Long-Distance Caregivers' Use Of Supportive Services.

While long-distance caregiving has received increased attention as a unique care experience, prior research has not explored the supportive services used by long-distance caregivers (LDCs) and the factors that predict their supportive service utilization. Using the Andersen Model of Health Care Utilization, the current study sought to: 1) describe the types of supportive services LDCs used and the frequency of usage and 2) identify predisposing, enabling, and need-related factors associated with supportive service use in a sample of LDCs. Participants were recruited from aging services organizations, a national participant registry, professional networks, participant referrals, and an existing pool of research participants. The sample included 304 LDCs who reported on the use of nine supportive services and completed measures assessing depression, caregiver burden, self-rated health, sociodemographic characteristics, and the condition of the care recipient (CR). Fifty percent of LDCs reported no service use. Multiple hierarchical regression analyses demonstrated that younger age, higher caregiver burden, greater depressive symptoms, more time spent helping the CR, and worse CR functional status were significantly related to greater total supportive service use by LDCs. The current study contributes to our understanding of the factors associated with LDCs' supportive service utilization, highlighting the importance of need-related factors.

Development of an indirect enzyme-linked immunosorbent assay test for detecting antibodies to chicken astrovirus in chicken sera.

The development of an indirect enzyme-linked immunosorbent assay (ELISA) for the serological diagnosis of Group B chicken astrovirus (CAstV) infections is described. The test was based on the use of an affinity-purified capsid antigen, specific to CAstV isolate 11672, produced as a glutathione-S-transferase N-terminal fusion protein by a recombinant baculovirus. Strongly positive ELISA signals were elicited against experimentally produced antisera raised to CAstVs from Group B (subgroups i and ii) but were negative for antisera raised to a Group A CAstV. Using a panel of 240 selected serum samples, 99% agreement was observed when the results obtained by ELISA were compared to those from an indirect immunofluorescence test for CAstV 11672. The ELISA test was applied to 68 serum sets comprising 1864 samples, which were obtained from parent and grandparent flocks originating mainly in the UK. Of the 52 sets containing ELISA-positive samples, 24 sets had >75% samples positive and nine sets had <25% samples positive and were regarded as having high and low seropositivities, respectively. Of the 1864 serum samples tested 1090 (58.5%) were ELISA positive and of these, 234 sera (21.5%) produced strongly positive signals, whereas moderately positive and weakly positive signals were produced by 562 (51.5%) and 294 (27%) sera. When used for flock screening purposes, this ELISA test can be used to (i) investigate the occurrence of first-time CAstV infections of parent flocks during lay and the possible adverse effects caused by vertically transmitted CAstV infections on broiler hatchability and performance and (ii) diagnose Group B CAstV infections within specific pathogen free flocks.

Chicken astrovirus capsid proteins produced by recombinant baculoviruses: potential use for diagnosis and vaccination.

Chicken astroviruses (CAstVs) have been characterized recently. Due to their relatively poor growth in cell culture, virus-specific antigens are not readily available for the development of diagnostic reagents and vaccines. For this purpose two capsid protein antigens, specified by the 11672 isolate of CAstV, were produced in insect cells following infection with recombinant baculoviruses. The GST-11672 capsid protein, a fusion protein comprising the capsid protein and glutathione-S-transferase (GST) as an N-terminal affinity tag, and the 11672 capsid protein alone were detected by western blotting as proteins of ~100 and 70 kDa, respectively. Immunization with the affinity-purified GST-11672 capsid protein produced a polyclonal rabbit antiserum, which reacted by indirect immunofluorescence with Group B CAstVs but which showed no reactivity with the Group A CAstV isolate, 612. When used as part of an immunoperoxidase-based immunohistochemical procedure, this rabbit antiserum facilitated the detection of CAstV antigen in formalin-fixed, paraffin-embedded kidney tissue at the sites of histopathology characteristic of nephritis. Although further evaluation with sera from commercial chickens is required, a prototype indirect antibody-detecting enzyme-linked immunosorbent assay (ELISA) based on affinity-purified GST-11672 capsid protein as coating antigen demonstrated considerable potential with low ELISA absorbance values being generated with sera from specific pathogen free (SPF) chickens, and high absorbance values being generated with serum samples from experimentally infected chickens. Immunization experiments of SPF chickens showed that, when administered as mixtures with oil adjuvant, crude cell lysates containing the GST-11672 capsid protein or the 11672 capsid protein elicited virus-specific antibody responses that were detectable by indirect immunofluorescence and by virus neutralization assays.

Biological considerations of dental materials as orifice barriers for restoring root-filled teeth.

