Cortactin: A major cellular target of viral, protozoal, and fungal pathogens.

Many viral, protozoal, and fungal pathogens represent major human and animal health problems due to their great potential of causing infectious diseases. Research on these pathogens has contributed substantially to our current understanding of both microbial virulence determinants and host key factors during infection. Countless studies have also shed light on the molecular mechanisms of host-pathogen interactions that are employed by these microbes. For example, actin cytoskeletal dynamics play critical roles in effective adhesion, host cell entry, and intracellular movements of intruding pathogens. Cortactin is an eminent host cell protein that stimulates actin polymerization and signal transduction, and recently emerged as fundamental player during host-pathogen crosstalk. Here we review the important role of cortactin as major target for various prominent viral, protozoal and fungal pathogens in humans, and its role in human disease development and cancer progression. Most if not all of these important classes of pathogens have been reported to hijack cortactin during infection through mediating up- or downregulation of cortactin mRNA and protein expression as well as signaling. In particular, pathogen-induced changes in tyrosine and serine phosphorylation status of cortactin at its major phospho-sites (Y-421, Y-470, Y-486, S-113, S-298, S-405, and S-418) are addressed. As has been reported for various Gram-negative and Gram-positive bacteria, many pathogenic viruses, protozoa, and fungi also control these regulatory phospho-sites, for example, by activating kinases such as Src, PAK, ERK1/2, and PKD, which are known to phosphorylate cortactin. In addition, the recruitment of cortactin and its interaction partners, like the Arp2/3 complex and F-actin, to the contact sites between pathogens and host cells is highlighted, as this plays an important role in the infection process and internalization of several pathogens. However, there are also other ways in which the pathogens can exploit the function of cortactin for their needs, as the cortactin-mediated regulation of cellular processes is complex and involves numerous different interaction partners. Here, the current state of knowledge is summarized.

Resting-state fMRI in patients with refractory epilepsy with and without drop attacks: exploring the connectivity of sensorimotor cortex.

OBJECTIVE: Patients with multifocal or generalized epilepsies manifesting with drop attacks have severe refractory seizures and significant cognitive and behavioural abnormalities. It is unclear to what extent these features relate to network abnormalities and how networks in sensorimotor cortex differ from those in patients with refractory focal epilepsies. Thus, in this study we sought to provide preliminary data on connectivity of sensorimotor cortex in patients with epileptic drop attacks, in comparison to patients with focal refractory epilepsies. METHODS: Resting-state fMRI (rs-fMRI) data was available for 5 patients with epileptic drop attacks and 15 with refractory focal epilepsies undergoing presurgical evaluation. Functional connectivity was analyzed with a seed-based protocol, with primary seeds placed at the precentral gyrus, the postcentral gyrus and the premotor cortex. For each seed, the subjects' timeseries were extracted and transformed to Z scores. Between-group analysis was then performed using the 3dttest+ + AFNI program. RESULTS: Two clusters of reduced connectivity in the group with drop attacks (DA group) in relation to those with focal epilepsies were found in the between-group analysis: the precentral seed showed reduced connectivity in the surrounding motor area, and the postcentral seed, reduced connectivity with the ipsilateral posterior cingulate gyrus. In the intra-group analyses, sensorimotor and premotor networks were abnormal in the DA group, whereas patients with focal epilepsies had the usual connectivity maps with each seed. CONCLUSION: This pilot study shows differences in the cerebral connectivity in the sensorimotor cortex of patients with generalized epilepsies and drop attacks which should be further explored to better understand the biological bases of the seizure generation and cognitive changes in these people.

Being Unprepared: A Grounded Theory of the Transition of Asthma Self-Care in College Students.

PURPOSE: The purpose of this study was to conceptualize the basic social process of how college students transition from home-based asthma management to independent self-care management. DESIGN AND METHODS: Classical grounded theory was used to explore the transition of asthma self-care in college students. Seventeen college students with asthma from a Midwestern urban university were interviewed. RESULTS: Being Unprepared emerged as the basic social process used by students transitioning from home-based management of their asthma to managing their asthma in college. Being Unprepared conceptualizes a process by which participants engaged in relying on others, primarily their mother, to manage their asthma while in high school. This reliance on others continued when participants became college students with asthma where they were found lacking preparation for self-management in college exemplified by their being relatively unprepared for dealing with the unexpected stressors associated with starting college or for managing asthma episodes safely and effectively as students. Participants acknowledged that they were unprepared for managing their asthma independently and the need for becoming better prepared for their own safe asthma self-management. CONCLUSIONS: Youth with asthma may be at risk for poor health outcomes as they transition to self-care in college. The grounded theory, Being Unprepared, derived from empirical data can provide a scientific basis for deriving practice protocols. PRACTICE IMPLICATIONS: These findings can be used to inform parents and healthcare providers about the need for early intervention designed to prepare students with asthma for the transition to college while in high school. The theory concepts can be operationalized as instrument items for future research studies.

