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Covid-19, Artificial Intelligence (AI), and Climate Change, have disrupted work education, rendering sustainability of careers and livelihoods a concern. This paper outlines a collaborative response to that challenge, offering opportunities for sustainable livelihoods in a work education cloud collaboration, Project SLiC (Sustainable Livelihoods Collaboration). We have joined forces across nation states in the Global South/North to share cloud resources, focused on teaching a postgraduate course, Sustainable Livelihoods. Online modules are stored in a secure cloud site, from which local courses draw-down, autochthonously, whichever resources fit workforce development in context. We outline modules, and an evaluative process, in a proof-of-concept trial. Finally, we envisage how this initial collaboration may morph into a whole degree, including research supervision. We close with a call to career development professionals to share their unique expertise and experiences at the work education frontline, on how to develop this sustainable careers project, for the greater good. [ABSTRACT FROM AUTHOR]

The evolution of morphinan alkaloid biosynthesis in plants of the genus Papaver includes permutation of several processes including gene duplication, fusion, neofunctionalization, and deletion resulting in the present chemotaxonomy. A critical gene fusion event resulting in the key bifunctional enzyme reticuline epimerase (REPI), which catalyzes the stereochemical inversion of (S)-reticuline, was suggested to precede neofunctionalization of downstream enzymes leading to morphine biosynthesis in opium poppy (Papaver somniferum). The ancestrally related aldo-keto reductases 1,2-dehydroreticuline reductase (DRR), which occurs in some species as a component of REPI, and codeinone reductase (COR) catalyze the second and penultimate steps, respectively, in the pathway converting (S)-reticuline to morphine. Orthologs for each enzyme isolated from the transcriptomes of 12 Papaver species were shown to catalyze their respective reactions in species that capture states of the metabolic pathway prior to key evolutionary events, including the gene fusion event leading to REPI, thus suggesting a patchwork model for pathway evolution. Analysis of the structure and substrate preferences of DRR orthologs in comparison with COR orthologs revealed structure-function relationships underpinning the functional latency of DRR and COR orthologs in the genus Papaver, thus providing insights into the molecular events leading to the evolution of the pathway., (© 2024. The Author(s).)

Several proteins from plant pathogenesis-related family 10 (PR10) are highly abundant in the latex of opium poppy and have recently been shown to play diverse and important roles in the biosynthesis of benzylisoquinoline alkaloids (BIAs). The recent determination of the first crystal structures of PR10-10 showed how large conformational changes in a surface loop and adjacent β-strand are coupled to the binding of BIA compounds to the central hydrophobic binding pocket. A more detailed analysis of these conformational changes is now reported to further clarify how ligand binding is coupled to the formation and cleavage of an intermolecular disulfide bond that is only sterically allowed when the BIA binding pocket is empty. To decouple ligand binding from disulfide-bond formation, each of the two highly conserved cysteine residues (Cys59 and Cys155) in PR10-10 was replaced with serine using site-directed mutagenesis. Crystal structures of the Cys59Ser mutant were determined in the presence of papaverine and in the absence of exogenous BIA compounds. A crystal structure of the Cys155Ser mutant was also determined in the absence of exogenous BIA compounds. All three of these crystal structures reveal conformations similar to that of wild-type PR10-10 with bound BIA compounds. In the absence of exogenous BIA compounds, the Cys59Ser and Cys155Ser mutants appear to bind an unidentified ligand or mixture of ligands that was presumably introduced during expression of the proteins in Escherichia coli. The analysis of conformational changes triggered by the binding of BIA compounds suggests a molecular mechanism coupling ligand binding to the disruption of an intermolecular disulfide bond. This mechanism may be involved in the regulation of biosynthetic reactions in plants and possibly other organisms., (open access.)

Opium poppy accumulates copious amounts of several benzylisoquinoline alkaloids including morphine, noscapine, and papaverine, in the specialized cytoplasm of laticifers, which compose an internal secretory system associated with phloem throughout the plant. The contiguous latex includes an abundance of related proteins belonging to the pathogenesis-related (PR)10 family known collectively as major latex proteins (MLPs) and representing at least 35% of the total cellular protein content. Two latex MLP/PR10 proteins, thebaine synthase and neopione isomerase, have recently been shown to catalyze late steps in morphine biosynthesis previously assigned as spontaneous reactions. Using a combination of sucrose density-gradient fractionation-coupled proteomics, differential scanning fluorimetry, isothermal titration calorimetry, and X-ray crystallography, we show that the major latex proteins are a family of alkaloid-binding proteins that display altered conformation in the presence of certain ligands. Addition of MLP/PR10 proteins to yeast strains engineered with morphine biosynthetic genes from the plant significantly enhanced the conversion of salutaridine to morphinan alkaloids., (© 2022. The Author(s).)

Most developed nations have a statutory minimum wage set at levels insufficient to alleviate poverty. Increased calls for a living wage have generated considerable public controversy. This article draws on 25 interviews and four focus groups with employers, low-pay industry representatives, representatives of chambers of commerce, pay consultants, and unions. The core focus is on how participants use prominent narrative tropes for the living wage and against the living wage to argue their respective perspectives. We also document how both affirmative and negative tropes are often combined by participants to craft their own rhetorical positions on the issue., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hodgetts, Young-Hauser, Arrowsmith, Parker, Carr, Haar and Alefaio.)

Recent pre-pandemic research suggests that living wages can be pivotal for enhancing employee attitudes and subjective wellbeing. This article explores whether or not the present COVID-19 pandemic is impacting pivotal links between living wages and employee attitudes and subjective wellbeing, with replication indicating robustness. Twin cohorts each of 1,000 low-waged workers across New Zealand (NZ), one pre- (2018), and one present-pandemic (2020) were sample surveyed on hourly wage, job attitudes, and subjective wellbeing as linked to changes in the world of work associated with the pandemic (e.g., job security, stress, anxiety, depression, and holistic wellbeing). Using locally estimated scatter-point smoothing, job attitudes and subjective wellbeing scores tended to pivot upward at the living wage level in NZ. These findings replicate earlier findings and extend these into considering subjective wellbeing in the context of a crisis for employee livelihoods and lives more generally. Convergence across multiple measures, constructs, and contexts, suggests the positive impacts of living wages are durable. We draw inspiration from systems dynamics to argue that the present government policy of raising legal minimum wages (as NZ has done) may not protect subjective wellbeing until wages cross the living wage Rubicon. Future research should address this challenge., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Carr, Haar, Hodgetts, Jones, Arrowsmith, Parker, Young-Hauser and Alefaio.)