There is ample published literature regarding the technical aspects of restoring root-filled teeth, but little concerning the biological impacts, consequences, and criteria for the selection of direct restorative materials following endodontic treatment. The provision of an effective coronal seal in addition to a sound root filling is known to be important in the prevention of root canal infection. This review seeks to explore the evidence concerning the selection of dental materials in the restoration of root-filled teeth, specifically with a close examination of the properties of commonly used materials as orifice barriers. © 2023 Australian Dental Association.

A retrospective chart review of management strategies for lichenoid eruptions associated with immune-checkpoint inhibitor therapy from a single institution.

Immune checkpoint inhibitors and their associated immune-related cutaneous adverse events are continuing to become a mainstay of cancer treatment regimens. While most rashes are mild and easily manageable, severe or persistent rashes like lichenoid dermatoses can significantly impact the quality of life and may require ICI cessation. Lichenoid dermatoses currently have no management guidelines beyond the use of topical or oral steroids. Our study is a single-institution retrospective chart review to characterize ICI-induced lichenoid eruptions, their treatments, and associated tumor response. We utilized natural language processing and our institutional medical record to identify patients with lichenoid eruptions on ICI therapy. One-hundred nineteen patients were identified, of which 108 rashes were characterized as lichenoid dermatitis and fifteen as lichenoid mucositis. Most patients presented with a diffuse distribution (86%, 101/117), with pruritus in lichenoid dermatoses (82%, 89/108) and pain in lichenoid mucositis (80%, 12/15). Successful treatments for lichenoid dermatitis included topical steroids (81%, 88/108), oral antihistamines (21%, 23/108), and oral steroids (15%, 16/108). Of lichenoid dermatitis patients, 21% (23/108) did not respond to treatment (7) or required oral steroids (16). Approximately 28% of patients who had lichenoid dermatitis had delay, reduction, or discontinuation of their ICI because of their irCAE. This descriptive study highlights the impact of lichenoid dermatitis on patients' ability to remain on ICI therapy and the need for more effective non-steroidal management strategies.

Ablation of chronic total occlusions using kilohertz-frequency mechanical vibrations in minimally invasive angioplasty procedures.

Certain minimally invasive cardiology procedures, such as balloon angioplasty and stent implantation, critically require that the site of an arterial blockage be crossed by an intraluminal guidewire. Plaques resulting in near or totally occluded arteries are known as chronic total occlusions, and crossing them with conventional guidewires is a significant challenge. Among the most promising proposed solutions is the delivery of high-power, low-frequency ultrasonic vibrations to the occlusion site via an intraluminal wire waveguide. The vibrating distal tip of the ultrasound wire waveguide is used to transmit energy to the surrounding plaques, tissues, and fluids to ablate or weaken atherosclerotic plaque. Potential mechanisms of interaction with the plaque and adjacent fluids identified in the literature include: (i) direct contact with the waveguide distal tip, (ii) subcavitational acoustic fluid pressure fluctuations, (iii) cavitation, and (iv) acoustic streaming. We summarize developments in this area over more than two decades, describing experimental methods for device performance characterization, preclinical tests, early clinical investigations, and, later, full clinical trials. The article also reviews theoretical foundations and numerical models suitable for device design and analysis. Finally, important issues for future research and for the development of this technology will be considered.

Identification of chicken enterovirus-like viruses, duck hepatitis virus type 2 and duck hepatitis virus type 3 as astroviruses.

Earlier work identified and biologically characterized antigenically distinct enterovirus-like viruses (ELVs) of chickens. Three of these ELVs can now be identified as astroviruses. Characterization involved the use of a hitherto undescribed, degenerate primer-based reverse transcription-polymerase chain reaction (RT-PCR) to amplify astrovirus open reading frame (ORF) 1b-specific cDNA fragments followed by nucleotide sequence determination and analysis of the amplified fragments. ELV-1 was confirmed as an isolate of the astrovirus avian nephritis virus (ANV). ELV-4 (isolate 612) and ELV-3 (isolates FP3 and 11672) were antigenically and genetically related to the second characterized astrovirus of chickens, namely chicken astrovirus (CAstV). Using indirect immunofluorescence, the FP3 and 11672 ELV-3 isolates were very closely related to one another, and less closely related to ELV-4 and the previously described CAstV (P22 18.8.00 reference isolate). Comparative analyses based on the ORF 1b amplicon sequences showed that the FP3 and 11672 ELV-3 isolates shared high nucleotide (95%) and amino acid (98%) identities with one another, and lower nucleotide (76% to 79%) and amino acid (84% to 85%) identity levels with ELV-4 and the reference CAstV P22 18.8.00 isolates. The combined degenerate primer RT-PCR and sequencing methods also provided a nucleotide sequence specific to duck hepatitis virus type 2 (DHV-2) (renamed duck astrovirus) and duck hepatitis virus type 3 (DHV-3), which, for the first time, can also be identified as an astrovirus. Phylogenetic analyses based on the amplified ORF 1b sequences showed that ANV was the most distantly related avian astrovirus, with DHV-3 being more closely related to turkey astrovirus type 2 than DHV-2.

