"When she goes out, she feels better:" co-designing a Green Activity Program with Hispanic/Latino people living with memory challenges and care partners.

Purpose: Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and their care partners, local outdoor professionals, and healthcare providers. Methods: Participants were recruited via convenience and snowball sampling in the Bronx, New York with Hispanic/Latino persons living with memory challenges and care partners, outdoor activity professionals, and interdisciplinary healthcare providers/dementia experts. Co-design occurred iteratively with 5 focus groups and 4 individual interviews lasting 30-90 min and focused on program and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes program design and research design. Results: 21 participants completed co-design activities: (n = 8 outdoor activity professionals, n = 6 Hispanic/Latino persons living with memory challenges and care partners, and n = 7 interdisciplinary healthcare providers/dementia experts). Participant preferences for program design were captured by subcodes session duration (30-90 min), frequency (4-8 sessions), and delivery modes (in-person and phone). Participants' preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of social participation, connectedness to nature, decreased loneliness, and stewardship were identified. Preferred language for recruiting and describing the program were "memory challenges," "Hispanic/Latino," and "wellbeing." Referral pathways were identified including community-based organizations and primary care. Conclusion: Co-design was a successful form of engagement for people living with memory challenges that enabled participants to help design key elements of the GAP and research design. Our processes, findings, and recommendations for tailoring co-design to engage Hispanic/Latino people living with memory challenges can inform the development of other programs for this population.

Comparison of Oil Content and Fatty Acids Profile of Western Schley, Wichita, and Native Pecan Nuts Cultured in Chihuahua, Mexico.

Two different extraction processes, Soxhlet and ultrasound, were used to obtain the oil extracts of Western Schley, Wichita, and Native pecan nuts cultured in Chihuahua, Mexico. The aspects evaluated in this study were the extraction yield of the processes and fatty acids' profile of the resulting extracts. Gas chromatography coupled with mass spectrometry (GC-MS) was used to identify and determine the composition percentage of fatty acids present in pecan nuts oils extracted. The results obtained show that higher oil extraction yields were obtained by Soxhlet method with hexane (69.90%) in Wichita varieties. Wichita, Western Schley, and Native pecan nuts from Chihuahua are rich in PUFA (polyunsaturated fatty acids) and MUFA (monounsaturated fatty acids) and have low levels of SFA (saturated fatty acids). The predominant fatty acid present in all pecan nuts oils was linoleic acid followed by oleic acid. Myristic acid, palmitic acid, and linolenic acid were also identified in representative quantities. The results from this study suggest that there are statistically significant differences in the chemical composition of the pecan nuts oils extracted from the varieties cultured in Chihuahua, Mexico, and those cultivated in other regions of the world.

Motivational interviewing as a pedagogical approach in behavioral science education: "walking the talk".

Motivational Interviewing (MI) is an evidence-based approach to facilitating behavior change. This approach has been applied in multiple settings (e.g., healthcare, drug and alcohol treatment, psychotherapy, health and wellness coaching, etc.). This article applies MI in a pedagogical context with medical residents as a semi-directive, learner-centered teaching style for eliciting clinical behavior change. Herein we present the foundational theories that inform this approach, describe the process of teaching, address barriers and challenges, and conclude with a review of performance to date including residents' narrative accounts of their experience with the curriculum.

A new paradigm for teaching behavior change: implications for residency training in family medicine and psychiatry.

BACKGROUND: Primary care physicians (PCPs) provide ~50 % of all mental health services in the U.S. Given the widening gap between patient mental health needs and resources available to meet those needs, there is an increasing demand for family medicine and psychiatry trainees to master competencies in both behavioral medicine and primary care counseling during residency-if for no other reason than to accommodate the realities of medical practice given the oft present gap between the need for psychiatric services and the availability, quality, and/or affordability of specialized psychiatric care. To begin to address this gap, a skills-based, interactive curriculum based on motivational interviewing (MI) as a teaching method is presented. METHODS: The curriculum described in this paper is a four-week block rotation taught in the second year of residency. Motivational interviewing (MI) is used as a teaching approach toward the goal of clinical behavior change. Residents' strengths, personal choice and autonomy are emphasized. Each week of the rotation, there is a clinical topic and a set of specific skills for mastery. Residents are offered a "menu" of skills, role modeling, role/real play, practice with standardized patients (SP), and direct supervision in clinic. RESULTS: Thirty-nine residents have completed the curriculum. Based on residents' subjective reporting using pre-post scales (i.e., importance and confidence), all participants to date have reported substantial increases in confidence/self-efficacy using primary care counseling skills in their continuity clinic. CONCLUSIONS: This paper presents an innovative, empirically based model for teaching the essential skills necessary for physicians providing care for patients with mental/emotional health needs as well as health-behavior change concerns. Implications for training in the broader context, particularly as it relates to multi-disciplinary and collaborative models of teaching/training are discussed.

Identificación de infección oculta por Virus de Hepatitis B en pacientes con insuficiencia renal crónica en Hemodiálisis en Unidad Renal del Hospital Militar Central Bogota Colombia Noviembre 2008

La infección oculta por virus de hepatitis B es una forma reconocida de infección que ha ganado interés en la última década, por su significado clínico y las implicaciones frente a los crecientes estados de inmunosupresión. La hepatitis B oculta corresponde a un estado de infección que no presenta marcadores serológicos como antígeno de superficie de hepatitis b, o elevación de transaminasas; su diagnostico se basa en la presencia de DNA viral en población con o sin anticuerpos contra la partícula del core viral, siendo la población de mayor riesgo, los pacientes con trasplante hepático receptores de donante core +, pacientes con hepatocarcinoma, pacientes con cirrosis criptogénica pacientes con insuficiencia renal crónica, usuarios de drogas intravenosas y donantes de sangre frecuentes. Objetivo: Identificar pacientes con infección oculta por virus de hepatitis B en población con insuficiencia renal crónica en hemodiálisis con mayor riesgo, dados por la presencia de anticuerpo contra partícula core VHB y coinfección con virus de hepatitis C. Materiales y métodos: Pacientes con insuficiencia renal crónica en hemodiálisis en la unidad renal del hospital Militar central. Se describen las características demográficas básicas y se identifican los pacientes con anticuerpo core positivo de manera exclusiva, e infección por virus de hepatitis C. Teniendo en cuenta que esta es la población de mayor riesgo de infección oculta, se realiza cuantificacion del genoma viral por técnica de amplificación. Resultados: La serie corresponde a una población adulta mayor predominantemente masculina, con insuficiencia renal crónica secundaria a nefropatía diabética e hipertensiva en su mayoría; el 54 % de los pacientes vacunados contra hepatitis B presenta anticuerpos protectores, y el 13 % presenta anticuerpo contra partícula core del virus de hepatitis B como marcador exclusivo de enfermedad y un paciente con infección por virus de hepatitis C, sin encontrar la presencia de genoma viral en estos pacientes. Discusión: Los pacientes con insuficiencia renal crónica en hemodiálisis que están expuestos a hemoderivados y procedimientos invasivos; a pesar de las normas de bioseguridad, se encuentran en alto riesgo de infección oculta por virus de hepatitis B. Los estudios multinaciones realizados a nivel mundial muestran una gran variabiliadad en la prevalencia de Hepatitis B oculta, a razón de las características demográficas propias de las poblaciones estudiadas. Conclusiones: No se encontró genoma viral de virus de hepatitis B en pacientes con insuficiencia renal crónica en hemodiálisis mayor de seis meses con anticuerpo contra partícula core positivo exclusivo y coinfección con virus de hepatitis C en la unidad renal del hospital Militar central a noviembre de 2008.

