Biophysical cues enhance myogenesis of human adipose derived stem/stromal cells.

Adipose-derived stem/stromal cell (ASC)-based tissue engineered muscle grafts could provide an effective alternative therapy to autografts - which are limited by their availability - for the regeneration of damaged muscle. However, the current myogenic potential of ASCs is limited by their low differentiation efficiency into myoblasts. The aim of this study was to enhance the myogenic response of human ASCs to biochemical cues by providing biophysical stimuli (11% cyclic uniaxial strain, 0.5 Hz, 1h/day) to mimic the cues present in the native muscle microenvironment. ASCs elongated and fused upon induction with myogenic induction medium alone. Yet, their myogenic characteristics were significantly enhanced with the addition of biophysical stimulation; the nuclei per cell increased approximately 4.5-fold by day 21 in dynamic compared to static conditions (23.3 ± 7.3 vs. 5.2 ± 1.6, respectively), they aligned at almost 45° to the direction of strain, and exhibited significantly higher expression of myogenic proteins (desmin, myoD and myosin heavy chain). These results demonstrate that mimicking the biophysical cues inherent to the native muscle microenvironment in monolayer ASC cultures significantly improves their differentiation along the myogenic lineage.

Hemoproteids (Apicomplexa: Haemoproteidae) from South African tortoises (Cryptodira: Testudinidae).

Terrestrial tortoises, Chersina angulata (Schweigger, 1812), Kinixys belliana belliana Gray, 1831, K. lobatsiana Power, 1927, K. natalensis Hewitt, 1935, and Stigmochelys pardalis (Bell, 1828), both wild (n  =  84) and captive (n  =  70), were examined for hematozoans from the provinces of Gauteng, Kwazulu-Natal, North West, and Western Cape, South Africa. In Giemsa-stained blood films, 2 species of hemoproteids were identified, 1 previously described, that is, Haemoproteus testudinalis ( Laveran, 1905 ) Wenyon, 1915, the other unknown. Haemoproteus testudinalis occurred in 2/27 wild K. lobatsiana and 1/41 S. pardalis and 2/2 captive K. lobatsiana from the North West and Gauteng, respectively, whereas Haemoproteus sp. A was recorded in 1 of 3 captive K. natalensis from Kwazulu-Natal. Haemoproteus testudinalis had pale blue-stained, often vacuolated, halteridial macrogametocytes, pale pink-stained microhalterdial to halteridial microgametocytes, and dark, scattered, often bacillus-like hemozoin granules. Haemoproteus natalensis n. sp. had ameboid growth stages, blue-stained halteridial to circumnuclear macrogametocytes, purple-stained circumnuclear microgametocytes, and brownish, often clustered, pigment granules. It is recommended that Haemoproteus balazuci Dias, 1953, become a junior synonym of H. testudinalis.

Long-term Adjustment After Surviving Open Heart Surgery: The Effect of Using Prayer for Coping Replicated in a Prospective Design.

PURPOSE: despite the growing evidence for effects of religious factors on cardiac health in general populations, findings are not always consistent in sicker and older populations. We previously demonstrated that short-term negative outcomes (depression and anxiety) among older adults following open heart surgery are partially alleviated when patients employ prayer as part of their coping strategy. The present study examines multifaceted effects of religious factors on long-term postoperative adjustment, extending our previous findings concerning prayer and coping with cardiac disease. DESIGN AND METHODS: analyses capitalized on a preoperative survey and medical variables from the Society of Thoracic Surgeons' National Database of patients undergoing open heart surgery. The current participants completed a mailed survey 30 months after surgery. Two hierarchical regressions were performed to evaluate the extent to which religious factors predicted depression and anxiety, after controlling for key demographics, medical indices, and mental health. RESULTS: predicting lower levels of depression at the follow-up were preoperative use of prayer for coping, optimism, and hope. Predicting lower levels of anxiety at the follow-up were subjective religiousness, marital status, and hope. Predicting poorer adjustment were reverence in religious contexts, preoperative mental health symptoms, and medical comorbidity. Including optimism and hope in the model did not eliminate effects of religious factors. Several other religious factors had no long-term influences. MPLICATIONS: the influence of religious factors on the long-term postoperative adjustment is independent and complex, with mediating factors yet to be determined. Future research should investigate mechanisms underlying religion-health relations.

