Genome wide transcriptomic analysis identifies pathways affected by the infusion of Clostridium perfringens culture supernatant in the duodenum of broilers in situ.

Clostridium perfringens type A is the main etiological factor for necrotic enteritis, a multifactorial enteric disease that penalizes performance, health, and welfare of poultry. Lack of knowledge of host responses and disease pathogenesis is slowing down progress on developing therapies for disease control. A combined genomewide and targeted gene approach was used to investigate pathways and biological functions affected by the infusion of C. perfringens culture supernatant in the duodenum of broilers in 2 experiments. An in situ isolated loop of duodenum was prepared in anesthetized broilers of 3 wk of age (Exp. 1) and was infused either with crude C. perfringens culture supernatant (n = 7; treated), positive for necrotic enteritis B-like toxin (NetB) as determined by a cytotoxicity assay, or with a control preparation (n = 6; control). Birds were maintained alive for 1 h and then euthanized for tissue recovery. The use of the Affymetrix chicken genome array on RNA samples from loop tissue showed top biological functions affected by culture supernatant infusion included cell morphology, immune cell trafficking, and cell death; pathways affected included death receptor signaling, inflammatory response, and nuclear factor (NF)-κB signaling. In a second in situ study (Exp. 2), broilers were maintained alive for 4 h to monitor temporal expression patterns of targeted genes. Duodenal tissue was removed at 0.5, 1, 2, and 4 h post-infusion with culture supernatant (n = 9) or a control preparation (n = 5) for histology and gene expression analysis. Genes encoding proinflammatory cytokines, such as interferon γ (IFNγ), cell trafficking, such as neuroblastoma 1 (NBL1) and B cell CLL/Lymphoma 6 (BCL6), and cell death, such as Fas cell surface death receptor (FAS) and GTPase IMAP family member 8 (GIMAP8), were differentially expressed in the duodenum of treated and control broilers (P < 0.05). We have demonstrated that C. perfringens culture supernatant (NetB positive) infusion resulted in histological and gene expression changes consistent with necrotic enteritis in the duodenum of broilers. In the absence of live bacteria, crude culture supernatant resulted in early immunomodulation, inflammation, and cell death in the duodenum. The pathways identified here can be targeted for the development of new drugs, vaccines, and novel therapies for necrotic enteritis in broilers.

Quantitative ultrasonic diagnosis of silicone breast implant rupture: an in vitro feasibility study.

Ultrasound is useful in evaluating the integrity of silicone breast implants. However, extensive operator experience is required. A system for computer-assisted diagnosis is being developed to reduce operator dependence. Feasibility was examined by measuring the ultrasonic properties of breast implants in vitro. Silicone gels from 45 explanted implants (26 intact and 19 ruptured) were placed in sealed acoustic test chambers and 60 RF A-lines were acquired from each. Velocity of sound, attenuation and integrated backscatter (IB) were estimated. Receiver operating characteristic (ROC) analysis was performed. The mean speed of sound was 1060 m/s +/- 50.1 m/s in intact implants and 1115 m/s +/- 74.3 m/s in ruptured ones (p < 0.003). Differences in attenuation were not statistically significant. The mean IB was -83.9 dB +/- 7.94 dB in intact and -77.2 dB +/- 9.07 dB in ruptured implants (p < 0.006). The area under the ROC curve (Az) was 0.70 and 0.73 for IB and velocity, respectively, while combining the two yielded Az = 0.81. Changes in speed of sound and IB, with changes in integrity of breast implants, have been demonstrated in vitro. The results indicate the potential for quantitative assessment of silicone breast implants performed in vivo.

Volume flow estimation using time domain correlation and ultrasonic flowmetry.

A comparison of two volumetric blood flow measurement techniques, CVI-Q (based on time domain correlation) and ultrasonic flowmetry, has been performed in vitro and in vivo. A pulsatile flowpump was used to simulate carotid and femoral type waveforms which were measured simultaneously using the two methods. Five dogs had their common carotid and femoral arteries exposed, and the instantaneous maximum volume flow and the mean flow were measured. Each vessel was partially occluded halfway through the experiment, simulating a 90% stenosis. In vitro, both techniques achieved absolute errors below +/- 5% for flow rates over 100 mL/min, but ultrasonic flowmetry had statistically significant larger errors for slower flow rates. In vivo correlation coefficients ranging from 0.73 to 0.95 were obtained with regression line slopes close to unity. The two techniques were in reasonable agreement, but with standard deviations of 20% to 28%. These studies indicate that noninvasive CVI-Q measurements of blood flow in the carotid and femoral arteries are linear and accurate compared to invasive ultrasonic flowmetry.

Laparoscopic telescope with alpha port and aesop to view open surgical procedures.

