Intermolecular Interactions between Cysteine and Aromatic Amino Acids with a Phenyl Moiety in the DNA-Binding Domain of Heat Shock Factor 1 Regulate Thermal Stress-Induced Trimerization.

In this study, we investigated the trimerization mechanism and structure of heat shock factor 1 (HSF1) using western blotting, tryptophan (Trp) fluorescence spectroscopy, and molecular modeling. First, we examined the DNA-binding domains of human (Homo sapiens), goldfish (Carassius auratus), and walleye pollock (Gadus chalcogrammus) HSF1s by mutating key residues (36 and 103) that are thought to directly affect trimer formation. Human, goldfish, and walleye pollock HSF1s contain cysteine at residue 36 but cysteine (C), tyrosine (Y), and phenylalanine (F), respectively, at residue 103. The optimal trimerization temperatures for the wild-type HSF1s of each species were found to be 42, 37, and 20 °C, respectively. Interestingly, a mutation experiment revealed that trimerization occurred at 42 °C when residue 103 was cysteine, at 37 °C when it was tyrosine, and at 20 °C when it was phenylalanine, regardless of the species. In addition, it was confirmed that when residue 103 of the three species was mutated to alanine, trimerization did not occur. This suggests that in addition to trimerization via disulfide bond formation between the cysteine residues in human HSF1, trimerization can also occur via the formation of a different type of bond between cysteine and aromatic ring residues such as tyrosine and phenylalanine. We also confirmed that at least one cysteine is required for the trimerization of HSF1s, regardless of its position (residue 36 or 103). Additionally, it was shown that the trimer formation temperature is related to growth and survival in fish.

Effect of Dietary Vitamin C Supplementation on Growth Performance and Biochemical Parameters in Grower Walleye Pollock, Gadus chalcogrammus.

The optimal dietary vitamin C (VC) levels for walleye pollock (Gadus chalcogrammus) remain undefined. This study aimed to assess the effect of dietary VC levels on the growth performance and biochemical parameters of grower walleye pollock and determine the optimal VC level for their diet. Six experimental diets (VC0, VC1, VC3, VC5, VC7, and VC10) with VC levels of 3.24, 21.92, 63.31, 101.42, 145.46, and 202.51 mg kg-1 diet, respectively, were fed to fish (initial mean weight: 173.5 ± 0.31 g) for 8 weeks. At the end of the feeding trial, fish fed the VC7 and VC10 diets exhibited significantly higher growth (final body weight, weight gain, and specific growth rate) and improved feed utilization (feed efficiency and protein efficiency ratio) compared with fish fed the VC0 diet (p < 0.05). The VC3-VC10 diets significantly reduced plasma superoxide dismutase (SOD) activity (p < 0.05). Compared with the VC0 group, fish fed the VC7 and VC10 diets showed significantly elevated growth hormone and insulin-like growth factor-1 levels in plasma (p < 0.05). In conclusion, dietary VC supplementation in walleye pollock improved growth performance and SOD activity. Moreover, broken-line analysis on weight gain indicated that the optimal dietary VC level for grower walleye pollock was approximately 156.42 mg kg-1 diet.

Differential virulence of infectious hematopoietic necrosis virus (IHNV) isolated from salmonid fish in Gangwon Province, Korea.

The present study investigated the virulence and expression of innate immunity genes in isolates of infectious hematopoietic necrosis virus (IHNV) in Gangwon province, South Korea, by challenging rainbow trout, Atlantic salmon, and coho salmon. Eight IHNV isolates were used to infect RTG-2 cells for viral replication using plaque assays. Three isolates with the highest replication rates, the RtPc0314g and RtPc0314c isolates of the JRt-Shizuoka type and the RtPc0816g isolate of the JRt-Nagano type, were experimentally infected into the fish. In rainbow trout, both RtPc0314c and RtPc0314g isolates showed 100% cumulative mortality while the RtPc0816g isolate showed 60% cumulative mortality for 14 days. In contrast, all three isolates showed <60% cumulative mortality in Atlantic salmon and coho salmon. The expression of G genes in the kidney was higher than that in the spleen-infected fish, with the highest expression observed in the kidneys of rainbow trout. The relative expression levels of innate immunity genes were higher in rainbow trout than in Atlantic salmon and coho salmon. The expression level of immunoglobulin M increased until day 7, and the expression of type I interferon was higher in the spleen than in other tissues. The expression of Mx-1 was higher in the kidney and liver than other tissues. These results indicate that IHNV isolates from Gangwon province show host-specific virulence in rainbow trout and that their virulence and replication were higher in JRt-Shizuoka type than in JRt-Nagano type isolates.