Aging of the optics of the human eye: lens refraction models and principal plane locations.

Biometric data describing the geometry and spacings of emmetropic human eyes were combined with lens shape and placement within the globe to generate paraxial models of image formation as a function of age. Three different representations of the shape of the internal refractive index gradient of the lens were evaluated--a Gullstrand-type model consisting of cortical and nuclear regions with different refractive indices, a power series model, and a linear-gradient model. All three refractive models satisfy the requirements for focus for all the data sets, indicating that lenticular refractive index gradient shape is essentially underdetermined in the paraxial limit. Lens refractive power decreases by almost 2 D during a 50-year period, and the concomitant decrease in system refractive power is due almost entirely to this effect. The reduction in spacing between the lens principal planes is a function of this, as is their anterior movement with age, and suggests that the compensatory processes maintaining far focus at the expense of near are not exactly balanced. Despite these changes in the lens contribution and their effect on the location of the system principal planes, which also move anteriorly, the spacing between the system principal planes remains constant. However, the trend toward reduced overall system power with age indicates the primary role of the lens in mediating image formation onto the retina over time.

Persistence of impaired functioning and psychological distress after medical hospitalization for men with co-occurring psychiatric and substance use disorders.

OBJECTIVE: To measure the persistence of impaired health-related quality of life (HRQL) and psychological distress associated with co-occurring psychiatric and substance use disorders in a longitudinal sample of medically hospitalized male veterans. DESIGN: A random sample followed observationally for 1 year after study enrollment. SETTING: Inpatient medical and surgical wards at 3 university-affiliated Department of Veterans Affairs Medical Centers. PATIENTS/PARTICIPANTS: A random sample of 1,007 admissions to medical and surgical inpatient services, excluding women and admissions for psychiatric reasons. A subset of participants (n = 736) was designated for longitudinal follow-up assessments at 3 and 12 months after study enrollment. This subset was selected to include all possible participants with study-administered psychiatric diagnoses (52%) frequency-matched by date of study enrollment to approximately equivalent numbers of participants without psychiatric diagnoses (48%). MEASUREMENTS AND MAIN RESULTS: All participants were administered a computerized structured psychiatric diagnostic interview for 13 psychiatric (include substance use) disorders and received longitudinal assessments at 3 and 12months on a multidimensional measure of HRQL, the SF-36, and a measure of psychological distress, the Symptom Checklist, 90-item version. On average, HRQL declined and psychological distress increased over time (P <.05). Psychiatric disorders were associated with significantly greater impairments in functioning and increased distress on all measures (P <.001) except physical functioning (P <.05). These results were replicated in the patients (n = 130) who received inpatient or outpatient mental health or substance abuse services. CONCLUSIONS: General medical physicians need to evaluate the mental health status of their hospitalized and seriously ill patients. Effective mental health interventions can be initiated posthospitalization, either immediately in primary care or through referral to appropriate specialty care, and should improve health functioning over time.

Aging of the human lens: changes in lens shape at zero-diopter accommodation.

Scheimpflug photographs of the zero-diopter-accommodated anterior segments of 100 human subjects, aged 18 to 70 yr and evenly spaced over this range, were digitized and analyzed to characterize lens and lens nucleus shape as a function of age by the Hough transform and other image analysis methods. Anterior and posterior lens surface curves exhibit a decrease in radius of curvature with increasing age, in qualitative but not quantitative agreement with the earlier observations of Brown [Exp. Eye Res. 19, 175 (1974)]. In contrast, the shape of the lens nuclear boundaries changes little with age. Overall lens volume at zero diopters increases with age, but the volume of the lens nucleus remains unchanged. The lens center of mass moves anteriorly with increasing age, as does the central clear region of the lens. Although these data sets were found to be more variable than those of Brown, the complementary variability of other factors, such as anterior chamber depth, for each subject leads to a very high statistical correlation between lens shape and lens location relative to the cornea. This supports the finding of previous work that image formation on the retina for a given individual results from the multifactorial balancing of related factors.

