A pattern language of compassion in intensive care and palliative care contexts.

BACKGROUND: Compassion has been identified as important for therapeutic relationships in clinical medicine however there have been few empirical studies looking at how compassion is expressed different contexts. The purpose of this study was to explore how context impacts perceptions and expressions of compassion in the intensive care unit and in palliative care. METHODS: This was an inductive qualitative study that employed sensitizing concepts from activity theory, realist inquiry, phenomenology and autoethnography. Clinicians working in intensive care units and palliative care services wrote guided field notes on their observations and experiences of how suffering and compassion were expressed in these settings. Data were analyzed using constructivist grounded theory. RESULTS: Fifty-eight field notes were generated, along with transcripts from three focus groups. Clinicians conceptualized, observed, and expressed compassion in different ways within different contexts. Patterns of compassion identified were relational, dispositional, activity-focused, and situational. A pattern language of compassion in healthcare was developed based on these findings. CONCLUSIONS: Recognizing compassion as shifting patterns of diverse attitudes, behaviours, and relationships raises numerous questions as to how compassion can be developed, supported and recognized in different clinical settings.

The 2009/2010 Caribbean drought: a case study.

The impacts of drought in the Caribbean have not been as dramatic as in some other parts of world, but it is not exempt from the experiences of drought. As a result of the effects of a prolonged drought in 2009/2010, the agenda for the 21st Inter-Sessional Meeting of the Caribbean Community (CARICOM) paid particular attention to the issue of drought. This paper reviews the management framework for responding to drought disasters in five CARICOM countries. The paper also reports on some of the effects of the 2009/2010 drought with particular reference to Grenada and the Grenadines. During the drought in these islands there were numerous bush fires with devastating effects on agriculture, severe water shortages that impacted on the tourism industry and other social effects. It is evident that there was inadequate preparation for the event. Greater planning and investment are therefore required to reduce future impacts.

Phase chemistry, structure, and radiation effects in lunar samples.

Phase chemistry, structure, and radiation effects were studied in rock, breccia, and soil samples. The regolith apparently developed in the final stages of accretion and was modified by later impact processes and radiation weathering. Exposure ages indicate transfer of buried igneous rock fragments to the near surface late in lunar history. With a few exceptions igneous rock fragments, soil, and breccia share the same distinctive chemistry, probably acquired before accretion of the moon. The igneous rocks texturally resemble basaltic achondrites, and the soil and breccias contain glassy spheres analogous to chondrules.

Sulfur-rich proteins of Chlamydia trachomatis: developmentally regulated transcription of polycistronic mRNA from tandem promoters.

RNA was extracted at various times from cells infected with Chlamydia trachomatis serovar L1. Northern-blot analysis showed that transcription of the CrP gene encoding the 60-kDa cysteine-rich outer membrane protein (CrP) produces a temporally controlled polycistronic mRNA. Primer extension analysis indicated the presence of tandem promoters separated by 66 nt with transcriptional start points (tsp) located 577 and 643 nt upstream from the start codon of the mature 60-kDa CrP. Nucleotide (nt) sequencing of this region revealed a small open reading frame (SORF) with coding potential for an 88-amino acid protein containing 13 cysteine residues. This SORF is transcribed as both a polycistronic 2300-nt mRNA together with the CrP gene, and as a separate 480-nt mRNA. Analysis of the upstream sequences, around the tsp for these mRNAs, revealed the presence of three inverted repeat structures that might act as binding domain(s) for a regulatory protein.

Similarities between parents and offspring on a personality inventory.

The authors administered a personality inventory that has been used as a psychiatric screening test to 28 children and their natural parents. By intercorrelations between the tests of parents and offspring they attempted to find out whether the offspring resembled the parent of same sex, the parent of the opposite sex, or a composite of both parents. They found that the offspring resembled their peer group more often than either parent or a composite of both parents.

A comparison of the use of adaptive microswitches by students with cerebral palsy.

This paper describes systematic procedures used to assess, train, and compare the use of adaptive microswitches for microcomputers used by adolescents with cerebral palsy. A comparison is made of three students with cerebral palsy using microswitches to increase their production rates as part of a vocational training program. Future uses of adaptive microswitches in vocational and educational training programs are also considered.