Benzylisoquinoline alkaloids (BIAs) are a class of specialized metabolites with a diverse range of chemical structures and physiological effects. Codeine and morphine are two closely related BIAs with particularly useful analgesic properties. The aldo-keto reductase (AKR) codeinone reductase (COR) catalyzes the final and penultimate steps in the biosynthesis of codeine and morphine, respectively, in opium poppy (Papaver somniferum). However, the structural determinants that mediate substrate recognition and catalysis are not well defined. Here, we describe the crystal structure of apo-COR determined to a resolution of 2.4 Å by molecular replacement using chalcone reductase as a search model. Structural comparisons of COR to closely related plant AKRs and more distantly related homologues reveal a novel conformation in the β1α1 loop adjacent to the BIA-binding pocket. The proximity of this loop to several highly conserved active-site residues and the expected location of the nicotinamide ring of the NADP(H) cofactor suggest a model for BIA recognition that implies roles for several key residues. Using site-directed mutagenesis, we show that substitutions at Met-28 and His-120 of COR lead to changes in AKR activity for the major and minor substrates codeinone and neopinone, respectively. Our findings provide a framework for understanding the molecular basis of substrate recognition in COR and the closely related 1,2-dehydroreticuline reductase responsible for the second half of a stereochemical inversion that initiates the morphine biosynthesis pathway., Competing Interests: Conflict of interest The authors declare that they have no conflicts of interest with the contents of this article., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

According to the UN Sustainable Development Goals (SDGs), poverty eradication in the 21st century means everyday access to decent health care, education and livelihoods, political participation, social inclusion, a clean and safe environment, and more. These are aspirational goals that together support a decent quality of life. Crossing monetary, 'poverty thresholds' may enable such goals. Most estimates of 'where' the monetary threshold lies derive the estimates circularly from monetary costs of living. The link to quality of living is thereby made by fiat, untested empirically in everyday human experience. We already know we can measure income independently of middle class quality of life, and probe for relationships between the two. Why not for poverty too? A quantity of money where quality of life changed would mark a genuine threshold required for example to escape from poverty traps. Using this approach, studies in quality of work-life, using multiple indicators, have identified at least three thresholds where quality of life ticked markedly upwards, including inter-threshold ranges where gradients went from zero to positive. The concept of work-life balance suggests that this approach may be usefully extended to include quality health care, education, and other SDGs in sustainability science., (© Springer Japan KK, part of Springer Nature 2020.)

Purpose: Pediatric asthma disproportionately affects low-income and minority children. The HEAL (Head-Off Environmental Asthma in Louisiana), Phase II Project was a collaborative effort with a primary focus to improve pediatric asthma management in New Orleans, Louisiana. The purpose of this article is to report clinical outcomes captured at baseline and 12-month follow-up., Method: HEAL (Head-off Environmental Asthma in Louisiana), Phase II was a pre-post intervention study that enrolled children ages 2 to 18 years of age with a diagnosis of asthma to receive asthma education within the clinic setting. Enrollees received an asthma education intervention, an environmental evaluation, and a 12-month follow-up session. Endpoints included symptom days, level of asthma control, asthma exacerbations, emergency room visits, hospitalizations, and missed school days., Results: The majority of participants were aged 5 years and older, male, Black, and persistent asthmatics. Emergency room visits decreased from 41% to 20% ( p < .001). Improvements in coughing (83% to 62%, p < .001), wheezing (50% to 26%, p < .001), and chest tightness (29% to 18%, p < .001) were also seen., Conclusion: The novel intervention was associated with improved asthma outcomes among pediatric patients receiving care at the clinical sites in the Greater New Orleans area.

There is growing evidence for the role of attachment in psychosis, however, to date there has been no quantitative review of the prevalence of insecure attachment in psychosis. The current study sought to systematically appraise studies investigating the prevalence of insecure attachment and the association with psychosis-spectrum experiences using meta-analytic techniques. A systematic search of studies carried out between January 1980 and 30th November 2015 found 25 papers eligible for inclusion. The meta-analysis showed that the prevalence of insecure attachment style was significantly higher in individuals with psychosis (76%) than in non-clinical samples (38%), with fearful attachment being the most prevalent. Across the continuum, there was a small but significant relationship between positive symptom severity and insecure attachment and a significant relationship between negative symptom severity and insecure attachment in the non-clinical analysis. This relationship was not found in the clinical group. The prevalence of insecure attachment appears to be high in psychosis, however, the relationship between symptom severity and attachment is small. Attachment theory may provide greater understanding of the development of positive symptoms than previously thought, however, research needs to include more at-risk samples and longitudinal research to fully understand the dynamics of this relationship., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: Demonstrate safety and effectiveness of the light-driven contact hearing aid to support FDA clearance., Study Design: A single-arm, open-label investigational-device clinical trial., Setting: Two private-practice and one hospital-based ENT clinics., Patients: Forty-three subjects (86 ears) with mild-to-severe bilateral sensorineural hearing impairment., Intervention: Bilateral amplification delivered via a light-driven contact hearing aid comprising a Tympanic Lens (Lens) with a customized platform to directly drive the umbo and a behind-the-ear sound processor (Processor) that encodes sound into light pulses to wirelessly deliver signal and power to the Lens., Main Outcome Measures: The primary safety endpoint was a determination of "no change" (PTA4 < 10 dB) in residual unaided hearing at the 120-day measurement interval. The primary efficacy endpoint was improvement in word recognition using NU-6 at the 30-day measurement interval over the baseline unaided case. Secondary efficacy endpoints included functional gain from 2 to 10 kHz and speech-in-noise improvement over the baseline unaided case using both omnidirectional and directional microphones., Results: The results for the 86 ears in the study determined a mean change of -0.40 dB in PTA4, indicating no change in residual hearing (p < 0.0001). There were no serious device- or procedure-related adverse events, or unanticipated adverse events. Word recognition aided with the Earlens improved significantly (p < 0.0001) over the unaided performance, by 35% rationalized arcsine units on average. Mean functional gain was 31 dB across 2 to 10 kHz. The average speech-recognition threshold improvement over the unaided case for the Hearing in Noise Test was 0.75 dB (p = 0.028) and 3.14 dB (p < 0.0001) for the omnidirectional and directional microphone modes, respectively., Conclusion: The safety and effectiveness data supported a de novo 510(k) submission that received clearance from the FDA., Competing Interests: and Source of Funding: Bruce Gantz is on the medical advistory board for Earlens, Rodney Perkins is a consultant and chief medical officer, Michael Muray is on the medical advisory board, Suzanne Carr Levy is an employee, Sunil Puria is the Chief Scientist all at Earlens Corporation. The study was funded by Earlens Corporation and work was supported in part by SBIR Phase IIB grant R44 DC08499 from the NIDCD of the NIH.

