A novel T‐cell receptor mimic defines dendritic cells that present an immunodominant West Nile virus epitope in mice

We used a newly generated T‐cell receptor mimic monoclonal antibody (TCRm MAb) that recognizes a known nonself immunodominant peptide epitope from West Nile virus (WNV) NS4B protein to investigate epitope presentation after virus infection in C57BL/6 mice. Previous studies suggested that peptides of different length, either SSVWNATTAI (10‐mer) or SSVWNATTA (9‐mer) in complex with class I MHC antigen H‐2D^b, were immunodominant after WNV infection. Our data establish that both peptides are presented on the cell surface after WNV infection and that CD8⁺ T cells can detect 10‐ and 9‐mer length variants similarly. This result varies from the idea that a given T‐cell receptor (TCR) prefers a single peptide length bound to its cognate class I MHC. In separate WNV infection studies with the TCRm MAb, we show that in vivo the 10‐mer was presented on the surface of uninfected and infected CD8α⁺CD11c⁺ dendritic cells, which suggests the use of direct and cross‐presentation pathways. In contrast, CD11b⁺CD11c^? cells bound the TCRm MAb only when they were infected. Our study demonstrates that TCR recognition of peptides is not limited to certain peptide lengths and that TCRm MAbs can be used to dissect the cell‐type specific mechanisms of antigen presentation in vivo.     

Unintended Consequences of Implementing a National Performance Measurement System into Local Practice

BACKGROUND  

Although benefits of performance measurement (PM) systems have been well documented, there is little research on negative unintended consequences of performance measurement systems in primary care. To optimize PM systems, a better understanding is needed of the types of negative unintended consequences that occur and of their causal antecedents.     

Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa

Ninety subjects with DSM-III-R anorexia nervosa were randomly allocated to four treatment options, one inpatient, two outpatient, and one comprising an assessment interview only. Twenty were thus offered a package of outpatient individual and family psychotherapy. At 2-year follow-up, 12 of the 20 were classed as well, or very nearly well, according to operationally defined criteria. Statistically significant improvements over time were obtained for weight, mean body mass index (BMI), and also for psychological, sexual, and socioeconomic adjustments. Weight and BMI changes were significantly better than for the assessment only group, some of whom had received extensive treatment elsewhere. The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented. Lower weights at presentation and vomiting were associated with poorer outcome, although age and length of history were not. © 1994 by John Wiley & Sons, Inc.     

Spontaneous reports of emotional upset and health care utilization among veterans with posttraumatic stress disorder after receiving a potentially upsetting survey

This study assessed the effects of a potentially distressing mailed survey on the emotional well-being and health care utilization (HCU) of 4,918 male and female veterans who applied for posttraumatic stress disorder disability benefits. Content analysis of spontaneous comments, in combination with analysis of subjects' HCU before and after receipt of the survey, suggested that spontaneously disclosed episodes of emotional upset were rare. In general, surveyed veterans' HCU decreased after receipt of the survey.     

The influence of understanding diagnostics on perceived stress of nurses caring for nursing home residents with dementia

Health services for nursing home residents with dementia require the expertise of highly trained nursing staff. In addition, dealing with challenging behaviour of people with dementia is often stressful for nurses and causes major difficulties for them. Being a part of the general nursing guidelines, ?understanding diagnostics? enables nursing staff to deal with challenging behaviour of persons with dementia. The primary focus of the concept is to understand the behaviour. The aim of the study was to implement and evaluate ?understanding diagnostics? through structured case conferences and the application of the 'Innovative dementia-oriented Assessment system' (IdA) in nursing homes for the first time. Nursing staff of 15 nursing homes in North- Rhine Westphalia were trained about the content and implementation of ?understanding diagnostics?. Nurses' perceived level of stress was measured before (n = 106) and after (n = 71) the intervention (9 months). The study results show positive effects on the nurses' perceived level of stress. They support the use of structured case conferences and the IdA assessment in order to understand the behaviour of nursing residents with dementia. The implementation of ?understanding diagnostics? allows nursing staff to deal with challenging behaviour of nursing home residents with dementia.     

Community-dwelling persons with dementia: What do they need? What do they demand? What do they do? A systematic review on the subjective experiences of persons with dementia

Objectives: Including the perspectives of persons with dementia (PwD) is essential in order to organize care structures for them. With this systematic review, we set out to screen the existing scientific evidence on self-expressions of community-dwelling individuals with dementia in order to provide a research base for developing an intervention for persons in early stages of the disease. The leading research questions for this review are: What needs do PwD living at home express? What are their subjective demands? What do they do to cope with their situation?

Methods: We performed a systematic literature review of review publications on subjective experiences of PwD. The publications were analysed using MAXQDA 10 to perform a thematic analysis.

Results: We identified 41 relevant reviews, of which 6 met our inclusion criteria. PwD experience the whole range of human emotions. Their needs and demands do not differ significantly from those of other groups of patients with chronic conditions. Coming to terms with the disease and maintaining normality appeared to be major themes. With regard to expectations from the side of professional health care, the need for accompanying, continuous support and counselling appeared to be central. Furthermore, disclosure of diagnosis represents a critical stage for PwD, but our findings indicated that they prefer to be included in this process.

Conclusions: PwD are well able to express their needs. They should be included in research since they can provide valuable findings. Furthermore, those findings should be implemented in applied dementia care.     

Workplace building design and office‐based workers' activity: a study of a natural experiment

Objective : This opportunistic natural study investigated the effects of relocation of office workers from a 30‐year‐old building to a new purpose‐built building. The new building included an attractive central staircase that was easily accessed and negotiated, as well as breakout spaces and a centralised facilities area. The researchers aimed to determine the impact of the purpose‐built office building on the office workers' sedentariness and level of physical activity. Method : In 2013, a natural pre‐post study was undertaken with office‐based workers in their old conventional 1970s building and on relocating to a new purpose‐built ‘activity permissive’ building. Objective movement data was measured using accelerometers. Anthropometric and demographic data was also collected. Results : Forty‐two office‐based workers significantly decreased their percentage of daily sitting time (T1 = 84.9% to T2=79.7%; p<0.001) and increased their percentage of daily standing time (T1=11.2% to T2 17.0%; p<0.001) in the new building. Moderate activity significantly declined (T1=3.9% to 3.2%=T2; p=0.038). There was a significant decrease in mean minutes of sitting time (19.62 minutes; p<0.001) and increase in standing time (22.03 minutes; p<0.001). Conclusions : The design of a building can influence activity. This opportunistic study on the impact of workplace relocation on office‐based workers' activity showed modest positive outcomes in sitting and standing. Evidence is required to inform building design policy and practice that supports physical activity and reduces levels of sedentariness in the workplace.