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A measure of linear influence between patient and therapist.

This paper describes the application of the cross-correlation function (CCF) to four quantified dimensions of the therapeutic consultation dialogue: newness of themes, degree of narration, and positive and negative thematic tone of images. A 10-min. window was used to study lag relationships in both directions of effect--from therapist to patient and the reverse. This measure of linear influence was applied to six psychotherapeutic consultation sessions carried out by different well known psychoanalysts with two women patients. Analysis showed a range of significant CCF effects that totaled from zero to 1360 sec. depending on the consultation. The implications of these and other findings are discussed in the context of viewing the present study as part of a program of investigations into the nonexperimental nature--the underlying laws, structures, and transactions--of therapeutic and everyday emotional dialogues.

Communication↗

Multidimensional stress management in nursing education.

This study investigated the effectiveness of multidimensional stress management training for beginning baccalaureate nursing students (N = 57). An experimental pretest-posttest placebo group, control group design was used. Two pretest and three posttest measurements of the dependent variables of state anxiety (SA), reported emotions, and coping methods were completed. The program incorporated cognitive, physiological, and behavioral approaches. Second, this study examined the relationship of self-esteem, recent life experiences, and trait anxiety (TA) to encountered stressors. A repeated measures analysis of variance demonstrated no significant differences between treatment groups across time. However, written workshop evaluations demonstrated a strongly positive response by the experimental group. Significant within-subjects change was demonstrated for all 57 subjects over the semester on the dependent variables of SA, Threat emotions, and Challenge emotions reinforcing Lazarus' transactional model. A correlation matrix revealed that individuals with low self-esteem appraised the environment in a negative manner as did those subjects with high state and TA. Recommendations include further revision of the multidimensional stress management approach and continued use of the transactional theoretical framework.

Adaptation, Psychological↗

[Multidimensional assessment of coping: validation of the Brief COPE among French population].

This Article aims to introduce the translation and the validation of a multidimensional measure of coping strategies: the Brief COPE, in a French population. The coping concept comes from psychological studies that were conducted on stress. In the conceptual analysis of stress by Lazarus and Folkman, coping works with two cognitive appraisals performed by the person concerning the perception of a threatening situation and his or her available resources to deal with it. Coping is defined as "cognitive and behavioural efforts to master, reduce, or tolerate the internal and/or external demands that are created by the stressful transaction". The Brief COPE is the abridged version of the COPE inventory and presents fourteen scales all assessing different coping dimensions: 1) active coping, 2) planning, 3) using instrumental support, 4) using emotional support, 5) venting, 6) behavioural disengagement, 7) self-distraction, 8) self-blame, 9) positive reframing, 10) humor, 11) denial, 12) acceptance, 13) religion, and 14) substance use. Each scale contains two items (28 altogether). This inventory has the advantage of being built from acknowledged theoretical models (Lazarus' transactional model of stress, 1984; behavioral self-regulation model, Carver and Scheier, 1981, 1998). It can be used to assess trait coping (the usual way people cope with stress in everyday life) and state coping (the particular way people cope with a specific stressful situation). As is the COPE inventory, the Brief COPE is a measure used for many health-relevant studies: drugs addiction, ageing, breast cancer, depression, AIDS. Both measures are widely used in Anglophone countries and translated in many Languages. Today, the COPE inventory has been validated among Estonian, Croatian, Chinese, and Italian populations and the Brief COPE is also validated among Spanish people. Thus, the worldwide use of this coping inventory should allow a broad comparison of medical and psychological research for coping strategies regarding every kind of pathologies. Thus, we were led to present the translation and the validation of this measure in a French population. Two studies are presented in this Article: the first one describes the validation of the inventory in a dispositional format (trait coping) and the second one the validation of the inventory in a situational format (state coping). The French version of Brief COPE, which was used for both studies, was back-translated and analysed by the Brief COPE Author: Charles S. Carver. For study 1, 834 first Year university students answered the Brief COPE in its dispositional format. To study the factor structure of the Brief COPE, we used structural equation modeling and the LISREL software. Results show that the expected theoretical structure and the observed one fit adequately (c2=606, p<0,05, RMSEA=0,04, GFI>0,95, AGFI>0,92, RMR<0,03). In order to study convergent and discriminant validity of Brief COPE, self-esteem (SEI, Rosenberg, 1979), perceived stress (PSS, Cohen et al., 1983), and psychological distress (GHQ-12, Goldberg, 1972) measures were used. Results show that functional coping strategies (eg, active coping) are linked to good self-esteem, to lower perceived stress, and to lower psychological distress, whereas less functional strategies (eg, denial or self-blame) are widely linked to poor self-esteem, to a high perceived stress, and to psychological distress. Study 1 shows also several significant gender differences. Study 2 describes the Brief COPE validation in its situational format. 178 additional students answered this version. The method that was used is the same the one developed by Lazarus and his colleagues for the WCC validation. Participants were asked to recall and think about the most stressful event they had experienced during the past two Months. They were also to give an account of how much that situation mattered to them. They had to evaluate their capacity to control the situation and indicated whether they felt the situation was amenable to change. The study includes only peoples only people who labeled an event as "important" or "very important". Here again LISREL was used to study the factor structure of the Brief COPE. The results emphasise - as in study 1 - that the expected theoretical structure and the observed one fit adequately (c2=391, p<0,05, RMSEA<0,05, GFI=0,87, AGFI=0,80, RMR<0,06). Differences among means showed how the perceived control of the situation and how the perception of its favourable evolution influenced the coping strategies used (eg, humour or denial). Results in both studies indicate good psychometric properties for the Brief COPE in its French version, whatever the format (ie, dispositional or situational). Thus French searchers have a relevant tool on hand to measure as accurately as possible the coping strategies someone used in everyday life (strategies interfering on health, on a long scale), or in distressful situations (eg, serious illness, traumas). The fact that this easy-to-use coping measure is worldwide spread among medical and psychological studies allows a better broadcast and comparison of results whatever the pathology.

