Subnanometer structure of an enveloped virus fusion complex on viral surface reveals new entry mechanisms.

Paramyxoviruses-including important pathogens like parainfluenza, measles, and Nipah viruses-use a receptor binding protein [hemagglutinin-neuraminidase (HN) for parainfluenza] and a fusion protein (F), acting in a complex, to enter cells. We use cryo-electron tomography to visualize the fusion complex of human parainfluenza virus 3 (HN/F) on the surface of authentic clinical viruses at a subnanometer resolution sufficient to answer mechanistic questions. An HN loop inserts in a pocket on F, showing how the fusion complex remains in a ready but quiescent state until activation. The globular HN heads are rotated with respect to each other: one downward to contact F, and the other upward to grapple cellular receptors, demonstrating how HN/F performs distinct steps before F activation. This depiction of viral fusion illuminates potentially druggable targets for paramyxoviruses and sheds light on fusion processes that underpin wide-ranging biological processes but have not been visualized in situ or at the present resolution.

Immune function declines with unemployment and recovers after stressor termination.

OBJECTIVE: To examine the effect of unemployment on natural killer cell cytotoxicity (NKCC) and, in a subsample of persons who become re-employed, to determine if, after termination of the stressor, immune values recover to levels similar to matched controls. METHODS: One hundred unemployed and 100 matched employed healthy men and women, aged 29 to 45 years, were followed for 4 months with monthly blood samples taken to measure NKCC, the ability of NK cells to kill target cells. Twenty-five participants obtained employment before the end of the study, leaving 75 unemployed (and 75 employed) participants in the main sample. For unemployed participants who obtained employment before the end of the study, subsample analyses compared NKCC levels before and after obtaining a new job. RESULTS: The persistently unemployed sample had significantly lower NKCC levels for all three effector:target ratios (100:1, p = .0004; 50:1, p = .002; and 25:1, p = .02) when compared with the matched employed sample. There were no significant gender effects. In the subsample analyses, NKCC was significantly higher after the participants became employed, compared with their unemployed period, with substantial "recovery" of immune function (44%-72%) compared with values from the steadily employed group. CONCLUSIONS: Chronic stress is associated with persistent NKCC impairment. When the chronic stressor is terminated, however, the immune cell functional capacity quickly begins to recover. We believe this is the first study in humans to document immune function recovery after the definable end of a chronic stressor.

Parents' self-identified stressors and coping strategies during adolescents' spinal surgery experiences.

Spinal fusion surgery for idiopathic scoliosis during adolescence is a tremendous stressor for parents. This study investigated parents' pre- and postoperative stressors and their coping strategies. Ninety-two parents identified their predominant stressor and completed the Ways of Coping Questionnaire during their adolescent's preoperative clinic visit and 77 completed this procedure 4 days postoperatively. Results showed that primary stressors were parental role loss (28.26%), possibility of poor surgical outcomes (28.26%), and uncertainty about successful recovery (27.17%) preoperatively, and concerns about pain (32.47%) and parental role loss (32.47%) postoperatively. The greatest increase from pre- to postoperative periods occurred in concerns about pain. Parents used both emotion-focused and problem-focused coping strategies with significant increases postoperatively in confrontive coping, planful problem solving, and positive reappraisal and significant decreases in self-control and seeking social support. Providers should target interventions to alleviate stress and bolster coping for parents.

Effects of coping instruction in reducing young adolescents' pain after major spinal surgery.

BACKGROUND: Enduring pain following major orthopaedic surgery is a major challenge for adolescents. PURPOSE: To evaluate the effects of coping instruction and concrete-objective information on adolescents' postoperative pain and focus on potential applications of these interventions for orthopaedic nursing practice. DESIGN/METHOD: A randomized controlled trial of 66 young adolescents (age 11-14) undergoing major spinal surgery for idiopathic scoliosis. RESULTS: The intervention that focused only on coping instruction was the most effective intervention on postoperative Day 2. On postoperative Day 4, adolescents receiving coping instruction (coping alone or coping plus information) reported less pain than those not receiving coping instruction. DISCUSSION: Interventions that direct adolescent patients' attention to learning coping strategies they can use during recovery to lessen pain may be more efficacious than others following major spinal surgery.

Maternal differences and birth outcome disparities: Diversity within a high risk prenatal clinic.

BACKGROUND: We examined the influence of race/ethnicity on appointment attendance, maternal psychiatric and medical diagnoses, and birth outcomes within a diverse, low income, high risk pregnant population to determine whether birth outcome disparities would be lessened in a sample with high biopsychosocial risk across all groups. METHODS: Data were retrospectively obtained on all women scheduled for appointments in the San Francisco Genera Hospital (SFGH) High-Risk Obstetrics (HROB) clinic during a three-month period. General linear model and logistic regression procedures were used to examine the associations of race/ethnicity with maternal characteristics, clinic attendance, and birth outcomes. RESULTS: Our sample included 202 maternal-infant pairs (Hispanic 57%, Black 16%, Asian 15%, White 12%). Racial/ethnic differences were seen in language (p < .001), gravidity (p < .001), parity (p = .005), appointment attendance (p < .001), diabetes (p = .005), psychiatric diagnosis (p = .02), illicit drug use (p < .001), smoking (p < .001). These maternal characteristics, including rate of attendance at specialized prenatal appointments, did not predict birth outcomes with the exception of an association between diabetes and earlier gestational age (p = .03). In contrast, Black maternal race/ethnicity was associated with earlier gestational age at birth (p = .004) and lower birth weight (p < .001) compared to Whites. CONCLUSIONS: Within a diverse maternal population of high biopsychosocial risk, racial/ethnic disparities in birth outcomes persist. These disparities have implications for infant health trajectory throughout the lifecourse and for intervention implementation in high risk groups.

