The CNO/CFO partnership: navigating the changing landscape.

With increasing pressure to cut costs, both real and immediate, and those forecasted and anticipated, the partnership and collaboration between nursing and finance will continue to take on new challenges. This partnership has historically been strained and does not always come easy due to differences in focus, different priorities, and inadequate communication, listening, and hearing. That needs to change and a strong CNO-CFO partnership is needed.

Biochemical, inhibition and inhibitor resistance studies of xenotropic murine leukemia virus-related virus reverse transcriptase.

We report key mechanistic differences between the reverse transcriptases (RT) of human immunodeficiency virus type-1 (HIV-1) and of xenotropic murine leukemia virus-related virus (XMRV), a gammaretrovirus that can infect human cells. Steady and pre-steady state kinetics demonstrated that XMRV RT is significantly less efficient in DNA synthesis and in unblocking chain-terminated primers. Surface plasmon resonance experiments showed that the gammaretroviral enzyme has a remarkably higher dissociation rate (k(off)) from DNA, which also results in lower processivity than HIV-1 RT.

Push, pull, and reverse: self-interest, responsibility, and the global health care worker shortage.

The world is suffering from a dearth of health care workers, and sub-Saharan Africa, an area of great need, is experiencing the worst shortage. Developed countries are making the problem worse by luring health care workers away from the countries that need them most, while developing countries do not have the resources to stem the flow or even replace those lost. Postmodern philosopher Emmanuel Levinas offers a unique ethical framework that is helpful in assessing both the irresponsibility inherent in the current global health care situation and the responsibility and obligation held by the stakeholders involved in this global crisis.

A clinical index to stratify hospitalized older adults according to risk for new-onset disability.

Background: Many older adults who are independent prior to hospitalization develop a new disability by hospital discharge. Early risk stratification for new-onset disability may improve care. Thus, this study's objective was to develop and validate a clinical index to determine, at admission, risk for new-onset disability among older, hospitalized adults at discharge.

Long-term outcomes following positive fecal occult blood test results in older adults: benefits and burdens.

Background: In the United States, older adults have low rates of follow-up colonoscopy after a positive fecal occult blood test (FOBT) result. The long-term outcomes of these real world practices and their associated benefits and burdens are unknown.

Methods: Longitudinal cohort study of 212 patients 70 years or older with a positive FOBT result at 4 Veteran Affairs (VA) facilities in 2001 and followed up through 2008.

The sugar ring conformation of 4'-ethynyl-2-fluoro-2'-deoxyadenosine and its recognition by the polymerase active site of HIV reverse transcriptase.

4' Ethynyl-2-fluoro-2'-deoxyadenosine (EFdA) is the most potent inhibitor of HIV reverse transcriptase (RT). We have recently named EFdA a Translocation Defective RT Inhibitor (TDRTI) because after its incorporation in the nucleic acid it blocks DNA polymerization, primarily by preventing translocation of RT on the template/primer that has EFdA at the 3'-primer end (T/PEFdA). The sugar ring conformation of EFdA may also influence RT inhibition by a) affecting the binding of EFdA triphosphate (EFdATP) at the RT active site and/or b) by preventing proper positioning of the 3'-OH of EFdA in T/PEFdA that is required for efficient DNA synthesis.

An empirical assessment of the form of utility functions.

Utility functions, which relate subjective value to physical attributes of experience, are fundamental to most decision theories. Seven experiments were conducted to test predictions of the most widely assumed mathematical forms of utility (power, log, and negative exponential), and a function proposed by Rachlin (1992). For pairs of gambles for real monetary gains, undergraduate and nonstudent subjects either reported an equalizing amount for 1 outcome that made the gambles subjectively equal or chose between gambles where the amounts were varied across trial, which allowed the equalizing amount to be estimated from their pattern of choices.

K70Q adds high-level tenofovir resistance to "Q151M complex" HIV reverse transcriptase through the enhanced discrimination mechanism.

HIV-1 carrying the "Q151M complex" reverse transcriptase (RT) mutations (A62V/V75I/F77L/F116Y/Q151M, or Q151Mc) is resistant to many FDA-approved nucleoside RT inhibitors (NRTIs), but has been considered susceptible to tenofovir disoproxil fumarate (TFV-DF or TDF). We have isolated from a TFV-DF-treated HIV patient a Q151Mc-containing clinical isolate with high phenotypic resistance to TFV-DF. Analysis of the genotypic and phenotypic testing over the course of this patient's therapy lead us to hypothesize that TFV-DF resistance emerged upon appearance of the previously unreported K70Q mutation in the Q151Mc background.

