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PubMed1995

Solo or partnership.

Reassessment of the managed care environment and restructuring of our practice will be accomplished by transitional short-term actions while we institute our long-range plan. In the short term we must develop appropriate relationships with hospitals and medical groups that interrelate to our specialty, and develop a "love our enemy" philosophy. We must establish operating organizational units that will be competitive. Reassessment of our own practice, our unique skills, our inadequacies, our competition, and our performance through outcome studies is essential to retake positions weakened by loss of contract inclusion. Long-term strategy must develop insurance coverage in conjunction with our patients in such a way that the middleman is eliminated and the profit currently extracted by managed care is reinvested in patient care, research, and education. Whoever controls payment determines the quality of medicine and how it is delivered.

Clinical Competence↗
PubMed1994

Reduction of escapee formation in flow cytometric analysis of lymphocyte subsets.

Most experienced flow cytometrists performing immunophenotyping of lymphocyte subsets are aware of the escape phenomenon, in which some positive cells are found outside a lymphocyte gate based on forward and right angle scatter. However, little information is available on the levels of escapees formed with different antibodies, the roles of fluorochromes and lysing agents, the mechanism explaining the phenomenon, or methods to reduce it. We thus performed a systematic analysis of the escapee phenomenon to clarify these issues. A panel of monoclonal antibodies, including a phycoerythrin (PE) conjugate and a fluorescein isothiocyanate (FITC) conjugate of the same antibody from one manufacturer, was used to treat whole blood specimens, after which red cells were lysed using 0.15 M ammonium chloride (AmChl). The percentages of gated lymphocytes expressing CD3, CD8, CD19, and HLA-DR, but not CD2, CD4, CD16, and CD25, were significantly lower in FITC-stained versus PE-stained preparations. Correlated analysis of green fluorescence and forward scatter showed that, on average, 18% of CD3+ events, 24% of CD8+ events, and 25% of CD19+ events were escapees when using the FITC conjugate. In dual color analysis, CD3+ escapees were positive for CD62-P, CD13, and CD14, indicating that the escapee events consisted of FITC-anti-CD3-coated lymphocytes complexed with platelet-coated myeloid cells. In studies of the role of lysing agent, essentially no escapees were found in specimens treated with FACS lysing solution, which contains formaldehyde. We therefore included a similar denaturing agent, paraformaldehyde (0.1%), in the AmChl lysing agent, and found that the occurrence of escapees was markedly reduced. These findings show that the escapee phenomenon occurs when using some FITC-conjugated monoclonal antibodies in conjunction with AmChl lysing agent, and can be reduced by inclusion of paraformaldehyde in the lysing agent.

Ammonium Chloride↗
PubMedDate not supplied

Studies and observations on Lewis grouping of body fluids and stains.

Leb positive individuals may phenotypically express both Lea and Leb in their secreted body fluids. Therefore, the interpretation of a Le(a + ,b-), non-secretor result is dependent on the absence of Leb. This study emphasises the importance of accurate procedure and biased selection of antisera such that Leb is preferentially detected in comparison with Lea. The relationship of the ABO group to the expression of Le is discussed in conjunction with the selection of samples for testing antisera and inclusion as control standards.

Blood Grouping and Crossmatching↗
PubMed2005

Microscopic and clinical evidence for Anaplasma (Ehrlichia) phagocytophilum infection in Italian cats.

Fifteen cats from Italy with Ehrlichia-like inclusion bodies in their neutrophils were studied. They were diagnosed with Anaplasma (Ehrlichia) phagocytophilum infection on the basis of cytological observation of morulae within 1 to 21 per cent of their neutrophils, clinical signs characteristic of ehrlichiosis and their response to doxycycline. The predominant signs of disease were anorexia, lethargy, hyperaesthesia, muscle and joint pain, lameness, neck rigidity, lymphadenomegaly, gingivitis/periodontitis, conjunctivitis, weight loss, incoordination, pale mucous membranes and hyperglobulinaemia. The cat with inclusions in 21 per cent of its neutrophils had suffered arthralgia, tachypnoea, neck rigidity, vomiting and thrombocytopenia for four months, but recovered promptly after treatment with doxycycline.

