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At least 631 records · Page 35Linked to original sources

Identification of key peptide-specific CD4+ T cell responses to human cytomegalovirus: implications for tracking antiviral populations.

Human cytomegalovirus (CMV) infection is normally controlled effectively by the immune response, including CD4(+) T cells. Large numbers of these cells are present in healthy seropositive individuals but their loss in immunosuppression leads to reactivation and disease. Tracking such responses in vivo is hampered by poor definition of their peptide targets. In this study, we defined the key targets of the peptide-specific CD4(+) T cell responses to the CMV pp65 protein using functional assays and a peptide library. Despite a good deal of interindividual variation in the numbers of peptides recognized, responses to CMV pp65 were strikingly targeted at three key epitopes. A response to one or more of these three key peptides was seen in all individuals tested (P < 0.0001) and this finding was tested and reproduced in a second independent population. The most common response identified was that to a DR53 restricted epitope, aa281-295. HLA-DR1 restricted CMV pp65-specific populations, although reproducibly detected, were of low frequency ex vivo. However, it was possible to detect and phenotype these cells using an enrichment protocol and this revealed them to have 'effector memory' status although, in contrast to CD8(+) T cell responses, these were CD45RA(-). These data suggest that CD4(+) T cell responses to CMV can be identified reliably using a pool of just three peptides. This simple approach will provide a robust and reliable as well as economic method for tracking peptide specific populations in health and disease.

Adult↗

Using the online and offline change model to improve efficiency for fast-track patients in an emergency department.

BACKGROUND: In 1998 the emergency department (ED) Work Group at Johns Hopkins Bayview Medical Center (Baltimore) worked to reinvigorate the fast-track program within the ED to improve throughput for patients with minor illnesses and injuries who present for care. There had been two prior unsuccessful attempts to overhaul the fast-track process. METHODS: The work group used a change model intended to improve both processes and relationships for complex organizational problems that span departments and functional units. Before the first work group meeting, the work group evaluated the institutional commitment to address the issue. The next step was to find data to fully understand the issues and establish a baseline for evaluating improvements--for example, patients with minor illnesses and injuries had excessively long total ED (registration to discharge) times: 5 hours 57 minutes on average for nonacute patients. ONLINE AND OFFLINE MEETINGS: The work group identified process problems, but relationship barriers became evident as the new processes were discussed. Yet offline work was needed to minimize the potential for online surprises. The work group leaders met separately in small groups with nursing staff, lab staff, x-ray staff, registrars, and physician's assistants to inform them of data, obtain input about process changes, and address any potential concerns. The group conducted four tests of change (using Plan-Do-Study-Act cycles) to eliminate the root causes of slow turnaround identified previously. RESULTS: Total ED time decreased to an average of 1 hour 47 minutes; the practice of placing nonacute patients in fast track before all higher-acuity patients were seen gained acceptance. The percentage of higher-acuity patients sent to fast track decreased from 17% of all patients seen in fast track in January 1998 to 8.5% by February 1999. Patients with minor illnesses and injuries no longer had to wait behind higher-acuity patients just to be registered. The average wait for registration decreased from 42 minutes in January 1998 to 14 minutes in February 1999. Physician's assistant, nursing, and technician staff all report improved working relationships and feeling a team spirit. DISCUSSION: The offline component of the integrated model helped to improve organizational relationships and dialogue among team members, thereby facilitating the effectiveness of online efforts to improve processes. This model has also been applied to improve patient registration (revenue recovery) and the emergency transfer and admissions process.

Appointments and Schedules↗

The radiographic trabecular pattern of hips in patients with hip fractures and in elderly control subjects.

Due to the increasing number of osteoporotic fractures of hip, spine, and wrist there is a growing need for methods to track down the subjects with inferior bone structure and to monitor the effects of therapeutic measures. This study aims at a noninvasive diagnostic tool, deriving architectural properties of trabecular bone from in vivo measurements on plane radiographic films. Pelvic radiographs of the nonfractured hips of 81 patients with hip fractures and of the right hips of 74 controls were studied. The regions of interest, 2 x 2 cm2, located in the femoral neck, were sampled and digitized with a video camera connected to an image analysis system. Several geometrical and directional measurements were made. The measurements were evaluated by statistical comparison with fracture risk, gender, and Singh index. By discriminant analysis, type of fracture, as well as gender and Singh index could be predicted correctly for 58% of the subjects, whereas guessing would be correct in only 8%. It was found that the geometrical parameters discriminate between hips of controls and patients. With respect to the directional measurements associations were found with gender and Singh index. Although the new parameters assess fracture risk less accurately than bone density measurements, some parameters suggest by their behavior that they are relevant with respect to femoral bone architecture and its mechanical behavior. Although interpretation of the measurements in histological concepts requires methods that have been reported in literature only recently, it is concluded that digital analysis of the radiographic trabecular pattern is an interesting option to increase the diagnostic yield of plane film radiographs and to study the structure of bone in vivo.