Perceptions of Pediatric Hospital Safety Culture in the United States: An Analysis of the 2016 Hospital Survey on Patient Safety Culture.

INTRODUCTION: Medical errors in the pediatric population can quickly cause harm. Research identified that hospitals with positive safety cultures work collaboratively to reduce errors. Strategies that identify gaps in hospital's safety culture within the pediatric milieu have not been initiated. This study addressed this gap from an interprofessional perspective. METHODS: This cross-sectional descriptive study used data from the Agency for Healthcare Research and Quality's 2016 Hospital Patient Safety Culture survey measuring 12 safety culture dimensions for registered nurses (RNs), physician assistants/nurse practitioners (PAs/NPs), physicians (MDs), and administrators/managers (n = 6682) in the United States that were employed in 287 (42%) pediatric hospitals or specialty units. RESULTS: Findings indicated that in the United States, the overall safety culture had low levels of agreement. Pairings between pediatric RNs, PAs/NPs, and MDs had similar levels of agreement for all dimensions but the perceptions of these three practitioners differed when compared with pediatric administrators/managers in nine of the 12 dimensions. The perceptions of pediatric RNs and MDs differed in six of the 12 dimensions, with MDs indicating higher levels of agreement. All four professional groups rated teamwork within hospital units with the highest level of agreement (mean, 4.14), with hospital handoffs and transitions rated the lowest (mean, 2.64). All four professional groups found punitive cultures (mean, 2.71) throughout the pediatric specialty. CONCLUSIONS: Variations regarding pediatric professional's perception of safety culture exist within U.S. hospitals. Effective and creative management will support cultures that prevents harm and improves the overall safety of children's care with initiatives that are dedicated to excellence.

Effects of Glyphosate-, Glufosinate- and Flazasulfuron-Based Herbicides on Soil Microorganisms in a Vineyard.

In a vineyard we examined the effects of broad-spectrum herbicides with three different active ingredients (glyphosate, glufosinate, flazasulfuron) on soil microorganisms. Mechanical weeding served as control treatment. Treatments were applied within grapevine rows and soil samples taken from there in 10-20 cm depth 77 days after application. Fungi were analyzed using classical sequencing technology and bacteria using next-generation sequencing. The number of colony-forming units (CFU) comprising bacteria, yeasts and molds was higher under flazasulfuron compared to all other treatments which had similar CFU levels. Abundance of the fungus Mucor was higher under flazasulfuron than glufosinate and mechanical weeding; Mucor was absent under glyphosate. Several other fungi taxa were exclusively found under a specific treatment. Up to 160 different bacteria species were found - some of them for the first time in vineyard soils. Total bacterial counts under herbicides were on average 260% higher than under mechanical weeding; however due to high variability this was not statistically significant. We suggest that herbicide-induced alterations of soil microorganisms could have knock-on effects on other parts of the grapevine system.

Herbicides in vineyards reduce grapevine root mycorrhization and alter soil microorganisms and the nutrient composition in grapevine roots, leaves, xylem sap and grape juice.

Herbicides are increasingly applied in vineyards worldwide. However, not much is known on potential side effects on soil organisms or on the nutrition of grapevines (Vitis vinifera). In an experimental vineyard in Austria, we examined the impacts of three within-row herbicide treatments (active ingredients: flazasulfuron, glufosinate, glyphosate) and mechanical weeding on grapevine root mycorrhization; soil microorganisms; earthworms; and nutrient concentration in grapevine roots, leaves, xylem sap and grape juice. The three herbicides reduced grapevine root mycorrhization on average by 53% compared to mechanical weeding. Soil microorganisms (total colony-forming units, CFU) were significantly affected by herbicides with highest CFUs under glufosinate and lowest under glyphosate. Earthworms (surface casting activity, density, biomass, reproduction) or litter decomposition in soil were unaffected by herbicides. Herbicides altered nutrient composition in grapevine roots, leaves, grape juice and xylem sap that was collected 11 months after herbicide application. Xylem sap under herbicide treatments also contained on average 70% more bacteria than under mechanical weeding; however, due to high variability, this was not statistically significant. We conclude that interdisciplinary approaches should receive more attention when assessing ecological effects of herbicides in vineyard ecosystems.

Implementation of an Asthma Self-Management Education Guideline in the Emergency Department: A Feasibility Study.

Patients often present to emergency departments (EDs) for the management of chronic asthma. Because of the nature of ED care, national guideline recommendations for asthma education are generally not initiated in the ED. There is evidence that asthma education can have a positive effect on patient outcomes (; ). This study examines the feasibility of implementing an asthma self-management guideline in a tertiary care center ED. Despite protocol utilization by physicians (87%), nurse practitioners and physician assistants (66.7%), and nurses (41.7%), total compliance with national guideline was accomplished in only 25.93% of cases. Barriers to protocol implementation included staff education, high workload, rapid turnover, and competing initiatives within the department. Linear regression analysis identified high daily census as a predictor of protocol noncompliance (p = 0.033).

