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PubMed2001

Organisational implications of concentration orthopaedic services.

The re-organisation of the acute health services in 1999 is causing many acute trusts to consider the practical implications of concentrating services. This may be in terms of the complete merger of departments at different units or a less radical policy of the alternation of the responsibility for emergency receiving between units. The benefits may include the opportunity to improve the quality of care by providing more specialist services, more attractive working conditions with a larger pool of specialists providing the on-call rota and enhanced opportunity for training. Economic theory indicates that concentration should lead to economies of scale by greater sharing of fixed overhead costs, whilst statistical theory specifies that concentration should produce a relative decline in the variability of demand. This paper examines the effects of concentration on emergency admissions in an orthopaedic department by means of a series of simulation experiments. It examines the potential economies of scale for theatre utilisation and bed usage associated with increasing the volume of non-elective patients. As the volume of patients increases so the relative variability of demand decreases and the relative demand for emergency operating theatre time declines. Concentration could offer savings on theatre time allocated to trauma patients, but the impact on wards is less significant with concentration having a limited effect on the demand for beds.

Bed Occupancy↗

PubMed1978

Status within the family and early life experiences in patients with affective disorders and cycloid psychosis.

The family constellation and early childhood experiences have been investigated in 534 in- and outpatients (21 male and 323 female). The series comprised the following diagnostic subgroups: bipolar (n = 195) and unipolar (n = 175) affective psychotic disorders, non-psychotic depressive syndromes (n = 94) and cycloid psychosis (n = 70). A 34-item questionnaire was constructed for the purpose of the present investigation relying upon information about meaningful variables in the relevant literature. Five main areas (status within the family, separation and loss, disturbing life experiences, acts of violence, and somatic factors) were covered in the study. Female patients have been found to be over-represented in regard to many variables. Few inter-group differences were found. This finding would suggest that negative, early childhood experiences are shared by most psychiatric patients and are not specific for any of the disorders which have been taken into account in the study.

Adjustment Disorders↗

PubMedDate not supplied

Description of cellulitis lesions and associations between cellulitis and other categories of condemnation.

A total of 110 broiler flocks processed in a single processing plant in southern Ontario were studied for purposes of describing the cellulitis lesions and investigating possible associations between cellulitis and other categories of condemnation at the processing plant. Two hundred and ninety-five carcasses condemned for cellulitis were examined. They came from 65 of the 110 flocks. The lesions tended to be unilateral with most carcasses (87%) having one lesion. The majority of the lesions (92%) were located on the abdomen. Almost 65% of the lesions were large (> or = 8.1 cm2), and 27% were medium (2.1-8.0 cm2). On the basis of gross appearance, 69% of the lesions were classified as severe, 26% moderate, and 5% mild. Of 149 lesions examined histologically, 74% were classified as chronic, 21% ongoing, and 5% mild-acute. Condemnation data from the 110 broiler flocks were analyzed using Poisson regression. Simple relationships were examined between a count outcome (number of cellulitis-condemned carcasses per flock) and other categories of condemnation and average bird weight. Cellulitis was significantly associated with average bird weight (P = 0.0018), Escherichia coli-related conditions (SEROSITIS; P < or = 0.0001), ascites (P = 0.0004), cyanosis (P < or = 0.0001), valgus varus deformity (P < or = 0.0001), REJECT (combined carcass condemnations for bruising, mutilation, and contamination; P = 0.0003), and the interaction terms "average bird weight and ascites" (AVWT*ASCIT; P < or = 0.0001) and "average bird weight and cyanosis" (AVWT*CYAN; P < or = 0.0001). Average bird weight, SEROSITIS, ascites, cyanosis, valgus varus deformity, and AVWT*ASCIT were the only significant factors after adjusting for clustering. No association was observed between cellulitis and emaciation and dead on arrival. Variables significantly associated with cellulitis in the multivariate analysis could be considered as potential predictors. These predictors may share common risk factors predisposing broiler chickens to cellulitis.

Abattoirs↗

PubMed2005

An assessment of the shared-decision model in parents of children with acute otitis media.

