Plasmacytoid Dendritic Cells Enhance T-Independent B Cell Response through a p38 MAPK-STAT1 Axis.

TLR signaling in B cells triggers their activation and differentiation independent of help from T cells. Plasmacytoid dendritic cells (pDCs) cooperate with B cells to boost TLR-stimulated T-independent humoral immunity; however, the molecular mechanisms remain elusive. In this study, we demonstrate that in the mouse system, the adjuvant effects of pDCs also occurred following challenge with pathogens and that follicular (FO) B cells were more sensitive to pDC-induced enhancement than were marginal zone (MZ) B cells. Moreover, pDCs migrated to the FO zones and interacted with FO B cells upon stimulation in vivo. CXCL10, a ligand for CXCR3 expressed on pDCs, was superinduced in the coculture system and facilitated the cooperative activation of B cells. Moreover, pDCs also promoted TLR-stimulated autoantibody production in FO B and MZ B cells. Ingenuity Pathway Analysis and gene set enrichment analysis revealed that type I IFN (IFN-I)-mediated JAK-STAT and Ras-MAPK pathways were highly enriched in R848-stimulated B cells cocultured with pDCs compared with B cells alone. Whereas IFN-I receptor 1 deficiency reduced pDC-enhanced B cell responses, STAT1 deficiency displayed a more pronounced defect. One of the STAT1-dependent but IFN-I-independent mechanisms was TLR-induced STAT1-S727 phosphorylation by p38 MAPK. Serine 727 to alanine mutation attenuated the synergism between pDCs and B cells. In conclusion, we uncover a molecular mechanism for pDC-enhanced B cell response and define a crucial role of the IFN-I/TLR-mediated signaling pathway through a p38 MAPK-STAT1 axis in controlling T-independent humoral immunity and providing a novel therapeutic target for treating autoimmune diseases.

[Establishing Age-Friendly Community Guidelines in Taiwan].

As Taiwan heads steadily toward becoming a super-aged society, the impact of aging on society at large will become increasingly extensive and intense. Therefore, establishing an age-friendly environment in Taiwan is an important issue for the government. Feasible guidelines for age-friendly communities are necessary to ensure that appropriate social welfare measures are enacted to achieve the national goal of aging in place. The first draft of the guideline questionnaire was developed based on the World Health Organization Guidelines for Age-Friendly Cities, a literature review, and input from seven experts on aging. Three rounds of questionnaire surveys were then conducted to assess the correctness, appropriateness, and importance of the guidelines, with amendments, additions, and deletions made based on the experts' responses until they all expressed a high degree of satisfaction with all of the guidelines. The Taiwan Age-friendly Community Guidelines document discussed in this article includes 38 guidelines that address the eight facets of "outdoor spaces and buildings", "transportation", "housing", "social participation", "respect and social inclusion", "civil participation and employment", "communication and information", and "community support and health services". The guidelines document describes in detail the goals of age-friendly communities in specific and easy-to-understand terms. Moreover, it provides a reference for frontline personnel in the community to promote age-friendly environs.

Developing Indicators of Age-Friendliness in Taiwanese Communities through a Modified Delphi Method.

This study developed indicators of age-friendliness for communities in Taiwan that conform to international standards by referring to the World Health Organization Checklist of Essential Features of Age-Friendly Cities and Taiwan's existing indicators. The first stage of the research was based on the WHO's framework and involved a literature review to identify candidate indicators. In the second stage, experts' opinions were collected through a modified Delphi method, and the indicators were screened and revised on the basis of their importance, community enforceability, and generality. The third stage focused on practical feasibility. External parties were invited to offer their opinions regarding the indicators, which were adjusted accordingly. After three rounds of review and re-examination based on the modified Delphi method, the final set of indicators comprised five core indicators and five optional indicators. These indicators can be used to monitor various aspects of communities and determine their age-friendliness.

Study of Dendritic Cell Development by Short Hairpin RNA-Mediated Gene Knockdown in a Hematopoietic Stem and Progenitor Cell Line In vitro.

