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Purpose To determine whether somatic or cognitive depressive symptoms affect hospitalization and death in patients with end-stage renal disease. Design and method In an observational retrospective design, the patients (n = 190) completed the Beck Depression Inventory-II at baseline and were followed for 5 years to collect data all-cause mortality and hospitalization. Findings High somatic (53.7%, n = 102) and cognitive (52.1%, n = 99) depressive symptoms scores significantly associated with mortality (38% vs. 19%; hazard ratio [HR] = 2; 95% CI, 1.1-3.7; p = 0.02) and hospitalization (62.5% vs. 49.4%; HR = 1.6; 95% CI, 1.0-2.6; p = 0.03), respectively. Practice implications In the context of diagnosing and intervening, awareness of depressive symptoms dimensionality is crucial.

Assessment of functional health literacy (FHL) is not integrated into clinical settings in Jordan possibly because relevant psychometric studies are lacking. The aim of this secondary analysis of data on family caregivers ( N = 115) was to evaluate the internal consistency reliability and construct validity of three measures of FHL among Jordanians: the Short Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), and the Single Item Literacy Screener (SILS). Cronbach’s alpha was excellent for the S-TOFHLA (.92), but suboptimal for the REALM-R (.67). In bivariate analysis, FHL measured by the S-TOFHLA and the REALM-R, but not the SILS, was positively associated with educational attainment ( p < .05) and negatively related to self-reported anxiety ( p < .05). Among Jordanians, psychometric rigor was fully demonstrated for the S-TOFHLA and partially for the REALM-R, but not for the SILS.

Family caregivers of patients with end-stage renal disease (ESRD) experience significant caregiver-related burden, yet the contribution of their functional health literacy (FHL) to caregiving burden has not been elucidated. We investigated the magnitude of FHL and caregiving burden and their association in a descriptive, correlational cross-sectional study of family caregivers of Jordanian patients with ESRD (N = 88). The short versions of the FHL for Adults and the Zarit Burden Interview were used for assessment of caregivers. Demographic and clinical information of patients and their family caregivers were self-reported. Of family caregivers, 41% had limited FHL and 38% experienced high caregiver burden. FHL and history of comorbidity in family caregivers predicted caregiving burden independent of demographic and clinical factors. Consideration of FHL in support interventions for family caregivers may minimize some of the high perceived caregiving burden, but clinical trials of such interventions are needed to confirm this conclusion.

BACKGROUND:The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) on health outcomes in critically ill patients is unclear. Yet, CKD complicated by AKI in critically ill patients is common. OBJECTIVES:To compare risk of death within one-month of admission in critically ill patients with and without pre-existing CKD who developed AKI. METHODS:A multicenter retrospective comparative study using medical records review was conducted. Study participants consisted of 826 adult patients who received mechanical ventilation for at least 6 h in the critical care units from January 2012 to December 2017. Assessment of kidney function was established by serum creatinine. Severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Chronic kidney disease was defined as eGFR > 60 ml/mg/1.73 m2 on admission. RESULTS:Pre-existing CKD was present in 55% of patients and 7% had AKI within 7 days of admission. The overall mortality rate among these patients was 87.3%. The mortality rate was highest in patients with CKD (70.1%) followed by that of patients without pre-existing CKD but with AKI (20.7%) and that of patients with pre-existing CKD (7.1%) and AKI. Risks associated with mortality were APACHE II score (1.03; 95% CI 1.02-1.05;(P

Background Little is known about changes in illness perception (IP) among patients treated with percutaneous coronary intervention (PCI). Objectives To examine changes in IP among patients undergoing PCI and examine the effects of demographics and clinical details on IP. Methods A descriptive repeated measures design was used. IP was evaluated at pre discharge time and six months’ later. Results Six months’ post PCI, patients perceived their illness as chronic, had more control over their condition, and better understanding of it. They experienced less symptoms, lower perceptions of consequences on their life and less emotional representation indicating positive changes. Receiving health education at follow-up time had a significant interaction effects on increased personal and treatment control. Having a family history of coronary heart disease associated with better understanding of illness. Conclusion Assessing patient' IP and providing health education at follow-up time should be incorporated in optimizing the care of PCI patients.