OBJECTIVE: Medicine is shifting from a doctor-centered approach to a model entailing more shared decision-making. Many organizations now recommend a shared-decision approach to treating children with acute otitis media (AOM). Our primary objectives in this study were to assess (1) which style of decision-making on the physician's part would most effectively reduce parents' proclivity to use antibiotics for treatment of their child's AOM and (2) parental satisfaction with different doctor-patient decision-making styles. METHODS: We conducted a cross-sectional survey to examine how parents respond to doctor-patient communication styles in 3 clinical vignettes that presented 2 versions of a shared-decision model (SDM) and 1 paternalistic model. Parents were randomly assigned to receive 1 of 3 vignettes. The main predictor variable was the vignette assignment, and the main outcomes were (1) parent proclivity to use antibiotics and (2) parent ratings of care by the physician in the vignette. Using logistic regression, we adjusted for caregivers' age, gender, income, knowledge of antibiotics, decision-making preference, confidence in physician, and length of relationship with personal physician. RESULTS: Four hundred sixty-six parents met inclusion criteria, with a response rate of 94%. General characteristics were similar across vignette assignment groups. Parents who received the paternalistic-model vignettes were more likely to say that they would use antibiotics than those who received the SDM vignettes (odds ratio: 4.9; 95% confidence interval: 2.3-10.6). This result remained statistically significant after adjustment for potential confounders. In addition, parents in the shared-decision groups were more satisfied (93% and 84%) than those in the paternalistic-model group (76%). CONCLUSIONS: To our knowledge, this is the first study to examine parent interest, acceptance, and satisfaction with the SDM. Our findings suggest that shared decision-making for AOM may lead to less antibiotic usage and higher levels of parental satisfaction. Although more studies are needed to examine how best to incorporate parents in the SDM, our study serves as an example of the potential benefit of this approach in pediatric medicine.

Adult↗

PubMed2005

Barriers to adherence of deferoxamine usage in sickle cell disease.

BACKGROUND: We hypothesized that child cognitive disability would be a significant risk factor for non-adherence with home deferoxamine (DFO) administration and that a factor that would contribute to improved adherence would be sharing of responsibilities for chelation between parents and patients. We explored the influences on adherence of behavioral and psychological adjustment; family stress; perceived convenience of and satisfaction with the DFO regimen; and parent and patient knowledge about DFO. PROCEDURE: Fifteen pediatric patients with sickle cell disease (SCD) who had evidence of excessive iron stores, and their parents, were interviewed about adherence and responsibility for chelation therapy. A neuropsychological assessment battery was administered to the patients. Family stress, the child's emotional and behavioral status, knowledge about chelation and iron overload were explored. Adherence was rated objectively using pharmacy refill patterns and observable signs of chelation. RESULTS: Sharing of responsibilities for chelation between parents and children was related to better adherence while neuropsychological status bore a complex relation to adherence. Of the exploratory variables, low family stress were related to better adherence while satisfaction with the home care regimen and convenience ratings were not useful in predicting adherence. No one element of adherence, even objective measures, was capable of classifying adherence, while a multifactorial scheme categorizing adherent, partially adherent and non-adherent groups demonstrated good face validity. CONCLUSIONS: Supporting developmentally appropriate sharing of responsibilities for self-care is critical, taking patient neurocognitive status into consideration. Clinicians should evaluate adherence using a multifactorial model that highlights the most salient targets for intervention.

Adolescent↗

PubMed1999

Counseling by primary care physicians of patients who disclose psychosocial problems.

BACKGROUND: Most descriptive studies of psychosocial counseling by US primary care physicians (PCPs) have relied on the PCPs' recollections rather than researchers' observations of actual visit content. The latter approach should yield more accurate measurement of counseling frequency and duration. METHODS: Our sample consisted of 308 patients whose scores signified psychological distress on the 28-item General Health Questionnaire. Their visits to 69 community-based PCPs had been audiotaped for an earlier study of the benefits of communication skills training for PCPs. Using those tapes, we identified the disclosure of psychosocial problems by patients and subsequent counseling and psychotropic drug prescribing by their PCPs. We timed counseling and visit lengths. Effects of patient and PCP variables on visit duration and on counseling occurrence and duration were assessed using generalized estimating equations to accommodate the correlation among patients who shared PCPs. RESULTS: After adjusting for the effects of the communication skills training, we found that PCPs counseled 60% of patients who disclosed psychosocial problems. Given disclosure, counseling probability was lowest for new patients (P <.001); among patients with previous visits, counseling probability was inversely related to the number of visits (P <.001). When provided, counseling had a mean duration of 5.2 minutes. Counseling was associated with a 28% (95% confidence interval, 9%-49%) increase in visit duration after adjustment for the effects of other significant variables. PCPs prescribed psychotropic medications in 30% of visits with disclosure. CONCLUSIONS: PCPs treated psychosocial problems with brief counseling twice as often as with medication. Brief counseling interventions caused small but significant increases in visit durations.