Anaplasma phagocytophilum↗
PubMed1997

Physiological adaptations to a weight-loss dietary regimen and exercise programs in women.

Thirty-one women (mean age 35.4 +/- 8.5 yr) who were overweight were matched and randomly placed into either a control group (Con; n = 6), a diet-only group (D; n = 8), a diet+aerobic endurance exercise training group (DE; n = 9), or a diet+aerobic endurance exercise training+strength training group (DES; n = 8). After 12 wk, the three dietary groups demonstrated a significant (P </= 0.05) reduction in body mass, %body fat, and fat mass. No differences were observed in the magnitude of loss among groups, in fat-free mass, or in resting metabolic rate. The DE and DES groups increased maximal oxygen consumption, and the DES group demonstrated increases in maximal strength. Weight loss resulted in a similar reduction in total serum cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol among dietary groups. These data indicate that weight loss during moderate caloric restriction is not altered by inclusion of aerobic or aerobic+resistance exercise, but diet in conjunction with training can induce remarkable adaptations in aerobic capacity and muscular strength despite significant reductions in body mass.

Adaptation, Physiological↗
PubMed1982

Aspirin prophylaxis for pulmonary embolism following total hip arthroplasty. An incidence study.

Although this study was performed on a relatively small number of patients undergoing total hip arthroplasty in conjunction with aspirin prophylaxis for postoperative pulmonary embolism, several important points are noted: the use of pre- and postoperative lung perfusion scanning can eliminate a 15% rate of false-positive diagnosis of pulmonary embolism, and pulmonary embolism occurred in approximately 8% of patients undergoing total hip arthroplasty in conjunction with aspirin prophylaxis, without fatality. This occurred despite the inclusion of high-risk patients. "Silent" pulmonary embolization occurred in 4.1% of these patients. Patients who have a history of a thromboembolism, a delayed postoperative course, and two or more risk factors for pulmonary embolism present, are at risk of developing a postoperative pulmonary embolism, despite aspirin therapy, and should be managed more aggressively, i.e., early detection or prophylactic anticoagulation therapy.

Adolescent↗
PubMed1994

Composition of Gomori-positive inclusions in astrocytes of the hypothalamic arcuate nucleus.

BACKGROUND: Astrocytes within the hypothalamic arcuate nucleus contain Gomori-positive inclusions that exhibit a nonenzymatic peroxidase activity. The source and composition of these Gomori-positive inclusions are currently unknown. Recent evidence, derived from cultured astrocytes, suggests that Gomori-positive inclusions may consist of autophagocytized accumulations of altered mitochondria and that the peroxidase activity is generated by iron or other metals which accumulate in these mitochondria. METHODS: The present study applies electron microscopy, energy dispersive X-ray microanalysis, and immunocytochemistry in conjunction with confocal microscopy to determine the structure and composition of Gomori-positive inclusions in vivo. RESULTS: The results indicate that Gomori-positive inclusions are heterogeneous structures often associated with microtubules and that they contain conspicuous mitochondrial components. Gomori-positive inclusions exhibit X-ray emission peaks for copper and, less often, chromium, either of which could account for the peroxidase activity. CONCLUSIONS: These results support the hypothesis that Gomori-positive inclusions are autophagosomes in which mitochondria are prominent.

Animals↗
PubMed1989

Viral and bacterial conjunctivitis. Prevention of disastrous results.