Quality of Life and Health Outcomes in Overweight and Non-Overweight Children With Asthma.

BACKGROUND: During the past two decades, the number of children and adolescents who are obese has more than doubled. Following this trend in childhood obesity, there has been an alarming increase in the number of children with asthma who are overweight. OBJECTIVE: The aim of this study was to examine the differences in quality of life (QOL) and health outcomes of obese and overweight children with asthma compared with normal-weight children with asthma using a descriptive comparative survey design. METHODS: This comparative study consisted of 90 overweight and normal-weight 9- to 14-year-olds with asthma. Health outcomes examined included asthma-related missed number of school days, emergency department (ED) visits, hospitalizations, number of days wheezing, and number of night awakenings. QOL was measured using the Pediatric Asthma Quality of Life Questionnaire. RESULTS: The obese group reported the highest percentage of ED visits, hospitalizations, and number of days wheezing compared with the normal-weight group. A risk ratio analysis showed that the obese group had an overall 2.73 (95% confidence interval [CI] 2.15, 3.63) times higher likelihood of going to the ED and a 2.46 (95% CI 1.97, 3.19) times higher likelihood of hospitalization than the overweight and normal-weight groups. Asthma severity was a significant predictor of overall QOL (ß = -23.737, p = .002). CONCLUSIONS: The study results are consistent with other investigations that demonstrate that obese persons are at higher risk of experiencing severe asthma symptoms and support obesity as a potentially modifiable risk factor for asthma mitigation and prevention.

The Impact of Community Violence on School-Based Research.

Research conducted on youth exposure to violence has generally focused on documenting the prevalence of community violence and its emotional and behavioral implications. However, there is a dearth of information related to the impact of violence on the implementation and evaluation of community and school-based programs. This commentary examines the impact of community violence on a school-based research program. It is also a brief summary of the detrimental effects of exposure to community violence on psychological and academic functioning and health outcomes. An example of the impact of community violence on the implementation of a school-based asthma program will be addressed. Implications for school nurses will be discussed.

Factors predictive of depression in first-year college students.

Starting college is a challenging time for first-year students and is often accompanied by emotions such as depression, which can negatively affect academic performance and quality of life. This descriptive correlational study examined stress, coping, depressive symptomology, spirituality, and social support in a convenience sample of first-year students (N = 188) from two private colleges. Results indicated that 45% of students demonstrated greater than average levels of stress and 48% reported clinically significant depressive symptomology. Significant relationships existed between depressive symptoms and stress (p < 0.01) and depressive symptoms and social support (p < 0.01). Less social support was associated with more stress (p < 0.01). The results suggested that interventions targeting stress reduction in first-year students should be considered for decreasing depressive symptoms to enhance their college experience. \

Pediatric obesity and asthma quality of life.

Widely researched as separate entities, our understanding of the comorbid effects of childhood obesity and asthma on quality of life is limited. This article discusses the effects of childhood obesity and asthma on self-reported quality of life in low-income African American teens with asthma. When controlling for the influence of symptom frequency, asthma classification, asthma self-efficacy, and asthma self-care levels, body mass index remains a most important factor in determining self-reported quality of life among teens with asthma. Although overweight and obesity did not change the effectiveness of the asthma intervention program, obesity did affect participants quality of life scores.

Adolescent asthma education programs for teens: review and summary.

The purpose of this review is to describe and evaluate education programs for teens with asthma. Although asthma educational programs for children are plentiful, this is not the case for adolescents. The developmental tasks of adolescence require asthma education programs that are uniquely tailored to this age group. Although several well-designed studies appear in the literature, further research is needed to evaluate the efficacy of asthma education programs among teens. Although the quality of research varies, demonstrated program benefits include improved asthma self-management, self-efficacy, family support mechanisms, and quality of life. Practice implications point to the need for education programs in schools and camp settings that are consistent with national asthma guidelines.

Effects of coping-skills training in low-income urban African-American adolescents with asthma.

BACKGROUND: Minority teens with asthma are at particular risk for this life-threatening disease due to increased morbidity and mortality rates in addition to the normal challenges of adolescence. OBJECTIVE: The purpose of this randomized controlled trial (n = 137) was to determine the effects of a coping-skills training program (intervention) compared with standard asthma education (attention control) in African-American teens with asthma. METHODS: Adolescents were recruited from five African-American dominant high schools serving low-income areas of Chicago. Data were collected at baseline, 2 months (immediately following the intervention), 6 months, and 12 months. Results. Both groups improved over time, with significant increases in asthma-related quality of life, asthma knowledge, and asthma self-efficacy, accompanied by decreases in symptom days and asthma-related school absences. CONCLUSIONS: Findings suggest that coping-skills training as implemented in this study provided no additional benefit beyond that experienced in the control group. However, group-based interventions delivered in the school setting may be beneficial for low-income, minority teens with asthma.