Toward establishing procedural, criterion, and discriminant validity for PTSD in early childhood.

OBJECTIVE: To explore several key aspects of the diagnosis and assessment for posttraumatic stress disorder (PTSD) in infants and young children. METHOD: Fifteen traumatized, clinic-referred children, and a comparison sample of 12 at-risk children, all younger than 48 months of age, were assessed with a standardized procedure and a semistructured diagnostic interview. The assessments were videotaped and reviewed by two blind raters for scoring DSM-IV PTSD criteria and an alternative set of PTSD criteria for young children. Raters were debriefed and consensus ratings were used to make best-estimate diagnoses. RESULTS: The investigation of procedural validity showed that 12% of the diagnostic criteria present in these children could be detected by a clinician through direct observation or interaction with the children. The remainder of criteria were apparent only through caregiver report. Problematic aspects of parental reporting were most evident for the avoidance/numbing of responsiveness criteria. The traumatized subjects showed significantly more alternative criteria of PTSD than DSM-IV criteria of PTSD. The main sources of rater disagreement are described. CONCLUSIONS: Additional sources of information would complement the multidimensional assessment of PTSD in young children. The set of alternative criteria appears to show greater criterion validity than the DSM-IV criteria.

Complementary alternative medicine in health and mental health: implications for social work practice.

This article describes the increasing use of complementary alternative medicine (CAM) in this country and its implications for social work practice, education, research and policy in the health care field. Descriptive examples of CAM treatment modalities are provided along with their underlying rationale, common uses and available empirical support. It is concluded that patients will be better served by social workers who have knowledge of CAM treatment modalities. Furthermore, the need for further research on the efficacy of many CAM treatments and the certification of CAM treatment providers is discussed.

Access barriers and the use of prenatal care by low-income, inner-city women.

An important public health agenda in the United States is improving access to prenatal care, particularly for low-income women. The study discussed in this article was designed to determine which social, environmental, and psychological barriers are most likely to interfere with the early and regular use of prenatal health services. Low-income adult women hospitalized on the postpartum unit of a large urban medical center were interviewed about the barriers they experienced gaining access to prenatal care. Access barriers involving family and friends significantly increased the odds of receiving inadequate care, particularly not wanting anyone to know about the pregnancy and not having help getting to clinic appointments. Other important barriers included those related to the health care system and intrapersonal issues. Social workers are in an ideal position to help women eliminate barriers to access to prenatal care through clinical expertise in assessment, advocacy, outreach, and case management.

Caring for yourself during times of organizational change.

Mergers, acquisitions, and other organizational changes in the health care system pose many challenges and stresses for nursing leaders. Although considerable effort is expended helping staff adjust to change, nurse managers and executives often neglect their own vulnerability to occupational stress. The personal and organizational costs of managerial burnout are high, sometimes resulting in physical illness, mental exhaustion, and decreased productivity. This article emphasizes the importance of prevention through the recognition of potential or actual signs of organizational stress. Handy tips are provided on effective ways to cope with the stress of organizational change.

Functional impairment and co-occurring psychiatric disorders in medically hospitalized men.

