Three-color supplement to the NIAID DAIDS guideline for flow cytometric immunophenotyping.
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Antibodies, Monoclonal↗
Biomedical subjects
P Kidd
Publications and source records attributed to P Kidd.
Cues to parent involvement in drug prevention and school activities.
This exploratory study used focus group methods to identify strategies that promote parent involvement with young children in an alcohol, tobacco, and other drug (ATOD) prevention program. The Health Belief Model (HBM) guided the interview process and data analysis. Five focus groups were conducted with low-income parents and school personnel from two urban elementary schools in Lexington, Kentucky. Cues to Action was the most frequent HBM construct expressed by both parents and school personnel in regard to ATOD prevention programs and general school activities. Enthusiasm for school activities expressed by children to their parents was identified as the core cue to parent involvement. Transportation, child care, and incentives were the basic requirements for parent involvement. Positive attitudes of school personnel, a combination of communication strategies, and multiple channels for involvement were major cues to parent involvement. Recommendations for involving parents in ATOD prevention and general school activities are suggested.
Adult↗
Linking stress and injury in the farming environment: a secondary analysis of qualitative data.
The first step in injury prevention is to understand the injury problem. This includes examining the nature of the problem from the perspective of the target community. This article uses qualitative methods to explain the nature of the injury problem and identifies prevention strategies through a three-step process: identify a causal model, validate the model, and identify strategies using the causal model. A causal model linking safety performance and safety demand, health decision making, and occupational stress was derived by secondary analysis of farm family focus group data (step 1) and validated by other farm family focus groups (step 2). Prevention strategies identified from the causal model (step 3) include decreasing the number of roles performed exclusively by one individual, developing an easy-to-use planning tool that assists farmers in anticipating and reducing future work demands, and developing an education module that incorporates injury costs into safety decision making.
Accidents, Occupational↗
Lymphocytosis of large granular lymphocytes in patients with Hodgkin's disease.
Clonal disorders of large granular lymphocytes (LGL) of either CD3- (NK cell) or CD 3+ (T-cell) phenotype have been described. B-cell malignancies such as hairy cell leukemia and non-Hodgkin's lymphoma have been observed in association with the T-cell type of LGL leukemia. Here we report the occurrence of LGL lymphocytosis in four patients with Hodgkin's disease. Immunophenotyping studies showed that these LGL were CD 3- in three patients and CD3+ in the other. LGL were polyclonally expanded in both patients in whom clonality could be assessed.
Antineoplastic Combined Chemotherapy Protocols↗
Where did all the nurses go? The need to capture nursing.
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Emergency Nursing↗
Developing and evaluating an emergency nursing orientation pathway.
OBJECTIVE: Orientee evaluation forms frequently focus on tasks and technical skills rather than decision-making skills. An orientation pathway was developed to evaluate orientee clinical decision-making skills. The pathway can assist in identifying orientees who require additional educational resources or interventions. Early interventions may decrease the length of orientation, increase an employee's length of stay in the institution, and contribute to cost savings. METHODS: The pathway was developed with employee exit interview data, preceptor interviews, identification of critical indicators, and the orientation literature. The pathway consists of six categories. Indicators within each category were identified and ranked according to four levels of proficiency (level 1 for the least proficient and level 4 for the most proficient). A convenience sample of seven ED orientee and preceptor pairs agreed to participate in the pilot use of the pathway. An expected timeline of progress had been developed by a group of 20 preceptors during a preceptor workshop. An average proficiency level (score) was obtained for each category for 12 weeks with the weekly scores plotted on the pathway. This level was compared with the expected proficiency level in each category for each week. Demographic information was obtained from the orientee and preceptor pairs to determine whether certain characteristics facilitate pathway progression. Data were analyzed with frequency distributions, and measures of central tendency and variance. Spearman's rank correlations were used to examine the proficiency level in each category for each week in relation to demographic characteristics of the preceptor and orientee. RESULTS: Orientees progressed faster than expected in all categories. It took 8 weeks for an orientee to attain the highest proficiency level in all categories. The fastest progress was made in the category " Accurately Evaluates Patient Responses." Slowest progress was made in the category "Safety in Blood and Drug Administration." Preceptors and orientees rated in the pathway as very useful. DISCUSSION: Further studies with the orientation pathway may help to determine the ideal time frame for orientation, characteristics of orientees who progress as expected or faster, and educational strategies to facilitate orientee progression and clinical decision making.