Dendritic cells (DCs) are important antigen-presenting cells that connect innate and adaptive immune responses. DCs are heterogeneous and can be divided into conventional DCs (cDCs) and plasmacytoid DCs (pDCs). cDCs specializes in presenting antigens to and activate naïve T cells. On the other hand, pDCs can produce large quantities of type I interferons (IFN-I) during viral infection. The specification of DCs occurs at an early stage of DC progenitors in the bone marrow (BM) and is defined by a network of transcription factors (TFs). For example, cDCs highly express ID2, while pDCs highly express E2-2. Since more and more subsets of DCs are being identified, there is a growing interest in understanding specific TFs controlling DC development. Here, we establish a method to screen TFs critical for DCs differentiation in vitro by delivering lentivirus carrying short hairpin RNA (shRNA) into an immortalized hematopoietic stem and progenitor cell (iHSPCs) line. After the selection and in vitro differentiation, cDC and pDC potential of the stable knockdown cell lines are analyzed by flow cytometry. This approach provides a platform to identify genes potentially governing DC fates from progenitors in vitro.

A Pilot Study of Interactive-Video Games in People with Mild Cognitive Impairment.

Early preventive strategies for improving cognitive function are crucial for people with mild cognitive impairment (MCI). Cognitive training exercises may improve cognitive functioning. However, there was limited evidence from training programs that combined cognitive-specific and physical activities, particularly in using interactive video games as interventions. This study aimed to evaluate the feasibility and effects of the interactive-video games on cognitive function, physical function, mood status and quality of life in community-dwelling people with MCI. A quasi-experimental study was undertaken. Participants in the intervention group received 60 min group-based training program once per week for 12 weeks. A generalised estimating equation (GEE) was used to examine the main effect, interactions and changes in outcomes over time. Sixteen participants completed the trial with eight in the intervention group and eight in the comparison group. The tolerable acceptance rate, perfect attendance rate, high satisfaction with the training content, and no injuries or falls demonstrated the feasibility of this program. The scores of cognitive function increased in both groups and the interaction between time and groups were significant over 12 weeks of training (p < 0.05). As the result, we determined that interactive-video games can be a safe, feasible, enjoyable intervention and user-friendly among people with MCI in community settings.

Support and Empowerment for Older Adult Spousal Caregiving of People with Mild and Moderate Dementia: A Participatory Action Research.

BACKGROUND: Little attention has been given to the older adult caregivers of spouses with mild and moderate dementia in the caring dynamics process. The aim of this action research was to develop a program for providing support and empowerment to older adult caregivers of spouses with mild and moderate dementia in the community. METHODS: The researchers acted as facilitators, with a view to empowering participants. We recruited participants from a day-care center and two community service stations. Data were collected with semi-structured, in-depth interviews with 19 dementia care dyads and from the notes, reflections, and feedback of collaborative researchers. Relevant themes for content analysis were extracted. RESULTS: Three action cycles were completed over 18 months. The results revealed goals of three cycles: to connect the home situation and effective dialogue as a bridge to the researcher, to confirm the daily needs or expectations of the caregiver and the patient, and to enhance the interactions and quality of life of family members with resources and network. This process was cyclical and repetitive, and it also generated partnerships that built relationships among the interdisciplinary team, families, and researchers. At the same time, team workers formed a cooperative and coordinated family service mechanism to reflect the professional values and practice capabilities. CONCLUSIONS: The intervention program was based on the promotion of factors for the caregiver, linking to environmental protective factors, and the stabilization of mental and neurological symptoms of dementia patients, thereby enhancing the response capabilities of home caregivers while meeting the patient's care needs in life. It is a tool that can effectively be used for support and empowerment in this population.

Community Health Nursing Competency and Psychological and Organizational Empowerment of Public Health Nurses: A Cross-Sectional Survey.

AIM: This study explored the effect of public health nurses' current community care nursing competency on the psychological and organizational empowerment of public health services in Taiwan. DESIGN: A cross-sectional nationwide survey design was used. METHODS: A self-developed structured questionnaire was administered to public health nurses. They were recruited using a purposive sampling technique, and they participated in community healthcare workshops. RESULTS: The mean score of Community Care Nursing Competence (CCNC) was 3.92 ± 0.83. The mean score in Community Empowerment (CE) was 3.66 ± 0.90. The study revealed that age and communication competence were crucial factors in public health nurses working in the community. With age and through the accumulation of practical experience, public health nurses' communication competence may also improve, which can further enhance their psychological and organizational empowerment in the nursing workplace.

An interesting phenomenon in immigrant spouses and elderly suicides in Taiwan.

