Practising homelessness: a typology approach to young people's daily routines

In a study exploring the relationship between typology and risk, we investigated the daily routines of a heterogeneous sample of young men and women from two sites who had been homeless for varying periods (N = 1289). Cluster analysis yielded four groups-'Partnered', 'Socially engaged', 'Service connected-harm avoidant', and 'Transgressive'-based on where and with whom they congregated and slept during the day and night and how they spent most of their time. Although the patterns of responses differed between the groups, there was overlap in the extent of engagement in specific activities, including risk practices. Interpretation of the impact of homeless young people's engagement in risk practices needs to take account of the interaction between their harmful and non-harmful practices.     

Limb distribution, motor impairment, and functional classification of cerebral palsy

This study explored the relationships between the Gross Motor Function Classification System (GMFCS), limb distribution, and type of motor impairment. Data used were collected in the Ontario Motor Growth study, a longitudinal cohort study with a population-based sample of children with cerebral palsy (CP) in Canada (n=657; age 1 to 13 years at study onset). The majority (87.8%) of children with hemiplegia were classified as level I. Children with a bilateral syndrome were represented in all GMFCS levels, with most in levels III, IV, and V. Classifications by GMFCS and 'limb distribution' or by GMFCS and 'type of motor impairment' were statistically significantly associated (Pearson's chi2 p<0.001), though the correlation for limb distribution (two categories) by GMFCS was low (tau-b=0.43). An analysis of function (GMFCS) by impairment (limb distribution) indicates that the latter clinical characteristic does not add prognostic value over GMFCS. Although classification of CP by impairment level is useful for clinical and epidemiological purposes, the value of these subgroups as an indicator of mobility is limited in comparison with the classification of severity with the GMFCS.     

Synchronizing clinician engagement and client motivation in telephone counseling

Health care increasingly incorporates telephone counseling, but the interactions supporting its delivery are not well understood. The authors' clinical trial of a tailored, nurse-administered smoking cessation intervention for surgical patients included a telephone counseling component and provided an opportunity to describe the interaction dynamics of proactive telephone counseling over the course of 4 months. Tape-recorded telephone counseling calls for 56 consecutively enrolled individuals randomized to the intervention group resulted in a data set of 368 calls, which were transcribed and analyzed using constant comparative methods. The findings revealed varying interaction dynamics depending on the nurse's level of engagement with participants and participants' motivation to stop smoking. The authors identified four interaction dynamics: affirming/working, chasing/skirting, controlling/withdrawing, and avoiding commitment. Shifts in interaction dynamics were common and influenced the provision of support both positively and negatively. The findings challenge many assumptions underlying telephone counseling and suggest strategies to improve its delivery.     

An in vitro investigation of the effects of the nerve agent pretreatment pyridostigmine bromide on human peripheral blood T-cell function

The current pretreatment against nerve agent poisoning deployed by the UK and US armed forces is the acetylcholinesterase (EC 3.1.1.7) inhibitor pyridostigmine bromide (PB). At higher doses, PB is also used to treat the autoimmune disease myasthenia gravis. In both cases, the therapeutic effect is mediated by inhibition of acetylcholinesterase (AChE) at cholinergic synapses. However, the location of AChE is not restricted to these sites. AChE, acetylcholine (ACh) receptors and choline acetyltransferase have been reported to be expressed by T cells, suggesting that cholinergic signalling may exert some modulatory influence on T-cell function and consequently on the immune system. The aim of this study was to investigate the role of the T-cell cholinergic system in the immunological activation process and to examine whether inhibitors of AChE such as PB affect immune function. To investigate this, human peripheral blood mononuclear cells (PBMC) were stimulated using either mitogen, cross-linking of the T-cell receptor and co-receptors with antibodies (anti-CD3/CD28) or by antigen presentation in the presence of various AChE inhibitors and ACh receptor agonists or antagonist. Several indices were used to assess T-cell activation, including the secretion of IL-2, cell proliferation and expression of CD69. Treatment with PB had no significant effect on the immunological assays selected. Physostigmine (PHY), a carbamate compound similar to PB, consistently showed inhibition of T-cell activation, but only at concentrations in excess of those required to inhibit AChE. No evidence was found to support previously published findings showing muscarinic enhancement of cell proliferation or IL-2 secretion.     