BACKGROUND Recovery among patients with cardiac disease also requires attention to their sexual health. However, cultural, religious, and social factors may make Arab Muslim patients reluctant to disclose their sexual concerns and nurses hesitant to discuss patients' sexuality matters. OBJECTIVE The aim of this study was to explore sexual counseling (SC) among nurses in Jordan in terms of responsibility, confidence, and practice. METHOD This was a descriptive, correlational study. Staff nurses were recruited from 10 hospitals in Jordan. Nurses completed the cardiac version of the Survey of Sexuality-Related Nursing Practice and reported their demographics. RESULTS The sample consisted of 379 nurses (female, 59%; mean age, 28.1 years). A significant proportion of nurses viewed assessment/discussion of patients' sexuality matters as not within their responsibilities (39%), did not feel confident to address sexuality matters (50%), and rated themselves as not at all/not very knowledgeable about sexuality (60%). Few nurses were routinely integrating SC in clinical practice (9%). Sexual counseling was associated with nurses' gender (male, higher confidence and practice) and previous training on sexuality in nursing practice. CONCLUSIONS Nurses in Jordan, especially female nurses, are neither prepared nor competent to provide SC. Nurses need focused education on sexuality to optimize patients' sexual health.

Background In developing countries, the number of adults who develop myocardial infarction (MI) at a young age is high. The popularity of waterpipe smoking (WPS) has increased among the same age group. It is unknown if WPS contributes to the incidence of early-onset MI. Objective To study the association of WPS with early-onset MI, which is defined as first MI occurring in individuals 18 ≥ age ≤ 45 years compared to those older than 45 years. Methods This was a cross-sectional study. The association of WPS with first-time MI was compared between younger and older adults (N = 225). Results Twenty-five percent of all participants developed an acute MI before the age of 46 years. Both cigarette and WPS were more common among younger first-time MI patients than older first-time MI patients. Conclusions WPS is one risk factor that distinguishes the risk profile of young adults with early-onset MI.

SUMMARYBackground Jordan has no relevant database or registry by which chronic kidney disease (CKD) would be early identified. The purpose of the present study is to uncover the prevalence of CKD in a national sample of Jordanian patients at high risk and examine the association of CKD with demographic and clinical factors. Methods This is a cross-sectional, correlational study that involved 540 outpatients at high risk for CKD. Demographic and clinical data were obtained in the period from September 2013 to March 2014. Prevalence of CKD was defined based on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Classification of CKD using estimated glomerular filtration rate. Associations of CKD and demographic and clinical factors were examined using bivariate analysis. Results The majority of the sample were females (64%), their mean age (±SD) was 55.0 ± 12.5 years, their mean eGFR (±SD) was 116.0 ± 47.5. One third of patients had eGFR of 23.5%, 5.4%, 0.7% and 0.7% which corresponds with mild, moderate, severe and very severe reduction in eGFR, respectively. Ageing, being male, unemployment, packs/years of smoking, co-morbidities [hypertension (HTN), diabetes mellitus (DM) and cardiovascular disease] and low high density lipoprotein (HDL) correlated positively with development of CKD. Conclusion This study demonstrates a high rate of under-diagnosed CKD among Jordanians. Several demographic and clinical factors are linked with the development of CKD. Policymakers and healthcare providers need to establish an evidence-based practice project to prevent and screen for CKD in Jordan.

Adolescent pregnancy and early motherhood are associated with poor social and physical outcomes. This study explored the experiences of marriage and motherhood among Jordanian young women. A descriptive qualitative design was employed. Participants (n = 15, age 15-37 years) who had experienced adolescent marriage and motherhood and who lived in eastern Amman, the capital of Jordan, were selected via snowball sampling. Data were collected by tape-recorded face-to-face interviews and analysed thematically. Five themes were identified: lost opportunities for personal development, learning to be submissive and indecisive, uncertainty toward cultural norms, ambivalent feelings toward a maternal role and empowering oneself to face life demands. The findings indicate that the experience of marriage and motherhood among Jordanian adolescents was mostly negative; they felt that they had been deprived of their rights, respect and the experience of being a young person. Additionally, they felt that the transition into motherhood was very difficult, and that they were prematurely forced into adult social roles and responsibilities, which caused them to experience numerous challenges. Adolescent mothers are a vulnerable group that should be better targeted by prevention and intervention measures.