BACKGROUND: Immigration is a global issue. Taiwan has a high proportion of immigrant spouses who take care of the aging parents-in-law at home mainly based on filial piety. Difficulties in communication in many aspects of daily life occur between the elderly and immigrant spouses, and result in the elderly becoming vulnerable and thus, influencing their psychological well-being. Although past studies demonstrated that due to cultural differences, employed foreign care providers negatively influenced elder care quality (e.g., care receipts' health or mortality rates), no studies have explored whether immigrant spouses, as family caregivers, have any influence on elderly suicides due to cross cultural communication differences. OBJECTIVE: To address the above gap, this study was to examine the static relationship between immigrant spouses and elderly suicides. METHOD: National-level authority data, comprising a 10-year longitudinal nationwide sample, were used. The number of immigrant spouses was treated as a proxy of cultural differences. Twelve models of outcomes with and without city- and time-fixed effects were conducted using panel data analysis. RESULTS: Descriptive statistics of the study variables are provided. The results revealed that overall the number of immigrant spouses had a positive correlation with suicides in older adults. Further, the gender of immigrant spouses had different impacts on elderly suicides. CONCLUSIONS: This is the first study to examine relation between immigrant spouses and the elderly suicides. The study results provide another viewpoint of understanding of the role of immigrant spouses in elder care, while promoting elder-caregiver interactions for optimal elder health outcomes.

Enantioselective effects of herbicide imazapyr on Arabidopsis thaliana.

The enantioselective toxicity of chiral herbicides in the environment is of increasing concern. To investigate the enantioselective effects of the chiral herbicide imazapyr on target organisms, we exposed Arabidopsis thaliana to imazapyr enantiomers and racemate. The results show that imazapyr was enantioselectively toxic to A. thaliana. The total chlorophyll content in A. thaliana was affected more by (+)-imazapyr than (±)-imazapyr and (-)-imazapyr. Concentrations of proline and malondialdehyde reflected a toxic effect in the order of (+)-imazapyr > (±)-imazapyr > (-)-imazapyr at every concentration. Acetolactate synthase (ALS) activity was inhibited more by (+)-imazapyr than (±)-imazapyr or (-)-imazapyr. At 100 mg L(-1) of imazapyr, ALS activity was 78%, 43%, and 19% with (-)-, (±)-, and (+)-imazapyr, respectively. The results suggest the significant enantioselective toxicity of imazapyr in A. thaliana for greater toxicity with (+)-imazapyr than (±)-imazapyr and (-)-imazapyr, which suggests that (+)-imazapyr has more herbicidal effect.

Effect of octylphenol on physiologic features during growth in Arabidopsis thaliana.

Alkylphenol ethoxylates are widely used as detergents, emulsifiers, solubilizers, wetting agents and dispersants. Octylphenol (OP) ethoxylates, one of alkylphenol ethoxylates, represent 15-20% of the market, and their metabolic residues may be discharged to surface waters, sediments and soils as a persistent and ubiquitous pollutant. We tested the response of Arabidopsis thaliana to different concentrations of OP. OP affected the germination percentage and mean germination period. 10d treatment with OP, especially high concentration (10 and 50 mg L(-1)), decreased shoot and root biomass and root length of 30 d-old A. thaliana. Content of chlorophyll was decreased but that of proline was increased in leaves with OP treatment. OP caused oxidative stress in leaves; malondialdehyde content was increased, and the activities of ascorbate peroxidase, catalase and superoxide dismutase were induced. OP affects the physiologic and morphologic features of A. thaliana during growth. Because plants might be exposed to OP for a long time in the surroundings, more attention needs to be paid to the effect of OP on plants.

Vertical distribution in soil column and dissipation in soil of benzoylurea insecticides diflubenzuron, flufenoxuron and novaluron and effect on the bacterial community.

Benzoylurea insecticides are used for prevention and eradication of household or field pests. However, few studies have investigated their distribution and dissipation in soils and the effects on the soil microbial community. We examined the dissipation and vertical distribution of diflubenzuron, flufenoxuron and novaluron and their effects on bacterial diversity in two soils in Taiwan. The dissipation of the three benzoylureas was concentration dependent. The half-life of 1, 10 and 50 mg kg(-1) concentration was from 3.0 to 45.9, 52.1 to 433.2 and 27.7 to 533.2 d, respectively. The proportion of residual benzoylureas in sterilized soils remained up to 83% at the end of the incubation, which implied that the dissipation was mainly by microorganisms. All three benzoylureas were not detected below 10 cm in soil column experiments. Comparison of initial pesticides concentrations (50 mg kg(-1)), diflubenzuron was detected at <1%. However, flufenoxuron and novaluron remained at >30% and 50% in Pu and Wl soil, respectively after leaching for 70 d. Furthermore, the presence of flufenoxuron and novaluron at 5- to 10-cm depth led to greater change in bacterial community diversity in Pu than Wl soil.

Effects of interactive video-game based system exercise on the balance of the elderly.

