Outshopping: the battle between rural and urban medical services.
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Choice Behavior↗
Biomedical subjects
S L Taylor
Publications and source records attributed to S L Taylor.
Assessing the health care needs of a rural community.
This article describes the methods used to complete a recent community health needs assessment study in a rural area. It illustrates the strategic marketing and management value of conducting this type of assessment by examining selected results from the study and discussing their implications for the local health care delivery system.
Catchment Area, Health↗
Single-well genotyping of diallelic sequence variations by a two-color ELISA-based oligonucleotide ligation assay.
Single nucleotide substitutions and unique insertions/deletions are the most common form of DNA sequence variation and disease-causing mutation in the human genome. Because of the biological and medical importance of these variations, a wide array of methods have been developed for their typing. We have applied an approach that combines the amplification of polymorphic regions by the polymerase chain reaction (PCR) with a system for typing diallelic variants using an oligonucleotide ligation assay (OLA). In this report, we describe a significant advance in this technology that permits the typing of two alleles in a single microtiter well. By marking each of the allele-specific primers with a unique hapten, i.e. digoxigenin and fluorescein, each OLA reaction can be detected by using hapten specific antibodies that are labeled with different enzyme reporters, alkaline phosphatase or horseradish peroxidase. This system permits the detection of the two alleles using a high throughput format that leads to the production of two different colors. We demonstrate the specificity, sensitivity and ease of data interpretation with this system. Furthermore, we show that multiplex PCR/OLA not only increases the throughput of DNA typing but also increases its accuracy in typing diallelic sequence variations using an approach that can be broadly applied for human genome analysis (in evaluating genotype/phenotype links), in typing infectious agents and in forensic analysis.
Alleles↗
Pseudomeningocele/CSF fistula in a patient with lumbar spinal implants treated with epidural blood patch and a brief course of closed subarachnoid drainage. A case report.
STUDY DESIGN: This case report illustrates the development of a cerebrospinal fluid fistula and pseudomeningocele in a patient after lumbar discectomy and fusion with instrumentation. OBJECTIVE: The patient is treated successfully with a combined treatment protocol of epidural blood patch and brief course of spinal drainage. SUMMARY OF BACKGROUND DATA: Many surgeons advocate a trial of cerebrospinal fluid diversion for postoperative cerebrospinal fluid fistula. This treatment may be problematic in patients with spinal implants because a trial of cerebrospinal fluid diversion may not obliterate the extradural anatomic dead space that is created by instrumentation procedures and increases the rist of infection. A few case reports indicate that epidural blood patch also may be an effective management technique. A combined treatment protocol that may offer some advantages to either treatment alone is described METHODS: The patient was brought to the radiology department, and a lumbar spinal drain was placed at the L2-L3 interspace under fluoroscopic guidance with the patient in the prone position. A Tuohy needle was inserted into the pseudomeningocele, and the collection was drained. Thirty milliters of blood drawn from an antecubital vein was injected into the epidural space over the laminectomy site. Spinal drainage was continued for 4 days. RESULTS: The treatment protocol resulted in resolution of cerebrospinal fluid leakage in the patient. This result was confirmed by myelogram. CONCLUSIONS: Postoperative pseudomeningocele and cerebrospinal fluid fistula in patients with spinal instrumentation can be treated successfully with epidural blood patch and a brief course (4 days) of spinal drainage. This combined treatment protocol may have some advantages to treatment with 7 days of cerebrospinal fluid diversion or to percutaneous epidural blood patch alone.
Adult↗
Identification of a Brazil-nut allergen in transgenic soybeans.
BACKGROUND: The nutritional quality of soybeans (Glycine max) is compromised by a relative deficiency of methionine in the protein fraction of the seeds. To improve the nutritional quality, methionine-rich 2S albumin from the Brazil nut (Betholletia excelsa) has been introduced into transgenic soybeans. Since the Brazil nut is a known allergenic food, we assessed the allergenicity of the 2S albumin. METHODS: The ability of proteins in transgenic and non-transgenic soybeans, Brazil nuts, and purified 2S albumin to bind to IgE in serum from subjects allergic to Brazil nuts was determined by radioallergosorbent tests (4 subjects) and sodium dodecyl sulfate-polyacrylamide-gel electrophoresis (9 subjects) with immunoblotting and autoradiography. Three subjects also underwent skin-prick testing with extracts of soybean, transgenic soybean, and Brazil nut. RESULTS: On radioallergosorbent testing of pooled serum from four subjects allergic to Brazil nuts, protein extracts of transgenic soybean inhibited binding of IgE to Brazil-nut proteins. On immunoblotting, serum IgE from eight of nine subjects bound to purified 2S albumin from the Brazil nut and the transgenic soybean. On skin-prick testing, three subjects had positive reactions to extracts of Brazil nut and transgenic soybean and negative reactions to soybean extract. CONCLUSIONS: The 2S albumin is probably a major Brazil-nut allergen, and the transgenic soybeans analyzed in this study contain this protein. Our study show that an allergen from a food known to be allergenic can be transferred into another food by genetic engineering.
