Lentivector-mediated delivery of GDNF protects complex motor functions relevant to human Parkinsonism in a rat lesion model

Although viral vector-mediated delivery of glial cell-line derived neurotrophic factor (GDNF) to the brain has considerable potential as a neuroprotective strategy in Parkinson's disease (PD), its ability to protect complex motor functions relevant to the human condition has yet to be established. In this study, we used an operant task that assesses the selection, initiation and execution of lateralized nose-pokes in Lister Hooded rats to assess the efficacy with which complex behaviours are protected against neurotoxic lesions by prior injection of a lentiviral vector expressing GDNF. Unilateral injection of 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle (MFB) caused rats to attempt fewer trials and to make more procedural errors. Lesioned rats also developed a pronounced ipsilateral bias, with a corresponding drop in contralateral accuracy. They were also slower to react to contralateral stimuli and to execute movements bilaterally. Rats that were pre-treated 4 weeks prior to lesion surgery with an equine infectious anaemia virus (EIAV) vector carrying GDNF [EIAV-GDNF, injected into the striatum and above the substantia nigra (SN)] performed significantly better on all of these parameters than control rats. In addition to the operant task, EIAV-GDNF successfully rescued contralateral impairments in the corridor, staircase, stepping and cylinder tasks, and prevented drug-induced rotational asymmetry. This study confirms that GDNF can protect against 6-OHDA-induced impairments in complex as well as simple behaviours, and reinforces the use of EIAV-based vectors for the treatment of PD.     

Continuous bleeding from a basilar terminus aneurysm imaged with CT angiography and conventional angiography

We report a case of fatal subarachnoid hemorrhage from nontraumatic rupture of an aneurysm at the basilar terminus in which both computed tomography angiography and conventional angiography showed evidence of active bleeding. The time period from initial ictus to CT angiography was 30–50 minutes and to conventional angiography was 120–140 minutes. This case illustrates that aneurysmal bleeding is not necessarily as brief as a few seconds and can last up to 30 to 50 minutes and perhaps longer. Continued bleeding from an intracranial aneurysm is a rare event that can be recognized using computed tomography angiography and likely indicates a poor prognosis.     

The doctor-nurse relationship

All nurses will from time to time find themselves in negative interactions with doctors and other health professionals. By using positive communication techniques the nurse can promote healthy interpersonal interactions and a positive atmosphere. By selecting responses rather than responding spontaneously difficult situations can be managed and a professional environment maintained. This will improve patient outcomes and promote optimal patient care.     

Confirmed detection of Cyclospora cayetanesis, Encephalitozoon intestinalis and Cryptosporidium parvum in water used for drinking

Human enteropathogenic microsporidia (HEM), Cryptosporidium parvum, Cyclospora cayetanesis, and Giardia lamblia are associated with gastrointestinal disease in humans. To date, the mode of transmission and environmental occurrence of HEM (Encephalitozoon intestinalis and Enterocytozoon bieneusi) and Cyclospora cayetanesis have not been fully elucidated due to lack of sensitive and specific environmental screening methods. The present study was undertaken with recently developed methods, to screen various water sources used for public consumption in rural areas around the city of Guatemala. Water concentrates collected in these areas were subjected to community DNA extraction followed by PCR amplification, PCR sequencing and computer database homology comparison (CDHC). All water samples screened in this study had been previously confirmed positive for Giardia spp. by immunofluorescent assay (IFA). Of the 12 water concentrates screened, 6 showed amplification of microsporidial SSU-rDNA and were subsequently confirmed to be Encephalitozoon intestinalis. Five of the samples allowed for amplification of Cyclospora 18S-rDNA; three of these were confirmed to be Cyclospora cayetanesis while two could not be identified because of inadequate sequence information. Thus, this study represents the first confirmed identification of Cyclospora cayetanesis and Encephalitozoon intestinalis in source water used for consumption. The fact that the waters tested may be used for human consumption indicates that these emerging protozoa may be transmitted by ingestion of contaminated water.     

The hospital manager and game theory: chess master, poker player, or cooperative game player?

Hospital management can be seen as a game, and doctors, nurses, and health maintenance organizations are its players. The astute hospital manager realizes the interdependence of individual career strategies and the hospital's success, just as players in a game are interdependent on each other. Managers familiar with game theory may successfully transfer that knowledge to the hospital realm. They may recognize patterns and calculate outcomes like chess players, bluff other hospitals into folding services as poker players do, and cooperate with their own team to maximize productivity. Knowledge of game theory may also make the hospital manager's job.     

Risk selection and benefits in the Medicare+Choice program

We estimate the relation between enhanced benefits offered by the Medicare+Choice (M+C) plan in 1999 and a measure of risk selection based on inpatient encounter data. Higher risks are attracted to plans that offer outpatient drug coverage. The risk score increases by 2.2 percent for drug coverage with an annual limit less than $800 and by 3.6 percent for coverage with a limit more than $800. However, some benefits such as dental coverage were related to favorable risk selection. If M+C plans competed on the basis of benefits and premiums, as they would if they could give untaxed premium rebates, benefits that attract high risks would be underprovided.     

"How to get along with doctors and other health professionals"

All nurses will from time to time find themselves in negative interactions with doctors and other healthcare professionals. By using positive communication techniques the nurse can promote healthy interpersonal interactions and a positive atmosphere. By selecting responses rather than responding spontaneously difficult situations can be managed and a professional environment maintained.