Biomedical subjects
Publications and source records attributed to J Muldoon.
Practitioners are generally advised not to use short-stretch bandages on patients who are immobile. But this appears to reflect confusion about calf muscle function, which research indicates still occurs during periods of limited mobility.
O-specific polysaccharide was isolated by mild acid degradation of the lipopolysaccharide of Pseudoalteromonas tetraodonis type strain IAM 14160(T) and studied by sugar and methylation analyses along with 1H and 13C NMR spectroscopy, including 2D COSY, TOCSY, 1H,(13)C HMQC and HMBC experiments. The polysaccharide was found to consist of hexasaccharide repeating units containing one residue each of D-Gal, D-GlcA, D-GalNAc and D-GlcNAc and two residues of 3,6-dideoxy-L-xylo-hexose (colitose, Col) and having the following structure:In common with the polysaccharides of some other bacteria, the polysaccharide studied contains a tetrasaccharide fragment alpha-Colp-(1-->2)-beta-D-Galp-(1-->3)-[alpha-Colp-(1-->4)]-beta-D-GlcpNAc, which is a colitose ('3-deoxy-L-fucose') analogue of the Lewis(b) blood group antigenic determinant.
An acidic polysaccharide was obtained from the lipopolysaccharide of Pseudoalteromonas distincta strain KMM 638, isolated from a marine sponge, and found to contain D-GlcA, D-GalNAc, 2-acetamido-2,6-dideoxy-D-glucose (D-QuiNAc) and two unusual acidic amino sugars: 2-acetamido-2-deoxy-D-galacturonic acid (D-GalNAcA) and 5-acetamido-3,5,7,9-tetradeoxy-7-formamido-L-glycero-L-manno-nonulosonic acid (Pse5Ac7Fo, a derivative of pseudaminic acid). Oligosaccharides were derived from the polysaccharide by partial acid hydrolysis and mild alkaline degradation and characterised by electrospray ionisation (ESI) MS and 1H and 13C NMR spectroscopy. Based on these data and NMR spectroscopic studies of the initial and O-deacetylated polysaccharides, including quaternary carbon detection, 2D COSY, TOCSY, ROESY, H-detected 1H,13C HMQC and HMBC experiments, the following structure of the branched pentasaccharide repeating unit was established: [structure: see text].
We have identified two single nucleotide polymorphisms and one dinucleotide microsatellite within the promoter region of the interferon-alpha receptor gene (IFNAR, GenBank accession number X60459). Allele frequencies in a Caucasian population were established using PCR-RFLP for the two SNPs and semi-automated genotyping for the microsatellite.
The Episode Classification System is intended to perform two tasks. First, it will be a prospective capitation risk adjuster and predict future health care costs. It will do this by assigning each individual a single capitation risk adjustment category based on an analysis of the medical history and of health care services rendered during a specific period of time. Second, the Episode Classification System will create retrospective severity adjusted Episodes of illness or Episodes of Care. These latter Episodes will provide a framework for relating patient characteristics to the amount, type, and duration of services provided during the treatment of a specific disease. These Episodes will give users the ability to understand past costs and the risk of mortality. As such they will form the basis for provider profiling by allowing users to analyze a complete clinical episode.
Gastrointestinal complications occur after renal transplantation in up to 16% of patients. Cytomegalovirus (CMV) vasculitis can affect the gastrointestinal tract with significant manifestations, including colonic ulceration, bleeding, and perforation. We present a case of CMV vasculitis in a renal transplant patient that caused middle and left colic vein thrombosis and resultant ischemic colitis. There was no evidence of arterial involvement. To our knowledge, this is the first reported case of ischemic colitis secondary to large vein thrombosis associated with CMV infection.
A pilot study was undertaken to test the safety and establish the side effect profile of recombinant human interferon-beta 1b (Betaseron, Berlex Laboratories, Richmond, CA), in patients with relapsing-remitting multiple sclerosis (RRMS). During the initial dose finding period (24 weeks), five groups of 6 patients each were treated by subcutaneous injection three times each week with either 0.8, 4, 8, or 16 million units (mU) of Betaseron or placebo (WHO Standard). Although some side effects were noted in all groups, a dose-related trend in reduction of exacerbation frequency and side-effect profile was noted. Patients given 16 mU had no exacerbations during the initial dosing period, but associated side effects led to dose reduction or dropout. An 8 mU dose was selected for further study after 24 weeks, and continuous dosing at 8 mU in 15 patients has now exceeded 6 years. Side effects abated over time. Neutralizing antibody developed in most patients, but titers were variable, fluctuated independently of clinical course, and tended to fall with prolonged treatment. A dose-dependent rise in neopterin levels was observed during the initial dosing period. This pilot study has demonstrated responsiveness to Betaseron, shown a stable safety profile over time, and established guidelines for a dosing regimen to evaluate and optimize further the efficacy of Betaseron in RRMS.
The concept of publicly financed competition serves as a possible strategy for controlling expenditures and improving the efficiency of the health care system in Ontario. Potential cost savings, although rough estimates, for a 10-year period range from $1.0 billion to $1.6 billion, depending upon the model structure. This paper investigates the assumptions and structure of a publicly financed competition proposal and addresses legislative issues concerning the feasibility and desirability of such a system.