Clinical Competence↗
Regulation and targeting of T-cell immune responses by IgE and IgG antibodies.
A set of chimeric antibodies with identical F(ab')2 fragments specific for the hapten 5-iodo-4-hydroxyl-3-nitrophenacetyl (NIP), but with different human Fc parts (gamma 1, gamma 2, gamma 3, gamma 4, epsilon), was used to compare the role of IgG and IgE antibodies in antigen presentation by human Epstein-Barr virus (EBV) B cells. Two or three molecules of NIP were coupled to one molecule of Der pI (Der pI-(3)NIP), a major allergen of Dermatophagoides pteronyssinus. Both monomeric IgG and performed complexes of various Der pI/IgG ratios failed to bind significantly to the Fc receptor for IgG on B cells (Fc gamma RII; CD32). Binding of IgG3 (> IgG1)-containing complexes (optimal ratio of antigen to antibody = 1:1) could be enhanced by increasing the number of haptens per Der pI molecule to nine or more. However, antigen presentation mediated by IgG and CD32 was not seen with either pulsed B cells or B cells that were allowed to capture the IgG complexes during the whole stimulation period. IgE binding to CD23 and subsequent IgE-mediated antigen presentation was seen under all conditions tested. Even monomeric immune complexes (IC) (Der pI-(3)NIP/IgE), in the absence of CD23 cross-linking, induced an immune response. As the number of natural epitopes for human antibodies on Der pI was less than five, we conclude that, in vivo, complexes consisting of Der pI/IgG will be directed to antigen-presenting cells expressing the high-affinity receptor for IgG (CD64), whereas IgE will allow antigen presentation by CD23-expressing cells, including B cells.
Allergens↗
Psychometric properties of the Driving Practices Questionnaire: assessment of risky driving.
A national public health goal is to reduce injuries and deaths from motor vehicle crashes (MVC). The development and psychometric evaluation of the 10-item Driving Practices Questionnaire (DPQ) to measure risky driving is described. Based on responses from 297 drivers divided into safe, unsafe, and injured groups, the DPQ was evaluated using item and factor analysis, and reliability and validity measures. Principal axis factor analysis isolated one factor with 42.3% of the variance explained. The alpha coefficient for the scale was .87 and test-retest correlation was .94. High DPQ scorers were three times more likely to have prior traffic violations. The identification of driver subtypes will assist the testing of injury prevention interventions.
Adolescent↗
Familial occurrence of LGL leukaemia.
The aetiology of LGL leukaemia is now known; however, we recently detected HTLV-II from such a patient. We describe here the occurrence of LGL leukaemia in a mother and her son. Serum from the son reacted to HTLV-I/II gag proteins, but not a recombinant HTLV-I env protein p21e; serum from the mother was negative. PCR analyses in both patients were negative for pX and pol sequences shared by HTLV-I/II and also for specific gag sequences of HTLV-I and HTLV-II. These data show that familial cases of LGL leukaemia are not associated with prototypical HTLV-I or HTLV-II infection.
Adult↗
NIAID Division of AIDS flow cytometry quality assessment program.
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Acquired Immunodeficiency Syndrome↗
Assessment of the effects of instrumentation, monoclonal antibody, and fluorochrome on flow cytometric immunophenotyping: a report based on 2 years of the NIAID DAIDS flow cytometry quality assessment program.
This study of the effect on CD4%, CD8%, CD3+8+%, and CD3% of flow cytometer, monoclonal antibody, and fluorochrome was based on 71 whole-blood samples, each evaluated by 42 to 59 laboratories during 2 years of a flow cytometry quality assessment program. For the 24 HIV-positive specimens, FACScans produced significantly lower CD4% values than EPICS-Cs or EPICS Profiles, and for the 47 HIV-negative specimens, FITC was associated with significantly lower CD4% values than PE or RD1, but differences were never larger than 2% and regressions accounted for only 3-12% of the variability. The labs using the most common CD4 technique had significantly higher between-laboratory variability than all other labs grouped together. For both CD8 and CD3+8+, measurements on FACScans were significantly higher than measurements on EPICS, and measurements using Leu2 were significantly higher than measurements using T8, with regressions accounting for 12-31% of the variability. The machine differences in medians were 3-7% for labs using Leu2-FITC. It might be worthwhile to discourage the use of Leu2-FITC for measuring CD8% but no change in instrument, monoclonal antibody, or fluorochrome would greatly improve interlaboratory agreement on CD4%.