Adaptation, Psychological↗

Improving the quality of ambulatory health care with enhanced medical information systems: using the computer to diagnose faulty clinical processes.

The lack of consistency in the performance of the processes which implement clinical decisions is an important problem in ambulatory care. Since delayed or neglected actions in patient care may have serious consequences, we studied the use of industrial quality management techniques to determine where three clinical processes could be improved. These quantitative and graphical tools were useful in showing that in some processes, the failure rate could be as high as 33%. However, lack of readily available process data prevented a full analysis of the extent of the failures, so specific suggestions for improvement could not be made. Medical informatics and management specialists have an important role in designing enhanced medical information systems with which to examine and improve patient care processes. This new generation of MIS's should include order entry systems with flags for selected transactions, audit trails for all automated processes, functional integration of the separate departmental information systems, and enhanced communications features.

Ambulatory Care↗

Reverse transcriptase associated with the biosynthesis of the branched RNA-linked msDNA in Myxococcus xanthus.

Myxobacteria have been shown to produce a peculiar RNA-DNA complex called msDNA, in which a single-stranded DNA is branched out from a RNA molecule (msdRNA) by a 2',5' phosphodiester linkage. It has been predicted that reverse transcriptase is required for msDNA biosynthesis. We identified a gene for reverse transcriptase in M. xanthus in the region that has been demonstrated to code for a cis- or transacting element for msDNA synthesis. This gene is located immediately downstream of the msdRNA coding region, and codes for a polypeptide of 485 amino acid residues. The polypeptide shows sequence similarity with retroviral reverse transcriptases. This fact, together with the mode of msDNA synthesis, suggests a possible relationship between retroviruses and the msDNA system. The analysis of the gene and the distribution of the msDNA system in independent isolates of M. xanthus indicate that the element is as old as other essential genes in M. xanthus and that it was not recently acquired into the genome.

Amino Acid Sequence↗

Fundamental dimensions of subjective state in performance settings: task engagement, distress, and worry.