Adolescent↗

PubMed1985

The majority of human monoclonal IgM rheumatoid factors express a "primary structure-dependent" cross-reactive idiotype.

Genetic studies of human immunoglobulin variable regions have been hampered by the lack of anti-idiotypic antibodies that recognize specific heavy and light chain variable region sequences. Sixty percent of human monoclonal IgM anti-IgG autoantibodies (rheumatoid factors [RF]) from unrelated individuals share a cross-reactive idiotype (CRI) termed Wa. In previous experiments in which we used an enzyme-linked immunosorbent assay, we reported that a synthetic peptide (PSL2), corresponding to the second hypervariable region in the kappa light chain of a monoclonal IgM-RF (Sie), induced rabbit antibodies reactive with several RF paraproteins. In the present experiments, to avoid interference due to the human IgM-RF binding toward rabbit IgG, the reactivity of the anti-PSL2 antibody to the separated heavy and light chains of multiple IgM proteins and Bence-Jones proteins was assessed by the Western blot technique. The PSL2-induced anti-CRI reacted well with the separated kappa chains from 10 out of 12 IgM-RF, zero out of four light chains from IgM proteins lacking anti-IgG activity, and one out of six kappa Bence-Jones proteins. The results show that the PSL2-CRI is associated with RF and is not a kappa subgroup marker. Furthermore, a comparison of the reported light chain sequences of the PSL2-CRI-positive IgM-RF suggests that the majority of human IgM-RF light chains derive from a single germ-line VK gene or from a family of closely related VK genes that is highly conserved in the human population. Synthetic peptide-induced anti-CRI provide a potent tool for analyzing the genetic basis of CRI and abnormal autoantibody production in humans.

Amino Acid Sequence↗

PubMed1998

T-cell restriction in thyroid eye disease.

Infiltrating immunocompetent cells act to establish and perpetuate the orbital autoimmune process in thyroid eye disease (TED). Until recently, it has remained unclear whether T cells infiltrating the orbital connective/fatty tissue and extraocular muscles represent a primary immune response that is specifically directed against orbital antigens. In addition, despite a close clinical and temporal association of the thyroidal and extrathyroidal manifestations in Graves' disease (GD), it has not been proven whether T cells infiltrating thyroid, orbital, and pretibial tissue in patients with TED and pretibial dermopathy (PTD) are directed against certain antigenic determinants shared between these anatomically distinct tissues. Using polymerase chain reaction (PCR)-based molecular analysis of T-cell antigen receptor (TcR) variable (V) region genes, we have demonstrated marked restriction of orbital and pretibial TcR Valpha and Vbeta genes in patients with active TED and PTD. In addition, molecular analysis of T cells in paired samples of extraocular muscle and orbital connective/fatty tissue revealed usage of similar TcR V genes. In contrast, TcR V gene restriction was either absent or much less pronounced in patients with longstanding TED and PTD. Comparison of TcR V genes in T cells obtained from thyroid gland, orbital tissue, pretibial tissue, and peripheral blood of three individual patients with active GD, TED, and PTD also revealed marked restriction and, in addition, striking similarities of TcR V gene usage. Sequencing of complementarity determining regions 3 (CDR3) and junctional domains of TcR Vbeta genes confirmed oligoclonality of intrathyroidal, orbital, and pretibial T cells. Moreover, several conserved junctional motifs were shared by T cells infiltrating the thyroid gland and the extrathyroidal sites. Taken together, these data suggest that, in patients with GD and extrathyroidal manifestations, similar antigenic determinants may be responsible for recruitment and oligoclonal expansion of T cells both within the thyroid gland and in the involved extrathyroidal sites.

Amino Acid Sequence↗

PubMed1992

Evidence for independent genetic influences on obesity in middle age.