BACKGROUND: Although previous research has described a high prevalence of psychiatric comorbidity among general medical and surgical patients, prevalence estimates based on diagnostic criteria and the assessment of health care outcomes including functional status has not been conducted for a broad range of psychiatric disorders. METHODS: A random sample of male medical and surgical admissions to 3 Department of Veterans Affairs Medical Centers was enrolled in the study. Subjects were administered a computerized structured psychiatric diagnostic interview and completed a multidimensional measure of health-related functioning, the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS: Of 1007 medical and surgical inpatients, almost half (46.6%) met lifetime criteria for at least 1 Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition disorder, most commonly for alcohol abuse or dependence (32.5%), posttraumatic stress disorder (10.0%), and major depression or dysthymia (9.0%). Almost one fifth reported recent symptoms, most frequently for major depression or dysthymia (7.0%). Co-occurring psychiatric disorders were associated with substantial and significant (P<.001) impairment on all dimensions of functioning, with the greatest decrements observed in physical and emotional role functioning. Anxiety and mood disorders were associated with the most and somewhat similar reductions in functioning. CONCLUSIONS: The prevalence of co-occurring psychiatric disorders was substantial but consistent with other studies of populations receiving health services. Given the observed additional burden of psychiatric disorders on functioning in medically hospitalized patients, the study indicates the importance of identification and treatment of co-occurring psychiatric disorders in this high-risk and clinically challenging group of patients.

Methods to obtain quantitative parametric descriptions of the optical surfaces of the human crystalline lens from Scheimpflug slit-lamp images. I. Image processing methods.

Of the methods developed (e.g., phakometry, magnetic resonance imaging, etc.) for noninvasive measurement of the geometry of the anterior segment of the human eye, Scheimpflug photography offers the best resolution and the highest precision. The primary obstacle encountered with this or any other image-based method has been in obtaining quantitative measurements directly from the images. Image enhancement (gray-scale gradient analysis) and pattern recognition methods (Hough transform and recursive least-squares algorithms) are developed so that parametric representations of lens surfaces and zone boundaries can be obtained directly from the images. Methods to correct for nonlinear Scheimpflug camera reproduction ratios and provide error estimates for geometrical parameters are also developed and will be presented separately. Combined, these techniques yield representations of lens geometry having sufficient precision, to which paraxial ray tracing can be applied to determine lens optical properties by using well-posed optical models with one unknown.

Postpartum teaching priorities: the viewpoints of nurses and mothers.

OBJECTIVE: To compare mothers' and nurses' perceptions of postpartum learning needs and effective teaching modalities. DESIGN: Cross-sectional research design. Mothers were given a questionnaire during their postpartum stay to rate how important it was for them to learn about 44 maternal-infant topics before discharge. Nurses rated similar items on the basis of their perception of what is most important for mothers to learn during their postpartum stay. SETTING: Postpartum units in six hospitals that are part of a large midwestern health care system. PARTICIPANTS: English-speaking women who delivered either vaginally or by cesarean section without complications and the nurses on their postpartum units. MAIN OUTCOME MEASURES: Identification of preferred topics and methods for postpartum teaching. RESULTS: Mothers and nurses agreed that topics related to immediate physical health needs were most important. Unmarried mothers considered topics related to personal care and mobility as particularly important. First-time mothers rated more topics as important than did experienced mothers. Individual teaching was rated most effective by both groups. Classroom teaching and the use of audiovisual media were considered less effective. CONCLUSIONS: This study supports postpartum education that focuses on the physical needs of mothers and infants, as well as individual teaching models. The special learning needs of new mothers, including those who are not married, must be considered.

Relationship between inpatient alcoholism treatment and longitudinal changes in health care utilization.