Subjective state constructs are defined within the traditional domains of affect, motivation, and cognition. Currently, there is no overarching state model that interrelates constructs within the different domains. This article reports 3 studies that provide converging evidence for 3 fundamental state dimensions labeled task engagement, distress, and worry that integrate constructs across the traditional domains. Study 1 differentiated the state dimensions by factor analysis of the scales of the Dundee Stress State Questionnaire (G. Matthews et al., 1999). Study 2 showed differential state response to performance of tasks making different cognitive demands. Study 3 showed that states are correlated with differing patterns of appraisal and coping. The 3 stress state dimensions provide a general descriptive framework consistent with transactional accounts of stress and performance.

Adaptation, Psychological↗

Measurement of stress in clinical nursing.

The Nurse Stress Checklist was developed to measure stress in clinical nursing as a multidimensional construct. The instrument was formulated within a transactional model of stress. The items were derived from five domains thought to contribute to nurse stress in clinical settings and were organized into a questionnaire. Holmes Schedule of Recent Events was included as a validity measure. The instrument was tested on 104 staff nurses working in three institutions in an urban community. Exploratory factor analysis was applied to the 74 items presented to subjects in Likert-type format. Five factors were derived and subjected to psychometric evaluation. Internal consistency reliability for the five factors was good, ranging from 0.80 to 0.91. Means and measures of dispersion supported the potential of the five subscales to discriminate among respondents on the attributes being measured. Intercorrelations of the factors provided evidence of the distinctiveness of the five components of stress, although factor loadings showed some overlap between Personal Reactions and Work Concerns and Work Concerns and Work Completion Concerns. Validity of the factors also was supported by correlations with Holmes' Schedule of Recent Events. Content validity was supported by comparison of these results with findings of other investigators. Limitations of the results are discussed, and recommendations for future work on the instrument are offered.

Adult↗

Transcriptional regulation of the human c-myc gene.

The involvement of c-myc in the genesis of animal neoplasia is now well documented for several systems. In order to define the precise role played by the myc gene in tumorigenesis, a better understanding of the normal regulation of myc expression is necessary. We have begun a study of the cis-acting regulatory sequences within the 5' flanking domain of the human c-myc gene. Regions important for myc promoter function have been identified by linkage to the coding sequences of the bacterial chloramphenicol acetyltransferase (cat) gene. Promoter deletion studies and in vivo competition assays for c-myc/cat recombinant plasmids have allowed the identification of a proximal 'core' promoter region capable of directing high levels of CAT activity. Further upstream a negative regulatory element (NRE2) has been identified which is capable of repressing cat gene expression and which functions by interaction with a transacting factor(s). Preliminary data suggests detection of NRE2 is dependent on both the type and amount of carrier DNA used in transient CAT assays. Initial experiments further indicate the involvement of at least two other distal regulatory domains, a negative regulatory domain (NRE1) and a putative enhancer-type region (E). In vitro footprint analysis has allowed the identification of DNA binding proteins which interact with NRE2 and the 'core' promoter. NRE2 contains binding sites for transcription factors Sp1 and CTF. The 'core' promoter domain appears to be highly complex and possesses several Sp1 binding sites.

Animals↗

Identification of cell types in human melanoma cultures using a panel of morphological, cytochemical and immunological tests.

Although it is well known that fibroblasts can overgrow melanoma cells in culture during early passaging, some investigators have claimed recently that these fibroblast-like cells are actually melanocytes de-differentiated in vitro. In order to test these claims, we examined 27 melanoma-derived cell lines using anti-melanoma and anti-fibroblast monoclonal antibodies, the dioxyphenylalanine cytochemical reaction specific for melanocytes, the leucine aminopeptidase cytochemical reaction for fibroblast cells, and chromosomal analysis. All these assays - which discriminate melanomas from fibroblasts - confirmed our initial classification by morphology, namely that thirteen of the lines were melanocytic and twelve were fibroblastic, while the remaining two were a mixture of the two cell types. There was no indication of a mixed phenotype which would have been the result of some transaction in the state of differentiation. Our results suggest that the 27 cell lines and cultures are composed of pure melanocytic populations, or are fibroblasts as a result of fibroblast overgrowth. The two cultures containing a mixed cell population are those in which one cell type has not overtaken the other. There is no evidence to support the idea that some true melanoma cultures have the morphology of fibroblast-like cells.

Antibodies, Monoclonal↗

Child physical abuse and aggression: preliminary findings on the role of internalizing problems.