The National Heart, Lung, and Blood Institute (NHLBI) Twin Study provided longitudinal data on a cohort of 514 pairs of adult male twin pairs who were examined at approximate ages of 48, 57, and 63 years. Because the sample was selected from military veterans, height and weight data were also available from their induction physical examinations when they were approximately 20 years of age. From the total NHLBI Twin Study cohort, 124 monozygotic and 119 dizygotic male twin pairs had complete data available for both members of the pair at induction and three examinations spanning 43 years of adult life. Using these data, the contributions of genetics and shared and non-shared environmental factors to BMI over the 43 year period were estimated by model fitting procedures. Model fitting included both a factor decomposition of these effects as well as a developmental path model. Results from the decomposition procedure indicate significant genetic effects at each examination cycle. Fitting a developmental path model, two independent genetic contributions to the variability of BMI were found: one at, or prior to, the induction examination about age 20, and a second between ages 20 and 48. Significant non-shared environmental contributions at each examination were also indicated, but shared environmental effects were not significant. We conclude that cumulative genetic effects explain most of the tracking in obesity over time; non-shared environmental effects, although significant at each age, are relatively short-lived and make only a minor contribution to tracking.

Adult↗

PubMed2003

Unisexuality and molecular drive: bag320 sequence diversity in bacillus taxa (insecta phasmatodea).

Satellite DNA variability follows a pattern of concerted evolution through homogenization of new variants by genomic turnover mechanisms and variant fixation by chromosome redistribution into new combinations with the sexual process. Bacillus taxa share the same Bag320 satellite family and their reproduction ranges from strict bisexuality (B. grandii) to automictic (B. atticus) and apomictic (B. whitei = rossius/ grandii; B. lynceorum = rossius/grandii/atticus) unisexuality. Thelytokous reproduction clearly allows uncoupling of homogenization from fixation. Both trends and absolute values of satellite variability were analyzed in all Bacillus taxa but B. rossius, on 906 sequenced monomers at all level of comparisons: intraspecimen, intrapopulation, interpopulation, intersubspecies, and interspecies. For unisexuals, allozymic and mitochondrial clones were also taken into account. Different reproductive modes (sexual/parthenogenetic) appear to explain observed variability trends, supporting Dover's hypothesis of sexuality acting as a driving force in the fixation of sequence variants, but the present analyses also highlight current spreading of new variants in B. grandii maretimi specimens and point to a biased sequence inheritance at the time of hybrid onset in the apomictic hybrids B. whitei and B. lynceorum. Evidence of biased gene conversion events suggests that, given enough time, sequence homogenization can take place in a unisexual such as B. lynceorum. On the contrary, the absolute values of sequence diversity in each taxon are linked to the species' range, time of divergence, and repeat copy number and, possibly, to transposon features. Satellite dynamics appears therefore to be the outcome of both general molecular processes and specific organismal traits.

Animals↗

PubMed2002

HIV risk behaviors in African-American drug injector networks: implications of injection-partner mixing and partnership characteristics.

AIMS: We explore the mechanisms by which 'partnership-level' variables--the mix of characteristics of individuals who inject drugs together--affect the incidence of HIV risk behaviors, including receptive syringe sharing, and facilitate or impede the spread of HIV. DESIGN: We apply multivariate analysis techniques to data on injection partnerships (pairs of individuals who inject drugs together) collected using a network sample of 401 African-American IDUs in Washington, DC. FINDINGS: Drug injectors tended to select injection partners of the same gender and similar age, but risk behaviors were most common in partnerships between individuals who are dissimilar in both gender and age. Partners who had a sexual relationship, injected drugs frequently together, smoked crack-cocaine regularly, injected speedball (heroin mixed with cocaine) regularly and/or had close social ties were more likely to engage in risky injection practices than otherwise similar partners. These factors account largely for the association between the gender-age mix of the partnership and injection risk behavior. CONCLUSIONS: Among African-American IDUs in Washington DC, partnership-level variables appear critical in the transmission of HIV.

Adult↗

PubMed1989

Sets of synaptic currents paired by common presynaptic or postsynaptic neurons.