Prevalence and frequency of problems of concerned family members with a substance-using loved one.

Background: Limited research has examined the prevalence and frequency of specific problems of concerned family members and significant others (CSOs) of alcohol- or substance-using individuals (SUIs).

Objectives: We surveyed CSOs of SUIs to determine the prevalence and frequency of their problems and explored whether relationship to the SUI, gender of the CSO, or living arrangements altered problem prevalence and frequency.

Methods: Non-substance-using CSOs (n=110) completed the Significant Other Survey, which asks about problems in seven domains (emotional; family; relationship; financial; health; violence; legal).

In-shoe pressure measurement and foot orthosis research: a giant leap forward or a step too far?

Foot orthoses are believed to exert their therapeutic effect on the human locomotor apparatus by altering the location, magnitude, and temporal patterns of ground reaction forces acting on the plantar foot during weightbearing activities. In-shoe pressure-measurement systems are increasingly being used by clinicians and researchers to assess kinetic changes at the foot-orthosis interface to better understand the function of foot orthoses and to derive more efficacious treatments for many painful foot and lower-extremity abnormalities. This article explores how the inherent three-dimensional surface topography and load-deformation characteristics of foot orthoses may challenge the validity, reliability, and clinical usefulness of the data obtained from in-shoe pressure-measurement systems in the context of foot orthotic therapy and research.

Lack of follow-up after fecal occult blood testing in older adults: inappropriate screening or failure to follow up?

Background: It is unclear whether lack of follow-up after screening fecal occult blood testing (FOBT) in older adults is due to screening patients whose comorbidity or preferences do not permit follow-up vs failure to complete follow-up in healthy patients.

Methods: A prospective cohort study of 2410 patients 70 years or older screened with FOBT was conducted at 4 Veteran Affairs (VA) medical centers from January 1 to December 31, 2001. The main outcome measure was receipt of follow-up within 1 year of FOBT based on national VA and Medicare data.

The N348I mutation at the connection subdomain of HIV-1 reverse transcriptase decreases binding to nevirapine.

The N348I mutation at the connection subdomain of HIV-1 reverse transcriptase (RT) confers clinically significant resistance to both nucleoside and non-nucleoside RT inhibitors (NNRTIs) by mechanisms that are not well understood. We used transient kinetics to characterize the enzymatic properties of N348I RT and determine the biochemical mechanism of resistance to the NNRTI nevirapine (NVP). We demonstrate that changes distant from the NNRTI binding pocket decrease inhibitor binding (increase K(d)(-NVP)) by primarily decreasing the association rate of the inhibitor (k(on-NVP)).

Are your nurse managers ready for health care reform? Consider the 8 'Es'.

The most significant investment a nursing executive can make in an organization and to the delivery of quality patient care is the development of current and future front-line nurse managers. We are on the brink of massive changes in access and the delivery of health care. The front-line manager is in a critical position to make it all work and deliver what the public wants: better access, improved quality, and less cost.

Feasibility and effectiveness of computer-based therapy in community treatment.

Computerized therapy approaches may expand the reach of evidence-based treatment; however, it is unclear how to integrate these therapies into community-based treatment. We conducted a two-phase pilot study to explore (a) whether clients' use of the Therapeutic Education System (TES), a Web-based community reinforcement approach (CRA) learning program, would benefit them in the absence of counselor support and (b) whether counselors and clients would use the TES in the absence of tangible research-based reinforcement. In Phase 1, clients in the TES condition (n = 14) demonstrated large improvements in knowledge, F(1, 20) = 8.

Extended voucher-based reinforcement therapy for long-term drug abstinence.

Objective: To determine whether longer durations of voucher-based reinforcement therapy (VBRT) increase long-term abstinence compared to standard durations.

Methods: Cocaine-abusing or dependent methadone-maintenance patients (N = 130) were randomized to receive either Standard (12-week; n = 62) or Extended (36-week; n = 68) VBRT. Participants provided 3 urine samples weekly during VBRT, and each cocaine-negative sample produced a voucher exchangeable for goods and services.

A lexicon for measuring maintenance of behavior change.