OBJECTIVE: To test the prediction that the interaction of physical abuse and internalizing problems will heighten levels of aggressive behavior in a group of disruptive children. METHOD: Fifty-two clinic-referred disruptive children (aged 7 through 15 years) were assessed in terms of history of physical abuse, internalizing behavior problems (rated by parents), and aggressive behavior (rated by parents, teachers, and clinic staff). RESULTS: Physically abused children with co-occurring high levels of internalizing problems (based on a median split) exhibited significantly higher levels of aggression as rated by parents (p < .000) and teachers (p < .020) and a trend toward heightened aggression as rated by staff (p < .08). The patterns were similar across the three independent informants and remained regardless of age, gender, or race. CONCLUSIONS: Physical abuse was related to heightened levels of aggression only in those children who also had emotional difficulties. Results lend some support to a transactional model of the development of aggression, suggesting that problems arise out of interactions between child factors (such as internalizing problems) and adverse family experiences (such as physical abuse).

Adolescent↗

Rapid reprogramming of globin gene expression in transient heterokaryons.

Interspecific heterokaryons were formed by fusing adult mouse erythroleukemia (MEL) cells and human embryonic/fetal erythroid (K562) cells with each other, or with a variety of mouse and human nonerythroid cell types. Analysis of total cellular RNA isolated 24 hr after fusion revealed that normally inactive globin genes can be activated in these "transient" heterokaryons, in which the nuclei do not fuse. In general, the types of globin genes expressed in the donor erythroid cell are activated in the nucleus of the recipient cell. Therefore, erythroid cells contain transacting regulatory factors that are capable of activating the expression of globin genes in a stage- and tissue-specific manner. These observations also indicate that globin genes are not irreversibly repressed in differentiated cells and that their expression can be rapidly reprogrammed in the presence of the appropriate regulatory factors.

Animals↗

Characterization of a corticotropin-releasing hormone-responsive element in the rat proopiomelanocortin gene promoter and molecular cloning of its binding protein.

A corticotropin-releasing hormone (CRH) and cAMP-responsive region (-236/-133) in the rat POMC gene promoter previously reported to confer CRH/cAMP responsiveness to heterologous reporter constructs has been characterized. DNAse footprint analysis revealed that multiple elements in this region were bound by nuclear proteins from the POMC expressing AtT20 cells. When these individual DNA elements were separately tested in heterologous reporter constructs for CRH induction, only one element, designated PCRH-RE (POMC CRH responsive element, -171/-160) was found to give strong CRH stimulation (5- to 7-fold). This element appears novel as to the possible binding factors, although it has homology to the mouse metallothionein metal regulatory element. Gel shift analyses of the PCRH-RE with AtT20 cell nuclear extracts showed marked stimulation of retarded nucleoproteins following CRH stimulation, suggesting that the possible binding factor(s) may mediate transcriptional regulation at this site. The activity of PCRH-RE binding protein was inhibited by divalent cations, with Cu2+ and Cd2+ being most effective; Zn2+ had no effect, indicating that this binding factor(s) is functionally distinct from the metallothionein metal regulatory element binding protein. A 2.6 kilobase cDNA clone encoding a protein (PCRH-REB-1) binding to this element was isolated by Southwestern screening of an AtT20 expression library with radiolabeled PCRH-RE oligonucleotides. This clone was used to isolate several other cDNA clones to determine the sequence corresponding to the entire coding region of the protein (PCRH-REB), which proved to be identical to a recently described DNA binding protein of the replication factor C complex, mRFC140/Mouse Southwestern. Primer extension and Northern blot analysis revealed that the size of the full length mRNA is about 4.9 kilobases. PCRH-REB mRNA expression is not restricted to corticotrophs but is present in a broad tissue distribution as evaluated by reverse transcription polymerase chain reaction analysis. A bacterially expressed beta-galactosidase-PCRH-REB-1 fusion protein was shown to bind PCRH-RE efficiently. Furthermore, binding of the PCRH-REB-1 fusion protein to the POMC CRH-responsive element was inhibited by divalent cations with similar sensitivities to those observed using AtT20 nuclear extracts. The predicted PCHR-REB protein sequence presents several interesting motifs: one p-Loop motif (ATP binding site), nine protein kinase A phosphorylation sites (implying a possible role in responding to the CRH-induced cAMP signal), and regions of homology to proteins involved in DNA replication and repair. PCRH-REB is, therefore, a potential transacting factor binding to a major CRH-responsive element in the POMC promoter.