Objectives: The hypothesis that extending the audible frequency bandwidth beyond the range currently implemented in most hearing aids can improve speech understanding was tested for normal-hearing and hearing-impaired participants using target sentences and spatially separated masking speech., Design: The Hearing In Speech Test (HIST) speech corpus was re-recorded, and four masking talkers were recorded at a sample rate of 44.1 kHz. All talkers were male native speakers of American English. For each subject, the reception threshold for sentences (RTS) was measured in two spatial configurations. In the asymmetric configuration, the target was presented from -45° azimuth and two colocated masking talkers were presented from +45° azimuth. In the diffuse configuration, the target was presented from 0° azimuth and four masking talkers were each presented from a different azimuth: +45°, +135°, -135°, and -45°. The new speech sentences, masking materials, and configurations were presented using low-pass filter cutoff frequencies of 4, 6, 8, and 10 kHz. For the normal-hearing participants, stimuli were presented in the sound field using loudspeakers. For the hearing-impaired participants, the spatial configurations were simulated using earphones, and a multiband wide-dynamic-range compressor with a modified CAM2 fitting algorithm was used to compensate for each participant's hearing loss., Results: For the normal-hearing participants (N = 24, mean age 40 years), the RTS improved significantly by 3.0 dB when the bandwidth was increased from 4 to 10 kHz, and a significant improvement of 1.3 dB was obtained from extending the bandwidth from 6 to 10 kHz, in both spatial configurations. Hearing-impaired participants (N = 25, mean age 71 years) also showed a significant improvement in RTS with extended bandwidth, but the effect was smaller than for the normal-hearing participants. The mean decrease in RTS when the bandwidth was increased from 4 to 10 kHz was 1.3 dB for the asymmetric condition and 0.5 dB for the diffuse condition., Conclusions: Extending bandwidth from 4 to 10 kHz can improve the ability of normal-hearing and hearing-impaired participants to understand target speech in the presence of spatially separated masking speech. Future studies of the benefits of extended high-frequency amplification should investigate other realistic listening situations, masker types, spatial configurations, and room reverberation conditions, to determine added value in overcoming the technical challenges associated with implementing a device capable of providing extended high-frequency amplification.

Objective: To assess the safety, stability, and performance of the broad-spectrum, light-based contact hearing device (CHD) on listeners with hearing impairment., Study Design: Feasibility study., Setting: Single-site research and development facility., Participants: Thirteen participants with symmetric mild-to-severe sensorineural hearing impairment had the CHD placed bilaterally., Intervention: A custom-molded light-activated tympanic contact actuator (TCA) was placed into each ear by a physician, where it stayed in contact with the umbo and a portion of the medial wall of the ear canal for 4 months. Each CHD was calibrated and programmed to provide appropriate broad-spectrum amplification., Main Outcome Measures: Safety was determined through routine otologic examinations. Aided and pre-TCA-insertion unaided audiometric thresholds (functional gain), maximum gain before feedback, tympanic membrane damping, Reception Threshold for Sentences (RTS), and Abbreviated Profile of Hearing Aid Benefit (APHAB) measurements were made to characterize system performance as well as the benefits of amplification via the CHD., Results: The TCAs remained on participants' ears for an average total of 122 days, without causing signs of inflammation or infection, and there were no serious device-related adverse events. Measured average maximum output of 90 to 110 dB SPL in the range of 0.25 to 10 kHz, average maximum gain before feedback of 40 dB, and functional gain through 10 kHz show extended-bandwidth broad-spectrum output and gain. RTS results showed significant aided improvements of up to 2.8 dB, and APHAB results showed clinically significant aided benefits in 92% of participants (11/12)., Conclusion: The safety, stability, and performance demonstrated in this initial 4-month study suggest that the CHD may offer a feasible way of providing broad-spectrum amplification appropriate to treat listeners with mild-to-severe hearing impairment.

Nurses are in an ideal position to perform pelvic ultrasound evaluations, and appropriately trained nurses can perform limited ultrasound evaluations as part of the assessment and treatment of infertility. In this article, the author provides detailed descriptions and accompanying ultrasonic images illustrating the use of ultrasound in providing vital clinical information in reproductive medicine and in the assessment of the first trimester of pregnancy., (© 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Despite the rhetoric of a single global economy, professionals in poorer countries continue to be remunerated differently depending on whether they are compensated at a local vs. international rate. Project ADDUP (Are Development Discrepancies Undermining Performance?) surveyed 1290 expatriate and local professionals (response rate = 47%) from aid, education, government, and business sectors in (1) Island Nations (Papua New Guinea, Solomon Islands), (2) landlocked economies (Malaŵi, Uganda), and (3) emerging economies (India, China). Difference in pay was estimated using purchasing power parity, from the World Bank's World Development Indicators 2007. Psychological measures included self-reported pay and benefits (remuneration), self-attributed ability, remuneration comparison, sense of justice in remuneration, remuneration-related motivation, thoughts of turnover and thoughts about international mobility. We included control measures of candour, culture shock, cultural values (horizontal/vertical individualism/collectivism), personality (from the "big five"), job satisfaction and work engagement. Controlling for these and country (small effects) and organization effects (medium), (a) pay ratios between international and local workers exceeded what were perceived to be acceptable pay thresholds among respondents remunerated locally; who also reported a combination of a sense of relative (b) injustice and demotivation; which (c) together with job satisfaction/work engagement predicted turnover and international mobility. These findings question the wisdom of dual salary systems in general, expose and challenge a major contradiction between contemporary development policy and practice, and have a range of practical, organizational, and theoretical implications for poverty reduction work.