Background Patients with heart failure (HF) experience multiple psychologic symptoms. Depression and anxiety are independently associated with survival. Whether co-morbid symptoms of anxiety and depression are associated with outcomes in patients with HF is unknown. Objective To determine whether co-morbid symptoms of depression and anxiety are associated with all-cause mortality or rehospitalization for cardiac causes in patients with HF. Method A total of 1260 patients with HF participated in this study. Cox regression analysis was used to determine whether co-morbid symptoms of depression and anxiety independently predicted all-cause mortality and cardiac rehospitalization. Anxiety and depression were treated first as continuous-level variables, then as categorical variables using standard published cut points. Patients were then divided into 4 groups based on the presence of anxiety and depression symptoms. Results When entered as a continuous variable, the interaction between anxiety and depression (hazard ratio=1.02; 95% CI: 1.01–1.03; p = 0.002) was a significant predictor of all-cause mortality in patients with HF. When entered as a categorical variable, co-morbid symptoms of depression and anxiety (vs no symptoms or symptoms of anxiety or depression alone) independently predicted all-cause mortality (hazard ratio=2.59; 95% CI: 1.49–4.49; p = 0.001). None of the psychologic variables was a predictor of cardiac rehospitalization in patients with HF whether using the continuous or categorical level of measurement. Conclusion To improve mortality outcomes in patients with HF, attention must be paid by health care providers to the assessment and management of co-morbid symptoms of depression and anxiety.

Correspondence to Mona A. AbedE-mail: Maabed2@g.uky.eduMona A. AbedAssistant ProfessorCollege of NursingHashemite UniversityZarqa 13115, JordanAmani A. KhalilAssociate ProfessorFaculty of NursingThe University of JordanAmman, JordanDebra K. MoserProfessorCollege of NursingUniversity of KentuckyLexington KYSchool of NursingUniversity of Ulster,Belfast, IrelandAbstract: Qualitative investigators have suggested that symptom incongruence,or a mismatch between symptoms that patients expect and those they experiencein acute myocardial infarction (AMI), increases the time to hospitalization by affect-ing emotional, cognitive, and behavioral factors. No quantitative studies have beenconducted that verify these relationships. We aimed to (a) examine the relation-ships among symptom incongruence, prehospital delay, anxiety level at onset ofsymptoms, perceived seriousness and importance of symptoms, source to whichsymptoms were attributed, and patients’ first response at symptom onset and (b)test the independent association of symptom incongruence to prehospital delay.Jordanian patients with AMI (n¼299) were interviewed using validated question-naires, and medical records were reviewed to collect information on patients’prehospital delay time, symptom incongruence, and response to AMI symptoms.Patients had low mean (7.5 3.6) symptom incongruence scores (range 0–21 outof 24) and relatively short median prehospital delay (1.3hours). Symptom incon-gruence was positively correlated with and independently predicted prehospitaldelay. Greater anxiety and greater perceived seriousness and importance of symp-toms were associated with less incongruence and shorter prehospital delay.Patients who attributed their symptoms to a cardiac etiology had significantlyshorter prehospital delay and less symptom incongruence than their counterparts.Patients who contacted the emergency medical service directly after symptomonset had shorter prehospital delay than their counterparts who did not, but did notdiffer on the level of symptom incongruence. Symptom incongruence may increaseprehospital delay by complicating patients’ efforts to label and respond to AMIsymptoms.