This study evaluated the effects of interactive video-game based (IVGB) training on the balance of older adults. The participants of the study included 30 community-living persons over the age of 65. The participants were divided into 2 groups. Group A underwent IVGB training for 6 weeks and received no intervention in the following 6 weeks. Group B received no intervention during the first 6 weeks and then participated in training in the following 6 weeks. After IVGB intervention, both groups showed improved balance based on the results from the following tests: the Berg Balance Scale (BBS), Modified Falls Efficacy Scale (MFES), Timed Up and Go (TUG) test, and the Sway Velocity (SV) test (assessing bipedal stance center pressure with eyes open and closed). Results from the Sway Area (SA) test (assessing bipedal stance center pressure with eyes open and closed) revealed a significant improvement in Group B after IVGB training. Group A retained some training effects after 6 weeks without IVGB intervention. Additionally, a moderate association emerged between the Xavix measured step system stepping tests and BBS, MFES, Unipedal Stance test, and TUG test measurements. In conclusion, IVGB training improves balance after 6 weeks of implementation, and the beneficial effects partially remain after training is complete. Further investigation is required to determine if this training is superior to traditional physical therapy.

Liver injury caused by antibodies against dengue virus nonstructural protein 1 in a murine model.

Clinical manifestations of severe dengue diseases include thrombocytopenia, vascular leakage, and liver damage. Evidence shows that hepatic injury is involved in the pathogenesis of dengue infection; however, the mechanisms are not fully resolved. Our previous in vitro studies suggested a mechanism of molecular mimicry in which antibodies directed against dengue virus (DV) nonstructural protein 1 (NS1) cross-reacted with endothelial cells and caused inflammatory activation and apoptosis. In this study, the pathogenic effects of anti-DV NS1 antibodies were further examined in a murine model. We found, in liver sections, that anti-DV NS1 antibodies bound to naive mouse vessel endothelium and the binding activity was inhibited by preabsorption of antibodies with DV NS1. Active immunization with DV NS1 resulted in antibody deposition to liver vessel endothelium, and also apoptotic cell death of liver endothelium. Liver tissue damage was observed in DV NS1-immunized mice by histological examination. The serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were increased in mice either actively immunized with DV NS1 protein or passively immunized with antibodies obtained from DV NS1-immunized mice. Furthermore, histological examination revealed mononuclear phagocyte infiltration and cell apoptosis in mice passively immunized with antibodies obtained from mice immunized with DV NS1. Increased AST and ALT levels were observed in mice passively immunized with purified immunoglobulin G (IgG) from dengue patients compared with normal control human IgG-immunized mice. The increased AST and ALT levels were inhibited when dengue patient serum IgG was preabsorbed with DV NS1. In conclusion, active immunization with DV NS1 protein causes immune-mediated liver injury in mice. Passive immunization provides additional evidence that anti-DV NS1 antibodies may play a role in liver damage, which is a pathologic manifestation in dengue virus disease.

[Social segregation and the health care of female immigrants in Taiwan].

Technology has reduced the distance between people, and also blurred the boundaries between nations. In recent years the development of Taiwan society has been affected by cross-national marriages. In these cases, the foreigner--usually the female--living in a new country and adapting to the pressures of being in a new society very different from her own, is also confronted by a succession of social distinctions and differentiating selection processes, giving rise gradually to the phenomenon of social segregation in culture, language and marriage. Such segregation has in turn led gradually to inferior medical care for female immigrants. It is therefore worth investigating whether the current medical system can offer appropriate health care to the female immigrant. This article's approach is to discuss trans-national marriage and analyze the living situations of female immigrants, to investigate their social segregation, and hence their situation in relation to medical care. It also prompts more advanced reflection, on the part of clinical professional caregivers, of the needs of female immigrants, in the hope that those needs will become the subject of greater interest and attention.

Positive psychological measure: constructing and evaluating the reliability and validity of a Chinese Humor Scale applicable to professional nursing.

