Gene expression profile of tumor cell-fused or Noni (\u3ci\u3eMorinda citrifolia\u3c/i\u3e)-treated dendritic cells

Dendritic cell-mediated cancer immunotherapy employs several ways to engage tumor antigens. We have demonstrated both in pre-clinical animal studies and early clinical trials that dendritomas, highly purified hybrids between dendritic cells and tumor cells, are superior activators of anti-tumor immunity. In the present study, we examined the expression profile of several inflammatory chemokine and chemokine receptors of dendritomas by RNA microarray and real-time RT-PCR. The results indicate that dendritomas made from immature DCs and tumor cells express higher levels of CCL3, CCL5, and CCL22 and lower levels of CCR2 and CCR5, which mimics LPS matured DCs, while dendritomas made from mature DCs and tumor cells show a reversed expression profile of these genes: decreased levels of CCLs and increased levels of CCRs. Our data support the notion that dendritomas made from immature DCs and tumor cells may be more effective in migration from the injection site to draining lymph nodes and therefore make them more effective in stimulating anti-tumor immunity. Morinda citrifolia (Noni) has been used as a folk remedy to treat a myriad of ailments, and is gaining in popularity as a modern dietary supplement to enhance the immune system. Recent studies have shown that Noni juice has anticancer activity. Studies from our lab demonstrated that fermented Noni juice not only prevents mouse sarcoma tumor development but also eradicates existing tumors. Fermented Noni can also directly engage dendritic cells with B cells. Since Noni contains a wide array of microorganisms, and upon fermentation, all but one are killed, it is presumed to contain a plethora of degraded microbial products that would serve as microbial stress signals. We hypothesized that Noni may activate dendritic cells by engaging their toll-like receptors (TLRs), and investigated genes associated with TLR signaling via real-time RT-PCR. It was determined that Noni stimulates early low levels of inflammatory cytokines, followed by a latent upregulation of anti-inflammatory mediators. Intriguingly, Noni also appeared to trans-differentiate dendritic cells toward macrophage-like cells

End of life clinician-family communication in ICU: a retrospective observational study - implications for nursing

Objective: The objective of this study was to identify practice issues that influence end of life communication and care of patients and families in the intensive care unit (ICU). Design: This study used a retrospective observational approach utilising a medical record review. Setting: An Australian metropolitan mixed medical/surgical ICU. Subjects: There are two parts to this study. The first part related to all of the patients who died in the ICU in one calendar year, a total of 97. The second part of this study related to a random selection of 25% of these patients, a total of 24. Results: This study showed that death in the ICU was often anticipated, and that whilst communication between family and medical personnel was evident in the medical record, the involvement or occurrence of communication between the nurse and the family was not recorded, and that nurses were included in only 25% of formal family meetings. Conclusion: Whilst this study confirmed that death is often predicted for critically ill patients, and opportunities for communication with the family or next of kin assists to achieve consensus on end of life decisions, the involvement of nurses, as primary care-givers is not well represented in the medical record, thus undermining the importance of the nurses role in direct patient care that extends to the family in the ICU

Moral Rights Protection for the Visual Arts

Beginning in 1979, certain states extended extra copyright protection, known as moral rights protection, to visual artists. Moral rights protection, which was incorporated into U.S. copyright law in 1990, ensures that works cannot be altered in a manner that would negatively impact the reputation of the artist. Using difference-in-differences regression strategies, we compare artists and non-artists in states with moral rights laws to those in states without these laws, before and after the laws are enacted. This enables us to test the impact of the laws on the behavior of artists, consumers, and policy makers. Our analysis reveals that artists’ incomes fall by over $4000 per year as a result of moral rights legislation, but we find no impact of the laws on artists’ choices of residence or on state-level public spending on the arts

Loss and grief in the workplace. What can we learn from the literature?