Expression levels of protein kinase C-alpha in non-small-cell lung cancer

Current treatments of non-small-cell lung cancer (NSCLC) are inadequate and new therapies are being developed that target specific cellular signaling proteins associated with tumor growth. One potential target is protein kinase C (PKC)-alpha, a signaling molecule with an important role in cell regulation and proliferation. The present study examines the expression levels of PKC-alpha in NSCLC to better understand the distribution of PKC-alpha in NSCLC. We analyzed tumor specimens from an independent tumor tissue bank to determine PKC-alpha protein and messenger RNA gene expression in NSCLC. In addition, we used publicly available gene expression array data to further understand PKC-a-associated gene expression profiles in NSCLC. We found that PKC-alpha is highly expressed in < or = 20% of patients with NSCLC. We also found that PKC-alpha was preferentially expressed in adenocarcinoma compared with squamous cell carcinoma of the lung.     

Item generation and pilot testing of the Comprehensive Professional Behaviours Development Log

The purpose of this project was to generate and refine criteria for professional behaviors previously identified to be important for physical therapy practice and to develop and pilot test a new instrument, which we have called the Comprehensive Professional Behaviours Development Log (CPBDL). Items were generated from our previous work, the work of Warren May and his colleagues, a competency profile for entry-level physical therapists, our regulatory code of ethics, and an evaluation of clinical performance. A group of eight people, including recent graduates, clinical instructors and professional practice leaders, and faculty members, refined the items in two iterations using the Delphi process. The CPBDL contains nine key professional behaviors with a range of nine to 23 specific behavioral criteria for individuals to reflect on and to indicate the consistency of performance from a selection of "not at all," "sometimes," and "always" response options. Pilot testing with a group of 42 students in the final year of our entry-to-practice curriculum indicated that the criteria were clear, the measure was feasible to complete in a reasonable time frame, and there were no ceiling or floor effects. We believe that others, including health care educators and practicing professionals, might be interested in adapting the CPBDL in their own settings to enhance the professional behaviors of either students in preparation for entry to practice or clinicians wishing to demonstrate continuing competency to professional regulatory bodies.     

Diagnostic accuracy of follicular variant of papillary thyroid carcinoma in fine-needle aspirates processed by ultrafast Papanicolaou stain: histologic follow-up of 125 cases

BACKGROUND: Detection of follicular variant (FV) of papillary carcinoma (PC) of the thyroid is considered difficult in cytology. Various ancillary studies have been used to increase the sensitivity in the detection of FVPC in fine-needle aspiration (FNA). We previously reported that the clear nuclei of PC became conspicuous in Ultrafast Papanicolaou (UFP)-stained smears. This study reports our experience on using this UFP-induced artifact in the detection of FVPC. METHODS: Over an 11-year period, 5637 ultrasound-guided thyroid FNAs were performed. All samples were smeared and air-dried. Diff-Quik stain was used to assess the colloid and UFP stain was used to study the nuclei. RESULTS: Histologic follow-up was available from 125 cases. Of the 107 aspirates with diffuse "grape-like" watery clear nuclei, histologic follow-up showed 94 PCs, 8 follicular adenomas containing atypical nuclei, and 5 nonneoplastic lesions. Of the 18 aspirates with focal clear nuclei, histologic follow-up showed 6 PCs, 8 follicular adenomas, and 4 nonneoplastic nodules. As reported previously, histologic follow-up of 147 FNAs contained follicles with normal nuclei showed 107 true follicular neoplasms, 32 hyperplastic nodules, and 8 FVPC. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy in the detection of PC were 93.6%, 94.9%, 93.6%, 94.9%, and 94.3%, respectively, when follicular adenomas containing atypical nuclei were counted as encapsulated FVPC; and 92.6%, 85.6%, 80%, 94.9%, and 88.3%, respectively, when follicular adenomas containing atypical nuclei were counted as benign. CONCLUSION: UFP stain is one of the options to increase the sensitivity of detection of FVPC in preoperative FNA, and to triage microfollicular nodules into those that require surgery no matter how small, and those which can be followed when small.     

Bridging the information and support gap: evaluation of a hospital-based cancer support nurse service

Health professionals play an important role in meeting the information and support needs of individuals following a diagnosis of cancer. The aim of this study was to evaluate the acceptability and impact of a hospital-based cancer support nurse (CSN) service. A total of 98 patients completed a structured telephone interview after discharge concerning their use, perceptions and satisfaction with the service. The majority of patients perceived service delivery to be appropriate and reported that they had gained both information and support. The service also had a positive impact on behavioural, cognitive and affective outcomes. Overall satisfaction with the service was very high. Results indicate that a hospital-based cancer support nurse service provides a promising model for meeting the early information and support needs of patients, thereby promoting continuity of care.