The effects of coping skills training among teens with asthma.

This pilot study used a pretest and posttest design to examine the effect of a school-based intervention, Coping Skills Training, among teens with asthma (N = 39) aged 14 to 18 years randomly assigned to treatment and control groups from three midwestern high schools. Variables included asthma self-efficacy, social support, asthma-related quality of life, peak expiratory flow rate, asthma diary symptoms, and rescue medication usage. The treatment group scored significantly higher on self-efficacy (p < .001), activity-related quality of life (p = .05), and social support (p < .001) compared with the control group after using ANCOVA to adjust for baseline scores. Significant improvements were also noted from pre- to posttest in the treatment group for self-efficacy (p < .001) and quality of life (p = .02). This study indicates that Coping Skills Training is an important intervention for further study with teens with asthma.

The relationships among self-esteem, stress, coping, eating behavior, and depressive mood in adolescents.

The prevalence of adolescent overweight is significant, almost 25% in some minorities, and often is associated with depressive symptoms. Psychological and psychosocial factors as well as poor coping skills have been correlated with unhealthy eating and obesity. The purpose of this study was to examine relationships among self-esteem, stress, social support, and coping; and to test a model of their effects on eating behavior and depressive mood in a sample of 102 high school students (87% minority). Results indicate that (a) stress and low self-esteem were related to avoidant coping and depressive mood, and that (b) low self-esteem and avoidant coping were related to unhealthy eating behavior. Results suggest that teaching adolescents skills to reduce stress, build self-esteem, and use more positive approaches to coping may prevent unhealthy eating and subsequent obesity, and lower risk of depressive symptoms.

Switching from CFC to HFA Inhalers: What NPs and Their Patients Need to Know.

The aim of this article is to provide nurse practitioners with a better understanding of the transition from chlorofluorocarbon (CFC) to hydrofluoralkane (HFA) metered-dose inhalers (MDIs). The authors discuss the differences in these products' propellants; the proper use, cost, and efficacy of the HFA inhalers; and the implications of the switch for NPs and for their patients with asthma.

Interdisciplinary collaboration for healthcare professionals.

Interdisciplinary collaboration has the capacity to affect both healthcare providers and patients. Research has shown that the lack of communication and collaboration may be responsible for as much as 70% of the adverse events currently reported. The purpose of this article is 2-fold: to examine factors that may influence interdisciplinary collaboration and consequently patient outcomes and to examine the relationship between interdisciplinary collaboration and King's theory of goal attainment as a theory to support the phenomenon of interdisciplinary collaboration.

The psychological impact of living with diabetes: women's day-to-day experiences.

PURPOSE: The purpose of this study is to understand the feelings of depression, anxiety, and anger experienced by women with type 2 diabetes and the impact these feelings have on their overall quality of life. METHODS: Four focus groups (2 white, 2 African American) were conducted by ethnically matched professional moderators. Sessions were audiotaped, and transcriptions were analyzed using an inductive approach. Forty-one women (mean age, 55.6 years; SD = 7.9) who had type 2 diabetes for an average of 8.7 years (SD = 6.3) participated. Forty-two percent of the sample was African American. RESULTS: The themes generated directly from the focus group data are (1) struggling with the changing health situation; (2) encountering challenges in relationships with self, family, and others; (3) worrying about the present and future; (4) bearing multiple responsibilities for self and others; and (5) choosing to take a break. Women also expressed feelings of depression, anxiety, and anger, which were primarily related to having diabetes as well as managing the multiple responsibilities of being a caregiver. There were more similarities than differences noted by race. CONCLUSIONS: Women with type 2 diabetes experience feelings of depression, anxiety, and anger, which affect their health and overall quality of life. The findings suggest that health care providers should assess the psychological health of women with type 2 diabetes when developing plans of care. By understanding and addressing the emotional health of women with type 2 diabetes, the relationships between the patient, family, and health care provider may improve, allowing for more successful diabetes management.

Health promotion in adolescents: a review of Pender's health promotion model.

Adolescents have unique health considerations as they transition from parent-managed healthcare to personal responsibility for health behavior. One question to consider is the goodness-of-fit of available theoretical models for explaining and predicting adolescent health-promoting behavior. This integrative review explored Pender's health promotion model in relation to adolescent health. Specifically, this review summarizes the components of Pender's model and the supporting theoretical underpinnings based in the social cognitive theory. Research literature related to the health promotion model and various aspects of teen health is explored. Recommendations for further research and theory development are discussed.