A Validation Study of the Revised Caregiving Burden Instrument in Korean Family Caregivers of Stroke Survivors.

BACKGROUND: The purpose of the present study was to examine the internal consistency reliability and construct validity of the Caregiving Burden Instrument in Korean informal caregivers of stroke survivors. METHODS: A descriptive survey design was used with a convenience sample of 208 primary caregivers of stroke survivors. Internal consistency reliability was assessed using Cronbach's alpha coefficients. Construct validity was assessed using exploratory and known-group analysis. RESULTS: Each subscale and the total scale demonstrated satisfactory internal consistency reliability. Exploratory factor analysis identified five factors: family support, patient's dependency, physical health, financial burden, and psychological health, which together accounted for 62.7% of the variance. Known-group analysis indicated that caregivers with more than one year of experience reported significantly higher mean scores for the total burden score and its five subscales compared to those with less than one year. CONCLUSIONS: This 23-item instrument demonstrates good internal consistency reliability and construct validity. The tool can be used to effectively assess burden in caregivers of stroke survivors and the data obtained can form the basis for the development of family interventions.

Development and evaluation of a multimodality simulation disaster education and training program for hospital nurses.

AIM: To develop a multimodality simulation program for hospital nurses to enhance their disaster competency and evaluate the effect of the program. METHODS: The program implementation started in October 2016 and ended in December 2016. It was developed using the ADDIE model (analysis, design, development, implementation, and evaluation). Evaluation consisted of formative assessment and summative assessment. Formative assessment was performed during triage, crisis management, and problem-solving simulation programs through direct feedback and debriefing from the teacher. Summative assessment was performed using the Kirkpatrick curriculum evaluation framework. RESULTS: Needs assessment using the modified Delphi survey resulted in these competencies for hospital disaster nursing: triage, incident command, surge capacity, life-saving procedures, and special situations. Each competency was matched with the appropriate simulation modalities. A total of 40 emergency nurses participated in the study program. The evaluation of the program resulted in improvement in perception, crisis management, problem solving, and technical skills in disaster nursing. CONCLUSION: Multimodality simulation training program was developed to enhance the competency of hospital nurses in disaster response. All participants improved their disaster response competencies significantly. The program that was developed in this study could be used as a fundamental tool in future research in disaster curriculum development.

International Nursing: Needs Assessment for Training in Disaster Preparedness for Hospital Nurses: A Modified Delphi Study.

Despite high awareness of the need, opportunities for nurses to gain disaster experience or training are limited. In Korea, most disaster training is done in an undergraduate curriculum where there is very limited practice, and the educational topics are mostly focused on the field aspect of disaster events. The purpose of this study was to determine the need for such training for hospital nurses and to determine appropriate and relevant components of the training contents. A qualitative survey approach using the modified Delphi method was used to collect and analyze the data. The surveys were conducted in 3 rounds. After the results were analyzed from the third-round survey, the authors finalized the contents for a training program to prepare nurses for their roles during disasters. Through a structured needs analysis using a modified Delphi survey, the framework for the content development of disaster training curriculum for hospital nurses was developed.

Effects of nurse-led child health service in child-care centers: A survey study.

There are relatively few initiatives to promote children's health and prevent disease in Korean child-care centers. The purpose of this study was to describe the effects of the nurse-led child health service in Korean child-care centers. A total of 9664 parents and 3892 teachers at child-care centers and 49 nurses completed self-administered questionnaires. Parent satisfaction, teacher satisfaction, and nurses' self-evaluation were surveyed. Case-management reports of children were collected over 5 years. Dental problems were ranked high among children across 5 years in the study. Most parents perceived nurse-led child health service as being useful. Overall, teachers' satisfaction scores were statistically significantly higher for home child-care centers compared to public or private child-care centers. Increasing the need for the nurse-led child health service was ranked the highest item by nurses, whereas the health management of teachers was ranked the lowest. The nurse-led child health service in Korean child-care centers induced positive outcomes, including the satisfaction of parents, teachers and nurses.

Development and Effects of a Transition Nursing Program for Patients and Family Caregivers at a Neurological ICU in Korea.

The purpose of this study was to develop a transition nursing program for patients and family caregivers in neurological intensive care units (ICUs) and to evaluate the effects of the program. A literature review, focus group interviews, analysis of medical records, confirmation of validity, and clinical applicability were used to develop the program, which was tested using a pre- and post-test quasi-experimental design. Participants were recruited in 2011. The experimental group (46 patients and their family caregivers) received the developed program before transferring from the neurological ICU to a ward, whereas the control group (48 patients and their family caregivers) received routine care. The results showed that patients and family caregivers in the experimental group had significantly higher transition readiness and satisfaction with transition nursing and lower transition anxiety and transition stress, and family caregivers in the experimental group had a significantly lower burden of caregiving.