Laparoscopy has advanced surgery by allowing the surgeon to operate within a patient's abdominal and pelvic cavity with minimal trauma and scarring. The coupling of a video camera to the laparoscopic telescope has had the secondary effect of allowing others to view the surgical field either on color video monitors or by watching the video feed over the Internet at a remote location. These advancements have allowed better teaching and mentoring of operations. Open procedures can benefit from this technology as well but have suffered in the past from inadequate methods to depict the open surgical field. We used the Alpha Port and Aesop robot to position a sterile laparoscopic telescope near the surgical field to view open cholecystectomies performed on five pigs and to send the video feed over the Internet to remote physicians. Viewing the video on the monitor, the surgeons performed the operation in a comfortable ergonomic upright position. Both the surgeons and the remote physicians found the quality of the video to be excellent, and the remote physicians felt comfortable learning and mentoring surgical procedures using this technique.

Wireless telemetry and Internet technologies for medical management: a Martian analogy.

BACKGROUND: The NASA Haughton-Mars Project Base Camp on Devon Island, Canada (approximately 75 degrees north) was the site for transmission of vital signs from two "terranauts" (individuals who acted as Earthbound astronauts) back to the United States in (artificially delayed) real-time. METHODS: The subjects became "physiologic ciphers" for status monitoring using readily available technologies that affordably captured and distributed vital signs to a variety of platforms. This study of nominal monitoring and simulated medical emergency used wireless technologies and the Internet. RESULTS: Basic vital signs and images can be sent using wireless topologies and completely automated functions. Due to the lightweight transport requirements, existing low data rate connections can easily handle the volume of traffic. CONCLUSIONS: Monitoring, the health of space travelers will be an important component for both low-Earth orbiting spacecraft and long-term missions to distant planets. However, terrestrial applications represent the primary application of such technologies because the home can be a remote and hazardous environment as well.

Development of an instrument to assess maternal childhood injury health beliefs and social influence.

Unintentional home related injuries are a major cause of morbidity and mortality among children under the age of five years. Injury incidence in homes for these children continues at high levels despite injury prevention education programs for their caregivers. This article reports the development of an instrument that assesses injury prevention health beliefs and social influence perceptions in mothers of young children. Based on the Health Belief Model, the tool is composed of six scales that measure injury susceptibility and seriousness, benefits and barriers of injury prevention, self efficacy of injury prevention performance, and social influence. Reliability measurements showed that all scales produced high Cronbach alphas (.83 to .98) and significant test-retest correlations (.30 to .62, p < or = .05). Criterion related validity was established (-.36 to -.59, p < or = .05) for all scales except the seriousness scale. This instrument has utility for nursing investigations on the predictors of injury prevention behavior and for development of nursing interventions to prevent injuries in young children.

Preschool children at risk for repeat injuries.

Home-related injuries are a major problem in young children. This study investigated maternal and child characteristics related to repeat injuries in preschool children. A secondary data analysis was conducted on a national probability sample of African American and White mothers who participated in the longitudinal study of the National Maternal and Infant Health Survey. Repeat injuries in the African group were associated with poor maternal health status, maternal use of alcohol, and Ipecac in the home. Significant factors for the White group were male child, unmarried mother, difficulty managing the child, maternal depression, poor maternal health status, and Ipecac in the home. Findings support the need to identify high-risk children and to provide interventions specially aimed at amelioration of those factors related to repeat injuries.

Public policy analysis of Indiana's minority health initiatives.

Similar to national health trends in the US, racial/ethnic minorities in the state of Indiana continue to experience disparities in poor health status from preventable health conditions. To address this problem, people from minority communities across the state mobilized a broad base of individuals and organizations to facilitate the successful legislative enactment of a statewide minority health initiative. A case study of the initiative is presented for public policy analysis. The theoretical framework for the study is Etzioni's Societal Guidance Theory. The findings show that minority health advocates were able to impact favorably on public policy formulation and funding of the initiative by increasing knowledge about minority health status among grass-roots people, generating public consensus for public policy intervention, setting mutual goals via a 5-year strategic minority health plan, creating organizational structures to implement the plan and utilizing power to push the initiative through the legislative process. The weaknesses of the initiative efforts include a limited infrastructure development of minority health coalitions, restricted effective use of the legislative process and varying degrees of linkages among other advocacy groups. Improvements in these areas are discussed and recommendations are made for the implementation phase of the initiative.

Public policy analysis for registered nurses in a baccalaureate curriculum.

As nurses become more involved in the macro-decision-making arena, they need policy analysis skills in order to make effective recommendations on policy alternatives. Dunn's policy analysis framework, useful for examining and understanding policy issues, is relevant to nursing education and practice and provides guidance for effective action. This framework guided an educational experience for registered nurse (RN) students in a baccalaureate nursing program. The students participated in community-based policy analysis, examining public policies affecting the health of individuals, families, groups, and populations. Dunn's framework and this policy experience can be incorporated into formal education courses or continuing education programs.