Age Factors↗

Financial support for research in otolaryngology.

OBJECTIVES: This project describes the use of computer-assisted searches of medical literature in an attempt to track the prevalence and type of funding of medical research. STUDY DESIGN AND SETTING: The study is a computer-assisted observational survey of the medical literature. To establish a database and track funding trends, a computer-assisted Medline search (CAMS) of the literature from 1986 to 1991 and 1992 to August 1996 was undertaken for 3 areas of interest: (1) sources of support, (2) comparison with other specialties, and (3) the validity of CAMS. A journal-based search examined the field of otolaryngology, which includes all the head and neck related sciences, and an institution-based search examined the clinical specialty of otolaryngology. RESULTS: By selected journal search, the field of otolaryngology has about one-third funding (34% of 20,751 papers), and about one-half of that is supported by the National Institutes of Health. This proportion of federal support increased over time. By institution line search, the specialty of otolaryngology is less well funded (26% of 15,480 papers) as might be expected. However, in contrast to basic sciences, there is a trend of decreased funding over the 11-year period of the study. SIGNIFICANCE: It appears that while the field of otolaryngology (basic scientists and clinicians) may be enjoying increasing support of research, the clinical specialty of otolaryngology is among the many specialties that exhibit a trend of decreasing level of NIH support. CONCLUSIONS: Computer-assisted surveys are an effective method of tracking funding for research in otolaryngology and other specialties. CAMS may be a valuable tool for monitoring efforts to improve funding resources for otolaryngology.

Economics, Medical↗

Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study.

BACKGROUND: Adaptive support ventilation (ASV) is a microprocessor-controlled mode of mechanical ventilation that maintains a predefined minute ventilation with an optimal breathing pattern (tidal volume and rate) by automatically adapting inspiratory pressure and ventilator rate to changes in the patient's condition. The aim of the current study was to test the hypothesis that a protocol of respiratory weaning based on ASV could reduce the duration of tracheal intubation after uncomplicated cardiac surgery ("fast-track" surgery). METHODS: A group of patients being given ASV (group ASV) was compared with a control group (group control) in a randomized controlled study. After coronary artery bypass grafting during general anesthesia with midazolam and fentanyl, patients were randomly assigned to group ASV or group control. Both protocols were divided into three predefined phases, and weaning progressed according to arterial blood gas and clinical criteria. In phase 1, ASV mode was set at 100% of the theoretical value of volume/minute in group ASV, and synchronized intermittent mandatory ventilation mode was used in group control. When spontaneous breathing occurred, ASV setting was reduced by 50% of minute ventilation (phase 2) and again by 50% (phase 3), and the trachea was extubated. In group control, the ventilator was switched to 10 cm H2O inspiratory pressure support (phase 2), then to 5 cm H2O (phase 3) until extubation. RESULTS: Forty-nine patients were enrolled. Sixteen patients completed the ASV protocol, and 20 the standard protocol; 7 patients were excluded in group ASV and 6 in group control according to explicit, predefined criteria. There were no differences between groups in perioperative characteristics or in the doses of sedation. The primary outcome of the study, that is, the duration of tracheal intubation, was shorter in group ASV than in group control (median [quartiles]: 3.2 [2.5-4.6] vs. 4.1 [3.1-8.6] h; P < 0.02). Fewer arterial blood analyses were performed in group ASV (median number [quartiles]: 3 [3-4] vs. 4 [3-6]), suggesting that fewer changes in the settings of the ventilator were required in this group. CONCLUSIONS: A respiratory weaning protocol based on ASV is practicable; it may accelerate tracheal extubation and simplify ventilatory management in fast-track patients after cardiac surgery. The evaluation of potential advantages of the use of such technology on patient outcome and resource utilization deserves further studies.

Aged↗

Fast occluded object tracking by a robust appearance filter.

We propose a new method for object tracking in image sequences using template matching. To update the template, appearance features are smoothed temporally by robust Kalman filters, one to each pixel. The resistance of the resulting template to partial occlusions enables the accurate detection and handling of more severe occlusions. Abrupt changes of lighting conditions can also be handled, especially when photometric invariant color features are used. The method has only a few parameters and is computationally fast enough to track objects in real time.

Algorithms↗

3D ultrasound tissue motion tracking using correlation search.