Purpose – The purpose of this paper is to determine how Australian workplaces, their managers and employees respond to those who are grieving at work, as a result of chronic or terminal illness, or caring for those with chronic or terminal illness. The review draws on Australian and relevant international literature and seeks to answer this question. Design/methodology/approach – A literature review was undertaken in preparation for an Australian study examining workplace supports for people who are grieving – because they are carers, have experienced a death, or are balancing their own illness with their work. Using a range of search terms, the literature was searched for relevant work between 1980 and 2010. The search found examples of workplace supports throughout the world and some developing Australian literature. Findings – Despite illness and death occurring at any stage of a person\u27s life, there is little research that identifies workplace issues associated with grief and loss. And while workplace legislation allows for minimal supports, there was evidence that some workplaces have begun to offer flexibility for work life balance. Practical implications – Effective workplace supports will involve individual and workplace responses, but also require legislative approaches in order to effect broad-based system change. Originality/value – The paper compares Australian and international literature about workplace supports and provides an overview of the issues arising

Analysis of Hypertension Control Rates Among Participants in the Georgia Hypertension Management and Outreach Program

Background: This study utilized health department electronic medical records retrospectively to evaluate hypertension control rates achieved by the Georgia Hypertension Management and Outreach Program (HMOP), an education, screening, and treatment control program that provides services, including blood pressure screening and assessment, referral to physicians, counseling, educational material, disease case management, and treatment. Methods: Hypertension control rates after at least 6 months of study participation were determined for patients participating in the program for at least 6 months between 2010 and 2014, and for African American and uninsured subgroups. Results: The overall hypertension control rate was 61.1%, above the 2012 national average of 51.8%. The control rates for African Americans and the uninsured were 58.9% and 62%, respectively, compared to 41.7% and 28.7% nationally. Conclusions: Although potential bias sources in the use of retrospectively obtained electronic medical records should be considered, this analysis suggests that the Georgia HMOP provides substantial improvements in hypertension control for a population of patients with otherwise poor control. Key words: hypertension, blood pressure, cardiovascular diseases, African Americans, medically uninsure

Advancing the Future of Nursing: A Report by the Building Academic Geriatric Nursing

In the United States, the number of older adults will double during the next 25 years (United States Census Bureau, 2008). This dramatic demographic shift is changing the landscape of health care practice as more people live longer with multiple chronic conditions. To better prepare nurses to care for this future population, the John A. Hartford Foundation partnered with the American Academy of Nursing in 2000 to launch the Building Academic Geriatric Nursing Capacity (BAGNC) program. Since that time, 251 scholarships and fellowships have been awarded to nurses to advance geriatric nursing education, research, and practice. In 2009, the BAGNC nurse scholars and fellows formed an alumni organization to expand and continue their leadership development through peer networking and mentored policy initiatives. The BAGNC Alumni organization represents an elite set of new leaders in gerontological nursing to advance geriatric nursing education, research, and practice (Fagin, 2012). To this end, at the 2011 Council for Advancement of Nursing Science\u27s Special Topics Meeting, the BAGNC Alumni presented their ongoing and completed projects that relate to the Institute of Medicine (2011) (IOM) report The Future of Nursing: Leading Change, Advancing Health. Summaries of the individual presentations from this panel addressed the four key IOM messages and are presented in this article to highlight the action of these scholars and fellows

Age Differences in Driving-Specific Tests of Executive Function

The purpose of the present study was to examine age differences in executive function as measured by novel driving-specific tests of executive function using a novel driving simulator. Developmental changes in executive function have been implicated as possible contributing factors to elevated crash statistics for both older adult (over age 65) and adolescent (between age 15 and 20) populations, however for different reasons. Poorer older adult driving performance has been partially attributed to general age-related cognitive decline in executive function mediated by age-related frontal-lobe atrophy and neural disconnection. Immature executive function has been implicated in poorer adolescent driving performance and is thought to be expressed in situations where the developmentally high sensitivity of the socio-emotional reward system outcompetes the regulatory influence of the under developed executive system. Using a new, high fidelity, virtual reality driving simulator, we created drivingspecific tests to assess executive function. These operational tests employed driving-relevant stimuli, with driving-relevant challenges, that required drivingrelevant responses, in a driving-relevant context. Fifteen older adult and 20 adolescent drivers completed these driving-specific executive function tests. We hypothesized that poorer older adult driving performance would be reflected on these driving specific tests of executive function due to general cognitive decline and that, given the absence of social-emotional reward, adolescents would outperform older adults. Analyses of both bivariate correlations and group comparisons generally supported these predictions

Identifying Distinct Risk Profiles to Predict Adverse Events among Community-Dwelling Older Adults

Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p \u3c 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults