The Importance of Voluntary Behavior in Rehabilitation Treatment and Outcomes

Most rehabilitation treatments are volitional in nature, meaning that they require the patient’s active engagement and effort. Volitional treatments are particularly challenging to define in a standardized fashion, because the clinician is not in complete control of the patient’s role in enacting these treatments. Current recommendations for describing treatments in research reports fail to distinguish between 2 fundamentally different aspects of treatment design: the selection of treatment ingredients to produce the desired functional change and the selection of ingredients that will ensure the patient’s volitional performance. The Rehabilitation Treatment Specification System (RTSS) is a conceptual scheme for standardizing the way that rehabilitation treatments are defined by all disciplines across all areas of rehabilitation. The RTSS highlights the importance of volitional behavior in many treatment areas and provides specific guidance for how volitional treatments should be specified. In doing so, it suggests important crosscutting research questions about the nature of volitional behavior, factors that make it more or less likely to occur, and ingredients that are most effective in ensuring that patients perform desired treatment activities.     

Hand muscles corticomotor excitability in hereditary spastic paraparesis type 4

Transcranial magnetic stimulation (TMS) studies on the pathways to the upper limbs have revealed inconsistent results in patients harboring mutations in SPAST/SPG4 gene, responsible for the commonest form of hereditary spastic paraplegia (HSP). This paper is addressed to study the corticomotor excitability of the pathways to the upper limbs in SPG4 subjects. We assessed the corticomotor excitability of hand muscles in 12 subjects belonging to 7 unrelated SPG4 families and in 12 control subjects by stimulus–response curve [input–output (I–O) curve]. All the parameters of the recruitment curve (threshold, V50, slope and plateau) did not differ significantly from those of the controls. Presence of upper limb hyper-reflexia did not influence the results of I–O curve. Considering the multiplicity of possible genes/loci accounting for pure HSPs, performing TMS analyses could be helpful in differential diagnosis of pure HSPs in the absence of other clinical or neuroimaging tools.     

Self-assembly of the general membrane-remodeling protein PVAP into sevenfold virus-associated pyramids

Viruses have developed a wide range of strategies to escape from the host cells in which they replicate. For egress some archaeal viruses use a pyramidal structure with sevenfold rotational symmetry. Virus-associated pyramids (VAPs) assemble in the host cell membrane from the virus-encoded protein PVAP and open at the end of the infection cycle. We characterize this unusual supramolecular assembly using a combination of genetic, biochemical, and electron microscopic techniques. By whole-cell electron cryotomography, we monitored morphological changes in virus-infected host cells. Subtomogram averaging reveals the VAP structure. By heterologous expression of PVAP in cells from all three domains of life, we demonstrate that the protein integrates indiscriminately into virtually any biological membrane, where it forms sevenfold pyramids. We identify the protein domains essential for VAP formation in PVAP truncation mutants by their ability to remodel the cell membrane. Self-assembly of PVAP into pyramids requires at least two different, in-plane and out-of-plane, protein interactions. Our findings allow us to propose a model describing how PVAP arranges to form sevenfold pyramids and suggest how this small, robust protein may be used as a general membrane-remodeling system.Release of virus particles from infected cells is the last essential step of the viral replication cycle. In the course of this process, virions face the challenging task of crossing the cell envelope. Viruses have developed an arsenal of diverse strategies to overcome this problem. Most bacterial viruses are lytic and induce lysis of the infected cell with help of the holin-endolysin system (1), whereas others disrupt the host cell envelope via inhibition of the murein biosynthesis pathway (2). The morphological and genomic properties of archaeal viruses (3) suggested that their egress from host cells may have unusual traits that are different from those of bacterial viruses. Indeed, although most archaeal viruses exit cells without lysis, some, in particular the Sulfolobus islandicus rod-shaped virus 2 (SIRV2) and Sulfolobus turreted icosahedral virus (STIV), are lytic and exploit a special mechanism of virion egress (4–8). During the infection cycle of these viruses, pyramidal protrusions with sevenfold rotational symmetry form in the host cell membrane. As the final step of the infection cycle the virus-associated pyramids (VAPs) open outwards along the seams of their seven facets, creating ∼100-nm apertures through which the newly formed virions escape from the host cell (4, 7). VAPs consist of multiple copies of an ∼10-kDa virus-encoded protein, which we term “PVAP” (Protein forming Virus-Associated Pyramids/SIRV2_P98) (7–9). Surprisingly, PVAP assembles into membrane pyramids even when expressed heterologously in archaeal and bacterial expression systems, demonstrating that no other viral proteins are required for VAP formation (7). The mechanism by which VAPs self-assembles in the membrane remains unknown.In the present study we used electron cryotomography to investigate morphological features of SIRV2 replication and the formation of VAPs at different time points after infection. By subtomogram averaging, we determined a 3D map of the VAP. This map, in combination with secondary structure predictions of PVAP and the expression of wild-type (WT) PVAP or a variety of truncation mutants in archaeal, bacterial and eukaryotic cells allows us to propose a model showing how PVAP arranges to form the sevenfold pyramids. These insights are fundamental for understanding how this mechanism can be exploited as a universal tool to engineer the formation and controlled opening of large pores in biological or artificial lipid bilayers.     

Colorectal Cancer Screening Among American Indians in a Pacific Northwest Tribe: Cowlitz Tribal BRFSS Project, 2009–2010

Objectives

Colorectal cancer (CRC) screening is low among American Indians (AIs). We describe the demographics, health status, prevalence of modifiable CRC risk factors, and use of CRC screening modalities in a Pacific Northwest AI tribe.

Methods

We conducted a survey among Cowlitz tribal members using a Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. We analyzed demographic, health status, behavioral risk factor, and CRC screening variables. Using the Washington State 2010 BRFSS, we compared tribal members with non-Hispanic white (NHW) people. We used logistic regression to examine factors associated with CRC screening for tribal members.

Results

A greater proportion of tribal members than NHW people reported living below the federal poverty level (12% vs. 7%, p=0.013). A greater proportion of tribal members than NHW people aged ≥50 years had poor self-reported health (27% vs. 16%, p=0.006) and were without health insurance (12% vs. 6%, p=0.004). A greater proportion of tribal members than NHW people had a fecal occult blood test within the past year (20% vs. 13%, p=0.006). Being 60–69 years of age (odds ratio [OR] = 2.6, 95% confidence interval [CI] 1.4, 4.9), ≥70 years of age (OR=2.2, 95% CI 1.1, 4.5), and having a personal health-care provider (OR=3.7, 95% CI 1.4, 9.6) were associated with increased screening adherence in tribal members.

Conclusion

Data from the Cowlitz Tribal BRFSS demonstrate that members are receiving CRC screening in the same proportions as NHW people despite lower sociodemographic and health status indicators among members. Unique characteristics of the tribe likely contribute to this finding.Cancer is the second leading cause of death among American Indian/Alaska Native (AI/AN) people; cardiovascular disease is the leading cause of death.¹ Overall, colorectal cancer (CRC) is the third most common cancer among AI/ANs behind prostate and lung cancer for men and breast and lung cancer for women.^2,3 In the most recent “Annual Report to the Nation on the Status of Cancer,” the incidence of CRC decreased among men and women in all racial/ethnic groups except AI/ANs.⁴Based on the Surveillance, Epidemiology, and End Results (SEER) program, the incidence of CRC is lower for AI/AN people than for those in other racial/ethnic groups.⁵ However, regional diversity in CRC incidence and racial misclassification can bias these nationwide estimates.^3,6,7 One strategy to overcome these biases is to link Indian Health Service (IHS) records with state cancer registries. Using the linkage strategy, researchers in the Pacific Northwest have found that the incidence of CRC is greater, and “one- and five-year CRC-related survival is lower among Pacific Northwest AI/ANs than among non-Hispanic white (NHW) people”⁷ (Unpublished thesis. Peterson PS. Colorectal cancer survival among American Indian and Alaska Native people in the Pacific Northwest. Oregon Health and Science University, 2011). Thus, investigations are needed to understand CRC screening patterns in this region, as well as barriers to screening that are unique to these tribal communities.Self-reported history of CRC screening is lower among AI/ANs than among NHW people.⁸ IHS Government Performance and Results Act (GPRA) data indicate improvement in CRC screening adherence among AI/ANs nationwide; however, these numbers are significantly lower than the Healthy People 2020 target of 70.5%.^9,10 According to GPRA 2010 data, the percentage of CRC screening adherence among IHS tribal users in the Pacific Northwest aged ≥50 years was 38%.¹⁰CRC screening behaviors vary regionally and are influenced by a complex set of sociodemographic, health-care-access, and cultural factors.^11–13 Among Northern Plain and Southwest AIs, Perdue et al. found an inverse association between cultural identity measures and screening by endoscopy or colonoscopy, but no trend with fecal occult blood tests (FOBTs).¹¹ In a study conducted in Alaska and the Southwest, researchers demonstrated that age >60 years, state of residence, urban residence, higher education, family history of CRC, former smoking, multiple medical conditions, English language spoken at home, and higher income were factors associated with an increase in age-appropriate CRC screening.¹² In another study conducted among AIs in North Carolina, self-rated health status, nonsmoking, and physical activity were associated with CRC screening.¹³While progress has been made, disparities persist in CRC screening, incidence of CRC cases, and CRC-related mortality in AI/ANs nationwide, including in the Pacific Northwest.^2–10 To date, no published research has addressed factors associated with CRC screening in Pacific Northwest tribes. The Cowlitz Tribal Behavioral Risk Factor Surveillance System (BRFSS) Project 2009–2010 provided a unique opportunity to investigate the health information of a tribe that has not been previously studied and to gain a better understanding of factors associated with cancer screening behaviors in this at-risk population.     

Timeliness of infant vaccination and factors related with delay in Flanders,Belgium

Achieving high vaccination coverage is a necessary, but not a sufficient indicator of the quality of a vaccination programme, in terms of control and prevention of childhood infectious diseases. For optimal protection of infants, timeliness of vaccination is increasingly recognized as another important target.     

Breastfeeding after maternal immunisation during pregnancy: Providing immunological protection to the newborn: A review

Vaccination during pregnancy results in an augmentation of disease specific maternal antibodies. Immunoglobulin G (IgG) is mainly transferred through the placenta during the third trimester of pregnancy, while secretory Immunoglobulin A (sIgA) is passed through breast milk. At birth, newborns are partially protected against infectious diseases by these antibodies.