Predicting alcohol consumption during the month before and after beginning college.

BACKGROUND: We sought to determine predictors of drinking the month before and after beginning college, as well as changes in drinking between these two periods among adjudicated students. We conducted these analyses to inform individual and university-wide approaches to addressing underage drinking, particularly among the heaviest drinkers. METHODS: The sample consisted of 143 students entering college, adjudicated during their first semester, and interviewed during the same semester. The sample consisted of 43% women. Drinking data were collected through the Time-Line Follow-Back interview. RESULTS: The average number of drinking days (DD) during the first month of college was 7.0 (SD = 4.7), the average number of drinks per drinking day (DDD) was 7.4 (SD = 3.4), and the average volume of standard drink units consumed during this month was 56.3 (SD = 51.2). Students had volunteered for a two-year college facilitation study, and had been invited to participate after receiving a citation for violating university alcohol policies. Analyses consisted of nine backward elimination regression analyses with nine variables entered as predictors (one was a control variable). Age of first intoxication was related to every dependent measure. Men had a higher August DDD, September DDD, and September volume than women. Roommate drinking level was associated with September DDD and September volume. Out-of-state students had a lower August volume than in-state students. High school rank was inversely related to September drinking days. SAT score, declared major status, and fraternity/sorority status were not related to drinking according to these multivariate analyses. CONCLUSIONS: Results suggest that approaches to underage drinking for adjudicated students may need to be tailored according to age of first intoxication. Results also suggest the drinking level of the heaviest drinking roommate may moderate individual level interventions. Further, interventions applied to an entire dorm room may prove efficacious. Results also suggest that high school rank, rather than SAT scores, should be used as college entry criteria to yield a drier incoming class. Results may not generalize to non-adjudicated students.

Cognitive-behavioral intervention effects on adolescents' anxiety and pain following spinal fusion surgery.

BACKGROUND: Cognitive-behavioral interventions, typically effective in reducing anxiety and pain, have not been applied to adolescents undergoing major orthopaedic surgery. OBJECTIVES: To determine the effectiveness of three cognitive-behavioral interventions for reducing adolescents' postoperative anxiety and pain following spinal fusion surgery for scoliosis, and whether effectiveness depended on preoperative anxiety and age. METHODS: A randomized controlled trial with four groups receiving a videotape intervention (information only, coping only, information plus coping, or control) used a convenience sample of 109 adolescents (88 female, 93 White), 11-18 years of age (M = 14). Speilberger's (1983) State Anxiety scale assessed anxiety preoperatively and postoperatively on Day 2. A visual analogue scale assessed pain postoperatively on Days 2 and 4. RESULTS: Information plus coping was most effective for reducing postoperative anxiety in adolescents with high preoperative anxiety. Coping instruction led to less postoperative anxiety and pain for adolescents ages 13 and younger. The control group reported the highest levels of pain on Day 4. CONCLUSIONS: Cognitive-behavioral interventions designed to prepare adolescents for surgery should be tailored to individual factors and developmental needs, especially the adolescents' preoperative anxiety level and age.

Adolescent scoliosis: effects of corrective surgery, cognitive-behavioral interventions, and age on activity outcomes.

The effects of spinal fusion surgery and cognitive-behavioral interventions on 88 adolescents' (11-18 years) activity outcomes were examined using a randomized trial with three intervention groups (information only, coping only, coping plus information) and a control group. The effects included a significant drop from baseline (preoperative) in usual activities and social activities at 1 month postsurgery for all groups, indicating that initially postsurgical recovery is particularly disruptive to patients' lives. At 3 months after surgery, all groups showed increased usual activities and social activities. Between the 3- and 6-month assessments, all groups had increases in social activities. Furthermore, the information only group had a significant increase in usual activities from 3 to 6 months. Younger adolescents (ages 11-14) in the combined information plus coping group and the control group had higher social scores over the postsurgery recovery period compared with those in the coping-only group. No differences were found on academic performance. The adolescents did not return to their baseline social activity levels during the 9-month recovery period (typically when long-term recovery is completed), indicating that the surgery itself has a long-term negative effect on patients' social life.

Adolescents' coping with surgery for scoliosis: effects on recovery outcomes over time.

Surgery for adolescent idiopathic scoliosis is painful and stressful and has a long and demanding recovery. The purpose of this study was to examine pre- and postoperative avoidant/vigilant coping and long-term activity outcomes through 9 months postsurgery for adolescents (11-18 years, N = 113) undergoing scoliosis surgery. Generally, more vigilant copers (preoperatively and 1 month postoperatively) participated in more activities (usual, new, and social) and had higher academic performance during recovery. Several moderation effects indicated these relationships were stronger for older adolescents and those more internal in locus of control. Adolescents were more vigilant in the hospital, became more avoidant 1 month after surgery, and remained at these levels 6 months postsurgery. Understanding coping processes and individual factors is necessary to develop interventions to help adolescents cope successfully with recovery demands.