The nursing profession has generally accepted humor as beneficial to health care. As nursing has always emphasized holistic care and the importance of individual needs, the profession values the ability of humor to positively affect all aspects of a patient's well being. The purposes of this study were to develop a "Chinese Humor Scale (CHS)" for the nursing profession and then test its reliability and validity. The 405 individuals selected for participation in this study included nursing on-the-job students from a medical university and professional nurses practicing at four hospitals in north Taiwan. Researchers developed a list of 57 key humor measures which were filled out and returned by study participants. An evaluation of results using Cronbach's alpha coefficients demonstrated good consistency (alpha=.93) for the developed CHS. Intercorrelations amongst the four sub-scales were generally quite low, indicating each sub-scale measures dimensions relatively distinct from one another (r=.24 approximately .48, both p's<.001). The CHS was tested using item analysis. The scale was constructed in accordance with exploratory factor analysis (EFA) (K.M.O.=.92). Thirty CHS items, categorized under the four indices of "humorous creativity", "tendency to laugh", "perceptivity to humor", and "humorous attitude", were found to explain 55.42% of total variances. The CHS was found to provide good validity using a content validity index (CVI) developed by five experts. The results of this study provide encouraging evidence for the construct validity and reliability of the proposed humor scale and support its application by nursing educators and clinicians to further test and assess concepts related to humor. Further research is needed to explore more fully the implications of humor in nursing.

[Evidence nursing of menopausal women: telephone intervention services].

With rapid innovation in medical techniques and continuous improvements in public sanitation, people now live much longer than they used to. According to the Department of Health, Executive Yuan, the average life expectancy of women increased from 60.26 years in 1952 to 78.48 years in 2002. As the average life expectancy of women increases, the population of menopausal women also tends to increase year by year. For that reason, the government sees the health care of menopausal women as an important aspect of healthcare policy. With the health care environment constantly changing, it appears that simply relying on traditional experiences and subjective beliefs to do such nursing work cannot satisfy the needs of patients. Consequently, effective methods to apply research results to clinical practice has become a crucial goal of current evidence nursing. Rosswurn and Larrabee (1999) proposed six steps of change in the clinical nursing model. In this paper, we used this model to evaluate the effects of telephone intervention services for menopausal women.

Expression of cytokine, chemokine, and adhesion molecules during endothelial cell activation induced by antibodies against dengue virus nonstructural protein 1.

Vascular dysfunction is a hallmark associated with disease onset in dengue hemorrhagic fever and dengue shock syndrome. In addition to direct viral damage, immune responses to dengue virus (DV) infection may also underlie the pathogenesis of disease. We have proposed a mechanism of molecular mimicry in which Abs directed against DV nonstructural protein 1 (NS1) cross-react with endothelial cells and induce damage. In this study, we demonstrated the inflammatory endothelial cell activation induced by anti-DV NS1 via the transcription factor NF-kappaB-regulated pathway. Protein phosphorylation and NF-kappaB activation were observed after anti-DV NS1 stimulation in a human microvascular endothelial cell line-1. The cytokine and chemokine production, including IL-6, IL-8, and MCP-1, but not RANTES, in endothelial cells increased after treatment with anti-DV NS1 Abs. The expression of IL-6, IL-8, and MCP-1 was blocked by the preabsorption of anti-DV NS1 with DV NS1 or by the inhibition of NF-kappaB activation. Furthermore, the increases in both ICAM-1 expression and the ability of human PBMC to adhere to endothelial cells were also observed, and these effects were inhibited by pretreatment with anti-ICAM-1 or anti-MCP-1 Abs. Therefore, in addition to endothelial cell apoptosis, as previously reported, inflammatory activation occurs in endothelial cells after stimulation by anti-DV NS1 Abs. These results suggest the involvement of anti-DV NS1 Abs in the vasculopathy of DV infection.

[The relationship between hardiness, coping strategies and burnout in psychiatric nurses].

Hardiness is a personality trait in which the ability to buffer the health related effects of stress is inherent. It has been frequently and enthusiastically investigated in connection with human health. In order to understand hardiness in psychiatric nurses, to prevent burnout, and to enhance the quality of nursing care, this study sought to investigate the relationships between hardiness, burnout and quality of nursing care. One hundred and forty-seven psychiatric nurses were selected in a stratified random sample from the psychiatric units of district hospitals in Taipei City. Data were collected through structured questionnaires and concerned: (1) demographic variables, (2) the Health Related Hardiness Scale, (3) the Jalowiec Coping Scale, and (4) the Maslach Burnout Inventory. The main results indicated that: (1) Most respondents enjoyed high levels of hardiness (M = 157.84, SD = 18.42); (2) Respondents' levels of hardiness were positively correlated to the use of confrontational coping styles, optimistic coping styles, supportive coping styles and self-reliant coping styles; (3) Levels of hardiness were negatively correlated to emotional exhaustion but positively correlated to personal accomplishment; (4) There was a significantly positive correlation between the evasive coping style and emotional exhaustion; (5) The confrontational, optimistic and self-reliant coping styles were positively correlated to personal accomplishment. The findings of this study should contribute to our understanding of the relationship between hardiness, coping strategies and burnout in psychiatric nurses.