Status of cardiopulmonary resuscitation curricula for nursing students: A questionnaire study.

In this study, we explored the status of curricula for nursing students and identified the priorities for curricula improvement using importance-performance analysis. A cross-sectional, descriptive survey was conducted, which included 62 instructors in charge of resuscitation training. The participants completed the self-administered, 32-item Resuscitation Curricula Attributes Importance-Performance Scale. With Wilcoxon signed-rank test, an importance-performance analysis matrix was created. There was a significant overall mean difference between importance and performance in all 32 items, with "recognition of arrest rhythms" showing the largest difference. Importance-performance analysis suggests that the priorities for improvement are "nursing record documentation" and "recognition of arrest rhythms". The development of cardiopulmonary resuscitation curricula should focus on attributes that are expected of practitioners and are relevant to current healthcare environment needs.

Identification, tissue distribution and characterization of two heat shock factors (HSFs) in goldfish (Carassius auratus).

Heat shock proteins (HSPs) are synthesized rapidly in response to a variety of physiological or environmental stressors, whereas the transcriptional activation of HSPs is regulated by a family of heat shock factors (HSFs). In vertebrates, multiple HSFs (HSF1-4) have been reported to have different roles in response to a range of stresses. This paper reports the cDNA cloning of two goldfish (Carassius auratus) HSF gene families, HSF1 and three isoforms of HSF2. Both HSF1 and HSF2s showed high homology to the known HSFs from other organisms, particularly the zebrafish. Different patterns of HSF1 and HSF2 mRNA expression were detected in several goldfish tissues, highlighting their distinct roles. In cadmium (Cd)-treated tissues, the responses of HSP70 showed less difference. However, the increase in HSF1 and HSF2 in these tissues differs considerable. In particular, HSF2 was induced strongly in the heart and liver. On the other hand, in heart tissue, HSF1 showed the smallest increment. These results suggest the potential role of HSF2 in assisting HSF1 in these tissues. In another in vitro experiment of hepatocyte cultures, Cd exposure caused similar patterns of goldfish HSF1 and HSF2 mRNA expression and induction of the HSP70 protein. On the other hand, an examination of the characterization of recombinant proteins showed that HSF1 undergoes a conformation change induced by heat shock above 30 °C and approaches each other in the trimer, whereas HSF2 could not sense thermal stress directly. Furthermore, immune-blot analysis of HSFs showed that both monomers and trimmers of HSF1 were observed in cadmium-induced tissues, whereas HSF2 were all in monomeric. These results show that HSF1 and HSF2 play different roles in the transcription of heat shock proteins.

[Development and evaluation of an enteral nutrition protocol for dysphagia in patients with acute stroke].

PURPOSE: The study was done to develop an evidence-based enteral nutrition (EN) protocol for effective nutritional support for dysphagia in patients with acute stroke, and to evaluate effects of this protocol on clinical outcomes. METHODS: A methodological study was used to develop the EN protocol and a quasi-experimental study to verify the effectiveness of the protocol. The preliminary EN protocol was drawn by selecting recommendations from previous well-designed EN guidelines, and then developing additional recommendations based on high-quality evidence. Content validation was assessed by an expert group, and clinical applicability by care providers and patients. The scale-level content validity index of the final EN protocol was 0.99. Assessment was done of differences in percentage of caloric goals achieved and presence of undernutrition, aspiration pneumonia, and gastrointestinal (GI) complications after application of the EN protocol. RESULTS: In the EN protocol group, the percentage of caloric goals achieved (R(2)=.24, p=.001) and the reduction of GI complications (p=.045) were significantly improved, but the presence of undernutrition (p=.296) and aspiration pneumonia (p=.601) did not differ from the usual care group. CONCLUSION: Results indicate that the new EN protocol for dysphagia in patients with acute stroke significantly increased their nutritional intake and reduced GI complications.

Effects of a comprehensive cardiac rehabilitation program in patients with coronary heart disease in Korea.

The purpose of this study was to develop a comprehensive cardiac rehabilitation program that considered patients' learning needs and cultural context, and to identify the impact of this program on patients with coronary heart disease in Korea. We employed a quasi-experimental design to evaluate the effects of the developed program in 61 patients with coronary heart disease. The experimental group received education, counseling, educational materials, and telephone follow-ups by cardiac nurses for six months. Results showed that participants of the program exhibited reduced body mass index and waist circumference as well as improved left ventricular diastolic function and cardiac disease-related quality of life. There was no significant difference between the groups with the rate of recurring symptoms or cardiac events. This comprehensive cardiac rehabilitation program safely and effectively improved body composition, cardiac function, and quality of life in patients with coronary heart disease.