Jordan has no relevant database or registry by which chronic kidney disease (CKD) would be early identified. The purpose of the present study is to uncover the prevalence of CKD in a national sample of Jordanian patients at high risk and examine the association of CKD with demographic and clinical factors.This is a cross-sectional, correlational study that involved 540 outpatients at high risk for CKD. Demographic and clinical data were obtained in the period from September 2013 to March 2014. Prevalence of CKD was defined based on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Classification of CKD using estimated glomerular filtration rate. Associations of CKD and demographic and clinical factors were examined using bivariate analysis.The majority of the sample were females (64%), their mean age (±SD) was 55.0 ± 12.5 years, their mean eGFR (±SD) was 116.0 ± 47.5. One third of patients had eGFR of 23.5%, 5.4%, 0.7% and 0.7% which corresponds with mild, moderate, severe and very severe reduction in eGFR, respectively. Ageing, being male, unemployment, packs/years of smoking, co-morbidities [hypertension (HTN), diabetes mellitus (DM) and cardiovascular disease] and low high density lipoprotein (HDL) correlated positively with development of CKD.This study demonstrates a high rate of under-diagnosed CKD among Jordanians. Several demographic and clinical factors are linked with the development of CKD. Policymakers and healthcare providers need to establish an evidence-based practice project to prevent and screen for CKD in Jordan.

Public understanding of chronic kidney disease (CKD) is important to ensure informed participation in CKD prevention programs. This study aimed to develop and to test the psychometric profile of the CKD Screening Index that measures patient's knowledge, attitudes, and practices regarding CKD prevention and early detection.A cross-sectional design was implemented and a total of 740 Jordanian patients recognized at risk for CKD were recruited by convenience sampling from out-patient departments. Development and psychometric validation of the CKD Screening Index were conducted in four phases: (1) item generation, (2) pilot study, (3) preliminary psychometric validation study to examine factor structure, and (4) final psychometric validation with 740 participants.On factor analysis, 24 items categorical knowledge items loaded into one factor and yielded a Guttman Split-Half Coefficient of 0.80. In a separate factor analysis, 15 items were loaded on two attitude factors (Cronbach alpha coefficient = 0.69), and nine items loaded on two practice factors (Cronbach alpha coefficient = 0.68). The CKD Screening Index associated significantly and negatively with depressed and anxious patients compared to their counterparts.This promising CKD Screening Index can be used for an early identification of patients at risk for CKD, thus, allowing the development of interventions to raise these patients' awareness. Future studies are needed on other populations with different cultural background to support reliability and validity of this new instrument.

Aims and objectives. The purpose of this study is to provide insight into the relationship between dietary and fluid non-adherence, depressive symptoms, quality of life, perceived barriers and benefits of exercise, and perceived social support among Jordanian patients with end-stage renal disease receiving haemodialysis using Pender’s health promotion model. Background. Non-adherence to dietary and fluid restrictions is a leading cause of treatment failure and poor outcomes in end-stage renal disease. Yet, factors that interfere with the patients’ ability to follow their dietary restrictions are unknown. Design. A descriptive, correlational, cross-sectional design was used. Methods. Jordanian patients (n = 190) with end-stage renal disease receiving haemodialysis from three main Jordanian cities were included. The dialysis diet and fluid nonadherence questionnaire, Beck Depression Inventory-II, Quality Of Life Index, Dialysis Patient-Perceived Exercise Benefits and Barriers Scale, and the Multidimensional Perceived Social Support were employed to measure the key variables. Results. Patients were more likely men with mean age of 48·2 ± 14·9. Only 27% of the patients showed full commitment to diet guidelines and 23% to fluid guidelines during the last 14 days. Depression (M = 18·8 ± 11·4) had significant negative association with quality of life (importance and satisfaction) (r = −0·60, r = −0·32, p = 0·001, respectively). Multiple hierarchal regressions revealed a predictive model of only two variables: age (B = −0·22, p = 0·05) and residual renal function (B = −0·23, p = 0·012) for dietary non-adherence. Conclusions. Non-adherence to diet and fluid guidelines association with individual characteristics, health perception and psychosocial variables should be investigated in a longitudinal design. Relationship of non-adherence with culture-related factors should deeply be assessed among Jordanian patients with end-stage renal disease receiving haemodialysis. Relevance to clinical practice. Identification of the factors that may worsen dietary and fluid non-adherence may lead to improved therapeutic interventions within the mainstream of medical practice for Jordanian patients with end-stage renal disease receiving haemodialysis.