Conjunctivitis has many bacterial and viral causes. If the cause is bacterial, treatment with a broad-spectrum antibiotic resolves the problem in 1 to 3 days in almost all cases. If signs and symptoms persist, referral to an ophthalmologist is wise. Most cases of viral conjunctivitis are accompanied by follicular reactions in the inferior fornix, as observed with adult inclusion disease. If dendrites are seen, trifluridine (Viroptic) is preferred for treatment. Referral to an ophthalmologist is advisable because recurrence with scarring and permanent loss of vision is possible. Many topical antibiotics include a corticosteroid component that never should be used unless the conjunctivitis or keratitis is proven to be nonherpetic.

Adult↗
PubMed2000

Safety and efficacy comparison of emedastine 0.05% ophthalmic solution compared to levocabastine 0.05% ophthalmic suspension in pediatric subjects with allergic conjunctivitis. Emadine Study Group.

PURPOSE: To determine the efficacy and tolerance of emedastine 0.05% ophthalmic solution compared to levocabastine 0.05% ophthalmic suspension in pediatric subjects. METHODS AND MATERIALS: In a randomized, double-masked, parallel controlled study, emedastine 0.05% ophthalmic solution BID was compared to levocabastine 0.05% ophthalmic suspension BID, for control of the signs and symptoms of allergic conjunctivitis in pediatric subjects ages 3-16. Subjects who met all inclusion and exclusion criteria received masked study medication with instructions to instill drops twice daily, in the morning and evening. A diary was completed by the parents four times daily for the first two and last two weeks of the study. Treatment lasted 42 days. Drug efficacy was assessed at the initial administration in the office at Day 0 and after 3, 7, 14, 30 and 42 days. RESULTS: Overall results showed both drugs have an effect and that emedastine was significantly superior (p < 0.05) to levocabastine for the relief of chemosis on Days 14, 30 and 42; of itching on follow-up Days 30 and 42 (p < 0.05); of redness on Days 30 and 42; for eyelid swelling on Days 14 and 30; and for physician's impression score on Days 7, 14, 30 and 42. CONCLUSION: These results confirm previous preclinical and clinical data on the potent and long acting efficacy of this promising new ophthalmic anti-allergic drug, emedastine in pediatric subjects.

Adolescent↗
PubMed1995

Lipid metabolism in Chlamydia trachomatis-infected cells: directed trafficking of Golgi-derived sphingolipids to the chlamydial inclusion.

Chlamydia trachomatis undergoes its entire life cycle within an uncharacterized intracellular vesicle that does not fuse with lysosomes. We used a fluorescent Golgi-specific probe, (N-[7-(4-nitrobenzo-2-oxa-1,3-diazole)]) aminocaproylsphingosine (C6-NBD-Cer), in conjunction with conventional fluorescence or confocal microscopy to identify interactions between the Golgi apparatus and the chlamydial inclusion. We observed not only a close physical association between the Golgi apparatus and the chlamydial inclusion but the eventual presence of a metabolite of this fluorescent probe associated with the chlamydiae themselves. Sphingomyelin, endogenously synthesized from C6-NBD-Cer, was specifically transported to the inclusion and incorporated into the cell wall of the intracellular chlamydiae. Incorporation of the fluorescent sphingolipid by chlamydiae was inhibited by brefeldin A. Chlamydiae therefore occupy a vesicle distal to the Golgi apparatus that receives anterograde vesicular traffic from the Golgi normally bound for the plasma membrane. Collectively, the data suggest that the chlamydial inclusion may represent a unique compartment within the trans-Golgi network.

4-Chloro-7-nitrobenzofurazan↗
PubMed1976

Trachoma in a rural Haitian community.