Factor structure investigation of perceived facilitators and barriers in end-of-life care among Korean nurses.

AIM: The aim of this study was to assess the validity and reliability of the Korean version of a questionnaire assessing facilitators/barriers in end-of-life care that was originally developed for nurses in the USA. METHODS: Back-translation was undertaken to produce the Korean version. A principal component analysis with varimax rotation and Cronbach's alpha was used to test factorial validity and reliability, respectively. RESULTS: The analysis examined data from 383 nurses in a tertiary hospital in Korea. For end-of-life care facilitators, five factors accounted for 59% of the total variance. The factors were labeled "family preparedness", "support for nurses", "nurse-patient relationship", "transition after death", and "decision-making". Six factors, explaining 59% of the variance, were extracted for end-of-life care barriers. These factors were "misunderstanding patient's will", "preoccupied nursing workload", "lack of institutional support", "dealing with family's maladaptive coping", "visiting hours", and "communication about patient's status with family members". Cronbach's alpha was 0.89 for the 23 facilitator items and 0.90 for the 24 barrier items. CONCLUSION: Overall, the findings demonstrate that the questionnaire has measurement properties in a sample of Korean nurses. Further studies are needed with different populations to reflect end-of-life care in various clinical settings.

Potential role of HSP90 in mediating the interactions between estrogen receptor (ER) and aryl hydrocarbon receptor (AhR) signaling pathways.

The estrogen receptor (ER) and aryl hydrocarbon receptor (AhR) are ligand-activated transcription factors involved in estrogen or xenobiotic exposure, whereas the 90-kDa heat shock protein (HSP90), which is a ubiquitously expressed molecular chaperone, is involved in the signal transduction process. Although the interactions between these pathways have been under investigation, the mechanisms are unclear and the potential role of HSP90 in these interactions has not been reported. The results of goldfish primary hepatocytes showed that exposure to PCB77 and 17ß-estradiol (E2) alone induced significant protein expression of cytochrome P450 1A (CYP1A) and vitellogenin (VTG), respectively. On the other hand, the combined exposure to PCB77 and E2 led to the reduction of CYP1A and VTG compared to the single treatments. Although the AhRs and ERs were naturally induced during the co-treatment, the total amount of HSP90 binding to the receptors was not changed. Furthermore, while the HSP90 chaperon activity was blocked by the specific inhibitor (geldanamycin), reciprocal inhibition between AhR and ER pathways was not observed. These findings indicate a potential role of HSP90 where competition between AhR and ER for binding to HSP90 can occur and cause reciprocal inhibition.

Factors affecting quality of life in Korean patients with chronic heart failure.

AIM: Poor health-related quality of life (HRQOL) in patients with chronic heart failure (CHF) may be one of the most common predictors of mortality and rehospitalization. This study was conducted to identify factors affecting HRQOL in Korean patients with CHF using two HRQOL measurements. METHODS: The study included a sample of 114 patients. HRQOL was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the World Health Organization's Quality of Life Instrument - Short Version (WHOQOL-BREF). Multiple regression analyses were performed to analyze the relationship between the factors and HRQOL. RESULTS: Significant correlations were found between MLHFQ and WHOQOL-BREF in total and component scores, with the two exceptions of WHOQOL-BREF psychological and MLHFQ physical or total. The perceived economic status, functional status, and sex were factors identified as having an effect on HRQOL. CONCLUSION: The MLHFQ was better able to differentiate sex, comorbidity, and functional status. Further studies are needed to implement cost-effective nursing interventions for patients with CHF to improve their HRQOL.

Evidence-based practice for pain management for cancer patients in an acute care setting.

The purpose of this study is to implement an evidence utilization project using an audit and feedback approach to improve cancer pain management. A three-phased audit and feedback approach was used. A 46-bed oncology nursing unit in the university's cancer centre was selected as a research site. Nursing records extracted from 137 patients (65 for the baseline assessment and 72 for the follow-up audit) were used to examine nurse compliance with four audit criteria derived from best practice guidelines related to the assessment and management of pain. We observed a significant improvement in compliance from baseline to follow-up for the following criteria: documenting the side effects of opioids (2-83%), use of a formalized pain assessment tool (22-75%), and providing education for pain assessment and management to patients and caregivers (0-47%). The audit and feedback method was applicable to the implementation of clinical practice guidelines for cancer pain management. Leadership from both administrative personnel and staff nurses working together contributes to the spread of an evidence-based practice culture in clinical settings. As it was conducted in a single oncology nursing unit and was implemented over a short period of time, the results should be carefully interpreted.