A systematic evaluation of preferences identified through person-centered planning for people with profound multiple disabilities.

Person-centered planning is becoming a popular means of designing supports for people with disabilities. However, very little research evaluating person-centered planning exists. We evaluated the degree to which items and activities reported to be preferred in person-centered plans represented accurate preferences based on how individuals responded when presented with the items and activities. Person-centered planning meetings were conducted with 4 individuals with profound multiple disabilities to develop preference maps and to identify leisure-related preferences. A sample of the reported preferences in the plans was then systematically assessed by observing each participant's approach and avoidance responses to the items and activities. Of the sampled items and activities reported to be preferred in the plans, 42% represented moderate preferences based on the latter assessment process and 33% represented strong preferences. With 2 participants, several preferences identified in the plans were nonpreferred items and activities based on the preference assessments, and some were frequently avoided. These results suggested that although person-centered plans may identify some accurate preferences for people with profound multiple disabilities, this approach should be used cautiously. Results also suggested that such plans should be supplemented with systematic preference assessments to ensure the accuracy of identified preferences. Future research areas focus on evaluating other aspects of person-centered planning.

The plasmids of Chlamydia trachomatis and Chlamydophila pneumoniae (N16): accurate determination of copy number and the paradoxical effect of plasmid-curing agents.

A 7.5 kbp cryptic plasmid is found in almost all isolates of Chlamydia trachomatis. Real-time PCR assays, using TaqMan chemistry, were set up to quantify accurately both the chlamydial plasmid and the single copy, chromosomal omcB gene in the infectious, elementary bodies (EBs) of C. trachomatis L1 440. Plasmid copy number was also determined in the EBs of six other lymphogranuloma venereum (LGV) isolates (serovars L1-L3), ten trachoma isolates (serovars A-C) and nine urogenital isolates (serovars D-J). The results indicated an average plasmid copy number of 4.0+/-0.8 (mean+/-95 % confidence interval) plasmids per chromosome. During the chlamydial developmental cycle, up to 7.6 plasmids per chromosome were detected, indicating an increased plasmid copy number in the actively replicating reticulate bodies. Attempts to eliminate the plasmid from strain L1 440 using the plasmid-curing agents ethidium bromide, acridine orange or imipramine/novobiocin led to a paradoxical increase in plasmid copy number. It is speculated that the stress induced by chemical curing agents may stimulate the activity of plasmid-encoded replication (Rep) proteins. In contrast to C. trachomatis, only a single isolate of Chlamydophila pneumoniae bears a plasmid. C. pneumoniae strain N16 supports a 7.4 kbp plasmid in which ORF1, encoding one of the putative Rep proteins, is disrupted by a deletion and split into two smaller ORFs. Similar assay techniques revealed 1.3+/-0.2 plasmids per chromosome (mean+/-95 % confidence interval) in EBs of this strain. These findings are in agreement with the hypothesis that the ORF1-encoded protein is involved in, but not essential for, plasmid replication and control of copy number.

Focal-spot measurement: comparison of slit, pinhole, and star resolution pattern techniques.

The National Electrical Manufacturers Association (NEMA) has established a new standard for x-ray tube focal-spot measurements using a focal-spot camera with a slit instead of a pinhole. Measurements from the slit focal-spot camera are compared and star resolution pattern techniques for 50 focal spots. In addition, measurements were made using direct-exposure film as required by the NEMA standard and an extremity screen-film system, which minimizes x-ray tube loading. The slit, pinhole, and star resolution techniques provided similar results that were within the accuracy required for clinical focal-spot measurements. The focal-spot measurements were also similar when a direct-exposure film or an extremity screen-film system was used. A description of the use of the slit focal-spot camera and difficulties with implementing the new NEMA standards in the clinical setting are also presented.

Epitope specificities of human serum antibodies reactive with respiratory syncytial virus fusion protein.