Background: We evaluated the efficacy and acceptability of repeat doses of buccal misoprostol compared to vaginal misoprostol for second trimester pregnancy termination by induction., Study Design: Women requesting termination of a pregnancy between 18 and 22 weeks gestation were approached for participation. All women received 400 mcg misoprostol vaginally on admission. Participants were randomized to receive subsequent doses of 200 mcg misoprostol every 6 h either buccally or vaginally. All participants completed an acceptability survey., Results: Sixty-four women participated. The mean gestational age was 19.7 weeks. The median time to abortion in the buccal group was 15 h, which was not significantly different (p=0.44) from the vaginal-only group of 12 h. Most women in both groups preferred their allocated administrative route., Conclusion: Repeat doses of buccal misoprostol are as effective as vaginal misoprostol in inducing abortions in the midtrimester and are highly acceptable to most women. It is reasonable to offer both options to women.

Tyrosine kinases are critical mediators of intracellular signaling and of intracellular responses to extracellular signaling. Changes in tyrosine kinase activity are implicated in numerous human diseases, including cancers, diabetes, and pathogen infectivity. To address questions in tyrosine phosphorylation, we have designed a protein tyrosine kinase-inducible domain, a small, genetically encodable protein motif whose structure is dependent on its tyrosine phosphorylation state. Tyrosine kinase-inducible domain peptides are based on EF-hand loops in which a structurally critical Glu12 residue is replaced by tyrosine at residue 11 or at residue 15 of the protein. Tyrosine kinase-inducible domain peptides bind terbium(III) in a phosphorylation-dependent manner, showing strong terbium luminescence when phosphorylated but weak terbium luminescence when not phosphorylated. Lanthanide binding was confirmed by NMR. A tyrosine kinase-inducible domain peptide, pKID-Abl, was designed to incorporate a recognition sequence of the Abl kinase. Incubation of pKID-Abl with Abl kinase resulted in a large increase in terbium luminescence. This increase in luminescence was abolished when pKID-Abl and Abl kinase were incubated with the Abl kinase inhibitor Gleevec. In addition, incubation of phosphorylated pKID-Abl with the tyrosine phosphatase YOP resulted in a large reduction in terbium luminescence. pKID-Abl was employed as a fluorescent sensor of Abl tyrosine kinase activity in HeLa cell extracts, exhibiting low luminescence with extracts from serum-starved cells and increased luminescence using extracts from EGF-treated cells. These results indicate that tyrosine kinase-inducible domains may be used as sensors of tyrosine kinase and tyrosine phosphatase activity and in the detection of tyrosine kinase inhibitors.

Background: In the United States, asthma hospitalization rates are disproportionately high among blacks compared with other racial/ethnic groups and vary by geographic region. These disparities among asthma hospitalizations might be affected by social, environmental, and health-care access factors., Objective: To determine demographic risk factors for asthma hospitalizations in urban versus rural areas of Mississippi., Methods: A cross-sectional study using data from the Mississippi Asthma Surveillance System was conducted to compare asthma hospitalizations in the urban Jackson metropolitan statistical area and rural Delta regions of Mississippi from 2003 to 2005. Factors including race, sex, age, and household income that might be associated with multiple hospitalizations for asthma (3 or more during the study period) were assessed using logistic regression., Results: Asthma hospitalization rates were significantly higher among all demographic groups in the rural Delta region compared with the urban Jackson Metropolitan Statistical Area (P < .001). In both regions, hospitalization rates were higher among blacks and females (P < .001). Asthma hospitalization rates were highest among children (0-17 years) and older adults (>or=65 years). In both regions, blacks were more likely to have 3 or more asthma hospitalizations (P < .001). Residents of the Delta had higher odds for multiple hospitalizations controlling for race, sex, age, and household income (P < .05)., Conclusion: Blacks with asthma are more likely to have multiple asthma hospitalizations in Mississippi. Higher odds of multiple asthma discharges for Delta residents were not explained by race, sex, age, or income, indicating that other contributing factors (eg, environmental, social, and access to care factors) need further investigation.

Treatment for chronic venous disease has evolved from hospital-based surgical procedures to minimally invasive office-based office procedures that provide shorter recovery periods, less postprocedural discomfort, and quicker return to normal activities. A specialty venous clinic, separate from the arterial practice, with a specialized professional health care team, provides a comfortable setting in which patients can have access to the most up-to-date treatment options. Sclerotherapy treatment for telangectasias, reticular veins, tributary varicosities, insufficient truncal veins, and incompetent perforating veins is a common therapy that is well suited for the office setting. Most office-based minimally invasive venous procedures require little or no sedation. Tumescent anesthesia is safe and effective for ambulatory phlebectomy and endovenous ablation procedures. A calm, inviting atmosphere, confident and professional health care team, and prompt access to care will improve patient satisfaction and result in a successful, growing venous practice.

Venous ulceration of the lower extremities is a common and often disabling condition. Venous ulcers are the result of a chronic inflammatory condition caused by persistent venous hypertension. Therapy is directed at counteracting the chronic inflammation in the tissues and at decreasing ambulatory venous hypertension in the area. Compression therapy helps decrease the venous hypertension and aids healing. Topical agents may be used to help decrease the bacterial load in the wound, provide a moist healing environment for dry wounds, or absorb the exudate in wounds with a lot of drainage. Pharmacological adjuncts, such as pentoxifylline or flavanoids, may help counteract the chronic inflammation in the ulcerated area. Interventions to decrease the ambulatory venous hypertension can help patients with either active or healed ulcers. Ablation of incompetent superficial truncal veins and/or perforating veins using radiofrequency ablation, endovenous laser ablation, or foam sclerotherapy can speed ulcer healing and prevent recurrence.