1. In the buccal ganglia of Aplysia, presynaptic neurons B4 and B5 produce similar inhibitory postsynaptic currents (PSCs) in several postsynaptic follower cells. Previous work has shown that both duration and amplitude of these PSCs vary, that each parameter may be altered transiently by manipulating presynaptic activity, and that these variations affect synaptic efficacy. 2. To permit synapse-to-synapse comparisons, the mean and coefficient of variation (CV) of both peak conductance (gpeak) and time constant of decay (tau) were determined for sets of synaptic currents evoked by direct intracellular stimulation of presynaptic neurons. For 56 synapses, gpeak = 0.40 +/- 0.33 (SD) microS for a CV of 0.83, and tau = 19.7 +/- 4.0 ms for a CV of 0.20. The synapse-to-synapse variability was within 5% of values obtained from a previous population. 3. The relative contributions of presynaptic and postsynaptic factors to efficacy and variability of PSCs were examined by recordings from two classes of three-cell networks and by comparing values of gpeak and tau at synapses sharing a common presynaptic or postsynaptic neuron. 4. In the first case, paired presynaptic inputs from B4 and B5 converged on a common postsynaptic cell. For 16 examples of this case, mean values of both gpeak and tau recorded in a single follower cell, but produced by different presynaptic neurons, were significantly closer than those recorded in different followers (P less than 0.001). The common postsynaptic cell did not constrain variability of these parameters; CVs for paired synapses were not significantly different from the population (P greater than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1997

The relationship between middle-class parents' book-sharing discussion and their preschoolers' abstract language development.

Thirty-five mothers and fathers were videotaped in their homes as they read a familiar and unfamiliar book to their preschoolers aged between 3;6 and 4;1. Parental discussions about the text were coded for four levels of abstraction and correlated with children's gains one year later on a formal test of the same four levels of language abstraction (the Preschool Language Assessment Instrument). Parental input at three of the four levels of abstraction was positively and significantly correlated with their children's gains at the highest level of abstraction. This was also the level at which children's scores were the lowest initially and showed the greatest gains. The results suggest that discussions during book reading with preschoolers may be a positive influence, since it was parents' amount of input at lower as well as higher levels of abstraction that correlated with the children's development of more abstract language. We speculate that more input at lower levels might enhance learning by creating a climate of success in allowing children to display mastered skills, whereas more input at higher levels might enhance learning by challenging children with abstract language skills they are just beginning to acquire. In contrast to previous research, these results suggest that there is a great deal of variability in middle-class families in the amount of input that children receive at various level of abstractions during book sharing.

Child Language↗

PubMed2004

Andersen-Tawil syndrome: a model of clinical variability, pleiotropy, and genetic heterogeneity.

Due to its varied and variable phenotypes, Andersen-Tawil syndrome (ATS) holds a unique place in the field of channelopathies. Patients with ATS typically present with the triad of periodic paralysis, cardiac arrhythmias, and developmental dysmorphisms. Although penetrance of ATS is high, disease expression and severity are remarkably variable. Mutations in KCNJ2 are the primary cause of ATS with 21 mutations discovered in 30 families. These mutations affect channel function through heterogeneous mechanisms, including reduced PIP2-related channel activation and altered pore function. Aside from KCNJ2-based ATS, the genetic basis of this disease in nearly 40% of cases is unknown. Other ATS genes likely share a common pathway or function with Kir2.1 or facilitate the activity of this ion channel. In this review, we explore hypotheses explaining the pathogenesis, expression, and variability of ATS.

Arrhythmias, Cardiac↗

PubMed2004

Evaluation of educational programmes for paediatric cancer nursing in England.

The results of part of a larger study to evaluate educational provision for paediatric oncology and palliative care nursing in England are presented here. Mapping of cancer care provision, based upon the English National Board 240 programme, was undertaken by analysis of relevant curriculum documents. Prescribed programme outcomes were reviewed against expected course outcomes proposed by the European Oncology Nursing Society. Particular attention was also paid to expected processes of assessment of clinical practice, consideration of adolescent patients, and opportunities for shared learning. Widespread compliance with the European Oncology Nursing Society standard was found, with only two of the 19 areas substantially neglected. These related to the prevention and early detection of cancer (less relevant in paediatric cancer than for adults), and understanding the principles of cancer clinical trials (probably due to lack of explicit statement in curriculum documents rather than actual failure to address the topic). A range of prescribed assessment practices were noted, but the degree to which direct observation was involved was variable, and indirect measures appeared to predominate. There was little specific recognition of adolescence as a discrete topic to be addressed in the programmes. Shared learning tended to be introduced for logistical reasons of small class numbers rather than for any perceived intrinsic value.