An occupational injury surveillance project was conducted in 15 of Iowa's 99 counties. Trained abstractors reviewed the medical records of persons admitted for trauma to hospitals during 1983. Based on these chart reviews, subsequent mail-out questionnaires and phone contacts were made, and rate estimates for occupational injury hospitalization for farmers and non-farmers were generated. The 1980 U.S. census data for occupation and market area data for the sample hospitals were used for the rate calculations. Approximately 14.7% of hospitalizations for trauma in the sample area were for work-related injuries. Farmers were hospitalized for occupational injuries at a rate of 1,521/100,000 compared to non-farmers at a rate of 497/100,000. There were no significant differences in the mean number of days per hospitalization for farmers versus non-farmers, (7.4 days for farmers and 6.7 days for non-farmers). Based on the questionnaire data, farmers were much less likely to receive any form of remuneration for injury, (odds ratio = 0.26, p less than 5 x 10(-6]. Farmers also reported less time off from work, with a mean of 79 days compared to non-farmers with a mean of 289 days.
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Congress exempted certain types of specialty hospitals from the Medicare Prospective Payment System because it was recognized that Diagnosis-Related Groups (DRGs) may not properly define the case mixes in such institutions. This study is part of a larger investigation into case mix and payment in children's hospitals, one category of exempted institutions. A national sample of approximately 500,000 cases was developed with intentional oversampling of children's and university hospitals to allow detection of specialized types of cases. Five case-mix classification schemes--DRGs, Disease Staging, Patient Management Categories, Severity of Illness Score, and Pediatric Diagnosis System groups--were applied to the data set, and data items not included in the Uniform Hospital Discharge Data Set were collected. A set of Children's Diagnosis-Related Groups (CDRGs), based on modification of the current DRG system, resulted from the study. When CDRGs were applied to an independent sample of children's hospital data, length of stay variance was reduced by 47.6% compared with 32.3% for DRGs (length of stay outliers removed). These results suggest that incremental approaches to DRG refinement in other clinical areas where current definitions are inadequate may be better than rejecting the large amounts of statistical and clinical analyses existing in the DRG system. Similar methods can be used to correct problems brought on by changes in medical practice.
Groups of neonates who are usually treated at hospitals that provide specialized pediatric care are not adequately classified by the use of diagnosis-related groups (DRGs). Therefore, a set of revised DRGs, pediatric modified DRGs (PM-DRGs), have been developed. Use of PM-DRGs substantially improves the classification of neonates in the following ways: a single pediatric modified major diagnostic category has been defined to include only and all neonates (patients younger than 29 days of age when admitted to the hospital); deaths and transfers of newborns are no longer combined into a single group; birth weight (rather than diagnosis) is used as the primary variable to differentiate categories of neonates; and duration of mechanical ventilation, presence of major problems, and surgery are used to define specific PM-DRGs. A total of 46 PM-DRGs have been developed to replace the 7 DRGs for neonates. Based on a sample of discharged patients from 13 children's hospitals, the overall variance reduction in duration of stay for neonates using PM-DRGs was 38.7% compared with 20.4% for DRGs. Variance reduction for PM-DRGs was 45.9% compared with 16.3% for DRGs when operating cost per case was used instead of duration of stay. After removing outliers at 150 days, the duration of stay variance reduction was 53.3% vs 23.6%, respectively, and the operating cost variance reduction was 58.8% vs 17.8%, respectively.
PURPOSE: The purpose of this study was to evaluate whether a supermarket point-of-purchase intervention could increase shoppers' consumption of fruits and vegetables. METHODS: Eight supermarkets in rural Iowa were randomized to receive either an 8-month intervention or no intervention. The intervention consisted of: (1) one-page supermarket flyers that identified fruits and vegetables on sale, gave receipts and menu ideas for using sale foods, and gave a store coupon worth 50 cents toward the purchase of any fruit or vegetable; (2) store signage to identify fruits and vegetables featured on the flyer; and (3) consciousness raising activities such as food demonstrations and nutrition related signage. Evaluation was based on exit interviews and take-home surveys, completed by random samples of 120 shoppers from each store at baseline and approximately 1-year post randomization. RESULTS: At follow-up, 42.9% of intervention store shoppers and 6.5% of control shoppers recalled seeing the intervention flyer. Thirty-six percent of intervention shoppers had used a 50-cent coupon and 18% had used a recipe. Approximately 70% of all shoppers had purchased fruits or vegetables on the day they were interviewed, which did not differ between intervention and control stores. Compared to change in control shoppers, there was a borderline statistically significant 8.4 percentage point increase (p < .07) in the percentage of intervention store shoppers in the action or maintenance stages of dietary change, but there was no corresponding increase in fruit or vegetable consumption. DISCUSSION: Studies to test point-of-purchase interventions are difficult to design, implement, and evaluate. More powerful interventions are probably necessary to induce shoppers to purchase and consume more fruits and vegetables.
Evidence suggests that dentists' efforts to encourage their patients to stop tobacco use can significantly decrease tobacco-related morbidity and mortality. This study identified attitudes and counseling practices of 1116 Iowa dentists and compared results of a subgroup (N = 55) surveyed in both 1983 and 1989 to note changes in their tobacco-related attitudes and practices. Although only 9% of the dentists from the statewide survey felt counseling their patients on tobacco use was inappropriate, 56% reported they did not routinely ask their new patients about tobacco use. With some frequency 90% of the dentists discussed negative health effects of tobacco, whereas only 64% advised their smokers to quit. In addition, fewer than half made special efforts with pregnant patients or those at high risk for heart disease. The vast majority reported seldom if ever using intervention tools such as pamphlets or referral to cessation programs. Data from the subgroup surveyed in 1983 and 1989 indicated few substantial changes in attitudes and counseling practices. Substantial discrepancies exist between dentists' attitudes and counseling practices. Well-designed programs are needed to help dentists select and implement appropriate interventions.