explore spouses' conceptions concerning causes of coronary heart disease and drug treatment 1 year after the partner's cardiac event. DESIGN: Qualitative with an empirical and inductive approach. METHODS: Semi-structured interviews with strategically selected spouses (17 women and eight men) were taped. The transcripts were analysed within the phenomenographic framework. RESULTS: Spouses' conceptions about causes of coronary heart disease and its treatment consisted of correct facts, as judged on a lay level, less elaborated conceptions and misconceptions. Among causes of coronary heart disease, the spouses were most knowledgeable about fat intake. They knew less about contributions from inactivity, stress and smoking. Ambivalent feelings were expressed about benefits vs. side effects of drugs. The treatment was conceived as necessary for the heart, but harmful for other organs. Men and women were evenly distributed in most of the derived categories. More women than men considered stress as a cause of coronary heart disease and also misconceived physical exercise to cause the disease. CONCLUSION: A variation of spouses' conceptions was revealed about causes of coronary heart disease and drug treatment. There was a lack of understanding concerning important parts of cardiac rehabilitation activities. These misconceptions may have implications by influencing their partner's co-operative behaviour. RELEVANCE TO CLINICAL PRACTICE: Spouses' pre-existing conceptions of coronary heart disease and its treatment should be considered in the rehabilitation process of their partner. Couples with misconceptions should be given the opportunity to increase qualitatively their knowledge starting from their point of view rather than from that of the professional perspective.