Antibodies, Monoclonal↗
Clinical applications of cytometry: 5th annual meeting.
The 5th annual Clinical Applications of Cytometry meeting was held September 12-15, 1990 in charleston, SC. The theme which emerged repeatedly throughout the meeting was the need to take full advantage of the quantitative power of cytometry to provide the most useful clinically relevant diagnostic and prognostic information. Greater quantitative power is based on careful and reproducible standards and quality control. The same principles, albeit with somewhat different approaches, apply to cell surface immunofluorescence analysis, DNA measurements, and image cytometry assessments. Monoclonal antibody probes against oncogenes, others against lymphokines within the Golgi, and a novel fluorogenic substrate designed to quantitate the activity of a mitochondrial enzyme were exciting developments described at the meeting.
Autoimmune Diseases↗
Reversed helper/suppressor T-lymphocyte ratio in bronchoalveolar lavage fluid from patients with breast cancer and Pneumocystis carinii pneumonia.
Pneumocystis pneumonia (PCP) usually occurs in patients with hematologic malignancies and acquired immunodeficiency syndrome (AIDS). Patients with solid tumors represent a very small fraction of the reported cases of PCP. Over an 18-month period, PCP was diagnosed in three patients who had received radiation and chemotherapy for breast cancer. In all three patients, there was no serologic or clinical evidence of AIDS. Direct staining of bronchoalveolar lavage fluid (BAL) revealed Pneumocystis carinii, and cellular analysis of BAL revealed an increased percentage of lymphocytes with reversed helper/inducer:suppressor/cytotoxic T-cell (CD4:CD8) ratio. Because decreased CD4:CD8 ratio in BAL is commonly accepted as findings consistent with hypersensitivity pneumonitis and AIDS, we conclude that similar findings in patients without AIDS are not specific for hypersensitivity pneumonitis, and P. carinii should be ruled out in the appropriate clinical setting.
Adult↗
Oligoclonal immunoglobulin heavy chain gene rearrangement in a childhood immunoblastic lymphoma. Presentation as a polyphenotypic atypical lymphoproliferative reaction.
The authors describe a diagnostically difficult case of childhood lymphoma that presented as an atypical polyphenotypic lymphoproliferative reaction. Initial immunophenotyping revealed the presence of IgG, IgA, kappa, and lambda within the neoplastic lymphocytes. The patient had circulating plasmacytoid lymphocytes and a polyclonal hypergammaglobulinemia. The patient died of widespread immunoblastic lymphoma in two months. Postmortem tumor DNA showed a oligoclonal pattern of immunoglobulin heavy chain gene rearrangement. Blots for T-cell receptor beta-chain rearrangement showed germline bands. Epstein-Barr virus DNA was present within tumor cells, but there was no history of prior immunosuppression or serologic evidence of Epstein-Barr virus infection. The apparent polyclonal nature of the immunoproliferation delayed the institution of chemotherapy.
Blotting, Southern↗
Very low dose alpha-2b interferon for the treatment of hairy cell leukemia.
Alpha-2b interferon (alpha-2b IFN), administered at 2 x 10(6) U/m2 three times per week is highly effective in the treatment of progressive hairy cell leukemia (HCL) and in the retreatment of patients who have relapsed after previous IFN therapy. To determine if a lower interferon dose would induce a comparable antileukemic effect with less toxicity, a-2b IFN was administered at 2 x 10(5) U/m2 subcutaneously three times per week to 17 patients with progressive HCL. Thirteen patients had HCL in relapse after a previous response to alpha-2b IFN; four patients were previously untreated. The median duration of treatment was 9 months. Toxicity consisted only of transient, mild flu-like symptoms in two patients. Of the 13 previously IFN-treated patients, four had a minimal response, one had no response, and eight had progressive disease. Of four previously untreated patients, one had a partial response, two had a minimal response, and one had no response. In seven of eight patients whose disease progressed on low-dose IFN, the dose was escalated to 2 x 10(6) U/m2 three times per week, and all seven patients demonstrated hematologic response within 3 months to the dose escalation. We conclude that alpha-2b IFN at 2 x 10(5) U/m2 three times per week is relatively ineffective for the treatment of relapse after previous IFN therapy.