Occult Hepatitis B infection is a very well known form of infection, which has gained attention during the last decade because of its clinical significance and the implications facing immunosuppression conditions. Occult hepatitis B corresponds to an infectious state with the absence of serological hepatitis B markers or transaminase elevation. Its diagnostic is based on viral DNA presence in people who may have or not antibodies against viral coreÊs particle, being the most risky population patients who have had hepatic transplant, receivers of positive core donor, patients with hepatocellular carcinoma, patients with cryptogenic cirrhosis, patients with chronic kidney failure, intravenous drug users and frequent blood donors. This studyÊs objective was to identify patients with occult hepatitis B infection in a population with chronic kidney failure on hemodialysis with higher risk given by the presence of the core particle antibody and co-infection with hepatitis C virus. Materials and methods: the current study takes as target a population of patients with chronic kidney failure in hemodialysis at the kidney unit of the "Hospital Militar Central". A survey which pretends to describe the basic demographic characteristics and to identify patients with exclusive positive core antibody and hepatitis C is applied taking into account that this population is at the highest risk for hidden infection; viral genome identification by the amplification technique was done. Results: the series correspond to a basically adult male population with secondary chronic kidney failure due to diabetic and hypertensive nephropathy; 54% of vaccined patients against hepatitis B had protective antibodies and, 13% presented antibodies against core particle of hepatitis B virus, and one patient was positive to Hepatitis C virus, without the presence of viral genome in this population. Discussion: patients with chronic kidney failure on hemodialysis who are exposed to blood derivatives and invasive procedures in spite of bio - safety policies are at high risk for occult hepatitis B infection. Multinational studies conducted worldwide, show a wide geographical variability in occult hepatitis B prevalence. Conclusions: No hepatitis B viral genome was detected in patients with chronic kidney failure on hemodialysis treatment longer than six months with antibody against core particle and co-infection with hepatitis C virus in the kidney unit of "Hospital Militar Central" by November 2008.

Cranial chordomas: results of radical excision.

OBJECT: The authors analyze their experience with the treatment of 29 patients who underwent radical excision of skull base chordomas. METHODS: Modern skull base surgical techniques were used in all patients who were treated between August 1991 and July 2000. The degree of tumor resection was gauged according to intraoperative inspection and postoperative high-resolution imaging findings. There were 21 patients with primary disease and eight with recurrent disease. Total resection was accomplished in 18 patients. Five patients had undergone radiotherapy prior to the present surgery, and an additional eight patients underwent postoperative radiotherapy. There were no surgery-related deaths. In five patients who died of the disease, surgery and radiotherapy had failed to effect a cure. Two of the remaining patients are alive with recurrent disease, and there is questionable evidence of recurrence in another patient. All 24 patients are functioning independently. Cranial nerve impairment was the most common postoperative deficit, followed by cerebrospinal fluid (CSF) leakage and infection. CONCLUSIONS: The use of skull base techniques in radical surgery provides an opportunity to excise the tumor and the involved bone. In most cases the procedure-related cranial nerve deficits improve over time. The complications of CSF leakage and infection can be minimized and are preventable. Proton beam irradiation is an excellent adjuvant treatment but is reserved for patients with definite tumor recurrence or residual tumor that can be identified on the imaging studies.

Evaluation of chemokine- and phlogistin-mediated leukocyte chemotaxis using an in vivo sponge model.

We have directly compared the in vivo activity of a number of chemokines and phlogistins using a modified murine in vivo sponge model in which gelatin sponges are soaked with chemoattractant and implanted in the peritoneal cavity. Sponges soaked with murine JE/MCP-1 (monocyte chemoattractant protein-1) or zymosan promoted the chemotaxis of specific leukocyte populations in a time-dependent manner, as judged by multiparameter flow cytometry, with granulocytes predominating in zymosan-soaked sponges and granulocytes and macrophages present in JE/MCP-1-soaked sponges. Smaller numbers of B, T and dendritic cells were identified as well. Eotaxin selectively chemoattracted eosinophils in this model, while MIG induced significant T cell migration relative to other chemokines. Cell migration was inhibited by administration of methotrexate, piroxicam or dexamethasone, and JE/MCP-1-mediated trafficking was impaired by treatment with anti-JE antibody or with IL-10, suggesting a role for pro-inflammatory factors in amplifying the JE/MCP-1-induced response. This amplification phase involves the production of the chemokine KC, since anti-KC antibody significantly attenuated JE/MCP-1-induced chemotaxis. These results indicate that intraperitoneally implanted chemoattractant-soaked gelatin sponges are capable of inducing a pronounced inflammatory response characterized by the selective migration of leukocyte populations, and suggest that this model may be useful for delineating the activity of novel inhibitors of leukocyte chemotaxis.