We selected 43 patients, aged 15 days to 57 yesrs, for intensive study after screening 975 people for clinical evidence of trachoma in rural Haiti. Trachoma was present in Haiti with low endemicity and was followed by relatively mild sequelae. Laboratory studies confirmed the disease through demonstration of conjunctival inclusion bodies by immunofluoresence and serotyping of antibody in sera or eye secretions, or both. Of 23 patients (age 1 to 36 years) with active trachoma, all had serum antibody to chlamydia (range 1:10 to 1:640), nine had eye secretion antibody (range 1:10 to 1:1280), and one was inclusion positive. The remaining 20 patients (age 15 days to 57 years) had the following diagnosis: atypical follicles (eight), conjunctivitis with or without mucopurulent discharge (ten) innactive pannus only (one), and severe anemia (one). Only 16 of the 20 were tested for serum antibody and all were positive (1:10 to 1:5,120), 11 of 20 had eye secretion antibody (1:10 to less than or equal to 1:640), and one was inclusion positive. Serotyping attempted on 22 patients yielded 16 patients with antibodies specific for type A, one patient with type B, and five who were not typed.

Adolescent↗
PubMed2005

Early event-related potential changes during working memory activation predict rapid decline in mild cognitive impairment.

BACKGROUND: The conversion of mild cognitive impairment (MCI) to Alzheimer's disease is associated with substantial compromise of neocortical circuits subserving rapid cognitive functions such as working memory. Event-related potential (ERP) analysis is a powerful tool to identify early impairment of these circuits, yet research for an electrophysiological marker of cognitive deterioration in MCI is scarce. Using a "2-back" activation paradigm, we recently described an electrophysiological correlate of working memory activation (positive-negative working memory [PN(wm)] component) over parietal electrodes. METHODS: Ours was a longitudinal study of 24 MCI patients with ERP analysis at inclusion and neuropsychological follow-up after 1 year. We used ERP waveform subtraction analysis between the n-back and control tasks. Analysis of variance (ANOVA) was used to compare electroencephalograph latencies between progressive MCI (PMCI) and stable MCI (SMCI), and univariate regression was used to assess the relationship between neuropsychological measures at baseline and clinical outcome. RESULTS: Thirteen (54%) MCI patients showed PMCI, and 11 (46%) remained stable (SMCI). In SMCI, a PN(wm) component with significantly larger density compared to baseline was identified when subtracting the detection task for both the 1- and 2-back tasks. In contrast, in PMCI, the PN(wm) component was absent in both 1-back and 2-back conditions. Neuropsychological variables and n-back test performance at inclusion did not predict cognitive deterioration 1 year later. CONCLUSIONS: In conjunction with recent functional imaging data, the present results support the notion of an early dysfunction of neural generators within the parietal cortex in MCI. They also reveal that the absence of the PN(wm) component may provide an easily applicable qualitative predictive marker of rapid cognitive deterioration in MCI.

Aged↗
PubMed2004

Reconstructions in limited-view thermoacoustic tomography.

The limited-view problem is studied for thermoacoustic tomography, which is also referred to as photoacoustic or optoacoustic tomography depending on the type of radiation for the induction of acoustic waves. We define a "detection region," within which all points have sufficient detection views. It is explained analytically and shown numerically that the boundaries of any objects inside this region can be recovered stably. Otherwise some sharp details become blurred. One can identify in advance the parts of the boundaries that will be affected if the detection view is insufficient. If the detector scans along a circle in a two-dimensional case, acquiring a sufficient view might require covering more than a pi-, or less than a pi-arc of the trajectory depending on the position of the object. Similar results hold in a three-dimensional case. In order to support our theoretical conclusions, three types of reconstruction methods are utilized: a filtered backprojection (FBP) approximate inversion, which is shown to work well for limited-view data, a local-tomography-type reconstruction that emphasizes sharp details (e.g., the boundaries of inclusions), and an iterative algebraic truncated conjugate gradient algorithm used in conjunction with FBP. Computations are conducted for both numerically simulated and experimental data. The reconstructions confirm our theoretical predictions.

Acoustics↗
PubMed1999

Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group.