Several methods for ultrasound tissue motion tracking and blood velocity estimation have been proposed and clinically applied. While providing valuable information to the clinician that was not obtainable from B-mode anatomical imaging, these methods still suffer from various fundamental and practical limitations that compromise their performance in certain clinical situations. A significant limitation is the inability of most of these methods to estimate the complete 3D motion or velocity vectors. With the introduction of ultrasound volumetric imaging, the need for a method that is capable of obtaining the complete motion vector is even more pressing. In this paper, we investigate the implementation of a correlation search scheme to estimate the 3D motion vectors using successive volumetric ultrasound scans. We present tracking results for motion along different axes and discuss the advantages and limitations of performing the correlation search in 3D.

Algorithms↗

National trends in osteoporosis visits and osteoporosis treatment, 1988-2003.

BACKGROUND: Research is limited on physicians' prescribing practices for osteoporosis treatment. We investigated patterns of pharmacotherapy from 1988 to 2003 and the impact of new medications on identification and treatment of patients with osteoporosis. METHODS: We tracked trends from 1988 through 2003 in the frequency of osteoporosis visits and patterns of pharmacotherapy associated with these visits using nationally representative data on prescribing patterns by office-based US physicians from the IMS HEALTH National Disease and Therapeutic Index. RESULTS: The number of physician visits for osteoporosis increased 4-fold between 1994 (1.3 million visits) and 2003 (6.3 million visits), whereas it had remained stable in prior years. This increase coincided with the availability of oral daily bisphosphonates and the selective estrogen receptor modulator raloxifene. The annualized percentage of osteoporosis visits where medications were prescribed increased from 82% in 1988 to 97% by 2003. Prior to 1994, the leading choices for osteoporosis therapy were calcium and estrogens, with lesser roles played by calcitonins and bisphosphonates. Between 1994 and 2003, the percentage of visits where bisphosphonates and raloxifene were prescribed increased from 14% to 73% and from 0% to 12%, respectively, while prescriptions for other medications declined. CONCLUSIONS: New medications for osteoporosis offering improved efficacy and convenient dosing were associated with increased frequency of patient visits and treatment. This finding suggests that new drug therapy contributed to increased disease recognition and treatment.

Adult↗

Increasing immunization rates among inner-city, African American children. A randomized trial of case management.

CONTEXT: Immunization rates in the inner city remain lower than in the general US population, but efforts to raise immunization levels in inner-city areas have been largely untested. OBJECTIVE: To assess the effectiveness of case management in raising immunization levels among infants of inner-city, African American families. DESIGN: Randomized controlled trial with follow-up through 1 year of life. SETTING: Low-income areas of inner-city Los Angeles, Calif. PATIENTS: A representative sample of 419 African American infants and their families. INTERVENTIONS: In-depth assessment by case managers before infants were 6 weeks of age, with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed. MAIN OUTCOME MEASURES: Percentage of children with up-to-date immunizations at age 1 year, characteristics associated with improved immunization rates, and cost-effectiveness of case management intervention. RESULTS: A total of 365 newborns were followed up to age 1 year. Overall, the immunization completion for the case management group was 13.2 percentage points higher than the control group (63.8% vs 50.6%; P=.01). In a logistic model, the case management effect was limited to the 25% of the sample who reported 3 or fewer well-child visits (odds ratio, 3.43; 95% confidence interval, 1.26-9.35); for them, immunization levels increased by 28 percentage points. Although for the case management group intervention was not cost-effective ($12022 per additional child immunized), it was better ($4546) for the 25% of the sample identified retrospectively to have inadequate utilization of preventive health visits. CONCLUSIONS: A case management intervention in the first year of life was effective but not cost-effective at raising immunization levels in inner-city, African American infants. The intervention was demonstrated to be particularly effective for subpopulations that do not access well-child care; however, currently there are no means to identify these groups prospectively. For case management to be a useful tool to raise immunizations levels among high-risk populations, better methods of tracking and targeting, such as immunization registries, need to be developed.

Black or African American↗

The fall in incidence of prostate carcinoma. On the down side of a prostate specific antigen induced peak in incidence--data from the Utah Cancer Registry.