Health beliefs and social influence in home safety practices of mothers with preschool children.

The purpose of this study was to determine relationships among health beliefs, social influence, and home injury proofing-behavior in 140 low-income mothers with preschool children. Data were collected through structured interviews and observations of safety hazards in subjects' homes. Regression analysis showed that the combination of health beliefs, social influence, demographic, and experiential variables accounted for 51% of the variance in hazard accessibility and 44% in hazard frequency. Self efficacy, previous injury experience, knowledge, age, and birth position of the children were significant predictors of home safety practices. Recommendations are offered for practice, research, and health policy.

Increasing access to prenatal care: an evaluation of minority health coalitions' early pregnancy project.

Early prenatal care utilization is a problem for racial and ethnic minority women in Indiana. Minority health coalitions in Indiana developed early pregnancy care coordination projects to address this need. To evaluate project outcomes, birth certificates of infants born to project mothers were matched with birth certificates of infants whose mothers did not receive care coordination. Results showed that project mothers were significantly more likely to start prenatal care earlier, had better prenatal care utilization as measured by the Kessner Index (Kessner, Singer, Kalk, & Schlesinger, 1973), and had better adequacy of care as measured by the APNCU Index (Kotelchuck, 1994) than the noncare-coordinated mothers. Although the project was successful in meeting its primary objective, specific recommendations are made for community health nurses to partner with the coalitions in improving the content of prenatal care, decreasing sociocultural barriers to care, and assisting in the evaluation of outcomes of future projects.

Interprofessional education for undergraduate students.

Collaborative practice is an essential component of public health nursing. Using an interprofessional collaboration process, community health nursing and social work faculty developed joint classroom instruction and clinical experiences for their students. In partnership with a neighborhood organization, the undergraduate nursing and social work students conducted a community assessment and recommended a plan of action. Analysis of the student collaborative practice revealed both similarities and differences in role perceptions, group process, problem solving, and discipline-specific values and attitudes. Logistical concerns revolved around student scheduling and communications. Based on the analysis, specific recommendations are provided for faculty in developing student collaborative experiences across disciplines.

Epidemiology for community health nursing: an interactive computer assisted instruction program.

Epidemiology and its application to community health nursing is an essential concept for baccalaureate nursing students. To facilitate student learning, nursing faculty chose to use computer assisted instruction (CAI) as an adjunct teaching-learning strategy. An interdisciplinary team, including nursing content specialists and a computer programmer, produced an interactive CAI that integrated epidemiologic content, community health nursing practice, and learning-theory principles. Contents of the program modules are described, and program strategies used to enhance learning are delineated. Evaluation of the program indicated students (N = 106) believed the content was clearly explained and preferred learning epidemiology through combining classroom learning with CAI rather than through textbook reading assignments.

Community health nurses' knowledge of Lyme disease: implications for surveillance and community education.

A statewide assessment was conducted to determine the general knowledge and professional practices about Lyme disease (LD) of local health department nurses. The study sample included 226 nurses practicing in 80 health departments in Indiana. Data were collected using a self-administered questionnaire and analyzed using group independent t tests. Findings showed that nurses were most knowledgeable about personal protection against LD and least knowledgeable about symptoms, case definition, and reporting criteria. Nonbaccalaureate degreed nurses scored significantly higher on questions about LD than the baccalaureate or master's prepared nurses. Results point to the need for better dissemination of LD information among public health nurses, expanded LD education for the public, and further development of LD surveillance activities.

Performance of neuroradiologic examinations by nonradiologists.

PURPOSE: To determine the level of participation by nonradiologists in performing neuroradiologic examinations. MATERIALS AND METHODS: Medicare part B claims data from fiscal year 1992 were analyzed for CPT (current procedural terminology) codes related to computed tomography (CT) and magnetic resonance (MR) imaging of the brain, head and neck, and spine, as well as myelography, angiography, and diskography. Data were tabulated by place of service (hospital-based vs freestanding imaging centers) and by medical specialty. RESULTS: Among 363,224 Medicare claims for CT and MR imaging of the brain, head and neck, and spine, 91% of the examinations were performed in hospitals and 9% in offices or freestanding centers; 98% of studies were interpreted by a radiologist. The largest share of radiology billing by nonradiologists was from office-based or freestanding imaging centers (9%), versus 2% at hospital-based facilities. CONCLUSION: Radiologists perform the vast majority of neuroradiologic examinations. Most neuroradiologic examinations performed by nonradiologists are from neurologists at freestanding/office-based imaging centers.