The length of Spielberger's State Anxiety Inventory (SAI) makes its use difficult for critically ill populations. To shorten it, exploratory factor analysis was used with data from 530 acute myocardial infarction patients. The resulting 6-item shortened version demonstrated good internal reliability consistency with a Cronbach's alpha of .84. Construct validity of the shortened version was supported by strong correlations with the original SAI and the Brief Symptom Inventory (BSI), another measure of state anxiety, and through support of known hypotheses. This study offered a short version of the SAI with excellent psychometric properties that can be used in critically ill patients.

The Regulatory (R) subunit of Protein Kinase A (PKA) inhibits its kinase activity by shielding the Catalytic (C) subunit from physiological substrates. This inhibition is reversed in response to extra-cellular signals that increase cAMP levels in the cytoplasm. Upon cAMP binding to R, C is allosterically released from R, activating a spectrum of downstream signaling cascades. Crystallographic data indicated that a series of distinct conformational changes within CBD-A must occur to relay the cAMP signal from the cAMP binding site to the R:C interaction interface. One critical cAMP relay site within the CBD-A of R has been identified as Asp170 because the D170A mutation selectively reduces the negative cooperativity between the cAMP- and C-recognition sites (i.e. the KD for the R:C complex in the presence of cAMP is reduced by more than 12-fold), without significantly compromising the high affinity of R for both binding partners. Here, utilizing an integrated set of comparative NMR analyses we have elucidated how this critical electrostatic switch is able to control the interaction network which transmits the cAMP signal within CBD-A. The D170A-induced variations in backbone chemical shifts as well as in hydrogen-deuterium and hydrogen-hydrogen exchange profiles show that Asp170 not only plays a pivotal role in controlling the local conformation of the phosphate binding cassette (PBC), where cAMP docks, but also significantly affects the long-range cAMP-dependent interaction network that extends from the PBC to the three major sites of C-recognition. We also found that the D170A mutation promotes partial unfolding, thus assisting the uncoupling of the alpha- and beta-subdomains of CBD-A as required for the major alpha-helical conformational re-arrangement necessary for C-binding. Overall, the emerging map of allosteric networks features Asp170 as an essential component of an electrostatic switch mechanism that stabilizes the conformation of the PBC region for optimal interaction with cAMP and that is also crucial for relaying allosteric effects leading to C subunit activation. Taken together, our results consolidate the interdependence between the Asp170 relay site and the R:C interaction interface. Furthermore, they provide insight into the driving forces for the in vivo formation of intermediate PKA ternary complexes. Finally, our current study is relevant for elucidating the antagonistic properties of Rp-cAMPS on PKA by providing a detailed picture of the long-range effects of the altered interaction between this analog and the PBC.

cAMP and the cAMP binding domain (CBD) constitute a ubiquitous regulatory switch that translates an extracellular signal into a biological response. The CBD contains α- and β-subdomains with cAMP binding to a phosphate binding cassette (PBC) in the β-sandwich. The major receptors for cAMP in mammalian cells are the regulatory subunits (R-subunits) of PKA where cAMP and the catalytic subunit compete for the same CBD. The R-subunits inhibit kinase activity, whereas cAMP releases that inhibition. Here, we use NMR to map at residue resolution the cAMP-dependent interaction network of the CBD-A domain of isoform Iα of the R-subunit of PKA. Based on H/D, H/H, and N z exchange data, we propose a molecular model for the allosteric regulation of PKA by cAMP. According to our model, cAMP binding causes long-range perturbations that propagate well beyond the immediate surroundings of the PBC and involve two key relay sites located at the C terminus of β 2 (I163) and N terminus of β 3 (D170). The I163 site functions as one of the key triggers of global unfolding, whereas the D170 locus acts as an electrostatic switch that mediates the communication between the PBC and the B-helix. Removal of cAMP not only disrupts the cap for the B′ helix within the PBC, but also breaks the circuitry of cooperative interactions stemming from the PBC, thereby uncoupling the α- and β-subdomains. The proposed model defines a signaling mechanism, conserved in every genome, where allosteric binding of a small ligand disrupts a large protein–protein interface.