BACKGROUND: In the 1980s, prostate specific antigen (PSA) came into wide use as a prostate carcinoma screening and detection method in the United States. Following the introduction of PSA, the age-adjusted incidence of prostate carcinoma reported by the Surveillance, Epidemiology, and End Results (SEER) program in the United States rose rapidly (from 84.4/100,000 in 1984 to 163/100,000 in 1991). When an increase in incidence is observed following the introduction of a screening method, a subsequent decrease in incidence may be expected as prevalent cases are removed from the population (a cull effect). Incidence rates may also fall due to factors such as decreased intensity of screening. The Utah Cancer Registry data were examined for a decrease in prostate cancer incidence. METHODS: We tracked age-adjusted prostate carcinoma incidence trends from the population-based Utah Cancer Registry and compared them with rates from the SEER national registry. RESULTS: A rapid and highly correlated rise in prostate carcinoma incidence has been observed in both SEER and Utah incidence rates between 1988 and 1991, the last year for which SEER data are available. In 1992, Utah incidence rates peaked at 236.2 per 100,000. In 1993 and 1994, Utah incidence rates fell to 195.0, and an estimated 164.0 per 100,000, respectively. CONCLUSIONS: Population-based data from the Utah Cancer Registry indicates that the incidence of prostate carcinoma is decreasing rapidly after a similarly rapid increase.

Age Factors↗

Mental health patients in criminal justice populations: needs, treatment and criminal behaviour.

BACKGROUND: Government policy requires that health and social care agencies work more closely together and in partnership with the criminal justice system. There is a well-established relationship between crime and mental disorder. METHOD: The Tracking Project provides for the first time in England the means of collating and analysing data on mental disorder (defined as receiving secondary care as patients of a Mental Health Trust) and crime (defined as all those charged with an offence). Data were collected over a three-year period for all individuals who had contact with the criminal justice system and mental health services in an English county. RESULTS: In a county population of 800,400, some 30,329 were offenders. More than a third had used a health or social care service during the three-year period; 8.0% were mentally disordered. Those offenders aged 25-64 and who contacted the police more than once were significantly more likely to be mentally disordered. Type of offence was also a relevant variable. The probation service showed broadly similar results. DISCUSSION: The research has provided for the first time substantive quantitative evidence of the relationship between crime and mental disorder. The results can be used as the basis for further work to target assessment and risk reduction measures at those most at risk.

Adolescent↗

Nanometer-scale measurements using video light microscopy.

Video and digital image processing have been used to amplify the contrast of light microscopic images, making it possible to observe in real time the diffraction images of cell structures 10 times smaller than the Raleigh resolution limit of 0.2 micron. In this paper we discuss how quantitative analysis of diffraction images can be used to extract information about motion or structure at the nanometer level. This issue is considered in the context of a method for tracking the motion of kinesin-coated beads on microtubules with 1-2 nm precision (Gelles et al.:Nature 331:450-453, 1988).

Cell Movement↗

Capillary electrophoretic separation of cationic constituents of imidazolium ionic liquids.

A capillary electrophoretic method for resolving selected imidazolium ionic liquid cations is reported. The method, in which citric buffer is used as the running electrolyte, is simple and reproducible. The separation of a standard mixture is in linear accordance with the relative molecular mass (M(r)) of solutes regardless of the type of substitution (alkyl or aryl). The theoretical prediction of compounds as yet not analyzed is therefore possible; however, cations with identical molecular masses are inseparable with this method. Nevertheless, the method's quantitative analytical performance was excellent. The paper also discusses the applicability of a method for tracking the photodegradation kinetics of an exemplary ionic liquid.

Cations↗

Mechanisms and outcomes of angioplasty and atherectomy assessed by intravascular ultrasound imaging.

Catheter-based intravascular ultrasound is a relatively new imaging tool to examine endovascular structure. One major goal for the development of intravascular ultrasound imaging has been to help clarify the mechanism of interventional therapies such as balloon angioplasty and directional atherectomy. Pathologic studies have suggested that plaque distribution and composition are key features that relate to initial and long-term success of coronary interventions. However, relatively little is known by angiography about the nature of plaque in the clinical setting. Intravascular ultrasound imaging provides a high resolution, "on-line" method of tracking the effects of catheter interventions such as balloon angioplasty and atherectomy. Because of its ability to visualize tissue beneath the luminal surface, ultrasound is generating new insights into the effect of plaque composition and distribution on the response to catheter therapies. With pre-procedure ultrasound imaging, it is increasingly possible to predict the result of a particular intervention, offering the potential for developing strategies of lesion-targeted therapy based on certain plaque characteristics. This article presents the early results of the GUIDE trial as a "works in progress" view of the role of intravascular ultrasound in helping interventionalists to understand--and to optimize--angioplasty and atherectomy.

Angioplasty, Balloon, Coronary↗

Development and Validation of Amplicon-Based Protocol for Sequencing of Respiratory Syncytial Virus Genome.