Research on groups is often applied to sport teams, and research on teams is often applied to groups. This study investigates the extent to which individuals have distinct schemas for groups and teams. A list of team and group characteristics was generated from 250 individuals, for use in this and related research. Questions about teams versus groups carry an a priori implication that differences exist; therefore, list items were presented to new participants and were analyzed using signal detection theory, which can accommodate a finding of no detectable difference between a nominated category and similar items. Participants were 30 members from each of the following: netball teams, the general public, and hobby groups. Analysis revealed few features that set groups apart from teams; however, teams were perceived as more structured and demanding, requiring commitment and effort toward shared goals. Team and group characteristics were more clearly defined to team members than they were to other participant groups. The research has implications for coaches and practitioners.

Transcriptional activation and repression via the transcription factors p53 and p65 are mediated by hydrophobic short linear motifs (FXX phi phi) in their activation domains (ADs). To understand the molecular basis for specificity in binding to disparate biological targets, a series of chimeric peptides was synthesized, with sequences derived from the ADs of p53, which binds both the general transcriptional machinery and the repressor protein MDM2, and p65, which is reported to bind the general transcriptional machinery but not MDM2. The FXX phi phi motifs of p53 and p65 differ by only two residues, whereas the flanking sequences have no sequence identity. The affinities of the chimeric peptides to MDM2(25-117) and hTAF(II)31(1-140) were determined. Specificity for binding MDM2 via FXX phi phi motifs derives almost entirely from Trp23 of p53, with a 3.0 kcal mol(-1) loss of binding energy when Trp23 is changed to p65-derived Leu. The identity of the N-terminal flanking sequence did not significantly affect binding to MDM2. In contrast, replacement of the C-terminal sequence of p53 with that of p65 increased the affinity of the chimera for MDM2 by 1.1 kcal mol(-1), contrary to expectations. Replacement of the highly conserved residue Pro27 of p53 with Ser from p65 resulted in a 2.3 kcal mol(-1) improvement in binding to MDM2, generating a ligand (p53-P27S) (Kd = 4.7 nM) that exhibits the highest MDM2 affinity observed for a genetically encodable ligand. The basis for the increased affinity of p53-P27S over p53 was examined by circular dichroism and nuclear magnetic resonance. Pro27 disrupts the recognition alpha-helix of p53, with p53-P27S significantly more alpha-helical than p53.

Problematic varicose veins are estimated to occur in up to 30 million Americans and may be symptomatic and/or unsightly. The majority of symptomatic varicose veins occur in the lower extremities and can result in significant circulatory disease. This problem is more common in women as a result of pregnancy and child bearing. Cosmetic treatment for varicosities is best achieved with a variety of sclerosing procedures.

Objective: This pilot study was designed to evaluate the outcome of medical abortion following simultaneous mifepristone (100 mg) and misoprostol (800 microg)., Methods: Enrollees had gestational ages up to 56 days and desired a medical abortion. They received 100 mg of mifepristone orally and 800 microg of misoprostol vaginally. Follow-up examination occurred in 2-7 days. A phone call 3 weeks later assessed symptoms and acceptability. A 95% success rate, as seen in higher dose studies, gives a 95% confidence interval of 88-100% for 40 subjects., Results: Forty women were enrolled; 39 women had follow-up visits. Completed medical abortion was confirmed for 35 (90%) of 39 women. Four women had uterine aspiration. Two patients required repeat misoprostol. Median time from medication to abortion was 7 h. Most women (92%) strongly preferred taking all medications in the clinic., Conclusions: The simultaneous administration of vaginal misoprostol with 100 mg of oral mifepristone had the outcome of completed abortion within the predicted confidence interval. In addition, simultaneous dosing was highly acceptable.

Background: This study evaluates use of endovascular aortic repair (EVAR) and minimal incision aortic surgery (MIAS) for treatment of high-risk patients with infrarenal aneurysms., Methods: A retrospective review of patients treated with EVAR or MIAS between 2000 and 2002 was performed. High-risk criteria included age older than 80 years, creatinine level greater than 3.0 mg/dL, recent myocardial infarction, congestive heart failure, severe chronic obstructive pulmonary disease, hostile abdomen, or morbid obesity (body mass index greater than 30). Patient demographics, duration of stay, morbidity, and mortality were compared. Exclusionary criteria for EVAR treatment included neck less than 1.5 cm or greater than 26 mm in diameter, densely calcified iliac arteries less than 6 mm, or creatinine level greater than 3.0 mg/dL. Exclusionary criteria for MIAS included pararenal abdominal aortic aneurysm, aneurysm greater than 10 cm, and morbid obesity., Results: Eighty-four patients were treated (61 EVAR, 23 MIAS). Average age for EVAR was 74 years and 72 years for MIAS. Average aneurysm size was 6 cm for both. American Society of Anesthesiologists score was 3.1 for EVAR and 3.0 for MIAS patients. Thirty-two of 61 EVAR patients (52%) had 2 risk factors, and 12 of 61 (20%) had 3 risk factors. Seven of 23 MIAS patients (30%) had 2 risk factors, and 7 had more than 3 risk factors (30%). There were 2 EVAR deaths (3%) from multiorgan failure and 1 MIAS death (4%) from myocardial infarction. Average duration of stay was 5.1 days for both EVAR and MIAS. Thirty-day morbidity was 18% for EVAR and 17% for MIAS patients., Conclusions: EVAR and MIAS are comparable for the treatment of high-risk aneurysm patients.

