Prenatal Care for American Indian Women.

Early and regular prenatal care, which aims to prevent and identify complications associated with pregnancy, birth, and newborn health, is associated with improved health of pregnant women and their infants. American Indian/Alaska Native (AI/AN) women are at risk for pregnancy, birth, and newborn health complications associated with health disparities including poverty, lower educational levels, limited access to healthcare, and adverse childhood events. American Indian/Alaska Native women in the United States experience barriers specifically related to prenatal care, including lack of access, dissimilar communication styles, and inconsistent continuity of care. Culturally appropriate prenatal care should be provided to reduce maternal and newborn morbidity and mortality. Community-based interventions such as home visiting, that may potentially improve prenatal care, focusing on the American Indian tribes of the Northern Great Plains, specifically North Dakota, are discussed.

Expression, purification and characterization of soluble red rooster laforin as a fusion protein in Escherichia coli.

BACKGROUND: The gene that encodes laforin, a dual-specificity phosphatase with a carbohydrate-binding module, is mutated in Lafora disease (LD). LD is an autosomal recessive, fatal progressive myoclonus epilepsy characterized by the intracellular buildup of insoluble, hyperphosphorylated glycogen-like particles, called Lafora bodies. Laforin dephosphorylates glycogen and other glucans in vitro, but the structural basis of its activity remains unknown. Recombinant human laforin when expressed in and purified from E. coli is largely insoluble and prone to aggregation and precipitation. Identification of a laforin ortholog that is more soluble and stable in vitro would circumvent this issue. RESULTS: In this study, we cloned multiple laforin orthologs, established a purification scheme for each, and tested their solubility and stability. Gallus gallus (Gg) laforin is more stable in vitro than human laforin, Gg-laforin is largely monomeric, and it possesses carbohydrate binding and phosphatase activity similar to human laforin. CONCLUSIONS: Gg-laforin is more soluble and stable than human laforin in vitro, and possesses similar activity as a glucan phosphatase. Therefore, it can be used to model human laforin in structure-function studies. We have established a protocol for purifying recombinant Gg-laforin in sufficient quantity for crystallographic and other biophysical analyses, in order to better understand the function of laforin and define the molecular mechanisms of Lafora disease.

A bioassay for Lafora disease and laforin glucan phosphatase activity.

OBJECTIVES: Lafora disease is a rare yet invariably fatal form of progressive neurodegenerative epilepsy resulting from mutations in the phosphatase laforin. Several therapeutic options for Lafora disease patients are currently being explored, and these therapies would benefit from a biochemical means of assessing functional laforin activity following treatment. To date, only clinical outcomes such as decreases in seizure frequency and severity have been used to indicate success of epilepsy treatment. However, these qualitative measures exhibit variability and must be assessed over long periods of time. In this work, we detail a simple and sensitive bioassay that can be used for the detection of functional endogenous laforin from human and mouse tissue. DESIGN AND METHODS: We generated antibodies capable of detecting and immunoprecipitating endogenous laforin. Following laforin immunoprecipitation, laforin activity was assessed via phosphatase assays using para-nitrophenylphosphate (pNPP) and a malachite green-based assay specific for glucan phosphatase activity. RESULTS: We found that antibody binding to laforin does not impede laforin activity. Furthermore, the malachite green-based glucan phosphatase assay used in conjunction with a rabbit polyclonal laforin antibody was capable of detecting endogenous laforin activity from human and mouse tissues. Importantly, this assay discriminated between laforin activity and other phosphatases. CONCLUSIONS: The bioassay that we have developed utilizing laforin antibodies and an assay specific for glucan phosphatase activity could prove valuable in the rapid detection of functional laforin in patients to which novel Lafora disease therapies have been administered.

Impact of patient and family communication in a pediatric emergency department on likelihood to recommend.

OBJECTIVE: Identify the specific patient experience variables that most strongly predict satisfaction as measured by the likelihood to recommend rating. METHODS: We performed a retrospective analysis of a patient satisfaction survey distributed to patients during their visit to an academic children's hospital emergency department (ED) during a 3-month period. Any incomplete or incorrectly completed surveys were excluded. The associations between staff communication variables and "likelihood to recommend" were assessed while controlling for daily ED flow data. RESULTS: A total of 3135 surveys were completed with 825 (26%) excluded for incomplete or incorrect entry. After controlling for daily census, median daily wait time and median daily length of stay, the communication question that asks if the nurse or physician kept them informed while in the examination room had the strongest association (odds ratio, 12.2; 95% confidence interval, 9.3-16.1; P < 0.001), with the response of "always" likely to recommend this ED. CONCLUSIONS: This study demonstrates that keeping patients and their families informed has a more positive effect on patient satisfaction than any other variable studied even in the setting of increased census and wait times.