Regulatory effects of interleukin-4 and interleukin-10 on human neutrophil function ex vivo and on neutrophil influx in a rat model of arthritis.

OBJECTIVE: To assess the capacity of interleukin-4 (IL-4) and IL-10 to block polymorphonuclear neutrophil (PMN) activation in an ex vivo human model system, and to confirm their effect on neutrophil function in an animal model of arthritis. METHODS: The ex vivo phagocytic capacity of cytokine-activated human PMNs was assessed by use of assays for measuring the ingestion of heat-killed yeast and by subsequent hexose-monophosphate shunt activation using nitroblue tetrazolium reduction. The in vivo activity of IL-4 and IL-10 was measured using a rat adjuvant arthritis model in which the mycobacterial antigen concentration was titrated to modify disease intensity. RESULTS: IL-4 and IL-10 suppressed the ex vivo activation state of interferon-gamma- and tumor necrosis factor alpha-activated human neutrophils. In the rat adjuvant arthritis model, treatment with systemic murine IL-10 (mIL-10) effectively suppressed all disease parameters in rats that received the lower concentrations of mycobacteria, whereas systemic mIL-4 was effective against even the most severe disease. Both cytokines were effective in lowering the absolute PMN cell number recovered and the PMN activation state in the joint synovia. We also observed lower levels of the messenger RNA transcript for CINC protein (cytokine-induced neutrophil chemoattractant; a rat homolog for human IL-8) in the synovia. CONCLUSION: IL-10 is an effective antiarthritic agent and has a major effect on the presence and function of PMNs in the joint synovia when disease intensity is not severe. IL-4 has an inhibitory profile that is similar to that of IL-10, but is effective in modifying even the most severe disease. Both cytokines reduced the phagocytic activation of human PMNs in response to proinflammatory cytokines. These data demonstrate that IL-4 and IL-10 can exert powerful regulatory effects on neutrophil function that translate into a therapeutic response in a disease model of arthritis. Treatment with these cytokines alone or in combination may therefore be very useful in the management of patients with rheumatoid arthritis.

An additional regulatory gene for actinorhodin production in Streptomyces lividans involves a LysR-type transcriptional regulator.

The sequence of a 4.8-kbp DNA fragment adjacent to the right-hand end of the actinorhodin biosynthetic (act) cluster downstream of actVB-orf6 from Streptomyces coelicolor A3(2) reveals six complete open reading frames, named orf7 to orf12. The deduced amino acid sequences from orf7, orf10, and orf11 show significant similarities with the following products in the databases: a putative protein from the S. coelicolor SCP3 plasmid, LysR-type transcriptional regulators, and proteins belonging to the family of short-chain dehydrogenases/reductases, respectively. The deduced product of orf8 reveals low similarities with several methyltransferases from different sources, while orf9 and orf12 products show no similarities with other known proteins. Disruptions of orf10 and orf11 genes in S. coelicolor appear to have no significant effect on the production of actinorhodin. Nevertheless, disruption or deletion of orf10 in Streptomyces lividans causes actinorhodin overproduction. The introduction of extra copies of orf10 and orf11 genes in an S. coelicolor actIII mutant restores the ability to produce actinorhodin. Transcriptional analysis and DNA footprinting indicate that Orf10 represses its own transcription and regulates orf11 transcription, expression of which might require the presence of an unknown inducer. No DNA target for Orf10 protein was found within the act cluster.

The effects of colony stimulating factors on human monocyte cell function.