The most prevalent cause of severe respiratory infections in children is the human respiratory syncytial virus (RSV). The advent of next-generation sequencing (NGS) has made it possible to incorporate this technology into pathogen monitoring and surveillance. Whole-genome sequencing (WGS) of RSV has now become a relatively widely used method for tracking viral evolution. Here we report an improved high-throughput RSV-WGS assay performed directly on clinical samples that is suitable for short-read sequencing platforms. A total of 100 RSV-positive samples collected between November 2022 and March 2024 fulfilled the inclusion cycle quantification criteria and were randomly included in the validation process. The WGS protocol was designed to amplify three distinct amplicons to cover the entire RSV genome. The protocol described here can be successfully replicated in several instances (approximately 95%) in samples with a relatively low viral load, typically corresponding to cycle of quantification values of 27-32. The amplicon-based protocol produced meaningful sequencing results in terms of median depth of coverage (more than 12000&#xd7;) and median of mapped reads (>&#x2009;1&#x2009;&#xd7;&#x2009;106 reads). The sequences that had passed the filters showed a coverage of at least 98% across the entire genome, with cycle quantification values of 32. Based on the obtained data resulting in an easy-to-perform protocol helpful for the molecular epidemiology surveillance of RSV.

Humans↗

Visualization of sequential exocytosis in rat pancreatic islet beta cells.

The examination of insulin exocytosis at the single cell level by conventional electrophysiologic and amperometric methods possesses inherent limitations, and may not accurately reflect the morphologic events of exocytosis of the insulin granule. To overcome some of these limitations, we show by epifluorescent microscopy of a fluorescent dye, FM1-43, its incorporation into the plasma membrane and oncoming insulin granules undergoing exocytosis, and their core proteins. Using this method, we tracked exocytosis in real-time in insulinoma INS-1 and single rat islet beta cells in response to KCl and glucose. We observed both single transient and multi-stepwise increases in membrane FM1-43 fluorescence, suggesting single granule exocytosis as well as sequential and compound exocytosis, respectively. Confocal microscopy of nonpermeabilized cells shows that some of the exocytosed insulin granules labeled by the FM1-43 dye could also be labeled with insulin antibodies, suggesting prolonged openings of the fusion pores and slow dissolution of the granule core proteins on the membrane surface.

Animals↗

Strongyloides ratti: thermokinetic behavior of third-stage larvae on a temperature gradient.

We examined the thermokinetic behaviors of infective third-stage larvae (L3) of the rodent parasitic nematode Strongyloides ratti on temperature gradients using an in vitro agarose tracking assay method. Observed behaviors included both negative and positive thermokineses, the direction of movement depending both on the gradient temperature at which larvae were initially placed and on prior experience of culture temperature. Larvae isolated from rat feces cultured at 25 degrees C and placed on a gradient at temperatures between 22 degrees and 29 degrees C tended to move toward higher temperatures. At higher placement temperatures, most larvae moved little and showed no directional response, whereas at lower placement temperatures, many migrated toward cooler temperatures. At placement temperatures of 20 degrees C or below, few or no larvae moved toward the zone of higher temperature. Larvae isolated from rat feces cultured at 20 degrees C tended to migrate to a high temperature area regardless of placed temperature. Those cultured at 30 degrees C did not respond to the temperature gradient. L3 cultured at 30 degrees C were significantly less infective to rats than those cultured at 25 degrees or 20 degrees C. Additional experiments were designed to demonstrate thermokinetic behaviors during the period after reaching the L3 stage. Larvae incubated in double distilled water (DDW) for 24 h at 37 degrees C lost their ability to respond to lower temperatures, while in those incubated in DDW at 15 degrees and 25 degrees C, responses were still apparent. The thermokinetic behavior of S. ratti L3 is affected by surrounding environmental temperatures and this may have an important role in host finding.

Animals↗

Development of a feline whole genome radiation hybrid panel and comparative mapping of human chromosome 12 and 22 loci.

A 5000-rad whole genome radiation hybrid panel is described for the domestic cat, derived from irradiated male feline fibroblasts fused to a recipient hamster cell line. A panel of 93 cell lines has an estimated retention frequency of 0.39 (range 0.13-0.71) based upon PCR typing of 54 feline markers. To test the panel's utility, we determined the order of 16 Type I (coding gene) loci, 14 Type II (microsatellite) loci, and 1 endogenous retroviral element on feline chromosomes B4 and D3. Assessment of marker order derived from the RH panel was compared to assignments of the same loci using interspecies backcross mapping data, human homologue positions, and human-cat chromosome painting homologies. Assessment of concordant and discordant marker order for these loci provides improved resolution into the evolution of subchromosomal genome organizations and the methods to track them in these species.

Animals↗