The aim of this study was to evaluate the safety and efficacy of stent graft coverage of hypogastric artery in the management of aortoiliac aneurysms. Between January 2000 and December 2002, 98 patients underwent endovascular repair of aortoiliac aneurysms (EVAR). Of these, 24 (24.5%) required occlusion of one hypogastric artery to facilitate the endovascular repair. Based on the method of hypogastric artery occlusion, patients were divided in to two groups. Group A (13/24 = 54%) underwent standard coil embolization followed by hypogastric artery orifice coverage whereas group B (11/24 = 46) underwent hypogastric artery orifice coverage without coil embolization. Post-EVAR computed tomographic angiography (CTA) was used to determine occurrence of endoleaks from the hypogastric artery orifice and patency of superior gluteal artery in both groups. These findings were further correlated with presence or absence of gluteal claudication. There was no difference in age (p < 0.38) or iliac aneurysm size (p < 0.3). In group A (13 patients), occlusion of superior gluteal artery was seen in 6 (46%). Four of six (66%) patients developed severe gluteal claudication. Patients in group A were likely to require more than one intervention (p < 0.00036). No patients in group B developed occlusion of the superior gluteal artery (p < 0.04) or gluteal claudication (p < 0.046). No endoleaks were seen from the origins of hypogastric artery in either group. The follow-up period ranged from 2 to 35 months. Hypogastric artery orifice coverage without coil embolization effectively prevented retrograde endoleak without the occurrence of disabling gluteal claudication. Coil embolization of the hypogastric artery may be unnecessary during treatment of aortoiliac aneurysm.

Platelet microaggregates have been demonstrated in the systemic circulation of patients with atherosclerotic cardiovascular diseases. Glycoprotein IIb/IIIa antagonists have been reported to play roles in platelet activation, which may be associated with pro-thrombotic events. We report the effect of the orally active GPIIb/IIIa antagonist, orbofiban, on human platelet microaggregate formation in vitro. Laser light scatter (LSS) technology was used to monitor small, medium and large platelet aggregates formed in platelet-rich plasma in response to ADP or thrombin receptor activating peptide (TRAP)-6. ADP at 0.5 microM induced only small platelet aggregates that were prevented by orbofiban in a concentration-dependent manner. Likewise, orbofiban dissolved small aggregates after their formation. In marked contrast, in the presence of strong agonist stimulation (20 microM ADP or 3 microM TRAP-6) which generated primarily large platelet aggregates, orbofiban blocked the large aggregates while significantly augmenting small aggregates by three- to sixfold. The data suggest that GPIIb/IIIa antagonists do not induce platelet microaggregation directly but may augment small platelet microaggregate formation indirectly at conditions of strong stimuli. The percentage of the microaggregate population expressing P-selectin remained the same in the presence of orbofiban, indicating that these small microaggregates remain activated, although the mean intensity of expression was diminished, possibly reflecting the reduced size of the particles or density of P-selectin molecules. In summary, an increase in small platelet microaggregates might have contributed to pro-thrombotic events in orbofiban-treated patients.

This study evaluates the clinical and economic impact of using less extensive minimal invasive aortic surgery (MIAS) for elective treatment of infrarenal aortic aneurysms (AAA) and aortoiliac occlusive disease (AIOD) in two independent surgical departments. Surgeons from two institutions conducted a prospective consecutive, nonrandomized analysis of MIAS electively performed in 80 patients. MIAS outcomes were compared with 80 consecutive elective standard open aortic procedures (40 from each institution), which were performed during the same time period. Cost analyses for MIAS and standard open repair were performed at each institution. Our results indicated that MIAS is as safe as standard open repair, is more cost-effective, and has significantly shorter hospital stays than with standard open repair.

Purpose: In this study we evaluated the clinical and economic impact of minimal incision aortic surgery (MIAS) for treatment of patients with abdominal aortic aneurysms (AAAs) and aortoiliac occlusive disease (AIOD)., Method: Fifty patients with either AAA (34) or AIOD (16), prospectively treated with the MIAS technique, were compared with 50 patients (40 AAA and 10 AIOD) treated in the same time period with long midline incision and extracavitary small bowel retraction. MIAS was also compared with a cohort of 32 patients with AAA treated by means of endoaortic stent-grafts. Outcomes and cost (based on metric mean length of stay) were compared for the open and endoaortic techniques., Results: Patients who experienced no perioperative complications after the MIAS or endovascular repair technique had shorter hospital stays than patients with uncomplicated aortic repairs performed with a traditional long midline abdominal incision (3 days vs 3 days vs. 7.2 days). Hospital stay was also significantly shorter for the less invasive procedures when perioperative complications were included (4.8 days vs. 4.3 days vs 9.3 days). The MIAS and endovascular aortic repair groups had a shorter intensive care unit stay (< or = 1.0 day) and a quicker return to general dietary feeding (2.5 days) than patients treated with standard open repair (1.8 days, 4.7 days). The overall morbidity for the MIAS technique (14%) and endovascular technique (21%) was not significantly different from standard open repair (24%). The mortality rate for the different treatment groups was equivalent (MIAS, 2%; endovascular repair, 3%; standard repair, 2%). The MIAS was more cost-efficient than standard open repair ($12,585 vs $18,445) because of shorter intensive care unit and hospital stay and was more cost-efficient than endoaortic repair ($12,585 vs $32,040) because of reduced, direct intraoperative costs., Conclusions: MIAS is as safe as standard open or endovascular repair in the treatment of AAA and AIOD. MIAS is more cost-efficient than standard open or endoaortic repair.

Purpose: Aneurysms of the visceral arteries are infrequently encountered. Many are found incidentally and are thought to have a benign outcome. To better characterize these lesions and their clinical course, we reviewed our experience with visceral artery aneurysms (VAAs) at a single institution., Methods: A retrospective analysis of all VAAs diagnosed at our institution over the past 10 years was performed. The presentation, management, and outcome of therapy was examined for each patient., Results: Thirty-four VAAs in 26 patients were diagnosed over the past 10 years. Four patients had multiple VAAs: splenic (17), hepatic (7), celiac (3), superior mesenteric (2), gastroduodenal (2), pancreaticoduodenal (1), right gastric (1), ileal (1) artery aneurysms. Associated aneurysms were found in 31% of patients and involved the thoracic aorta (3 patients), abdominal aorta (4 patients), renal arteries (2 patients), iliac artery (3 patients), lower extremity (1 patient), and intracranium (1 patient). In 15 patients (58%), VAAs were detected before rupture by chance or because abdominal symptoms resulted in diagnostic evaluation. Eight of these underwent elective surgery, and there were no deaths. Of those 15 patients with known VAAs, one patient died of rupture and hemorrhage from an untreated splenic artery aneurysm. Eleven patients (42%) presented unexpectedly with rupture, and two died despite prompt surgical treatment. The mortality rate in patients who had ruptured VAAs was 25%, including those who presented with ruptured aneurysms and those observed whose aneurysms eventually ruptured., Conclusions: Aneurysms of the visceral arteries are rare but important vascular lesions. Associated aneurysms are common. Because of the risk of rupture, often with a fatal outcome, an aggressive approach to the treatment of VAA is essential.