Animals↗

Y box-binding protein-1 binds preferentially to single-stranded nucleic acids and exhibits 3'-->5' exonuclease activity.

We have previously shown that Y box-binding protein-1 (YB-1) binds preferentially to cisplatin-modified Y box sequences. Based on structural and biochemical data, we predicted that this protein binds single-stranded nucleic acids. In the present study we confirmed the prediction and also discovered some unexpected functional features of YB-1. We found that the cold shock domain of the protein is necessary but not sufficient for double-stranded DNA binding while the C-tail domain interacts with both single-stranded DNA and RNA independently of the cold shock domain. In an in vitro translation system the C-tail domain of the protein inhibited translation but the cold shock domain did not. Both in vitro pull-down and in vivo co-immunoprecipitation assays revealed that YB-1 can form a homodimer. Deletion analysis mapped the C-tail domain of the protein as the region of homodimerization. We also characterized an intrinsic 3'-->5' DNA exonuclease activity of the protein. The region between residues 51 and 205 of its 324-amino acid extent is required for full exonuclease activity. Our findings suggest that YB-1 functions in regulating DNA/RNA transactions and that these actions involve different domains.

Binding Sites↗

Rapid activation and down-regulation of protein kinase C alpha in 12-O-Tetradecanoylphorbol-13-acetate-induced differentiation of human rhabdomyosarcoma cells.

Human rhabdomyosarcoma RD cells express the myogenic regulatory factors MyoD and myogenin but differentiate spontaneously very poorly. Prolonged treatment of RD cells with the protein kinase C (PKC) activator 12-O-tetradecanoylphorbol-13-acetate (TPA) induces growth arrest and myogenic differentiation as shown by the accumulation of alpha-actin and myosin light and heavy chains, without affecting the expression of MyoD and myogenin. In this study, we show that short-term phorbol ester treatment of the cultures is sufficient to trigger myogenic differentiation but not growth arrest. Furthermore, PKC inhibitors, such as staurosporine or calphostin C, prevent TPA-induced differentiation but not cell growth arrest. These data suggest that the two events are mediated by different pathways; a possible interpretation is that the activation of one or more PKC isoforms mediates the induction of differentiation, whereas the down-regulation of the same or different isoforms mediates the growth arrest. To address the mechanism whereby TPA affects cell growth and differentiation in RD cells, we first analyzed PKC isoenzyme distribution. We found that RD cells express the alpha, beta 1, gamma, and sigma PKC isoenzymes. Only the alpha isoform is exclusively found in the soluble fraction, but it translocates to the membrane fraction within 5 min of TPA treatment and is completely down-regulated after 6 h. The other isoenzymes are found associated to both the soluble and the particulate fractions and are down-regulated after long-term TPA treatment. By immunofluorescence analysis, we show that the PKC alpha down-regulation is specific for those cells that respond to TPA by activating the muscle phenotype. We propose that TPA-induced differentiation in RD cells is mediated by the transient activation of PKC alpha, which activates some of the intracellular events that are necessary for MyoD and myogenin transacting activity and for the induction of terminal differentiation of RD cells. By contrast, the constitutively active beta 1 and sigma are responsible for the maintenance of cell growth, and their down-regulation is responsible for long-term TPA-induced cell growth arrest.

Amino Acid Sequence↗

Transactivation of the human interleukin-6 gene by human T-lymphotropic virus type 1 Tax protein.

