Developing core interprofessional competencies for community rehabilitation practitioners: findings from an Australian study.

This study aimed to determine the core competencies that underpin the practice of community rehabilitation (CR) practitioners working in a single state in Australia. Using a recursive and consultative methodology designed to build consensus, CR professionals, trainers, educators, and researchers developed a preliminary set of core interprofessional competencies that were considered essential to their practice. Data were collected in four main stages that engaged practitioners and experts in the CR field in the process of identifying, defining, validating, and endorsing a set of competencies. The first stage involved focus groups with 50 senior practitioners in metropolitan, rural/remote, regional, and indigenous communities. The second and third stages involved expert panels consisting of 20 trainers/educators, senior leaders, and scholars who refined, defined and validated the competency areas and developed statements that reflected the data.These statements formed the basis of a survey that was distributed to all current CR practitioners based in this state for endorsement, 40 of whom responded. Ten competencies emerged from this process. Although there are limitations to the application of competencies, they will have significant implications for the future training of CR practitioners who can transcend professional boundaries.

Health-related outcomes of people with spinal cord injury--a 10 year longitudinal study.

STUDY DESIGN: Longitudinal panel design over 10 years. OBJECTIVES: To describe the health outcomes for people with spinal cord injury and identify how indicators of health change over time. SETTING: Queensland, Australia. METHODS: A structured interview consisting of measures of perceived health, medical service utilization, hospitalization and pressure sore occurrence was administered on six occasions over 10 years after discharge from the hospital following the initial rehabilitation episode. RESULTS: The majority of respondents were relatively healthy over the course of the 10-year study and required minimal medical interventions or hospitalization. There was however a group of up to 20% of respondents who required extensive medical intervention, including hospitalization and pressure sore management. CONCLUSION: The findings have significant implications for health-care policy and strategic planning for the ongoing management of spinal cord injury. A biopsychosocial approach combining patient education, cognitive behavioral interventions, screening and treatment for affective disorders and environmental interventions is recommended to facilitate optimal health outcomes for people with spinal cord injury over the long term.

Bridging the gap: transitional rehabilitation services for people with spinal cord injury.

PURPOSE: To review the current international rehabilitation and healthcare climate and describe a new model of service delivery aimed at enhancing the continuity of care for people with spinal cord injury (SCI). METHOD: An extensive literature review was undertaken and a new model of service delivery conceptualized and implemented in the Australian context of SCI rehabilitation. RESULTS: This new model of service delivery aims to improve the rehabilitation continuum for people with SCI by reducing the time spent in hospital, increasing consumer control over the rehabilitation environment and enhancing community re-integration. The new model recognizes the changing nature of the healthcare system, the legislative frameworks within which rehabilitation services are provided and the increasing role of the consumer. CONCLUSIONS: Models of rehabilitation that address the need for shorter periods of hospitalization and attempt to improve client outcomes are integral to ensure sustainable rehabilitation services in the future.

Application of checkerboard immunoblotting (CBIB) to the detection of anti-viral IgG in human serum.

In the present study, we have begun to investigate the possibility of using checkerboard immunoblotting (CBIB) as a semi-quantitative screening tool for detecting human serum IgG against specific viral antigens. The viral antigens studied were Epstein-Barr, herpes simplex I and II, cytomegalovirus, varicella zoster, rubella, rubeola, and mumps. Western immunoblotting experiments using these partially purified preparations demonstrated that there were apparently no interactions between IgG from non-immune sera and the respective viral antigen preparations. The CBIB assay was evaluated using sera of known positive or negative immune status for the viral antigens. There was excellent agreement between the results of CBIB and the results of alternative methods for evaluating immune status: all discrepancies (1/18 sera for mumps, 3/18 sera for rubeola, and 1/28 sera for rubella) involved sera with borderline results, either by CBIB or by the alternative method. Therefore, although further work is required to define the method in terms of sensitivity and clinical specificity, and to refine positive/negative cutpoint criteria for certain antigen components, our preliminary experience suggests that CBIB has considerable potential in the efficient and inexpensive screening of sera for the presence of IgG against a panel of viral antigens, so as to identify subjects at risk for infection.

Effects of in vitro prepared immune complexes on rat adipose tissue lipoprotein lipase.