A seroprevalence investigation of chicken astrovirus infections.

Two genetically different isolates of chicken astrovirus (CAstV), named CAstV612 and CAstV11672, which share low levels of antigenic relatedness in cross-indirect immunofluorescence (IIF) tests, have been identified recently. In the present study, separate IIF tests for detecting antibodies to the CAstV612 and CAstV11672 isolates have been used to determine the seroprevalences of CAstV infections in four generations of flocks involved in broiler chicken production. CAstV antibodies were detected in 78% (73% CAstV612; 46% CAstV11672) of serum samples from UK broiler flocks and in all 10 flocks tested, indicating that infections were very common. Twenty-three (96%) out of 24 and 26 (93%) out of 28 broiler parent flocks, aged 23 to 26 weeks from three UK organizations, were positive for antibody to CAstV612 and CAstV11672, respectively. Of 718 samples tested from these parent flocks, 415 (53%) were positive for either CAstV612 or CAstV11672 antibody. CAstV infections were also widespread in parent flocks, with screening of pooled serum samples showing that antibodies to both CAstVs were detected in flocks from seven other UK poultry organizations and in flocks from eight other European countries. The seropositivities for CAstVs were substantially less in grandparent (28%) and great grandparent (21%) flocks. Overall, higher seropositivities were observed for CAstV612 than for CAstV11672 in broiler, parent, grandparent and great-grandparent flocks. A limited study of 99 sera from 10 turkey breeder flocks showed low-level seropositivities for CAstV612 (9%) and CAstV11672 (2%), indicating that turkeys were infected with CAstVs or antigenically related viruses.

The phosphohydrolase activity in lamellar bodies and its relationship to phosphatidylglycerol and lung surfactant formation.

Phosphohydrolase activity of a lamellar body-enriched preparation from pig lung was examined to ascertain if two separate enzymes catalyze the hydrolysis of phosphatidic acid and phosphatidylglycerol 3-phosphate. From sulfhydryl inhibition, heat inactivation and substrate specificity studies, we suggest that one phosphohydrolase may account for the hydrolysis of both substrates. The relationship of the reported experiments to the biosynthesis of the glycerophospholipids present in surfactant is discussed.

Isolation of bovine adenovirus serotype 6 from a calf in the United Kingdom.

Two viruses, designated 99-8130(C) and 99-8130(I), were isolated in calf testis cells from the colon and ileum, respectively, of a suckled beef calf which had developed dysentery and died. Electron microscopy indicated that the mean (sd) size of the viral particles, 83 (2.5) nm, and their morphology were consistent with their being members of the family Adenoviridae. They were confirmed as adenoviruses by PCR when products of the expected size (608 bp) were amplified from both isolates by using a primer pair specific for members of the genus Atadenovirus. A comparison of the sequence of a 567 bp segment of the 99-8130(C) amplicon with that of other prototype bovine adenovirus (BAdV) strains of atadenoviruses identified the isolate as BAdV serotype 6 (BAdV-6), which had 99.3 per cent and 100 per cent identities at the nucleotide and amino acid levels, respectively, with the prototype BAdV-6 strain 671130. A virus neutralisation test was developed and indicated a high prevalence of antibody to BAdV-6 in Northern Irish cattle. There was no evidence of adenoviral inclusions in tissues from the affected calf and no antigen was detected when the tissues were stained by an immunoperoxidase technique, using a homologous antiserum raised in rabbits. The two viruses were the third reported isolation of BAdV-6, and the first from a clinically ill bovine animal.

An effect of pharmacotherapy on the psychoanalytic process: case report of a modified analysis.

A woman who had appeared suitable for psychoanalysis was persistently unable to develop an analyzable transference. Her history, as it unfolded during analysis, suggested a form of atypical depression linked to a neurochemical abnormality, which appeared to be related to her reluctance to take the emotional risk involved in examining transference phenomena. The analysis was modified by a trial of phenelzine. Changes within the analysis and in the patient's private life after the drug trial ended support the hypothesis that her affective vulnerability had inhibited her ability to engage in analysis of transference before the administration of the drug.