Respiratory syncytial (RS) virus continues to cause serious human respiratory disease and no prophylactic vaccine is yet available. Serum antibodies to RS virus fusion protein (F) that have the appropriate specificities and activities could confer protection against severe RS virus infections. To explore human serum antibody responses to RS virus F we first characterised four epitopes on F and then measured the concentrations of human serum antibodies to these sites for 389 sera. Individuals varied in serum antibody concentration to the epitopes. The distribution patterns of the concentrations of antibodies reactive to each epitope were different. Antigenic variation of F at these epitopes in Southampton RS virus isolates was examined by immunofluorescence. The F proteins from different isolates varied within and between RS virus subtypes which co-circulated in the outbreak of winter 1985-1986. Variations in F detected by immunofluorescence were consistent with differences between the strains' susceptibilities to monoclonal antibody antiviral action.

Comparative virulence of opacity variants of Neisseria gonorrhoeae strain P9.

The invasive properties of nine variants of Neisseria gonorrhoeae strain P9 known to vary in their surface composition have been investigated. Relative virulence was evaluated by their cytotoxic effect on Chang epithelial cell monolayers. Piliated variants P9-2 (with alpha pili) and P9-20 (with beta pili plus protein II) showed increased ability to kill the target cells compared with the prototype P9-1 (lacking pili and additional outer membrane proteins). Two nonpiliated variants, P9-11 (with proteins IIa and IId) and P9-19 (with proteins II and IIc), were also relatively more virulent compared with P9-1. Enhanced attachment was exhibited by both piliated and some nonpiliated variants: beta-piliated P9-20 (with protein II; molecular weight, 29,000) and nonpiliated P9-16 (with protein IIb; molecular weight, 28,000) were the most effective in adherence to the target monolayers.

School-to-work transition for youth who are both deaf and blind.

Transition, collaborative planning for desired adult opportunities, and implementation of objectives and activities can increase the postsecondary employment opportunities open to youth who are deaf and blind. Collaborative transition planning is characterized by family-professional partnerships in developing visionary personal profiles, systematic and transdisciplinary vocational preparation in community-based settings, and infusion of related services within educational programs.

Indicator-based audit of cataract surgery in four neighbouring hospitals in East Anglia.

To review and compare management and outcomes of patients undergoing cataract surgery in order to improve practice by identifying weaknesses and standardising best practice where appropriate, a concurrent and prospective audit from June to October 1993 was carried out in four neighbouring ophthalmic units in East Anglia. Six hundred and twenty-seven consecutive patients were undergoing cataract surgery in the audit period. The main measures and results were as follows: (1) Patients with visual acuity reduced to 6/60 or less should not wait longer than 3 months from consultation to surgery; 69.5% met standard. (2) Patients with visual acuity reduced to 6/18 or less should not wait longer than 12 months from consultation to surgery; 85.8% met standard. (3) Patients who have had cataract surgery should achieve 6/12 or better corrected visual acuity by 3 months post-operatively; 88.6% met standard. (4) There should be less than 2% sight-threatening complications of surgery; 4.2% suffered sight-threatening complications. (5) There should be no life-threatening complications of surgery; 100% met standard. The audit identified key areas of variation in practice, and analysis of reasons for differences in outcome has led to some changes in the management of patients with cataracts in the four units.

"ULtra-clean" isotope diultion/mass spectrometic analyses for lead in human blood plasma indicated that most reported values are artificially high.

We measured lead concentrations in venous blood plasma from two subjects, one having a typical exposure and the other a high exposure to lead. Our preliminary data, obtained by isotope dilution/mass spectrometric techniques in an ultra-clean laboratory, show lead concentrations of 0.02 mug/L and 2 mug/L, respectively, in their blood plasma, and 110 mug/L and 800 mug/L, respectively, in samples of whole blood. These results indicate that plasma lead concentrations previously reported have been overestimated by a large factor, and that further improvements in analytical procedures are needed in most laboratories before data on lead concentratios in blood plasma can be properly interpreted. Our preliminary data indicate a positive correlation between lead intake and lead concentrations in blood plasma.

Effect of anti-pilus antisera on virulence of variants of Neisseria gonorrhoeae for cultured epithelial cells.