The possibility that circulating immune complexes (IC) could modify lipoprotein lipase (LPL) activity or release was explored in in vitro systems. IC were precipitated at antibody-Ag equivalence by using specific rabbit antisera and Ag from inactivated rubella virus and hemagglutinins from purified whole virions from three prototype strains of influenza (A/Brazil, A/Bangkok, and B/Singapore) as well as from a combined diphtheria and tetanus toxoid adsorbed with inactivated pertussis. After resolubilization, these IC were exposed to delipidated homogenates of rat epididymal fat pads before assay for LPL activity. LPL activity was stimulated two- to three-fold by the presence of 20 to 40 micrograms IC protein. This effect is not caused by the individual components of the IC because neither the specific Ag nor the individual antisera had any significant effect on LPL activity. With the rubella IC, a greater stimulatory effect was seen with increase in IC protein. With the influenza and diphtheria, pertussis, tetanus (DPT) IC, however, inhibition occurred when IC protein exceeded the amount of protein used for the LPL assay. C did not appear to be involved because IC prepared with heated antisera had similar effects. When intact rat epididymal fat pads were exposed to the rubella, influenza, or DPT IC, LPL activity recovered in the suspension medium was increased in each instance compared with pads exposed to a comparable amount of albumin. These findings may have implications for specific lipid changes that may occur during the immediate post-infectious period following rubella, influenza, or infections with the several bacteria whose Ag were present in the DPT IC used in these studies.

Rubella virus antigens: localization of epitopes involved in hemagglutination and neutralization by using monoclonal antibodies.

Monoclonal antibodies (MAbs) against the rubella virion were used to locate epitopes involved in hemagglutination and neutralization. The MAbs exhibiting high-level hemagglutination-inhibiting activity were shown by Western blot analysis to be specific for the E1 polypeptide; this is consistent with the presence of the hemagglutinin on the E1 polypeptide. Some of the E1-specific MAbs also neutralized viral infectivity. However, hemagglutination-inhibiting activity and neutralizing activity did not always correlate. Three distinct functional epitopes were identified on the E1 polypeptide by competition analyses: one which reacted with MAbs with high-level hemagglutination-inhibiting activity and with neutralizing activity, one which reacted with MAbs with low-level hemagglutination-inhibiting activity and with neutralizing activity, and one which reacted with MAbs with only hemagglutination-inhibiting activity. A MAb specific for the E2 polypeptide exhibited neutralizing activity. This E2-specific MAb and two E1-specific MAbs with neutralizing activity were capable of precipitating intact virus which indicates that at least three epitopes involved in neutralization are accessible on the surface of the virion.

Challenge with rubella virus after loss of detectable vaccine-induced antibody.

Studies were conducted of experimental challenge with rubella virus in vaccinees whose possession of vaccine-induced antibody after vaccination had been documented and whose antibody level had become undetectable or very low over time. The challenge virus was the Howell strain, which had been shown to produce typical clinical and laboratory features of rubella in susceptible persons. The challenge of the vaccinees resulted in local viral replication in all but one; in viremia, a primary immunologic response, and a secondary antibody response in some; and usually in illness without a rash or in subclinical infection. The results emphasize the importance of continuing careful clinical and laboratory surveillance of vaccinees for determining the persistence of vaccine-induced immunity and of considering methods for identifying and revaccinating the minority of vaccinees who lose such immunity.

Structure and function of the rubella virus proteins.

Rubella virus strain HPV-77 contains three structural polypeptides. The nucleocapsid is constructed with the C polypeptide chain, which has a molecular weight of 30,000. The envelope proteins are constructed with two glycopolypeptides; the E1 glycopolypeptide has a molecular weight of 63,000, and the E2 glycopolypeptide has a molecular weight of 45,000-48,000. The nucleocapsid capsomere is approximately 6.2S, has a molecular weight of 130,000, and consists of two disulfide-linked dimers of the C polypeptide. The E1 and E2 glycopolypeptides are associated, but the size and structure of the spike protein have not been determined. Strain-specific antigens were detected within the E2 glycopolypeptide in all of the strains tested. In chronologic serum samples, the titers of antibody to the E2 and C polypeptides were the first to decline. Hybridomas were produced that exhibited hemagglutination-inhibiting and neutralizing activities; however, these functions did not always correlate. Both the hemagglutination-inhibiting and neutralizing antibodies reacted with the E1 glycopolypeptide.

Early changes in the synthesis of proteins with affinity for single-stranded DNA during the onset of transformation in NRK cells.