OBJECTIVE: The purpose of the study was to evaluate changes in health care utilization associated with inpatient alcoholism treatment in alcoholics of low socioeconomic status with different histories of treatment relapse. METHOD: The sample consisted of more than 85,000 male alcoholics using inpatient care in Department of Veterans Affairs medical centers in fiscal year 1987. Five treatment groups were identified to represent a continuum of length and intensity of alcoholism treatment, including formal inpatient alcoholism treatment, short detoxification and hospitalizations for primary diagnoses other than alcoholism. All inpatient and outpatient health services for 3 years before and 3 years after the index hospitalization were examined for differential changes in utilization associated with the five treatment groups after controlling for patient predisposing, enabling and need characteristics. RESULTS: Both total inpatient days and outpatient visits increased significantly for all treatment groups, with the greatest increases occurring in the group completing inpatient alcoholism treatment (both p < .0001). However, use of inpatient medical care decreased and substance abuse inpatient care increased significantly for most groups, with the largest increases in substance abuse care found for the completed treatment group. CONCLUSIONS: In a hospital system that does not deny care on the basis of ability to pay, certain groups of chronic alcoholics who cannot sustain prolonged remission will continue to be heavy utilizers of services. Alcoholism treatment may be associated with higher short-term costs but it remains to be seen whether provision of more focused treatment services is able to achieve longer term better outcomes and, ultimately, lower costs.

Accommodation and presbyopia in the human eye. Changes in the anterior segment and crystalline lens with focus.

PURPOSE: To characterize changes in the sagittal dimensions of the human crystalline lens and anterior segment as a function of accommodation, to determine the potential age dependence of these changes, and to evaluate these changes in relation to the development of presbyopia. METHODS: Scheimpflug slit-lamp photography, as well as a variety of standard ophthalmologic methods, was used to collect information about lens and anterior segment sagital dimensions in a population of 82 adults with refractive error < or = magnitude of 2.0 diopters and at least 0.25 diopter of accommodation for subjects 18 to 70 years of age. Data were analyzed statistically for dependence on accommodation, age, and age dependence of accommodative rate. RESULTS: The rate of change per diopter of accommodation for each measured variable within the lens is independent of age for the entire adult age range. With increasing accommodation, the lens becomes thicker and the anterior chamber shallower along the polar axis. This increase in sagittal lens thickness is entirely because of an increase in the thickness of the lens nucleus. Because the anterior and posterior halves of the nucleus increase in thickness at approximately the same rate with accommodation, the increase in lens thickness results from equal changes in the lengths of the anterior and posterior portions. CONCLUSIONS: Because changes along the sagittal axis of the anterior segment with accommodation are independent of age, any explanation of presbyopia that relies on simple changes in the rates of lens thickening and anterior chamber shallowing with age does not hold. In light of other age-related changes in the anterior segment and lens (e.g., increased sharpness of lens curvature, increased lens sagittal thickness, decreased anterior chamber depth), it appears that compensatory mechanisms to preserve far vision with age also preserve the rate of change per diopter of sagittal spacings.

Hydrosalpinx fluid has embryotoxic effects on murine embryogenesis: a case for prophylactic salpingectomy.

OBJECTIVE: To ascertain if hydrosalpinges are associated with reduced pregnancy rates and increased pregnancy loss after IVF-ET. Increased volume and leakage of hydrosalpinx fluid may exert negative effects on follicular development and embryo quality and/or render the uterine environment hostile to embryogenesis. We undertook this study to examine the effect of hydrosalpinx fluid on murine embryogenesis in vitro. DESIGN: Descriptive study. SETTING: Tertiary care facility. PATIENT(S): Premenopausal females undergoing salpingectomy or salpingostomy for hydrosalpinges. INTERVENTION(S): Collection of discarded hydrosalpinx fluid and development of a dose response curve for the effect of hydrosalpinx fluid on murine embryogenesis. MAIN OUTCOME MEASURE(S): Development of single cell mouse embryos in vitro. RESULT(S): All samples of tubal fluid obtained from hydrosalpinges demonstrated a significant embryo toxic effect at either the 100% or 10% concentration. Hydrosalpinx fluid demonstrated pH values (8.45 to 8.65) significantly higher than the physiologic range. Correction of pH to that of media did not affect cavitation rate. CONCLUSION(S): There is a well-defined and significant toxic effect of hydrosalpinx fluid. Procedures such as salpingectomy or proximal tubal occlusion to circumvent the passage of hydrosalpinx fluid into the uterine cavity may have beneficial effects on the developmental environment for embryos in vivo.