Background/aims: Myofibroblasts are the primary cells responsible for increased matrix deposition in hepatic fibrosis. Activation of hepatic stellate cells and portal fibroblasts to myofibroblasts during cholestatic liver injury is accompanied by increased expression of the activation marker, alpha-smooth muscle actin (SMA), and collagen genes. In contrast to our understanding of injury, the cellular mechanisms of liver repair are not well defined. This study was designed to examine the morphological relationship between bile duct hyperplasia, matrix deposition and myofibroblast phenotype in a model of chronic cholestatic liver injury and repair., Methods: Reversible extrahepatic obstruction was accomplished in rats using a soft vessel loop suspended from the anterior abdominal wall: duct manipulation alone was performed in sham-operated controls. After 7 days, rats were either sacrificed or decompressed by release of the loop and subsequently sacrificed 2-10 days after reversal. Liver sections were obtained for in situ hybridization for procollagen alpha1(I) mRNA, immunohistochemical staining for SMA and cytokeratin 19, and histochemical staining for reticulin., Results: Cholestatic livers demonstrated bile duct hyperplasia, which reversed to normal within 10 days after decompression. Fibrosis was also substantially reduced during this period. SMA-positive myofibroblasts were abundant and localized to regions adjacent to proliferating ducts and excess matrix in the obstructed animals. Decompressed livers showed a dramatic time-dependent reduction in the number of SMA-positive cells and in the expression of procollagen I mRNA., Conclusions: Our results show that the disappearance of bile duct hyperplasia after biliary decompression is accompanied by a similarly rapid loss of SMA-positive myofibroblasts. Both cellular events may abrogate enhanced matrix synthesis and allow repair to occur.

Background: This study evaluated a less invasive technique for exposure of the infrarenal aorta and its impact on the treatment of patients with abdominal aortic aneurysms (AAA) or aortoiliac occlusive disease (AIOD), or both., Methods: Forty patients with AAA (26), aneurysmal extension into the iliac arteries (6), or AIOD (8) were prospectively selected for minilaparotomy aortic exposure and repair using a small periumbilical midline incision (< or =10 cm); intra-abdominal, nondisplaced retraction of the small bowel; and conventional hand-sewn vascular anastomoses. Perioperative comparisons with a contemporary group of AAA patients treated with long, open midline incision and extracavitary small bowel retraction were made., Results: There was no significant difference between the minilaparotomy and open surgical control groups for operating room time; intraoperative, perioperative morbidity; or mortality. Significant differences were documented between the minilaparotomy and the control group with regard to stay in the intensive care unit (days; 1.0+/-1.2 versus 1.8+/-1.5); return to general diet (days; 3+/-1.3 versus 4.7+/-2.8); and length of stay (days; 4.9+/-1.8 versus 7.3+/- 3.4)., Conclusions: Minilaparotomy exposure is safe and effective for treatment of infrarenal AAA and AIOD. This technique maintains quality outcome while reducing postoperative ileus, hospital stay, and resource utilization.

This prospective nonrandomized study assessed clinical outcomes of a minilaparotomy technique (MLT) used for elective graft repair of infrarenal aortic aneurysm (AAA) and/or aortoiliac occlusive disease (AIOD). Twenty-three patients requiring infrarenal AAA or aortofemoral bypass underwent a small periumbilical midline incision, nondisplacement of the small bowel, and a traditional vascular anastomosis. Results from these procedures were compared with those from contemporaneous procedures performed in the standard transabdominal (STA) fashion (n = 21). Age, weight, and comorbid conditions were comparable between groups. Patients requiring concomitant renal, mesenteric, or infrainguinal revascularization were excluded. Operating time, length of stay in the intensive care unit (ICU), number of oral feeding times, and length of hospital stay were recorded. There were no significant differences in age, operative time, or aneurysm size between the MLT and STA groups. With the MLT then were significant decreases in ICU stay (1 vs. 1.8 days), length of time to return to a general diet (3 vs. 4.7 days), and length of stay (4.9 vs. 7.3 days.) Morbidity and mortality were not statistically different between groups. Patients undergoing the MLT have reduced ICU and hospital stay, and decreased post operative ileus. The MLT does not increase operating room costs or require expensive laparoscopic equipment or the extended postoperative radiographic surveillance needed after endovascular repair.

Background: Histologic studies of carotid plaques have demonstrated an association between symptomatic disease and plaque rupture. The purpose of this study was to characterize the cellular changes associated with plaque rupture., Methods: Carotid plaques were obtained from 61 patients undergoing carotid endarterectomy for established indications. Plaques were fixed in formalin, embedded in paraffin, and stained with hematoxylineosin and Movat pentachrome stain to demonstrate plaque structure. Each plaque was examined with light microscopy and classified as containing evidence of plaque rupture (n = 29) or no plaque rupture (n = 32). By using immunohistochemical staining, the fibrous cap was examined for the presence of smooth muscle cells (alpha-actin), macrophages (KP-1), T lymphocytes (UCHL-1), and cell activation (HLA-DR). Data were analyzed with chi-squared analysis., Results: With plaque rupture, macrophages and T lymphocytes were significantly more common than in specimens without evidence of rupture. Similarly, macrophages and T lymphocytes expressing HLA-DR were more often found in sections containing plaque rupture. Furthermore, vascular smooth muscle cells were more common with intact fibrous caps and were diminished with cap thinning., Conclusions: Rupture of the fibrous cap in carotid artery lesions is associated with increased numbers of macrophages and T lymphocytes, which are in an activated state. The activated inflammatory cells may release cytokines or metalloproteinases, which may be responsible for loss of the fibrous cap. Thus inflammation appears to play a role in the pathogenesis of the neurologic symptoms associated with carotid artery stenosis.