Osteoarthritis [OA] is a condition characterized by hyaline cartilage damage, changes in subchondral bone sclerosis, and osteophyte formation. It is one of the most common medical disabling problems in the world. This study was carried out at the Orthopedics Outpatient Department, at the Main General Hospital in Port Said on a sample of 60 patients having primary OA of the knee joints. They were divided into two groups of 30 patients each [control and experimental groups]. The tools of data collection consisted of 1] Personal characteristics, 2] A knee joints assessment from, which consisted of measurement of the knee rang of movement [ROM], knee muscles circumference, and muscle strength, 3] The Arthritis Impact Measurement Scale [AIMS], and 4] The Osteoarthritis Screening Index [OASI]. An educational program was developed based on review of literature and on the identified patient’s problems. It was implemented on the experimental group. The results showed statistical significant improvements in the ROM, muscle strength, and health outcomes using as indicated by AIMS and OASI in the intervention group after program implementation. There were no noticeable changes in the control group as compared to baseline results. Statistically significant positive correlations were found among all used scales. The strongest correlation was between pain and depression. Therefore, it was concluded that this health education program for patients with knee OA had a positive impact on their health. The success of the program might be attributed to giving information suitable to patient education level. It is recommended that the program experimented in this study be replicated with OA patients in different settings and larger numbers. Teaching programs should be provided in illustrated booklets for patients and their relatives.

D. H. Maclennan, M. Abu-Abed and Chulhee Kang. Structure–Function Relationships in Ca2+ Cycling Proteins. Journal of Molecular and Cellular Cardiology (2002) 34, 897–918.

Background Poor awareness of modifiable risks for acute myocardial infarction (AMI) may explain the reported weak relationship between patients' actual and perceived risk for AMI. Objectives To assess the level of awareness of modifiable risks and perceived vulnerability for AMI among Jordanian patients, and to determine their independent association. Methods This was a cross-sectional correlational study (N = 231). Perceived risk, awareness of risk factors and risk profile were collected by self-reports and medical chart review. Results Patients were mostly males (80%) and had a mean of 55.3 ± 12.6 years for age. Perceived and actual AMI risks were not highly congruent even though patients had, on average, two modifiable risks and were knowledgeable of them. Awareness of risk factors independently explained 3.5% of the variance in perceived risk. Conclusions The risk for developing AMI is underestimated among cardiac patients and it is only weakly linked with their awareness of AMI risk factors.

Background The meaning of social support is well documented, but less is known about mediating characteristics that examine which patients with end stage renal disease (ESRD) and depressive symptoms are most likely to benefit. Aims The aim of this study was to examine whether perceived social support mediated depressive symptoms on the outcome of quality of life (QoL). Design A correlational, cross-sectional study was conducted with a convenience sampling of 190 patients with ESRD. Results There was partial mediation effect of social support on depressive symptoms in the prediction of QoL. Conclusion Effective management of depressive symptoms will improve QoL mostly when social support is promoted in patients with ESRD receiving hemodialysis.

Background Anxiety is a common experience among patients with acute coronary syndrome (ACS) that can have a negative impact on health outcomes. Nonetheless, the negative role of anxiety remains underappreciated, as reflected by clinicians' underrecognition and undertreatment of anxious hospitalized and nonhospitalized patients with ACS. Underappreciation of the role of anxiety is possibly related to inadequate understanding of the mechanisms whereby anxiety may adversely affect health outcomes. Purpose The aim of this study was to synthesize the evidence about potential mechanisms by which anxiety and adverse health outcomes are related. Conclusions A biobehavioral model links anxiety to the development of thrombogenic and arrhythmic events in patients with ACS. Biologically, anxiety may interfere with the immune system, lipid profile, automatic nervous system balance, and the coagulation cascade, whereas behaviorally, anxiety may adversely affect adoption of healthy habits and cardiac risk-reducing behaviors. The biological and behavioral pathways complement each other in the production of poor outcomes. Clinical implications Anxiety requires more attention from clinical cardiology. The adverse impact of anxiety on health outcomes could be avoided by efficient assessment and treatment of anxiety.