Screening for social and environmental problems in a VA primary care setting.

Social workers are in an ideal position to identify and treat social and environmental problems early in the continuum of care. Information on these problems will facilitate informed decision making on the development and reallocation of resources to better meet patients needs. This study assessed the social and environmental problems of 132 patients seen in a primary care clinic at a university-affiliated Veterans Affairs (VA) medical center. The most prevalent social problems were financial difficulties, personal stress, family problems, legal concerns, and employment concerns. When asked, nearly one-third of all respondents requested social work services or information about services related to their problems. The findings suggest a clear need for social work interventions in VA primary care clinics that focus on both psychosocial problems.

Collaborative QI in community-based long term care.

BACKGROUND: In a statewide demonstration project funded by The Robert Wood Johnson Foundation, the state of Indiana, vendors, clients and Indiana University researchers began working together in 1992 to use quality improvement (QI) techniques to improve the delivery of community-based long term care services. QI STRATEGIES: These collaborators, working with state Area Agencies on Aging (AAAs) case managers, are implementing two strategies--Normative Treatment Planning (NTP), which standardizes the clinical assessment of client needs and the prescription of services by case managers, and the Client Feedback System (CFS), a systematic method for obtaining feedback from long term care clients on the quality of in-home services. CURRENT STATUS: This community-based long term care project has been implemented in AAAs throughout the state of Indiana. In January 1995 the state's 16 AAAs were randomly assigned to four experimental or control groups to assess the project's effectiveness. In the interim, clients are surveyed by telephone every six months to evaluate their satisfaction with services and clinical needs. LESSONS LEARNED: The experience suggests several lessons: (1) build on existing and successful activities; (2) involve a wide range of participants, not just innovators; (3) obtain buy-in from trade and professional associations that represent program participants; (4) turn national attention given to the program into an asset; (5) conduct separate data collection to evaluate an intervention's success; (6) visit the field often; (7) pay as much attention to program implementation as to development; and (8) provide ongoing, informal educational opportunities for the field. SUMMARY AND CONCLUSIONS: This project has resulted in significant movement toward a shared quality improvement vocabulary, information system, and a shared vision of high-quality home care.

Attributions about spouse abuse in cases of bidirectional battering.

A particularly misunderstood type of domestic violence is the type of incident where both partners are violent, for example, where one partner is violent and the other is violent in self-defense. The present study examined third-party attributions about such battering. Subjects read a fictitious newspaper report of a domestic battering incident and then filled out rating scales about the participants and the event. The scenario described either an "asymmetric battering" incident where one party instigated the violence and was much more violent than the other, or an incident which was more of a mutual fight (symmetric battering). Both scenarios ended with one person seriously injuring the other. Each scenario had two versions, in which either the husband or the wife instigated the violence. Results showed that the person who had instigated the violence was judged more harshly and was given more responsibility for their actions in both the symmetric and asymmetric battering conditions. The less violent partner in the asymmetric conditions was judged to have more right to use force. In the symmetric battering, both parties were assigned blame.

Aging of the human crystalline lens and anterior segment.

Changes in the unaccommodated human crystalline lens were characterized as a function of subject age for 100 normal emmetropes over the age range 18-70 yr by Scheimpflug slit-lamp photography. With increasing age, the lens becomes thicker sagittally, but since the distance from the cornea to the posterior lens surface remains unchanged, this indicates that the center of lens mass moves anteriorly and the anterior chamber becomes shallower. Sagittal nuclear thickness is independent of age, but both anterior and posterior cortical thicknesses increase with age, shifting the location of the nucleus and the central sulcus in the anterior direction. The amount of light scattered by the lens at high angles, as represented by normalized and integrated lens densities from the digitized images, increases with increasing age in an exponential fashion. Similar relationships to age are observed for the major anterior zone of discontinuity (maximum density) and the central sulcus (minimum density). The relationships of these results to accommodation and presbyopia are discussed.