OBJECTIVES: To develop an outcome measure for patients with advanced cancer and their families which would cover more than either physical symptoms or quality of life related questions. To validate the measure in various specialist and non-specialist palliative care settings throughout the UK. DESIGN: A systematic literature review of measures appropriate for use in palliative care settings was conducted. In conjunction with a multidisciplinary project advisory group, questions were chosen for inclusion into the scale based on whether they measured aspects of physical, psychological, or spiritual domains pertinent to palliative care, and whether similar items had shown to be valid as part of another measure. A staff completed version was developed to facilitate data collection on all patients throughout their care, and a patient completed version was designed to enable the patient to contribute to the assessment of their outcomes when possible. A full validation study was conducted to evaluate construct validity, internal consistency, responsiveness to change over time, and test-retest reliability. Assessments were timed. SETTING: Eight centres in England and Scotland providing palliative care, including inpatient care, outpatient care, day care, home care, and primary care. PATIENTS: A total of 450 patients entered care during the study period. Staff collected data routinely on patients in care long enough to be assessed (n = 337). Of these, 262 were eligible for patient participation; 148 (33%) went on to complete a questionnaire. MAIN MEASURES: The Palliative Care Outcome Scale (POS), the European Organisation for Research on Cancer Treatment, and the Support Team Assessment Schedule. RESULTS: The POS consists of two almost identical measures, one of which is completed by staff, the other by patients. Agreement between staff and patient ratings was found to be acceptable for eight out of 10 items at the first assessment. The measure demonstrated construct validity (Spearman rho = 0.43 to 0.80). Test/re-test reliability was acceptable for seven items. Internal consistency was good (Cronbach's alpha = 0.65 (patients), 0.70 (staff)). Change over time was shown, but did not reach statistical significance. The questionnaire did not take more than 10 minutes to complete by staff or patients. CONCLUSION: The POS has acceptable validity and reliability. It can be used to assess prospectively palliative care for patients with advanced cancer.

England↗
PubMedDate not supplied

Mild infectious laryngotracheitis in broilers in the southeast.

During 2001, a mild infectious laryngotracheitis virus (ILTV) infection occurred in broiler flocks in the southeastern United States. Clinical signs included mild tracheitis, swollen sinuses, and conjunctivitis, with no increased mortality and minimal serologic response. Infrequent intranuclear inclusion bodies with or without syncytial cell formation were observed in eyelid, trachea, and larynx and in the chorioallantoic membrane of infected embryos. Immunohistochemistry and a nested infectious laryngotracheitis polymerase chain reaction (ILT PCR) were utilized to confirm the presence of ILTV nucleic acid in fixed tissues. In addition, 2-wk-old specific-pathogen-free (SPF) birds inoculated with field material exhibited the mild signs observed in broilers in the field. Tracheal swabs and tissues taken from these SPF birds were also positive by nested ILT PCR. Restriction fragment length polymorphism analysis of ILT PCR products indicated that ILT virus associated with mild respiratory disease in the southeast is related to the chicken embryo origin vaccine type strains.

Animal Husbandry↗
PubMed1990

Typicality and reasoning fallacies.

The work of Tversky and Kahneman on intuitive probability judgment leads to the following prediction: The judged probability that an instance belongs to a category is an increasing function of the typicality of the instance in the category. To test this prediction, subjects in Experiment 1 read a description of a person (e.g., "Linda is 31, bright, ... outspoken") followed by a category. Some subjects rated how typical the person was of the category, while others rated the probability that the person belonged to that category. For categories like bank teller and feminist bank teller: (1) subjects rated the person as more typical of the conjunctive category (a conjunction effect); (2) subjects rated it more probable that the person belonged to the conjunctive category (a conjunction fallacy); and (3) the magnitudes of the conjunction effect and fallacy were highly correlated. Experiment 2 documents an inclusion fallacy, wherein subjects judge, for example, "All bank tellers are conservative" to be more probable than "All feminist bank tellers are conservative." In Experiment 3, results parallel to those of Experiment 1 were obtained with respect to the inclusion fallacy.

Concept Formation↗