2S Albumins, Plant↗
Increasing the information content of STS-based genome maps: identifying polymorphisms in mapped STSs.
Physical maps of the human genome are being constructed by many groups using a mapping strategy that relies on the development of sequence-tagged sites (STSs). Thousands of physically mapped STSs, representing hundreds of kilobases (kb) of unique human DNA sequence, have been generated by these efforts. Since sequence variations are found every 1-2 kb in the genome, it is possible to extract additional information from mapped STSs by scanning them for variations. By screening 154 of the STSs published by the Whitehead Institute/MIT Genome Center, we have identified 47 new DNA sequence polymorphisms among the 37.2 kb of unique DNA sequence contained in these STSs. Using a sequence-based approach to estimate allele frequencies for these variations, 29 of the substitution polymorphisms (1 in 1.3 kb) were found to have heterozygosities exceeding 32%. Our study shows that the information content of STS-based genome maps can be increased with minimal additional effort by scanning for DNA polymorphisms, and that ambiguities and errors in the initial STS sequence can be resolved and corrected in the process.
Alleles↗
Principles and characteristics of food allergens.
Food allergens are typically proteins that are resistant to digestion, acid, and heat treatments. However, some notable exceptions exist. The amount of these proteins needed to elicit an allergic response in previously sensitized individuals is quite low (milligram amounts). The allergenicity of specific proteins derived from known allergenic sources can be determined, whereas the potential allergenicity of proteins derived from sources of unknown allergenicity is much harder to assess.
Allergens↗
Assessment of the allergenic potential of foods derived from genetically engineered crop plants.
This article provides a science-based, decision tree approach to assess the allergenic concerns associated with the introduction of gene products into new plant varieties. The assessment focuses on the source from which the transferred gene was derived. Sources fall into three general categories: common allergenic food proteins; less common allergenic foods or other known allergen sources; and sources with no history of allergenicity. Information concerning the amino acid sequence identity to known allergenic proteins, in vitro and/or in vivo immunologic assays, and assessment of key physiochemical properties are included in reaching a recommendation on whether food derived from the genetically modified plant variety should be labeled as to the source of the transferred gene. In the end, a balanced judgement of all the available data generated during allergenicity assessment will assure the safety of foods derived from genetically engineered crops. Using the approaches described here, new plant varieties generated by genetic modification should be introduced into the marketplace with the same confidence that new plant varieties developed by traditional breeding have been introduced for decades.
Allergens↗
Hospital outshopping: determinant attributes and hospital choice.
While hospital outshopping is becoming a significant problem for hospital administrators, little research exists in this area. Some health care studies have focused on the attributes deemed important by the consumer in choosing one hospital over another; however, not all service attributes are equally important in determining consumer preferences for hospitals. The authors describe an approach for calculating determinant attributes that rural consumers deem important and those in which these consumers perceive differences among hospitals.
Age Factors↗
Women's health centers and specialized services.
More than 75% of the female respondents in this study would choose a women's health center (WHC) over a standard health facility. Women who worked outside the home perceived a greater WHC need. And almost all respondents were interested in communications from the center via a quarterly newsletter. Significant test results related to age, income, education, and work status as segmentation variables, offering WHC's an opportunity to target their patients with specialized services such as cosmetic surgery, infertility treatment, breast imaging, etc. If enough resources are allocated, a WHC can design itself to attract highly lucrative patients. Little difference was found in the opinions of women regarding the need for a WHC or the core services desired, but the specific service mix decision must be carefully considered when designing a WHC.
Consumer Behavior↗
Pituitary adenoma as an unsuspected clival tumor.
Pituitary adenomas are common tumors that account for about 10% of intracranial neoplasms. Most arise from the adenohypophysis and are confined to the region of the sella turcica. Other sites may be involved as a result of extension, infiltration, or ectopic location. However, posterior extension or ectopic involvement of the clivus of the sphenoid and occipital bones is rare. Seven patients with destructive clival masses were referred to our institution with presumptive diagnoses of chordomas. In all cases, histologic workup revealed pituitary adenomas. Because they represent a subset of adenomas, the histologic features of the tumors were studied, and the clinical histories of the patients were reviewed. Five of the patients were men, aged 31 to 67 years, and two were women, aged 55 and 67 years. Four patients had extremely high plasma concentrations of prolactin (8,132-22,424 ng/ml, nl < 15). Four tumors resembled usual sellar adenomas; however, three exhibited nuclear pleomorphism, mitotic figures, and other morphologic features, suggesting alternate diagnoses. Three required immunoperoxidase stains in addition to those for pituitary hormones, and three required electron microscopy for diagnosis. Destructive invasion of the clivus by pituitary adenomas is rare, and anaplastic features of some of the tumors may lead to difficult diagnoses.
Adenoma↗
Delayed onset of hyponatremia after transsphenoidal surgery for pituitary adenomas.