Aims and objectives. To examine the association of anxiety level and anxiolytic medication use with in-hospital complications in patients following acute myocardial infarction (AMI). Background. There are conflicting data about the protective effect of anxiolytic medication used in patients after acute myocardial infarction. Examination of the interaction of anxiolytic medication and anxiety level may explain these disparate results. Design. This was a secondary analysis of existing data from a multisite, prospective study of the impact of anxiety on inhospital complications in patients with AMI. Methods. Patients were primarily men, Caucasians, with Killip class 1 or 2, from the USA and Australia (n = 156). Anxiety level in the emergency department and intensive care unit and in-hospital complications were collected using self-report measures and medical record review. Logistic regression analyses examined whether the use of anxiolytic medication influenced the relationship between anxiety and in-hospital complications after controlling for demographic and clinical covariates. Results. In the ED, 31% of participants were very or extremely anxious; anxiolytic medication was given to only 5%. In the intensive care unit, nearly half of participants received anxiolytic medication. There was no association between anxiety level and use of anxiolytic medication. Anxiety was an independent predictor of the probability of in-hospital complications. The administration of anxiolytic medication did not alter the relationship between anxiety and in-hospital complications. Conclusion. Use of anxiolytics in patients with AMI was not associated with anxiety level and did not reduce the probability of in-hospital complications. Relevance to clinical practice. Clinicians need to regularly assess anxiety and treat it appropriately. Regular anxiety assessment may promote appropriate use of anxiolytic medication. Clinical guidelines for the management of patients with an AMI should address anxiety assessment and appropriate use of anxiolytic medication to improve patients’ outcomes.

The purpose of this study is to provide insight into the relationship between dietary and fluid non-adherence, depressive symptoms, quality of life, perceived barriers and benefits of exercise, and perceived social support among Jordanian patients with end-stage renal disease receiving haemodialysis using Pender's health promotion model.Non-adherence to dietary and fluid restrictions is a leading cause of treatment failure and poor outcomes in end-stage renal disease. Yet, factors that interfere with the patients' ability to follow their dietary restrictions are unknown.A descriptive, correlational, cross-sectional design was used.Jordanian patients (n = 190) with end-stage renal disease receiving haemodialysis from three main Jordanian cities were included. The dialysis diet and fluid nonadherence questionnaire, Beck Depression Inventory-II, Quality Of Life Index, Dialysis Patient-Perceived Exercise Benefits and Barriers Scale, and the Multidimensional Perceived Social Support were employed to measure the key variables.Patients were more likely men with mean age of 48·2 ± 14·9. Only 27% of the patients showed full commitment to diet guidelines and 23% to fluid guidelines during the last 14 days. Depression (M = 18·8 ± 11·4) had significant negative association with quality of life (importance and satisfaction) (r = -0·60, r = -0·32, p = 0·001, respectively). Multiple hierarchal regressions revealed a predictive model of only two variables: age (B = -0·22, p = 0·05) and residual renal function (B = -0·23, p = 0·012) for dietary non-adherence.Non-adherence to diet and fluid guidelines association with individual characteristics, health perception and psychosocial variables should be investigated in a longitudinal design. Relationship of non-adherence with culture-related factors should deeply be assessed among Jordanian patients with end-stage renal disease receiving haemodialysis.Identification of the factors that may worsen dietary and fluid non-adherence may lead to improved therapeutic interventions within the mainstream of medical practice for Jordanian patients with end-stage renal disease receiving haemodialysis.

A duck δ II crystallin mutant, where histidine 178 has been replaced by an aspartic acid residue, has been purified from s bacterial expression system and subsequently crystallized. The crystals grow as flat plates, with unit cell dimensions a = 94.1 A, b = 99.9 A, c = 108.7 A and β = 102°. The crystals exhibit the symmetry of space group P 2 1 and diffract to a minimum d -spacing of 2.8 A resolution. On the basis of density calculation four monomers (one tetramer) are estimated to be present in the asymmetric unit ( V m = 2.5 A 3 /Da). Self-rotation functions clearly show the presence of 222 non-crystallographic symmetry.