Korean nurses' perceived facilitators and barriers in provision of end-of-life care.

This study examined nurses' perceived facilitators and barriers to end-of-life (EOL) care in clinical settings. The study participants were 383 Korean nurses working at tertiary hospitals. The nurses had an average of 7.6 years of clinical experience. The three highest-scoring facilitating items were 'family member acceptance of patient death', 'having time to prepare the family for the patient's expected death' and 'having the physician meet with the family after the patient's death to offer support and validate the given care'. The top two perceived barriers were 'families not accepting what the physician is telling them about the patient's prognosis' and 'dealing with angry family members'. Nurses who had received EOL care education showed a higher score in perception of facilitators than nurses who did not receive that education. EOL care for patients and their families is a challenge; thus, continuing education should be provided to improve nursing practice.

A survey of nurses' perceived competence and educational needs in performing resuscitation.

BACKGROUND: Effective training is needed for high-quality performance of staff nurses, who are often the first responders in initiating resuscitation. There is insufficient evidence to identify specific educational strategies that improve outcomes, including early recognition and rescue of the critical patient. This study was conducted to identify perceived competence and educational needs as well as to examine factors influencing perceived competence in resuscitation among staff nurses to build a resuscitation training curriculum. METHODS: A convenience sample of 502 staff nurses was recruited from 11 hospitals in a single city. Staff nurses were asked to complete a self-administered questionnaire. RESULTS: On a five-point scale, chest compression was the lowest-rated technical skill (M = 3.33, SD = 0.80), whereas staying calm and focusing on required tasks was the lowest-rated non-technical skill (M = 3.30, SD = 0.80). Work duration, the usefulness of simulation, recent code experience, and recent simulation-based training were significant factors in perceived competence, F(4, 496) = 45.94, p < .001. Simulation-based resuscitation training was the most preferred training modality, and cardiac arrest was the most preferred training topic. CONCLUSION: Based on this needs assessment, a simulation-based resuscitation training curriculum with cardiac arrest scenarios is suggested to improve the resuscitation skills of staff nurses.

Learning needs of patients with heart failure a descriptive, exploratory study.

AIMS AND OBJECTIVES: To assess the learning needs of patients with heart failure in Korea as this information is the cornerstone for developing a programme based on patients' learning needs. BACKGROUND: Heart failure is a life-threatening event and a significant cause of morbidity and mortality in Korea. Cardiac educational programmes are intended to prevent the recurrence of heart failure and improve patients' quality of life. However, patients' information requests have historically not been well met by physicians and nurses in Korea. DESIGN: A descriptive and exploratory study was designed. METHODS: We recruited 121 patients with heart failure between the ages of 19-88 years. Self-report questionnaires, which included general characteristics, disease-related characteristics and the Heart Failure Patients' Learning Needs Inventory patient version, were used to gather data. RESULTS: The only general characteristic that was significantly related to patients' learning needs was their occupation. No disease-related characteristics were related to learning needs. The overall mean learning needs score was 3·78. CONCLUSION: Patients' learning needs in Korea are lower than those typically seen in Western countries. Korean patients with heart failure had a low level of knowledge about heart failure and did not recognise the importance of being informed about their disease, which is why Korean patients with heart failure tend to depend on their physicians to make decisions related to their health management. These conditions can negatively affect clinical outcomes. RELEVANCE TO CLINICAL PRACTICE: Although an educational programme for patients with heart failure should be based on the patients' learning needs, heart failure management and education programmes in Korea are not currently developed using a needs-based approach. Therefore, this study will provide a basis for encouraging Korean patients to obtain information about their disease and to guide professionals in developing heart failure management and education programmes.

The life experiences of Korean children and adolescents with complex congenital heart disease: a qualitative study.

This exploratory study analyzed the life experiences of Korean children and adolescents with complex congenital heart disease in a sociocultural context and undertook in-depth interviews. Participants were 10 patients who ranged in age from 14 to 22 years, who were recruited at a hospital in Seoul, Korea. Our content analysis showed that the participants were initially unaware of the true nature of their conditions. After entering school, they realized that they were different from peers because of their physical limitations and their parents' overprotectiveness. Generally, health providers tend to convey information about congenital heart disease to parents, and not the patients. Therefore, most of our participants lacked knowledge about their disease and its management, and tended to have feelings of isolation and guilt. Healthcare providers of children and adolescents should provide disease and management information not only to parents, but also to patients, and should set aside specific times for communication with patients with complex congenital heart disease.