Hyponatremia is rarely reported as a delayed complication of transsphenoidal resection of pituitary adenoma. Usually attributed to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), hyponatremia causes nonspecific symptoms, often after hospital discharge. To clarify the frequency, presentation, and outcome of this poorly understood complication, we reviewed our database of 2297 patients who underwent transsphenoidal pituitary surgery between February 1971 and June 1993. Of 53 patients (2.3%) treated for symptomatic hyponatremia, 11 were excluded (2 received arginine vasopressin within 24 hours, 1 had untreated hypothyroidism, 4 had untreated adrenal insufficiency, and 4 had incomplete records). The remaining 42 patients (1.8%), 11 men and 31 women aged 21 to 79 years, presented 4 to 13 days (mean, 8 d) postoperatively with nausea and vomiting (20 patients), headache (18 patients), malaise (12 patients), dizziness (4 patients), anorexia (2 patients), and seizures (1 patient). Hyponatremia was unrelated to sex, age, adenoma type, tumor size, or glucocorticoid tapering. Although the clinical picture in our patients is consistent with SIADH, this was not supported by the antidiuretic hormone levels, which were normal or low-normal in the two patients in whom they were measured, suggesting the possibility that low serum sodium may not reflect SIADH. In all patients, hyponatremia resolved within 6 days (mean, 2 d); treatment consisted of salt replacement and mild fluid restriction in 37 patients and fluid restriction only in 4 (treatment unknown in 1). Delayed hyponatremia after transsphenoidal resection of pituitary adenoma is not as rare as previously thought, nor is it necessarily associated with SIADH or with hypoadrenalism during glucocorticoid tapering.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenoma↗
Monitoring chronic fatigue syndrome.
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Disability Evaluation↗
Evaluation of the Cosmed K2 portable telemetric oxygen uptake analyzer.
The purpose of this study was to determine the validity and evaluate the accuracy of a portable telemetric oxygen uptake analyzer (K2). Two experiments were carried out: a) using a mechanical lung, the accuracy of the K2 to measure oxygen fractions and minute ventilation following 10 and 60 min of warm-up was determined; and b) two maximal graded exercise tests (GXT) on 15 subjects, one with the K2 system and the other with a standardized breath-by-breath (BBB) system, while heart rate (HR), minute ventilation (VE), and oxygen uptake (VO2) were compared. Following 10-min warm-up prior to calibration, the K2 underestimated the true oxygen fraction as early as 5 min into the test, and this value continued to decrease throughout the 30-min test. After 60 min of warm-up prior to calibration, the K2 accurately measured the true oxygen fraction for the first 15 min; at minute 20, and on to minute 30, the K2 underestimated the oxygen fraction. Ventilation volumes were not affected by warm-up time. Minute ventilation during the K2 GXT was significantly higher than VE for the BBB test. No significant differences were found between the HRs obtained with the BBB or K2 systems. No differences in VO2 for any stage of the GXT were identified between the K2 device, BBB device or when a respiratory exchange ratio (RER) correction factor was applied to the K2 derived values. However, the RER correction factor did minimize the VO2 differences between the BBB and K2 systems. Therefore, we conclude that the K2 accurately measures VO2 during a GXT; however, its accuracy can be compromised by limitations inherent to the system.
Adult↗
Primary autoimmune cholangitis. An alternative to antimitochondrial antibody-negative primary biliary cirrhosis.
The authors report the clinical and liver biopsy features of nine patients with primary autoimmune cholangitis, a unique form of chronic nonsuppurative destructive cholangitis associated with high-titer serum antinuclear antibodies, including eight women and one man; their median age was 51 years. All patients showed cholestatic hepatic enzyme profiles (median gamma glutamyl transferase and alkaline phosphatase, 800 U/L and 700 U/L, respectively). The median antinuclear antibody titer was 1:1,280 (range, 1:640-1:2,560). All patients' sera were negative for antimitochondrial antibodies; six were also nonreactive for anti-M2 mitochondrial autoantigens. Liver biopsies showed marked paucity of interlobular bile ducts (median percentage of portal tracts containing bile ducts, 11%; range, 0-50%). Granulomatous cholangitis was present in two cases; five livers showed the pattern of bile ductular proliferative piecemeal necrosis. Seven patients were treated with prednisone and azathioprine without clinical benefit. During follow-up of 1 to 5 years, disease has progressed in seven patients, including four who have developed other autoimmune conditions. Although clinically, biochemically, and histopathologically comparable to primary biliary cirrhosis, autoimmune cholangitis abdicates antimitochondrial antibodies in favor of antinuclear antibodies. It represents a distinctive subset of antimitochondrial antibody-negative adult ductopenic disorders, for which conventional immunosuppressive therapy does not appear warranted.
Adult↗
Chemical additives in seafood products.
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Animals↗
Prevalence of chronic fatigue syndrome-related symptoms among nurses.
Chronic Fatigue Syndrome is an illness that is characterized by debilitating fatigue and a group of other related symptoms. Few epidemiological studies have been conducted, and none have focused on a nursing population. The present study is the first to assess the prevalence of Chronic Fatigue Syndrome-related symptoms in a sample of nurses. Demographic characteristics, symptoms, and possible prevalence rates are presented and discussed. When using both narrow and more inclusive criteria to define this symptom complex, higher rates of this disorder were found than in previous epidemiological studies. The implications of these findings are discussed.
Adult↗