The skeletal muscle sarco(endo)plasmic reticulum Ca(2+)-ATPase (SERCA1a) mediates muscle relaxation by pumping Ca(2+) from the cytosol to the ER/SR lumen. In efforts aimed at understanding the structural basis for the conformational changes accompanying the reaction cycle catalyzed by SERCA1a, we have studied the ATP-binding domain of SERCA1a in both nucleotide-bound and -free forms by NMR. Limited proteolysis analyses guided us to express a 28 kDa stably folded fragment containing the nucleotide-binding domain of SERCA1a spanning residues Thr357-Leu600. ATP binding activity was demonstrated for this fragment by a FITC competition assay. A nearly complete backbone resonance assignment of this 28 kDa ATP-binding fragment, in both the AMP-PNP-bound and -free forms, was obtained by means of heteronuclear multidimensional NMR techniques. NMR titration experiments with AMP-PNP revealed a confined nucleotide-binding site which coincides with a cytoplasmic pocket region identified in the crystal structure of apo-SERCA1a. These results are consistent with previous site-directed mutagenesis studies of SERCA1a.

The understanding of allostery relies on the comparative analysis of macromolecules in their free and bound states. However, the direct free versus bound comparison is often challenging due to the instability of one of the two forms. This problem is effectively circumvented by using minor free/bound equilibrium perturbations which are tolerated without compromising sample stability. The subtle equilibrium perturbations are still able to reveal significant apo/holo differences if monitored by NMR experiments that are sensitive to minor populations within dynamic equilibria, such as NMR relaxation dispersion (NMRD) and hydrogen exchange (H/D and H/H) rates. These measurements are complementary to each other as they unmask how a ligand affects both the stable and the excited states of the free energy landscape for its protein receptor. The proposed equilibrium perturbation approach therefore significantly expands the scope of applicability of NMRD and hydrogen exchange experiments to the investigation of ligand-protein interactions, in general, unveiling allosteric "hot spot" maps for systems that have been traditionally elusive to direct free/bound comparisons.

The major soluble protein component of avian and reptilian eye lenses, delta crystallin, is highly homologous to the urea cycle enzyme, argininosuccinate lyase (ASL). In duck lenses there are two highly homologous delta crystallins, termed delta I and delta II, that are 94% identical in amino acid sequence. While delta II crystallin has been shown to exhibit ASL activity in vitro, delta I crystallin is inactive. The X-ray structure of a His to Asn mutant of duck delta II crystallin (H91N) has been determined to 2.5 A resolution using the molecular replacement technique. The overall fold of the protein is similar to other members of the superfamily to which this protein belongs, with the active site located in a cleft between three different monomers of the tetrameric protein. A reexamination of the kinetic properties of the H91N mutant reveals that the mutant has 10% wild-type activity. The Vmax of the mutant protein is identical to that of the wild-type protein, but a 10-fold increase in the Michaelis constant is seen, suggesting that His 91 is involved in binding the substrate. In an effort to determine the reasons for the loss of enzymatic activity in delta I crystallin, a structural comparison of the H91N mutant with the enzymatically inactive turkey delta I crystallin has been performed. This study revealed a remarkable similarity in the overall structures of the two proteins. Three regions of secondary structure do differ significantly between the two models; these include the N-terminal tail, a loop containing residues 76-91, and a cis versus trans peptide linkage at residue Thr 322. The cis to trans peptide variation appears to be an interspecies difference between turkey and duck and is therefore not directly involved in the loss of enzymatic activity. All the residues implicated in the catalytic mechanism are conserved in both the active and inactive proteins, and given the linearity of the relationship between the enzymatic activity of duck delta I/delta II heterotetramers and their delta II content (PiatigorskyHorwitz, 1996), it is evident from the structure that only one of the three domains that contributes to the active site is responsible for the loss of activity in the delta I protein. Given the structural differences found in domain 1 (N-terminal tail and 76-91 loop), we postulate that these differences are responsible for the loss of catalytic activity in the delta I crystallin protein and that the delta I protein is inactive because it no longer binds the substrate.