Television advertising has been an important medium for health promotion campaigns addressing HIV/AIDS. This study sought to evaluate the 'Grim Reaper' and 'Multiple Beds' advertisements frequently broadcasted throughout Australia. Our model for evaluation was based on a theoretical synthesis of television advertising, transactional analysis (TA) and recall congruence. Eighty-three participants viewed each advertisement and rated which ego state the source of the message was attempting to 'hook' in the audience. They also predicted their own ego state during sexual intercourse and rated the effectiveness of the advertisements. As predicted by TA theory, a crossed transaction was associated with significantly less psychological impact than a parallel transaction for the 'Grim Reaper' advertisement. A similar trend was apparent for the 'Multiple Beds' advertisement. Important issues which warrant further research in order to evaluate whether transactional analysis could be a useful tool in promoting health are discussed.

The "double demotivation" hypothesis that pay discrepancies decrease work motivation among both lower and higher paid groups was tested in two experiments. In experiment 1, 70 Australian undergraduates received either $1 or $2 to work on an intrinsically rewarding puzzle, with or without knowledge of what amount other participants were receiving. A comparison of participants with a no-payment control showed that participants exhibited significantly reduced intrinsic motivation (seconds spent interacting with the puzzle during a free-choice period) when they knew that they were being under- or overpaid. In experiment 2, 126 occupationally matched Australian workers receiving wages equal to, lower than, or higher than those of counterparts reported their level of job satisfaction and whether they would stay on the job, change jobs, or retire, if given the financial opportunity. Compared with equitably paid workers, employees who felt they were being under- or overpaid reported lower job satisfaction and greater readiness to change jobs. The results provide experimental support for double demotivation, which is relevant not only to international development cooperation but also to Western enterprise bargaining, merit pay, and minority groups in the multicultural workplace.

Background: Visceral artery aneurysms are an uncommon but important form of abdominal vascular disease. This study reviews a contemporary experience with special emphasis on newer methods of diagnosis and treatment., Methods: From 1980 to 1994, 37 patients were diagnosed with 46 visceral artery aneurysms. These consisted of 22 splenic, 10 hepatic, 4 superior mesenteric, 2 gastroduodenal, 3 celiac, 2 left gastric, 1 pancreatoduodenal, 1 jejunal-ileal, and 1 inferior mesenteric artery aneurysms. Follow-up was complete for 28 patients, average of 37.7 months. There were 17 asymptomatic and 29 symptomatic aneurysms, including 11 presenting with rupture., Results: Seventeen patients were treated surgically, with no surgical deaths. Surgical complications included splenic abscess (two) and failure to thrombose (one). Transcatheter embolization was used in 12 patients. Complications included splenic infarction (one) and recurrence (two), successfully treated with repeat embolization. Nine patients were treated with observation. Eight experienced no complications during follow-up; one died of a ruptured splenic artery aneurysm before treatment was initiated., Conclusions: The widespread use of computed tomography has led to increased detection of asymptomatic visceral artery aneurysms. Although surgery remains necessary in many patients, transcatheter embolization is effective in the treatment of selected visceral artery aneurysms with few complications and low recurrence.

Acute hepatic injury initiates known cellular and molecular events for regeneration. In contrast, the molecular mechanisms of repair following chronic liver injuries have not been defined. Transforming growth factor alpha (TGF alpha) and hepatocyte growth factor (HGF) are hepatocyte mitogens whose in vivo expression in liver is central to the regulation of regeneration. To study the role of TGF alpha and HGF in liver injury and repair, we used a model of reversible biliary obstruction without a bilioenteric anastomosis. In rats, the common bile duct was obstructed either by a vessel loop suspended from the abdominal wall (LOOP) or by ligation and division (DLD). After 7 days of obstruction, animals were autopsied or were decompressed by subcutaneous release of the loop and then autopsied at 1, 2, 4, 7, or 10 days of postdecompression. Serum bilirubin (mg/dl) increased to 14.8 +/- 2.9 (DLD) and 10.3 +/- 3.0 (LOOP) (+/- SEM, NS, ANOVA) at 7 days of obstruction. Liver sections demonstrated equal ductal hyperplasia and collagen deposition after LOOP and DLD. Biliary decompression reversed bile duct proliferation and normalized bilirubin. Analysis of injured and repairing liver mRNA by ribonuclease protection assay showed that TGF alpha mRNA levels were not significantly altered by injury or during repair. HGF mRNA was elevated following obstruction and showed increased expression 1 day after decompression, peaking at 2 days of repair. This evidence of modulation of HGF during liver repair following chronic cholestatic injury suggests that HGF may have a role in cellular proliferation during repair or act as a compensatory growth factor during injury.

Although substantial evidence is now accumulating that some African peoples readily accept advice and help about health from both modern medical and traditional sources, this has not yet happened with--what is arguably the major health problem in many part of Africa--AIDS. We asked 175 of Malawi's undergraduates what sources they judged to be credible with regard to information on preventing and clinically managing AIDS. While traditional healers were seen on average to be less credible than modern health professionals (doctors and nurses), there was no correspondence between credibility of traditional healers and modern health professionals. Thus a strong belief in the credibility of modern health professionals was not associated with low credibility ratings for traditional healers. Our findings provide further support for "tropical tolerance", especially as regards a pluralistic (modern and traditional together) approach to the prevention of AIDS. Given the over-stretched health services in Malawi and many other African countries, a pluralistic approach to AIDS prevention could be a credible and economic use of indigenous human resources.

Although epilepsy may be successfully managed with appropriate medication, in Africa epileptics are often vilified, sometimes because of traditional beliefs about the illness. We investigated the strength of beliefs which 112 rural Malawians held regarding traditional and medical explanations for the cause, treatment and cure of epilepsy. Those who believed in traditional causes of epilepsy also endorsed traditional treatment for it, though they did not see such treatment as curative. Those who believed in a medical treatment, did however see such treatment as curative. Knowledge of a local medical facility for the treatment of epilepsy was also positively related to the belief that epilepsy is curable. The ability of people to simultaneously hold medical and traditional beliefs about epilepsy was noted.