Interleukin-6 (IL-6) is a multifunctional cytokine that regulates both humoral and cellular immune responses. Accumulating evidence suggests that the infection of T cells and other cell types with human T-lymphotropic virus type 1 (HTLV-1) results in the constitutive expression of IL-6. However, the underlying molecular mechanisms are little understood. When a reporter plasmid, pIL6-CAT-E3, in which the human IL-6 enhancer/promoter region from -630 to +14 was linked to the bacterial chloramphenicol acetyltransferase (CAT) gene, was transfected, HTLV-1-infected but not -uninfected T-cell lines activated the IL-6 promoter. This indicated the presence of a factor transactivating the IL-6 gene in the infected cells. To evaluate the involvement of the HTLV-1-encoded transacting factor (Tax) in this transactivation, we examined the effect of transient cotransfection with the Tax-expression plasmid, pMAX-Neo, on the transcription from the IL-6 promoter by use of COS1 cells. The cotransfected COS1 has about six-times greater the CAT activity than that transfected with pIL6-CAT-E3 alone. The analysis of a series of deletions of the IL-6 promoter suggested that the region (-105/-47) containing a NF kappa B site was crucial for the Tax responsiveness. We further examined the effect of Tax on endogenous IL-6 gene expression using the Jurkat clone, JPX-9, stably transfected with pMAX-Neo. JPX-9 accumulated steady state transcripts of the endogenous IL-6 gene in response to the induction of Tax expression. Our findings indicate an important role of the Tax protein in the expression of IL-6 in cells infected with HTLV-1.

Animals↗

The market shaping of charges, trust and abuse: health care transactions in Tanzania.

Effective health care is a relational activity, that is, it requires social relationships of trust and mutual understanding between providers and those needing and seeking care. The breakdown of these relationships is therefore impoverishing, cutting people off from a basic human capability, that of accessing of decent health care in time of need. In Tanzania as in much of Africa, health care relationships are generally also market transactions requiring out-of-pocket payment. This paper analyses the active constitution and destruction of trust within Tanzanian health care transactions, demonstrating systematic patterns both of exclusion and abuse and also of inclusion and merited trust. We triangulate evidence on charges paid and payment methods with perceptions of the trustworthiness of providers and with the socio-economic status of patients and household interviewees, distinguishing calculative, value based and personalised forms of trust. We draw on this interpretative analysis to argue that policy can support the construction of decent inclusive health care by constraining perverse market incentives that users understand to be a source of merited distrust; by assisting reputation-building and enlarging professional, managerial and public scrutiny; and by reinforcing value-based sources of trust.

Delivery of Health Care↗

[The anosognostic psychosyndrome. Studies and reflections on a case of acoustic agnosia].

We analyse structure and dynamics of anosognostic behavior by means of a case with auditory agnosia for both linguistic and non-linguistic material. First we investigate on the observational level the structural interweaving of conditions. Second we make an attempt of a structural dynamic analysis with inclusion of both neurophysiological and psychodynamic aspects within a frame which is orientated towards system theories. By doing this, the anosognostic syndrome which is describable in a phenomenalistic sense as a disturbance of body-scheme, neuropsychologically as a neglect-or extinction-syndrome and psychodynamically as regressive Ego dissolution, appears as disintegration of the transactional coherence between specific and non-specific functional systems. At the time also the relations to the structure of focal brain syndromes and organic psychoses are dealt with.

Agnosia↗

Another neural code?

This paper presents the conjecture that functional integration may be mediated by the mutual induction and maintenance of stereotyped spatiotemporal patterns of activity (i.e., transients) in different neuronal populations. In contradistinction to temporal and rate coding models of neuronal interactions, transient coding considers that transactions among neuronal systems use transient dynamics that are distributed in a structured way over both space and time. In contrast to synchronization models, transient coding does not depend on interactions at the same frequencies, in different parts of the brain, but involves covariations among different frequencies and can therefore be considered a more general form of coding. Using an analysis of the correlations among the spectral density of neuromagnetic signals, measured at different cortical regions, this hypothesis was confirmed. For example high (gamma)-frequency oscillations in the prefrontal cortex are associated with low (20 Hz)-frequency oscillations in the parietal cortex. The results are consistent with transient coding and suggest that transient dynamics endure for at least 40-200 ms. Transient coding means that correlations (rate coding) and coherence (synchrony) are neither complete nor sufficient characterizations of neuronal interactions. Although temporal coding, rate coding, and synchrony are important aspects of neuronal interactions, the results speak to further integrative neuronal mechanisms of a more general nature.

Models, Neurological↗