Mumps Outbreak in a Marshallese Community - Denver Metropolitan Area, Colorado, 2016-2017.

In January 2017, the Colorado Department of Public Health and Environment (CDPHE) identified four epidemiologically linked cases of mumps among persons from a Marshallese community who were members of the same church in the Denver metropolitan area. During 2016-2017, sizable outbreaks of mumps reported in Arkansas, Hawaii, and Washington also affected the Marshallese population (1). CDPHE, the Tri-County Health Department (TCHD), and Denver Public Health collaborated to conduct an outbreak investigation during January-March 2017 using active and passive surveillance that identified 17 confirmed and 30 probable cases. Public health actions included conducting measles-mumps-rubella (MMR) vaccination clinics at local Marshallese churches; these resulted in the vaccination of 126 persons with ≥1 doses of MMR vaccine. Implementation of active surveillance and support from local Marshallese church leaders in promoting vaccination programs likely contributed to interruption of the outbreak.

Public Health Economic Burden Associated with Two Single Measles Case Investigations - Colorado, 2016-2017.

During July 2016-January 2017, two unrelated measles cases were identified in the Denver, Colorado area after patients traveled to countries with endemic measles transmission. Each case resulted in multiple exposures at health care facilities and public venues, and activated an immediate and complex response by local and state public health agencies, with activities led by the Tri-County Health Department (TCHD), which serves Adams, Arapahoe, and Douglas counties. To track the economic burden associated with investigating and responding to single measles cases, personnel hours and supply costs incurred during each investigation were tracked prospectively. No secondary cases of measles were identified in either investigation. Postexposure prophylaxis (PEP) was administered to 31 contacts involving the first case; no contacts of the second case were eligible for PEP because of a delay in diagnosing measles disease. Public health costs of disease investigation in the first and second case were estimated at $49,769 and $18,423, respectively. Single measles cases prompted coordinated public health action and were costly and resource-intensive for local public health agencies.

Genomic imprinting defect in Zfp57 mutant iPS cell lines.

ZFP57 maintains genomic imprinting in mouse embryos and ES cells. To test its roles during iPS reprogramming,we derived iPS clones by utilizing retroviral infection to express reprogramming factors in mouse MEF cells. After analyzing four imprinted regions, we found that parentally derived DNA methylation imprint was largely maintained in the iPS clones with Zfp57 but missing in those without maternal or zygotic Zfp57. Intriguingly, DNA methylation imprint was lost at the Peg1 and Peg3 but retained at the Snrpn and Dlk1-Dio3 imprinted regions in the iPS clones without zygotic Zfp57. This finding will be pursued in future studies.

A critical analysis of online nursing education: balancing optimistic and cautionary perspectives.

The landscape of nursing education has been transformed by increasing student demand for online programs coupled with strong institutional directives to deliver nursing courses through distributed learning. The authors present a qualitative research design informed by philosophical hermeneutics in which 30 undergraduate and graduate nursing students discuss their experiences of the influence of peer dynamics on online learning. The findings include issues related to time, demands of online participation, experiences of conflict, and the development of skills in the online environment. Theoretical matters of curriculum such as instrumentality and tensionality are examined, generating both optimistic and cautionary possibilities for online learning. Online nursing students could benefit from a period of face-to-face orientation with a focus on building intellectual and social communities, limited class size, and opportunities to connect learners.

Contemplating the fit and utility of nursing theory and nursing scholarship informed by the social sciences and humanities.

In this article, authors contend that a lack of familiarity with philosophical thinking undermines the ability of students and subsequently practicing nurses to theorize for themselves. Engagement with philosophical ideas propels nurses well beyond the unthinking "application" of extant theory, to theorizing, that is, using theoretical formulations to engage with the significant phenomena we encounter in the world of human health. The authors present a framework to guide philosophical interrogation of knowledge, with a focus on the utility of both disciplinary knowledge and knowledge from the social sciences and humanities.

Mechanisms of triglyceride accumulation in activated macrophages.

LPS treatment of macrophages induces TG accumulation, which is accentuated by TG-rich lipoproteins or FFA. We defined pathways altered during macrophage activation that contribute to TG accumulation. Glucose uptake increased with activation, accompanied by increased GLUT1. Oxidation of glucose markedly decreased, whereas incorporation of glucose-derived carbon into FA and sterols increased. Macrophage activation also increased uptake of FFA, associated with an increase in CD36. Oxidation of FA was markedly reduced, whereas the incorporation of FA into TGs increased, associated with increased GPAT3 and DGAT2. Additionally, macrophage activation decreased TG lipolysis; however, expression of ATGL or HSL was not altered. Macrophage activation altered gene expression similarly when incubated with exogenous FA or AcLDL. Whereas activation with ligands of TLR2 (zymosan), TLR3 (poly I:C), or TLR4 (LPS) induced alterations in macrophage gene expression, leading to TG accumulation, treatment of macrophages with cytokines had minimal effects. Thus, activation of TLRs leads to accumulation of TG in macrophages by multiple pathways that may have beneficial effects in host defense but could contribute to the accelerated atherosclerosis in chronic infections and inflammatory diseases.