We used a panel of functional assays to compare directly the pattern and potency of GM-CSF and M-CSF on monocyte activity associated with cell-mediated immune defense. GM-CSF and M-CSF were found to be equivalent both in their capacity to stimulate human monocyte functions in vitro and in their pattern of monocyte activation. The two CSFs were effective in inducing monocyte chemotaxis towards either fMLP or LTB4 at equivalent concentrations across a panel of donors. GM-CSF and M-CSF demonstrated equipotency in the induction of monocyte phagocytosis of heat-killed baker's yeast and in the regulation of the hexose-monophosphate shunt (NBT reduction). Both were also found to be equivalent in preventing steroid (dexamethasone)-induced suppression of monocyte anti-bacterial (Candida albicans) and anti-fungal (Staphylococcus aureus) phagocytic capacities. GM-CSF was somewhat more effective than M-CSF in stimulating monocyte C. albicans killing at a lower E:T ratio.

The effect of GM-CSF and G-CSF on human neutrophil function.

A direct comparison of GM-CSF and G-CSF in a panel of in vitro neutrophil-function assays was performed to investigate any differences in activity profiles. In our modified chemotactic assay, GM-CSF rapidly increased the migratory capacity of polymorphonuclear cells (PMNs) to move toward fMLP and LTB4. In contrast, G-CSF only stimulated PMN migration towards fMLP. GM-CSF, but not G-CSF, increased PMN cytotoxic killing of C. albicans blastospores. The expression of PMN surface antigens associated with Fc- and complement-mediated cell-binding (Fc gamma R1, CR-1 and CR-3), and adhesion signalling (ICAM-1), was increased after the exposure of GM-CSF, but not to G-CSF. In contrast these CSFs demonstrated relative equipotency in their ability to induce PMN anti-bacterial phagocytosis, and to restore the Staphylococcus aureus killing capacity of dexamethasone-suppressed neutrophils. The phagocytic activity of PMNs for opsonized yeast, as well as hexose-monophosphate shunt activity, was equivalent following GM-CSF or G-CSF treatment. We discuss the significance of the difference in activity profiles in this article.

abaA, a new pleiotropic regulatory locus for antibiotic production in Streptomyces coelicolor.

Production of the blue-pigmented antibiotic actinorhodin is greatly enhanced in Streptomyces lividans and Streptomyces coelicolor by transformation with a 2.7-kb DNA fragment from the S. coelicolor chromosome cloned on a multicopy plasmid. Southern analysis, restriction map comparisons, and map locations of the cloned genes revealed that these genes were different from other known S. coelicolor genes concerned with actinorhodin biosynthesis or its pleiotropic regulation. Computer analysis of the DNA sequence showed five putative open reading frames (ORFs), which were named ORFA, ORFB, and ORFC (transcribed in one direction) and ORFD and ORFE (transcribed in the opposite direction). Subcloning experiments revealed that ORFB together with 137 bp downstream of it is responsible for antibiotic overproduction in S. lividans. Insertion of a phi C31 prophage into ORFB by homologous recombination gave rise to a mutant phenotype in which the production of actinorhodin, undecylprodigiosin, and the calcium-dependent antibiotic (but not methylenomycin) was reduced or abolished. The nonproducing mutants were not affected in the timing or vigor or sporulation. A possible involvement of ORFA in antibiotic production in S. coelicolor is not excluded. abaA constitutes a new locus which, like the afs and abs genes previously described, pleiotropically regulates antibiotic production. DNA sequences that hybridize with the cloned DNA are present in several different Streptomyces species.

Evaluation of the human epidermal keratinocyte neutral red release and neutral red uptake assay using the first 10 MEIC test materials.