Early alterations in the synthesis of proteins which bind to single-stranded DNA have been examined following the onset of transformation in NRK cells transformed by a heat-sensitive mutant (ts339) of Rous sarcoma virus. Transformation was initiated by shifting quiescent cultures from nonpermissive to permissive temperatures. Cultures were prelabelled with [3H]leucine for several generations at the non-permissive temperature, and with [35S]methionine at times after shift to the permissive temperature. Cytosol extracts were passed through sequential columns of double-stranded and single-stranded DNA bound to cellulose. Within the first hour of transformation there was an increase in the synthetic rate of proteins binding tightly to single-stranded DNA, but not to double-stranded DNA. More loosely bound protein fractions showed no such early synthetic increase. Electrophoresis of the fraction eluted from single stranded DNA-cellulose with 2 M NaCl demonstrated the presence of a major protein of 93 000 daltons, which comprised more than 0.1% of the cytosol protein. The synthesis of the 93 000 dalton protein increased continuously over the first 4 h interval after the onset of transformation. The synthetic rate of a 35 000 dalton protein, a major DNA-binding polypeptide found in mammalian cells, began to increase after a 1-h lag, following the onset of transformation. The protein fraction containing the 93 000 dalton protein had considerable unwinding activity, depressing the melting temperature of poly(dA-dT) by 39 degrees C. The protein fraction containing the bulk of the 35 000 dalton protein did not have unwinding activity. Transformation-induced DNA synthesis was measured in cells made permeable to deoxyribonucleoside triphosphates at times after shift to the permissive temperature. It was determined that synthesis of DNA began within the first 1--2 h after the onset of transformation. We conclude that the early transformation-associated synthesis of SS93 and perhaps other proteins binding to single-stranded DNA may be related to early transformation-associated changes preparatory to DNA replication and subsequent growth.

Enzyme-linked immunosorbent assay determination of specific rubella antibody levels in micrograms of immunoglobulin G per milliliter of serum in clinical samples.

A "microgram assay" is described in which solid-phase enzyme-linked immunosorbent assay is used for the determination of specific rubella immunoglobulin G (IgG) antibody levels in micrograms per milliliter of serum. The quantitation was based on a standard curve obtained by using a reference serum, for which the specific IgG content was assayed by immunochemical purification. IgG was first purified and specific rubella antibodies were separated by an immunoadsorbent prepared by linking rubella virus antigens to Sepharose 4B. By using IgG-specific conjugate, the levels of specific rubella IgG antibodies could then be determined from clinical samples. Seronegative samples showed antibody levels less than 1 microgram/ml, whereas levels up to several hundred micrograms per milliliter were detected in some postinfection sera. The correlation between microgram antibody levels and hemagglutination inhibition titers was linear. The method offers a simple and sensitive antibody assay which could be used both for the laboratory diagnosis of acute rubella and for the evaluation of immunity.

Delivery of wheelchairs to disabled children.

In a follow-up study from a children's wheelchair clinic the delivery times for 120 wheelchairs ordered during 1973--7 were analysed. Delivery delays were considerable: only 22 of the 120 chairs were delivered within one month and 69 within three months, while 21 took over six months to arrive. Factors such as the type of chair ordered, the need for modifications, and the centre handling the transaction did not influence delivery time. Administrative delays may be an important contributory factor.

Detection of antibody to rubella virus by enzyme-linked immunosorbent assay.

Titers of antibody to rubella virus in 68 human sera were compared by hemagglutination inhibition and enzyme-linked immunosorbent assay (ELISA). In general, the titers measured by ELISA were higher than those found by hemagglutination inhibition. Although the titers differed, the two methods showed parallel trends. Use of purified rubella virus and addition of 1% bovine serum albumin to the test wash solution aided in reducing false-positive titers in ELISA.

Changes in synthesis of DNA-binding proteins during the onset of transformation in NRK cells transformed by a temperature-sensitive mutant of Rous sarcoma virus.

Synthesis of cytoplasmic DNA-binding proteins was investigated after a shift from the nonpermissive to the permissive temperature in NRK cells transformed by a temperature-sensitive mutant of Rous sarcoma virus [ts339(RSV)]. Cells were labeled for several generations in [3H]leucine and were pulse-labeled with [35S]methionine for 1 h at the nonpermissive temperature (39 degrees C) and at the permissive temperature (33 degrees C, 5 h after shift from 39 degrees C). Proteins binding to sequential columns of double-stranded and single-stranded DNA-cellulose were examined by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate, and the 35S/3H ratios were obtained for each column fraction and for individual polypeptides. The protein fractions binding to single-stranded, but not double-stranded, DNA and eluting at high salt concentrations (greater than 0.60 M NaCl) showed elevated 35S/3H ratios. This indicated increased synthesis of these proteins within 5 h after the onset of transformation. The majority of the polypeptides in these fractions showed increased synthesis as a consequence of transformation. One prominent polypeptide among them constituted 0.1% of the cytosol protein and had a molecular weight of 93,000. We conclude that the synthesis of proteins binding tightly to single-stranded DNA is increased early after the onset of transformation.

Characterization of type 5 adenovirus fiber protein.

Type 5 adenovirus fiber protein was purified and subjected to chemical characterization. Equilibrium sedimentation ultracentrifugation analysis indicated that the intact fiber has a molecular weight of approximately 183,000. Denaturation and chemical analyses implied that the fiber consists of three polypeptide chains, each of about 61,000 mol wt. Mapping of tryptic peptides and electrophoretic separation of the constituent chains suggested that the intact fiber consists of two identical and one unique polypeptide chains.