Variants of Neisseria gonorrhoeae P9 possessing a, gamma or delta pili were shown to vary in their toxicity and virulence for human epithelial cells. Studies with antisera raised against purified pili showed that attachment and virulence were reduced to a significant degree in the presence of antisera to homologous pili. Heterologous antisera, while capable of agglutinating whole organisms, were largely ineffective in reducing attachment and cytotoxicity. Using an enzyme-linked immunosorbent assay (ELISA) system, the cross-reactivity between pili and heterologous antisera was estimated to be no more than 10-20%.

Antigenic and structural variation in the major nucleocapsid protein of respiratory syncytial virus.

Antigenic and structural variation in the major nucleocapsid protein, VPN41, from different strains of respiratory syncytial (RS) virus was observed using a combination of monoclonal antibodies and two-dimensional peptide mapping. Limited trypsin treatment of intact nucleocapsids produced two peptide fragments Mr 27K and Mr 14K. Two monoclonal antibodies, N1 and N2, reactive with primary sequence epitopes located on intact nucleocapsids also reacted with either the 27K fragment (N2) or the 14K fragment (N1). Competitive radioimmunoassay studies using N1 and N2 antibodies revealed two discrete antigenic groups among the seven human strains of RS virus examined. A bovine strain of RS virus, although antigenically similar to the human strain of RS virus, was placed in a separate group. Two-dimensional peptide mapping of 125I-labelled VPN41 purified by SDS-PAGE revealed extensive structural homology between all strains. However, several unique tryptic/chymotryptic peptides supported the grouping obtained with the monoclonal antibodies.

The CrP operon of Chlamydia psittaci and Chlamydia pneumoniae.

One of the critical developmental events during the unique intracellular life cycle of Chlamydiae is their differentiation from a metabolically active, replicative form or reticulate body (RB) to an infectious extracellular form of the organism (elementary body or EB). This process is characterized by the expression of two extraordinarily cysteine-rich envelope proteins of molecular masses 9 kDa and 60 kDa. We describe the molecular cloning and sequence determination of the 9 kDa cysteine-rich proteins (CrPs) of C. pneumoniae and C. psittaci. Comparison of these 9 kDa CrP amino acid sequences with those of C. trachomatis showed regions of structural variation and conservation. Transcription of the 9 kDa CrP genes occurred as both a monocistronic message and as a bicistronic message which included the 60 kDa CrP gene. Transcription of the 9 kDa and 60 kDa CrP genes was tightly linked to the chlamydial growth cycle with synthesis of their mRNAs and consequent translation of the 60 kDa CrPs occurring as RBs differentiated to form EBs. The maximal rate of transcription occurred late in the growth cycle from a single but highly conserved promoter which had close similarity with the Escherichia coli consensus promoter sequences. A stem and loop structure which could be involved in regulating translation of mRNA occurred in all three species between the transcriptional start point and the ribosome binding site. Although transcription is initiated from a single promoter in all three chlamydial species, transcriptional termination points for the monocistronic and bicistronic mRNAs differ in both number and position.

Immunoreactivity of the 60 kDa cysteine-rich proteins of Chlamydia trachomatis, Chlamydia psittaci and Chlamydia pneumoniae expressed in Escherichia coli.

The 60 kDa cysteine-rich proteins (CrPs) of Chlamydia are developmentally regulated outer envelope proteins synthesized late in the chlamydial growth cycle. These proteins, found only on the extracellular infectious elementary bodies, elicit major antibody responses in chlamydial infection. We have cloned and expressed in Escherichia coli the complete 60 kDa CrP genes from Chlamydia trachomatis, C. psittaci and C. pneumoniae. The recombinant products were expressed as either 'native' proteins or as fusions with the bacteriophage T7 gene 10 protein. Electron microscopy showed that recombinant proteins were produced as insoluble inclusions within the E. coli host cells. The recombinant 60 kDa CrPs were purified and used to raise high titre polyclonal antisera. In immunoblot analysis these antisera reacted with the 60 kDa CrPs from purified elementary bodies of all three chlamydial species in a genus-specific manner. Further molecular analysis allowed the genus-specific cross-reacting epitopes to be localized by using overlapping synthetic peptides covering the C. trachomatis 60 kDa CrP. Immunogold labelling experiments, using purified infectious elementary bodies from the three chlamydial species indicated that the 60 kDa CrPs are not surface accessible to antibody binding.