Two methodologies used in vitro to estimate cytotoxicity in cell culture systems were compared: these were the neutral red uptake assay (NRU), which is used to measure toxicity caused by an extended (48-hr) exposure to the test material, and the neutral red release assay (NRR), which is used to measure toxicity caused by a short-term (1-min) exposure to the test material. Both methodologies used the normal human epidermal keratinocyte (NHEK)-based NeutralRed Bioassay supplied by Clonetics Corporation (San Diego, CA, USA). 10 materials (paracetamol, acetylsalicylic acid, ferrous sulphate, diazepam, amitriptyline, digoxin, ethylene glycol, methanol, ethanol and isopropanol), which are part of the Multicenter Evaluation of In Vitro Cytotoxicity (MEIC) panel, were tested. NRU(50) values for the 10 compounds covered more than an eight-log range from 0.004 mum (digoxin) to 1.0 x 10(6) mum (methanol). Because of solubility limits, NRR(50) values for diazepam, digoxin, ferrous sulphate and paracetamol could not be determined. NRR(50) values for the remaining six compounds covered approximately a three-log range from 3.2 x 10(3) to 7.1 x 10(6) mum. When compared with documented values for either the human acute oral lethal dose or the human acute lethal blood concentration, the NRU assay was found to be much more useful in predicting human acute toxicity than was the NRR assay.

Dermatologic findings associated with human immunodeficiency virus infection.

Both human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are associated with an increased prevalence of several dermatologic diseases. We studied healthy homosexual men with negative reactivity to HIV antibody, homosexual men without AIDS but with positive reactivity to HIV antibody, and homosexual men with AIDS to compare the prevalence of dermatologic disease in these groups. We found that five cutaneous disorders were increased in persons with HIV infection. Oral hairy leukoplakia was increased both in seropositive subjects without AIDS and in subjects with AIDS. Condylomata acuminata and seborrheic dermatitis were slightly increased in seropositive non-AIDS subjects and significantly increased in the AIDS group. Molluscum contagiosum and oral candidiasis were increased only in the AIDS group.

Estudio antropométrico de fuerzas musculares en niñas adolescentes de una muestra de la población de Valparaíso / Anthropometric study of muscular force in adolescent girls of Valparaíso

La adolescencia es un período cuyo inicio en niñas está asociado con la menarquía, lo cual influye en la maduración biológica, como en una serie de factores antropométricos, que se pueden investigar en términos de: biotipo, composición corporal, capacidades de fuerzas, etc. El propósito de esta investigación es determinar el máximo potencial de fuerza muscular, capacidad específica a determinadas edades del período adolescente, relacionándolas con: edad, peso, altura, componentes del somatotipo y composición corporal; desarrolladas por un grupo de 200 niñas de edades entre 11.583-18.99 años. Se midió la fuerza desarrollada por mano y antebrazo derecho e izquierdo con el Harpender handgrip dynamometer y se registró la fuerza de los músculos de espalda, hombros y piernas con el Back and leg muscle dinamometer. Para determinar los somatotipos se aplicó el Método Antropométrico de Heath-Carter (1978). Se obtiene composición corporal, circunsferencias y áreas musculares de brazo y región dorsal de la pierna, test de fuerzas físicas, usando la metodología descrita en trabajos anteriores de Toro et. Al. (1982); Almagiá et. Al. (1983). La muestra se analiza estadísticamente, cuyos promedios totales del estudio son: edad 15,67 años, estatura 155,3 ñ 6,2 cms., peso corporal 52,42 ñ 7,96 kg. El desarrollo muscular alcanza un 38,48 <. La muestra se analiza estadísticamente, cuyos promedios totales del estudio son: edad 15,67 años, estatura 155,3 ñ 6,2 cms., peso corporal 52,42 ñ 7,96 kg. El desarrollo muscular alcanza un 38,48%de M.M., lo que corresponde a un somatotipo Mesomorfo-endomorfo (5- 5- 2). El grado de muscularidad de las niñas es mayor en la región de la pierna que del brazo, con 28,16 ñ 2,83 y 19,72 ñ 2,65 cms. respectivamente, que expresado en áreas musculares el valor de la pierna es (63,73 cm*) y el del brazo es (31,51 cm*). La F.M.G.D. es ligeramente superior a la izquierda 21,67 ñ 5,69 y 20,03 ñ 3,95 kg., la F.P.E. aumenta considerablemente los valores anteriores (63,59 ñ 17,84 kg.). Considerando un coeficiente de determinación (R*) mayor de 60%, se pudo concluir que las mayores F.M.G.D., F.M.G.I. y F.P.E. ejercidas por las alumnas se producen entre los 17.0 y 17,99 años de edad