Unveiling new dimensions: a hermeneutic exploration of perinatal mood disorder and infant feeding.

In this hermeneutic study, six women from the local Perinatal Mental Health Program were interviewed about their experiences with infant feeding. None of the women in the study were breastfeeding their infants. The research question centered on their experience of formula feeding with a view to gaining better insight about the issues that women face when feeding practices do not conform to best-practice (i.e., breastfeeding) promotional standards. We also considered the needs of nurses working in the mental health setting, who may face conflicting recommendations concerning the treatment of a mental health crisis in the presence of current infant feeding best-practice guidelines. Our findings support concerns that current guidelines overlook the special needs of women who live with perinatal mood disorder. We speculate that breastfeeding challenges may present a risk for postpartum depression in women who are biologically vulnerable. The need for ongoing assessment for emerging depression among women who are experiencing breastfeeding challenges is identified. The importance of deepened understanding among mental health nurses is highlighted.

The limitations of partial citizenship: health care institutions underpinned with heteronormative ideals.

Tensions between apparent rights of lesbian, gay, bisexual, transgender, or queer/questioning people and the continued prevalence of heteronormative health care practice emerged in research with older women who self-identified as lesbian. Having already faced considerable exclusionary institutional practices in their lives, these women expressed anticipatory dread of the erasure of their lives in residential or long-term care. Drawing on the framework of sexual citizenship, this article critiques the disjuncture between the legal reality and the lived reality of LGBTQ people and suggests that social or political rights of full citizenship remain tenuous or absent in residential care settings. Authors present an alternative approach to human health experience.

Zinc finger protein ZFP57 requires its co-factor to recruit DNA methyltransferases and maintains DNA methylation imprint in embryonic stem cells via its transcriptional repression domain.

Previously, we discovered that ZFP57 is a maternal-zygotic effect gene, and it maintains DNA methylation genomic imprint at multiple imprinted regions in mouse embryos. Despite these findings, it remains elusive how DNA methyltransferases are targeted to the imprinting control regions to initiate and maintain DNA methylation imprint. To gain insights into these essential processes in genomic imprinting, we examined how ZFP57 maintains genomic DNA methylation imprint in mouse embryonic stem (ES) cells. Here we demonstrate that the loss of ZFP57 in mouse ES cells led to a complete loss of genomic DNA methylation imprint at multiple imprinted regions, similar to its role in mouse embryos. However, reintroduction of ZFP57 into Zfp57-null ES cells did not result in reacquisition of DNA methylation imprint, suggesting that the memory for genomic imprinting had been lost or altered in Zfp57-null ES cells in culture. Interestingly, ZFP57 and DNA methyltransferases could form complexes in the presence of KAP1/TRIM28/TIF1ß when co-expressed in COS cells. We also found that the wild-type exogenous ZFP57 but not the mutant ZFP57 lacking the KRAB box that interacts with its co-factor KAP1/TRIM28/TIF1ß could substitute for the endogenous ZFP57 in maintaining the DNA methylation imprint in ES cells. These results suggest that ZFP57 may recruit DNA methyltransferases to its target regions to maintain DNA methylation imprint, and this interaction is likely facilitated by KAP1/TRIM28/TIF1ß.

Dialectic of the university: a critique of instrumental reason in graduate nursing education.

Our analysis in this paper unfolds on two levels: a critique of the 'realities' of graduate nursing education and an argument to sustain its 'ideals'. We open for discussion an aspect of graduate nursing education dominated by instrumental reason, namely the research industry, using an internal critique approach developed by Max Horkheimer and Theodor Adorno of the Early Frankfurt School. As we explain, internal critique arises out of, and relies on, the mismatch between goals, or 'ideals', and existing realities. Thinking about 'ideals' of the academy, we draw on Hans-Georg Gadamer's view of the university as a place to think freely, creatively, and critically. The contemporary realities of the university, on the other hand, that emphasize the market values of the research industry forcefully shape nursing academic scholarship in a particular direction. In our attempt to recognize and disrupt the forces of the research industry with its instrumental reason, we consider Judith Butler's writings on how norms operate in society. We show that our growing involvement in the research industry makes it very difficult to disentangle ourselves from that situation. The values of the research industry actually suppress the very ideals of education and scholarship that we would like to uphold. As a contra-force, the internal critique of the 'existing realities' in the graduate nursing education unmasks the tyranny of the research industry and makes visible the importance of sustaining the higher goals and ideals in nursing scholarship.