Inhibition of caffeine metabolism by estrogen replacement therapy in postmenopausal women.

This study was conducted to investigate the effect of therapeutic estrogen on cytochrome P450 1A2-mediated metabolism in postmenopausal women using caffeine as a model substrate. Twelve healthy postmenopausal women underwent estrogen replacement therapy in the form of estradiol (Estrace). Estradiol was initiated at a dose of 0.5 mg a day and titrated to achieve a steady-state plasma concentration of 50 to 150 pg/ml. Caffeine metabolic ratios (CMR; paraxanthine/caffeine) were assessed both before and after 8 weeks of estrogen replacement. For the 12 subjects, there was a mean reduction in CMR of -29.2 +/- 25.0 (p = 0.0019). Consistent with previous results found in younger women, these results indicate that exogenous estrogen in older women may inhibit CYP1A2-mediated caffeine metabolism.

Fluvoxamine pharmacotherapy of anxiety disorders in later life: preliminary open-trial data.

The authors present data from an open trial of fluvoxamine (median daily dosage: 200 mg) in the treatment of generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder in 19 older outpatients (mean age = 66.8). Of the 12 subjects completing the 21-week trial, 8 achieved a good response (50% reduction in symptom measures) and 7 were rated as much or very much improved. Fluvoxamine pharmacotherapy also had a significant effect in reducing comorbid depressive symptoms and in increasing levels of functioning. These data support the effectiveness of fluvoxamine in older subjects with anxiety disorders (particularly generalized anxiety disorder) and warrant further double-blind, placebo-controlled evaluation.

Mycobacterium triplex pulmonary infection in an immunocompetent patient.

We present the case of a 47-year-old immunocompetent patient with clinical evidence of pulmonary mycobacterial disease which was found to be due to Mycobacterium triplex. This novel organism is an uncommon, emerging, pathogen for which few reports of clinical infection exist in the medical literature.

Validity of specifically applied rare earth elements and compartmental models for estimating flux of undigested plant tissue residues through the gastrointestinal tract of ruminants.

The validity of using rare earth elements as flow markers of undigested residues was evaluated by comparing mean gastrointestinal residence time (GMRT) of rare earths specifically applied to cottonseed hulls (CSH) to that of the indigestible fiber of CSH. Feces were collected from five lambs fed a mineral supplemented diet of CSH containing 52 g CP/kg DM and five lambs fed a CSH plus cottonseed meal diet (CSH+CSM) containing 123 g CP/kg DM. Rare earth elements (La, Yb, and Tb) specifically bound to CSH were included in the diet for a 5-d period and then deleted from the diet for a 3-d period. Following the last fecal collection, lambs were slaughtered for collection of digesta from segments of the gastrointestinal tract. Potentially indigestible NDF (PIF) was determined in diets and digesta from each segment of the gastrointestinal tract. Mean turnover rate, time delay, and GMRT for each rare earth element was estimated by fitting an age-dependent compartment model to profiles of markers appearing in the feces (compartmental model-marker method, CMM). The GMRT also was computed by the indigestible entity pool dilution method (IEPD) as grams of PIF in sampled segment/mean intake rate of PIF proceeding slaughter, g/h. The GMRT computed by the CMM and the IEPD methods did not significantly (P < 0.05) differ (99.6 vs 94.8 h and 58.9 vs 59.5 h for CMM vs IEPD and CSH and CSH+CSM diets, respectively). Regression of GMRT estimated for rare earths vs PIF yielded a highly significant regression (P = 0.001) with a regression coefficient of 0.94 +/- 0.016. It was concluded that rare earth elements applied to specific feeds are valid flow markers for the undigested residues derived from such marked feeds.

Absorption of magnesium and other macrominerals in sheep infused with potassium in different parts of the digestive tract.

