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Biomedical subjects

B Roberts

Publications and source records attributed to B Roberts.

224 records · Page 13Linked to original sources
PubMedDate not supplied

An evolving continuous quality improvement role for managed care: a behavioral healthcare perspective.

Managed care's initial continuous quality improvement impact may have been comparable to the sentinel, or Hawthorne, effect. Managed behavioral healthcare's CQI role can be compared with that of the clinical navigator. The clinical navigator attempts to develop a consensus with the patient on what is the clinical destination, and must choose a route to travel that is the best approach to reach the destination (i.e., a focused treatment plan). In addition, the clinical navigator tries to find the most efficient mode of travel--or, the least restrictive, least intrusive site of care from where the patient can receive treatment. Essential clinical tasks or expectations in the clinical assessment are also outlined, and the concept of knowledge coupling is introduced to accommodate the unique, individual issues of the patient. The emphasis of managed care today is shifting to further accentuate a CQI, outcomes-based approach.

Efficiency, Organizational↗
PubMedDate not supplied

Brevetoxicosis in manatees (Trichechus manatus latirostris) from the 1996 epizootic: gross, histologic, and immunohistochemical features.

In 1996, at least 149 manatees (Trichechus manatus latirostris) died in an unprecedented epizootic along the southwest coast of Florida. At about the same time, a bloom of the brevetoxin-producing dinoflagellates, Gymnodinium breve, was present in the same area. Grossly, severe nasopharyngeal, pulmonary, hepatic, renal, and cerebral congestion was present in all cases. Nasopharyngeal and pulmonary edema and hemorrhage were also seen. Consistent microscopic lesions consisted of catarrhal rhinitis, pulmonary hemorrhage and edema, multiorgan hemosiderosis, and nonsuppurative leptomeningitis. Immunohistochemical staining using a polyclonal primary antibody to brevetoxin (GAB) showed intense positive staining of lymphocytes and macrophages in the lung, liver, and secondary lymphoid tissues. Additionally, lymphocytes and macrophages associated with the inflammatory lesions of the nasal mucosa and meninges were also positive for brevetoxin. These findings implicate brevetoxicosis as a component of and the likely primary etiology for the epizootic. The data suggest that mortality resulting from brevetoxicosis may not necessarily be acute but may occur after chronic inhalation and/or ingestion. Immunohistochemical staining with interleukin-1-beta-converting enzyme showed positive staining with a cellular tropism similar to GAB. This suggests that brevetoxicosis may initiate apoptosis and/or the release of inflammatory mediators that culminate in fatal toxic shock.

Adrenal Glands↗
PubMedDate not supplied

Observations of the incidence of structural abnormalities in the chromosomes of WI-38 cells prepared for vaccine manufacture.

Chromosome monitoring of 500 batches of WI-38 cells prepared for vaccine manufacture involved examining 50-60,000 metaphases at p31-32. Results collected over 6 years showed the mean incidence of aneuploidy and breaks to decrease slightly, whereas the incidence of structural abnormalities followed a sharply rising trend, eventually reaching a level where a substantial proportion of cell batches exceeded the limit set for this parameter for vaccine substrates. No technical or cultural factor accounted for the trend which appeared to be correlated with the date of receipt of the seed ampoule. The confidence limits set for this parameter in 1971 were regarded then as provisional. It is suggested that in the light of the observations reported, the position should now be reconsidered.

Cells, Cultured↗
PubMedDate not supplied

Improving child welfare performance through supervisory use of client outcome data.

Despite their benefits, there is little evidence that outcome data are being widely used by program managers or field level supervisors. Three interdependent factors that facilitate the use of outcome data are well-constructed reports, and organizational culture that supports learning and outcome achievement, and managerial skills in interpreting data and taking relevant action. This article describes an outcome reporting package and training oriented toward frontline supervisors to help them use outcome data, shape a learning culture, interpret data, and take focused action toward improving outcomes for children and families.

Child↗
PubMedDate not supplied

Persistent pulmonary interstitial fibrosis, induced by immune response to TNP, is associated with altered mRNA procollagen type I:III ratio.

Pulmonary interstitial fibrosis is characterized by a progressive increase in connective tissue in the lung parenchyma. Fibrosis is associated with conditions that result as a consequence of cell mediated responses including graft versus host disease, delayed type hypersensitivity reactions, and granulomas. The hapten-immune animal model for pulmonary interstitial fibrosis correlates the nonresolving fibrosis observed in the lung parenchyma directly with the animal's prior immunization to the hapten. Because the model is patterned after the well studied contact hypersensitivity assay in the skin, the immune response can be directly correlated with a cell-mediated (T-lymphocyte) immune mechanism. Previously, we reported that hapten-immune animals showed increased collagen deposition as identified on routine paraffin fixed slides that were stained with Masson's trichome. In this report, morphometric procedures were used to quantitate the fibrotic lesion. Fibroblasts were harvested from lungs of all treatment groups, cultured, and assayed for collagen production. Once it was determined that collagen production by fibroblasts was similar to that recorded in assays using fresh lung tissue, the fibroblasts were used as a homogeneous cell source for RNA. Total RNA from various treatment groups was used to assess the ratio of mRNA for procollagen I:III using slot and northern blot hybridization procedures. An increased ratio in the procollagen type I:III mRNA was observed in total RNA isolated from fibroblasts from immune and challenged hamsters, and not in samples from all other groups. These results support the hypothesis that the activated T lymphocytes involved in "contact" hypersensitivity-like reactions in the lung regulate not only the quantity, but also the quality of collagen produced by the fibroblasts in the lungs of the hamsters that develop nonresolving fibrosis. The model may be important for the study of skin and pulmonary disease induced by exposure to environmental haptens.

Animals↗
PubMedDate not supplied

Balloon angioplasty in the treatment of peripheral vascular disease.

Angioplasty carried out by means of a balloon catheter designed by Gruntzig, has been found to be very useful in treating some areas of stenosis of major vessels and some short areas of occlusion. This method of treatment when suitable, has some clear advantages over operative therapy, being far less expensive, time consuming and painful, but is probably less long lasting. Repetitive treatment is easily accomplished. Complications occurred in less than 5% and these were generally correctible by surgery. The technic requires real skill in angiography and competent vascular surgical back-up, but with experience in more than 600 cases, it is believed to be a definite therapeutic advance.

Angioplasty, Balloon↗