Objectives: To establish a workgroup within the NIH-funded Health Maintenance Consortium (HMC) to examine how "maintenance" of behavior change was conceptualized and measured across and within behaviors.

Methods: Multiple meetings were held by the workgroup to reach consensus definitions of maintenance and maintenance-related constructs across diet/nutrition, tobacco, substance abuse, and physical activity. Once consensus was reached, a survey assessed how maintenance was operationalized across 16 HMC intervention studies.

Resets do not appear to increase the rate of adverse events or prolong relapse in voucher-based reinforcement therapy.

Voucher-based reinforcement therapy (VBRT) is an efficacious contingency management intervention for substance use disorders that provides escalating voucher values to reinforce continuous abstinence and typically resets escalated values to the initial low level upon detection of drug use. The objective of this study involving 130 methadone-maintained outpatients receiving VBRT was to investigate whether resets (a) increase risk for adverse events (AEs) and (b) delay return to abstinence in relation to magnitude of voucher reset. Weeks following resets were examined for increased likelihood of AEs using a Poisson regression.

Measurement uncertainty in pulmonary vascular input impedance and characteristic impedance estimated from pulsed-wave Doppler ultrasound and pressure: clinical studies on 57 pediatric patients.

Pulmonary vascular input impedance better characterizes right ventricular (RV) afterload and disease outcomes in pulmonary hypertension compared to the standard clinical diagnostic, pulmonary vascular resistance (PVR). Early efforts to measure impedance were not routine, involving open-chest measurement. Recently, the use of pulsed-wave (PW) Doppler-measured velocity to non-invasively estimate instantaneous flow has made impedance measurement more practical.

Structural Aspects of Drug Resistance and Inhibition of HIV-1 Reverse Transcriptase.

HIV-1 Reverse Transcriptase (HIV-1 RT) has been the target of numerous approved anti-AIDS drugs that are key components of Highly Active Anti-Retroviral Therapies (HAART). It remains the target of extensive structural studies that continue unabated for almost twenty years. The crystal structures of wild-type or drug-resistant mutant HIV RTs in the unliganded form or in complex with substrates and/or drugs have offered valuable glimpses into the enzyme's folding and its interactions with DNA and dNTP substrates, as well as with nucleos(t)ide reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTIs) drugs.

Beyond the classroom to coaching: preparing new nurse managers.

Few would question that frontline nurse managers are critical to the success of any organization. They are the key interface with patients, nursing staff, medical staff, other clinical and ancillary staff, and administration. This makes the role one of the most difficult and one of the most important in any healthcare setting.

The hierarchical structure of self-reported impulsivity.

The hierarchical structure of 95 self-reported impulsivity items, along with delay-discount rates for money, was examined. A large sample of college students participated in the study (N = 407). Items represented every previously proposed dimension of self-reported impulsivity.

Shaping smoking cessation in hard-to-treat smokers.

Objective: Contingency management (CM) effectively treats addictions by providing abstinence incentives. However, CM fails for many who do not readily become abstinent and earn incentives. Shaping may improve outcomes in these hard-to-treat (HTT) individuals.

Beliefs about the empirical support of drug abuse treatment interventions: a survey of outpatient treatment providers.

This study assessed substance abuse treatment providers' beliefs about empirically supported treatments (ESTs) to determine if providing information about empirical support for interventions would change beliefs. Treatment providers (N=136) completed an interview regarding five interventions with varied empirical support: contingency management (CM), motivational interviewing (MI), relapse prevention (RP), 12-step approaches (TSA), and verbal confrontation (VC). Participants then read primers describing empirical support for each intervention prior to completing a repeat interview.

Mechanism of inhibition of HIV-1 reverse transcriptase by 4'-Ethynyl-2-fluoro-2'-deoxyadenosine triphosphate, a translocation-defective reverse transcriptase inhibitor.

Nucleoside reverse transcriptase inhibitors (NRTIs) are employed in first line therapies for the treatment of human immunodeficiency virus (HIV) infection. They generally lack a 3'-hydroxyl group, and thus when incorporated into the nascent DNA they prevent further elongation. In this report we show that 4'-ethynyl-2-fluoro-2'-deoxyadenosine (EFdA), a nucleoside analog that retains a 3'-hydroxyl moiety, inhibited HIV-1 replication in activated peripheral blood mononuclear cells with an EC(50) of 0.