Two metabolism trials were conducted with 12 crossbred wether lambs, each surgically equipped with a ruminal catheter and abomasal and ileal cannulae, to study the effect of K infusion in different sites of the digestive tract on site of absorption and flow of minerals. The treatments consisted of the infusion of 33.6, 12.0 or 12.0 g K/d as bicarbonate into either the rumen, abomasum or ileum, respectively. Each trial consisted of a minimum 5-d preliminary period, five 3-d collection periods to determine mineral balance and a 6-d sampling period to determine mineral flow and site of absorption. Chromic oxide was incorporated into the diet for use as a marker. Magnesium was absorbed primarily from the preintestinal region. Ruminal infusion of K tended to decrease preintestinal Mg absorption. Absorption of Mg in the entire tract was decreased (P less than .05) 43% when K was infused into the rumen. There was a slight absorption of Mg in the small intestine, followed by a net secretion into the large intestine. Serum Mg levels tended to be depressed in lambs infused with K intraruminally. Calcium flow from the preintestinal region was decreased (P less than .05) by infusion of K into the rumen. Only lambs infused with K in the rumen had a net secretion of Na into the small intestine. The large intestine was the primary site of net Na absorption for ruminal-infused lambs. Phosphorus flow from the preintestinal region was decreased (P less than .05) by infusion of K into the rumen. Potassium flow from both the preintestine and small intestine was increased (P less than .05) by ruminal K infusion. The infusion of K into the rumen, abomasum or ileum increased (P less than .05) the total absorption of K, with the small intestine being the major absorptive site. The infusion of potassium bicarbonate into the rumen of sheep raised (P less than .05) the pH of the ruminal contents 15%. Ruminal infusion of K depresses Mg absorption, while the infusion of K into the abomasum or ileum does not affect Mg absorption. Therefore, the role of K in grass tetany may be via this depression of Mg absorption.

The flow of undigested corn residues through the gastrointestinal tract of cattle.

Two experiments were conducted to measure effects of source and level of roughage on the flow of corn residues through the gastrointestinal tract of cattle. In Exp. 1, steers (195 kg) were fed diets of ground corn with 0, 30 or 60% of ground Coastal bermudagrass hay (Cynodon dactylon) [L.] Pers.) at intakes of 1, 1.5 or 2% of BW in a 9 x 9 Latin square. Experiment 2 consisted of two 4 x 4 Latin squares with either rice hulls (square 1) or ground Coastal bermudagrass hay (square 2) providing 0, 7.5, 15 or 30% of the total diet fed at 1.5% of BW. After a 28-d adjustment period, a portion of the corn in one meal was replaced with cracked corn stained with brilliant green. The concentrations of stained corn residues appearing in the feces subsequent to dosing were fitted to a one-compartment, age-dependent model and compartmental mean residence time (CMRT) and time delay (tau) were estimated. In Exp. 1, increasing the level of intake of the ration from 1% to 1.5 or 2.0% of BW increased (P less than .05) CMRT by 52% and reduced (P less than .05) tau by 41%. In Exp. 2, source of roughage had no effect (P = .95) on CMRT or tau. Combined results of the two experiments indicated that increasing proportion (P) of either roughage was associated with an exponential decline in CMRT of stained corn residues (CMRT = 1211 * e-.0315P) from rations consumed at 1.5 and 2.0% of BW. No consistent effect of roughage type or proportion was noted on time delay in the two experiments collectively. These results indicate that increasing the proportion of roughage in the diet exponentially reduces residence time of corn residues in the ruminoreticulum (CMRT) without affecting residence time in the postgastric segments (tau).

Patterns of alcohol use among rural and small-town adolescents.

Much research has indicated that age, gender, grade in school, religiosity, socioeconomic status, and involvement in extracurricular activities are all related to adolescent alcohol use. However, most of such research focuses on urban youth. The present study examines patterns of rural adolescent alcohol use and factors associated with such use. The Student Alcohol Inventory was administered to 650 students in grades 7-12 in a small, middle-Atlantic town and surrounding county. The survey contained sections addressing demographic data, attitudes regarding students' alcohol use, and their parents' use. Along with standard SES measures, items were included on unemployment and receipt of government assistance. The dependent variables included age at first drink, frequency of drinking, amount of drinking, and a composite heavy-drinking index. Eighty-three percent of the respondents indicated that they had drunk alcohol and 57% had had their first drink by age 12. Gender and grade in school were significant predictors of alcohol use for all four dependent variables. Time spent in social activities was significant in predicting all but age at first drink. Religiosity was a significant predictor for only one dependent variable--age at first drink. The SES measures were also weak predictors of drinking behavior. Policy implications and directions for future research are discussed.

The older analysand: countertransference issues in psychoanalysis.

The apparent reluctance among analysts to begin an analysis with a patient beyond his or her fifth decade, a view first articulated by Freud, is examined as an instance of counter-transference resistance. Although there is no greater consensus among analysts than the continuing necessity of self-analysis irrespective of age, it is an attitude which does not appear to be so readily extended to the older prospective analysand. This report examines counter-transference issues within the context of a seven year classical analysis of an older female who began an analysis at the end of her sixth decade. The case illustrates the timelessness of psychological conflicts at all levels and the particular character of the analyst's counter-transferences that surfaced listening to the material of this older analysand.