Bringing ourselves into view: disclosure as epistemological and ontological production of a lesbian subject.

Using Gadamerian hermeneutics as a methodology and feminist philosophical thought as an analytical framework, this study explores understandings of experiences of disclosure of sexual orientation for older 'lesbian' women. The study draws on an interpretative inquiry in which participants theoretically align with sexual identity categories with both an ontological and an epistemological purpose and later move away from or even disassociate from the 'category' (of lesbian). Reflecting on these interpretations, that of the epistemological and the ontological production of a subject, we ask: What does it mean then to say I am a lesbian? This is where a tension exists: how is it that in spite of the incongruencies of what constitutes a lesbian, and the apparent ambiguity of people to name themselves, we continue to act (as health care providers and researchers) as if the category itself is meaningful and stable? A feminist lens provides an inroad to consider sexuality as practices, rather than as fixed identity; practices that are constituted within the discursive, social and material realities of a life as well as within political and ideological systems in which one resides.

Regulation of the Epstein-Barr virus Zp promoter in B lymphocytes during reactivation from latency.

Ten novel mutations were introduced into the Zp promoter to test the role of sequences outside the established transcription factor-binding sites in Epstein-Barr virus (EBV) reactivation. Most of these had only small effects, but mutations in the ZID site were shown to reduce Zp activity strongly at early times after induction by anti-immunoglobulin (anti-Ig). The binding of MEF2 transcription factor to ZID was characterized in detail and linked functionally to Zp promoter activity. The presence of XBP-1s, the active form of XBP-1, after administration of anti-Ig to Akata Burkitt's lymphoma cells is consistent with a role for this factor in reactivation of the EBV lytic cycle, although signalling through MEF2D was quantitatively much more significant in activation of Zp. Silencing of Zp during latency is thought to be primarily a consequence of a repressive chromatin structure on Zp, and this aspect of Zp regulation can be observed in the Akata genome through protection of Zp from activation by BZLF1 in the absence of signalling from the B-cell receptor.

ADRP/ADFP and Mal1 expression are increased in macrophages treated with TLR agonists.

Activation of macrophages by TLR agonists enhances foam cell formation, but the underlying mechanisms are not understood. We examined the effects of TLR agonists on ADRP/ADFP, a protein associated with forming lipid droplets, and Mal1 a fatty acid-binding protein, in two mouse macrophage cell lines and human monocytes. Low doses of LPS, a TLR4 agonist increased both mRNA and protein levels of ADRP/ADFP and Mal1 in RAW 264.7 macrophages. Following pretreatment with Intralipid, fatty acids, or acetyl-LDL to increase triglyceride or cholesterol ester storage, LPS treatment still increased ADRP/ADFP and Mal1 mRNA levels. LPS also induced ADRP/ADFP and Mal1 in J774 macrophages and ADRP/ADFP in human monocytes. Zymosan, a fungal product that activates TLR2, poly-I:C, a viral mimetic that activates TLR3, and imiquimod, a TLR7 agonist, also increased ADRP/ADFP. Zymosan, but not poly-I:C or imiquimod, induced Mal1. In contrast, neither gene was induced by TNFalpha, IL-1beta, IL-6, or interferon-gamma. Thus TLR agonists induce ADRP/ADFP and Mal1, which likely contributes to macrophage triglyceride and cholesterol ester storage leading to foam cell formation.

Dilemmas, tetralemmas, reimagining the electronic health record.

With the transition from paper-based to computer-based records, nursing practice shifts to computerized documentation of care in the electronic health record (EHR). Viewed not only as an electronic document, but as an instrument of modern economic and technological ideology that serves organizational goals of cost-efficiency, the EHR can be perceived as creating a dilemma for a patient-centered nursing practice. Viewing the EHR as relying solely on the use of standardized languages begets a number of questions and furthers the dilemma for nurses. Through a discussion that draws on the Indian tradition of the tetralemma, authors transcend the EHR/nursing dilemma.

Lesbian disclosure: disrupting the taken for granted.

The purpose of this interpretive inquiry was to generate understandings about the experience of lesbian disclosure. The inquiry relied on Gadamerian hermeneutic and feminist philosophical thought and was situated in women's health. In a feminist understanding of women's health, experiences of health are inseparable from the everyday experiences of an embodied life and are constituted within each woman's social, material, and discursive realities.The study was informed by conversations with 15 women who self-identified as lesbian for the purpose of the inquiry, accounts of women in the media, and the researcher's reflective journals. The findings move us towards new understandings about the multiple meanings of "lesbian". "They challenge nurses to consider the binary categories of homosexual and heterosexual as inadequate signifiers for the reality of women's lives, to consider the particular arrangements of each woman's life, and to disrupt assumptions of heterosexism in order to reduce the negative impact of social exclusion, isolation, discrimination, and stigmatization as social determinants of health.

