Critical issues in the decision to retire: a comparison of retired and retirement-age faculty

The nursing faculty workforce is on the verge of a crisis because the number of full-time faculty expected to retire in the next 10 years is predicted to escalate dramatically. To propose evidence-based strategies to retain qualified nursing faculty beyond retirement age, this study built on previous qualitative research. An initial phenomenological study of retirement-age faculty identified 15 critical issues in the decision to remain employed in academia. To determine the degree to which these factors are shared by retired and still-employed faculty and the relative importance of each of these factors, a quasi-experimental comparative study was conducted. A Likert scale questionnaire was administered to a convenience sample drawn from a national population using the snowball sampling technique. ANOVA established the difference between retired and still-working faculty; discriminant analysis identified eight predictor variables for faculty decisions to remain in academia.     

Perceived parental protection and cortisol responses among young females with borderline personality disorder and controls

Borderline personality disorder (BPD) has been associated with deviations in cortisol in response to interpersonal stressors. Identifying mechanisms contributing to such deviations may help to address emotional dysregulation and the increased risk of self-destructive behavior. While dysfunctional relationships to caregivers have been widely reported among individuals with BPD, their contribution to cortisol hyperresponsiveness has yet to be investigated. Fifty-one females (aged 18-24 years) participated to assess the impact of BPD and the quality of protective care in mother-daughter relationships on stress responsiveness. Seventeen females with BPD and twenty females without BPD participated with their mothers in a videotaped parent-young adult conflict discussion. Fourteen non-BPD females without their mothers were assessed for cortisol levels without stress exposure. Salivary cortisol samples were collected at lab entry and 20 and 40 min after the onset of the discussion. Results revealed a higher overall cortisol response in the BPD group upon lab entry. BPD participants reported less experienced protection in the mother-daughter relationship which was associated with higher cortisol levels on lab entry and higher distress at study end. Results point to the perceived quality of parental protection as likely to modulate the activity of the stress response system among BPD patients.     

Pulmonary vein inflow artifact reduction for free‐breathing left atrium late gadolinium enhancement

Two‐dimensional “pencil‐beam” navigator, placed on the right hemidiaphragm, is used for free‐breathing late gadolinium enhancement of the left atrium in patients with atrial fibrillation. The pencil‐beam navigator creates an inflow artifact in the right pulmonary veins and atrial wall that may obscure local pulmonary vein and left atrium scars. To reduce this artifact, we propose a large slab right hemidiaphragm projection navigator that measures the respiratory motion while reducing the associated inflow artifact. Eighteen subjects underwent pulmonary vein late gadolinium enhancement using the pencil‐beam and projection navigator. Subjective inflow and respiratory motion artifact scores (1 = severe, 2 = moderate, 3 = mild, and 4 = none) from two blinded readers were compared. The artifact scores were 3.8 ± 0.4 and 2.1 ± 0.7 for the projection and pencil‐beam navigators, respectively (P < 0.001). Respiratory motion artifact scores were similar between the two techniques (3.0 ± 0.5 vs. 3.1 ± 0.5 for projection vs. pencil‐beam navigator). The proposed method greatly reduces the inflow artifact in free‐breathing pulmonary vein late gadolinium enhancement while allowing adequate respiratory motion compensation. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.     

Randomized trial of immunosuppressive regimens in renal transplantation

The optimal long-term regimen for immunosuppression for kidney transplant recipients is unknown. We conducted a randomized trial involving 150 kidney transplant recipients to compare tacrolimus/sirolimus, tacrolimus/mycophenolate mofetil (MMF), and cyclosporine/sirolimus. All patients received daclizumab induction and maintenance corticosteroids. Median follow-up was 8 yr post-transplant. Acute rejection (AR) occurred significantly less often among those treated with tacrolimus/MMF (12%) than among those treated with tacrolimus/sirolimus (30%) or cyclosporine/sirolimus (28%). Mean estimated GFR was consistently higher in the tacrolimus/MMF arm, especially after controlling for donor age in a multivariable model during the first 36 mo (P ≤ 0.008). The rate of dying with a functioning graft was significantly higher among those treated with tacrolimus/sirolimus (26%) than among those treated with tacrolimus/MMF (12%) or cyclosporine/sirolimus (4%). We did not observe significant differences in actuarial graft survival at 8 yr post-transplant between the groups. Patient noncompliance seemed responsible for 45% (13/29) of observed graft failures, with 11 of these occurring after 36 mo. Significantly more viral infections, protocol violations, and need for antilipid therapy occurred among patients receiving sirolimus, but we did not observe differences between the groups with regard to infections requiring hospitalization or new-onset diabetes. Taken together, these results suggest that maintenance therapy with tacrolimus/MMF is more favorable than either tacrolimus/sirolimus or cyclosporine/sirolimus.     

Alternate roles for immune regulators: establishing endometrial receptivity for implantation

Many immune regulators are now identified as having key roles at the embryo-maternal interface. Importantly, a cohort of cytokines, chemokines and growth factors are produced by the endometrial glands and secreted into the uterine cavity where they act both on the blastocyst and on the endometrial surface, changing adhesive capacity, modifying blastocyst development and outgrowth and providing chemoattraction, in addition to their previously known functions in immune regulation. As implantation progresses to highly controlled invasion of the trophoblast through the maternal decidua, similar factors produced by glands, decidual cells and cells of the innate immune system are critical for guiding the trophoblast to the maternal vasculature and establishing a functional placenta. Disturbance to production or action of such mediators can result in loss of uterine receptivity (manifesting as infertility) or disorders of early pregnancy including recurrent miscarriage and preeclampsia.     

5-Lipoxygenase metabolite 4-HDHA is a mediator of the antiangiogenic effect of ω-3 polyunsaturated fatty acids

Lipid signaling is dysregulated in many diseases with vascular pathology, including cancer, diabetic retinopathy, retinopathy of prematurity, and age-related macular degeneration. We have previously demonstrated that diets enriched in ω-3 polyunsaturated fatty acids (PUFAs) effectively reduce pathological retinal neovascularization in a mouse model of oxygen-induced retinopathy, in part through metabolic products that suppress microglial-derived tumor necrosis factor-α. To better understand the protective effects of ω-3 PUFAs, we examined the relative importance of major lipid metabolic pathways and their products in contributing to this effect. ω-3 PUFA diets were fed to four lines of mice deficient in each key lipid-processing enzyme (cyclooxygenase 1 or 2, or lipoxygenase 5 or 12/15), retinopathy was induced by oxygen exposure; only loss of 5-lipoxygenase (5-LOX) abrogated the protection against retinopathy of dietary ω-3 PUFAs. This protective effect was due to 5-LOX oxidation of the ω-3 PUFA lipid docosahexaenoic acid to 4-hydroxy-docosahexaenoic acid (4-HDHA). 4-HDHA directly inhibited endothelial cell proliferation and sprouting angiogenesis via peroxisome proliferator-activated receptor γ (PPARγ), independent of 4-HDHA's anti-inflammatory effects. Our study suggests that ω-3 PUFAs may be profitably used as an alternative or supplement to current anti-vascular endothelial growth factor (VEGF) treatment for proliferative retinopathy and points to the therapeutic potential of ω-3 PUFAs and metabolites in other diseases of vasoproliferation. It also suggests that cyclooxygenase inhibitors such as aspirin and ibuprofen (but not lipoxygenase inhibitors such as zileuton) might be used without losing the beneficial effect of dietary ω-3 PUFA.