Adolescent↗

PubMed2005

Bilirubin appears to be the only independent variable affecting mortality on liver transplant waiting list if waiting time exceeds 1 year.

BACKGROUND: The Model for End-Stage Liver Disease (MELD) score has been shown to be the best predictor of short-term mortality on the liver transplant waiting list in the United States but waiting time often exceeds 1 year in many countries. We wanted to identify the factors affecting mortality on the liver transplant waiting list in Singapore where waiting time for liver transplant exceeds 1 year. PATIENTS AND METHODS: All patients who were listed on the liver transplant waiting list in Singapore from January 1997 to December 2003 excluding those who were transplanted were analyzed. MELD was calculated according to the United Network for Organ Sharing formula. Univariate analysis was performed to identify factors affecting mortality on the waiting list and multivariate analysis by logistic regression. Categorical and continuous variables were compared with the chi-square and Mann-Whitney U tests. RESULTS: There were 48 patients in the study. We found that on univariate analysis, bilirubin, INR, MELD score, and Child's score significantly influenced mortality on the waiting list but on multivariate analysis, bilirubin was the only independent prognostic indicator of mortality on the waiting list (LR = 1.97; 95% confidence interval = 1.08 to 3.61). INR was found to be significantly correlated to bilirubin with Pearson correlation (R = 0.63, P < .001). CONCLUSION: Bilirubin is the only independent factor affecting mortality on the liver transplant waiting list where waiting time exceeds 1 year.

Analysis of Variance↗

PubMed1987

Differential treatment planning for young adult chronic patients.

An assessment of 110 young adult chronic patients on six variables related to their social interactions indicates that social behavior may be an important indicator of treatment needs. The assessment delineated four treatment profiles--subgroups of patients who share a common cluster of social behaviors and who require distinct treatment approaches. This paper describes the four treatment profiles by outlining each subgroup's salient characteristics and modal patient and the treatment approaches that are most and least appropriate for its members. The authors suggest that outpatient programs may need to accommodate the characterologic and personality variables of young chronic patients to make treatment tolerable and comfortable for them, rather than deny them admission because they do not demonstrate responsible, appropriate, and independent behavior.

Anxiety↗

PubMed2000

Inhibition of adhesion of Escherichia coli k88ac fimbria to its receptor, intestinal mucin-type glycoproteins, by a monoclonal antibody directed against a variable domain of the fimbria.

Strains of enterotoxigenic Escherichia coli that express K88 fimbriae are among the most common causes of diarrhea in young pigs. Adhesion of bacteria to receptors on intestinal epithelial cells, mediated by K88 fimbriae, is the initial step in the establishment of infection. Three antigenic variants of K88 fimbriae exist in nature: K88ab, K88ac, and K88ad. K88ac is the most prevalent and may be the only variant of significance in swine disease. Each K88 fimbrial variant is composed of multiple antigenic determinants. Some of these determinants are shared among the three variants and may be referred to as conserved epitopes, whereas others are unique to a specific variant and may be referred to as variable epitopes. In this study, monoclonal antibodies (MAbs) specific to either variable or conserved epitopes of K88ac fimbriae were produced. The specificity of each MAb was tested by enzyme-linked immunosorbent and immunoblot assays. Fab fragments were prepared from these MAbs and were tested for their ability to block the binding of K88-positive bacteria and purified fimbriae to porcine enterocyte brush border vesicles and purified K88 receptors, respectively. The purified receptors were intestinal mucin-type sialoglycoproteins (IMTGP) isolated from porcine enterocytes (A. K. Erickson, D. R. Baker, B. T. Bosworth, T. A. Casey, D. A. Benfield, and D. H. Francis, Infect. Immun. 62:5404-5410, 1994). Fab fragments prepared from MAbs specific for variable epitopes blocked the binding of bacteria to brush borders and of fimbriae to IMTGP. However, those from MAbs specific for a conserved epitope did not. These observations indicate that the receptor-binding domain of a K88ac fimbria is contained, at least in part, within the antigenically variable epitopes of that fimbria. Epitope mapping for one of the MAbs, which recognizes a linear epitope on K88ac fimbriae, indicated that this MAb binds to the region from amino acid no. 64 to no. 107 on the major subunit of K88ac fimbriae.

Adhesins, Escherichia coli↗