Dose-Response Relationship, Immunologic↗
Results of the flow cytometry ACTG quality control program: analysis and findings.
The AIDS Clinical Trial Group's (ACTG) Immunology Committee was charged with initiating a quality control program for all laboratories participating in the ACTG program reporting flow cytometry data. Forty-one laboratories were evaluated. This report defines the goals of this program and the subsequent findings after 19 send-outs were made. Both HIV positive volunteer donors and normal age-matched donors were used. Sample sets included both heparin and EDTA anticoagulated bloods. Laboratories were asked to report hematologic parameters as well as flow cytometry data both in percentages and absolute numbers. Results were evaluated using nonparametric statistical analysis. Robust CVs and interquartile ranges were used to define the performance of individual laboratories for each CD subset analyzed. Intralaboratory reproducibility was analyzed by paired sample sets. All laboratories were found to be able to define normal samples as normal. Seventy-five percent of the laboratories were able to define abnormal samples as abnormal. Twenty-five percent could not identify two abnormal samples as abnormal. Forty percent of the labs were found unable to reproduce paired samples within an absolute of +/- 5%. EDTA was found slightly superior to heparin in bloods evaluated by flow cytometry within 30 hr of collection. The analysis of specific histograms, questionnaires, and data analysis led to a specific set of recommendations for performance of flow cytometry studies.
Acquired Immunodeficiency Syndrome↗
Subcutaneous granulocyte-macrophage colony-stimulating factor in patients with myelodysplastic syndrome: toxicity, pharmacokinetics, and hematological effects.
The toxicity, pharmacokinetics, and hematologic effects of granulocyte-macrophage colony-stimulating (GM-CSF) were studied in a phase I/II trial of 16 patients with myelodysplastic syndrome (MDS). The GM-CSF was administered subcutaneously (SC) daily so as to achieve prolonged blood levels and to establish an outpatient treatment regimen. Four dose levels were administered for ten days: 0.3 microgram/kg/d (three patients), 1.0 microgram/kg/d (three), 3.0 micrograms/kg/d (four), and 10.0 micrograms/kg/d (six). The most common toxicities were fever and a flu-like syndrome, which were dose-dependent. The maximum-tolerated dose was 10.0 micrograms/kg/d, which induced severe rigors (two patients), fever greater than 40 degrees C (one), severe bronchospasm (one), and WBC 60,000 (one). In one patient, refractory anemia with excess blasts in transformation (RAEB-T) progressed to acute nonlymphocytic leukemia after two doses of GM-CSF, and the patient died of leukemia that did not respond to chemotherapy. After doses of 3.0 and 10.0 micrograms/kg, serum GM-CSF levels peaked at 3.8 to 6.3 hours, and persisted for 14 and 24 hours, respectively. Circulating granulocytes (neutrophils and bands) increased in a dose-dependent manner, as 11 of 13 patients who received greater than or equal to 1.0 microgram/kg/d responded with a two- to 194-fold increase. Although the neutrophils usually returned to pretreatment levels shortly after stopping GM-CSF, two patients continue to exhibit an elevation of neutrophils for 6 months. Dose-related increases in circulating monocytes and eosinophils were also noted. Transient increases in platelet and reticulocyte counts were observed in two and three patients, respectively. Five of the 16 patients later received maintenance GM-CSF at 3 micrograms/kg/d for 2 to 9 weeks. All showed a dramatic increase in neutrophils after 2 weeks. Thereafter, despite continued therapy, the neutrophil count in four patients declined markedly. In conclusion, GM-CSF is well tolerated by the SC route and induces striking, but usually temporary, improvement in the neutropenia of MDS. Larger prospective phase III trials will determine the duration of hematologic responses and the impact on infection, morbidity, and mortality.
Adolescent↗
Myasthenia gravis and lymphoblastic lymphoma antiacetylcholine receptor antibody as a tumor marker--a case report.
This report documents an association between lymphoblastic lymphoma and myasthenia gravis. Elevation of acetylcholine receptor antibody titer was an unusual marker for the lymphoblastic lymphoma. Following chemotherapy all symptoms of myasthenia gravis resolved and the acetylcholine receptor antibody titer normalized. The patient remains in complete remission off all therapy 20 months since the diagnosis of myasthenia gravis was made and 12 months after chemotherapy for her lymphoma.
Antigens, Neoplasm↗