Interaction of Epstein-Barr virus BZLF1 C-terminal tail structure and core zipper is required for DNA replication but not for promoter transactivation.

The Epstein-Barr virus (EBV) protein BZLF1 contains a bZIP DNA binding domain in which C-terminal tail residues fold back against a zipper region that forms a coiled coil and mediates dimerization. Point mutagenesis in the zipper region reveals the importance of individual residues within the (208)SSENDRLR(215) sequence that is conserved in C/EBP for transactivation and EBV DNA replication. The restoration of BZLF1 DNA replication activity by the complementation of two deleterious mutations (S208E and D236K) indicates that the interaction of the C-terminal tail and the core zipper is required for DNA replication, identifying a functional role for this structural feature unique to BZLF1.

Unpacking disclosure: interrupting unquestioned practices.

Disclosure, the social practice of sharing the details, the "truths" of one's life, is embedded in our social world, and in the assumptions that drive the provision of mental health and psychotherapeutic intervention. In this paper the author interrogates the ways in which categories of sexuality and disclosure itself is historically derived and asks: How would care be different if we consider the constructed categories of sexual orientation as an exemplar of an unstable truth? In addition, the author suggests approaches to practice that unseat the valorization of disclosure.

Lesbian disclosure: disrupting the taken for granted.

The purpose of this interpretive inquiry was to generate understandings about the experience of lesbian disclosure. The inquiry relied on Gadamerian hermeneutic and feminist philosophical thought and was situated in women's health. In a feminist understanding of women's health, experiences of health are inseparable from the everyday experiences of an embodied life and are constituted within each woman's social, material, and discursive realities. The study was informed by conversations with 15 women who self-identified as lesbian for the purpose of the inquiry, accounts of women in the media, and the researcher's reflective journals. The findings move us towards new understandings about the multiple meanings of "lesbian." They challenge nurses to consider the binary categories of homosexual and heterosexual as inadequate signifiers for the reality of women's lives, to consider the particular arrangements of each woman's life, and to disrupt assumptions of heterosexism in order to reduce the negative impact of social exclusion, isolation, discrimination, and stigmatization as social determinants of health.

Adipocyte fatty acid-binding protein expression and lipid accumulation are increased during activation of murine macrophages by toll-like receptor agonists.

OBJECTIVE: Toll-like receptors (TLRs) recognize pathogens and mediate signaling pathways important for host defense. Recent studies implicate TLR polymorphisms in atherosclerosis risk in humans. Adipocyte fatty acid-binding protein (aP2) is present in macrophages and has an important role in atherosclerotic plaque development. We investigated aP2 expression in RAW 264.7 cells treated with lipopolysaccharide (LPS) and other TLR agonists and assessed lipid accumulation in these activated murine macrophages. METHODS AND RESULTS: Stimulation with LPS, a TLR4 ligand, resulted in a 56-fold increase in aP2 mRNA expression, and zymosan, a TLR2 ligand, induced an approximately 1500-fold increase. Polyinosine: polycytidylic acid (poly I:C), a TLR3 ligand, led to a 9-fold increase. Levels of aP2 protein were significantly increased in LPS or zymosan-treated macrophages compared with control or poly I:C-treated cells. In addition, the cholesteryl ester content of LPS or zymosan-treated macrophages was approximately 5-fold greater in the presence of low-density lipoprotein, and triglyceride content was approximately 2-fold greater in the absence of exogenous lipid than control or poly I:C-treated cells. CONCLUSIONS: Expression of macrophage aP2 is induced on TLR activation and parallels increases in cholesteryl ester and triglyceride levels. These results provide a molecular link between the known roles of TLR and aP2 in foam cell formation.

The view from somewhere: locating lesbian experience in women's health.

In some circles of nursing practice and research, "women's health" is seen to stand for "women's reproductive and heterosexual health." In this article we offer a view of women's health that makes central the contexualized reality of the material, social, and discursive experiences of women's lives. We suggest that the barriers to adopting broader conceptualizations of health are grounded in pervasive ideologies that privilege biology and a traditional model of health over nonmedical determinants of health. Lesbian disclosure is a central experience in lesbian life, and, as such, is seen as an exemplar of research questions that challenges our taken-for-granted ideologies and contextualizes women's health experiences.