Biomedical subjects

I B Wilson

Publications and source records attributed to I B Wilson.

At least 37 records · Page 2Linked to original sources

PubMed2000

Physician manipulation of reimbursement rules for patients: between a rock and a hard place.

CONTEXT: Health plan utilization review rules are intended to enforce insurance contracts and can alter and constrain the services that physicians provide to their patients. Physicians can manipulate these rules, but how often they do so is unknown. OBJECTIVE: To determine the frequency with which physicians manipulate reimbursement rules to obtain coverage for services they perceive as necessary, and the physician attitudes and personal and practice characteristics associated with these manipulations. DESIGN, SETTING, AND PARTICIPANTS: A random national sample of 1124 practicing physicians was surveyed by mail in 1998; the response rate was 64% (n = 720). MAIN OUTCOME MEASURE: Use of 3 different tactics "sometimes" or more often in the last year: (1) exaggerating the severity of patients' conditions; (2) changing patients' billing diagnoses; and/or (3) reporting signs or symptoms that patients did not have to help the patients secure coverage for needed care. RESULTS: Thirty-nine percent of physicians reported using at least 1 tactic "sometimes" or more often in the last year. In multivariate models comparing these physicians with physicians who "never" or "rarely" used any of these tactics, physicians using these tactics were more likely to (1) believe that "gaming the system" is necessary to provide high-quality care today (odds ratio [OR], 3.67; 95% confidence interval [CI], 2.54-5.29); (2) have received requests from patients to deceive insurers (OR, 2.44; 95% CI, 1.72-3.45); (3) feel pressed for time during patient visits (OR, 1.69; 95% CI, 1.21-2.37); and (4) have more than 25% of their patients covered by Medicaid (OR, 1.60; 95% CI, 1.08-2.38). Notably, greater worry about prosecution for fraud did not affect physicians' use of these tactics (P = .34). Of those reporting using these tactics, 54% reported doing so more often now than 5 years ago. CONCLUSIONS: A sizable minority of physicians report manipulating reimbursement rules so patients can receive care that physicians perceive is necessary. Unless novel strategies are developed to address this, greater utilization restrictions in the health care system are likely to increase physicians' use of such manipulative "covert advocacy" tactics.

Attitude of Health Personnel↗

PubMed2000

Composition of N-linked carbohydrates from ovalbumin and co-purified glycoproteins.

Analysis of commercial samples of chicken ovalbumin by reversed-phase high performance liquid chromatography and matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) showed the presence of several other co-purifying glycoproteins. These were isolated, subjected to tryptic digestion, and two of them were identified as ovomucoid and chicken riboflavin binding-protein following database matching of the peptide masses obtained by MALDI. The N-linked glycans were released from the glycoproteins and their structures were examined by MALDI-MS in combination with exoglycosidase digestion. Ovalbumin was found to be glycosylated mainly with high-mannose and hybrid structures, consistent with profiles obtained on the intact glycoprotein by electrospray. The other glycoproteins contained mainly larger, complex glycans with up to five antennae, many of which had earlier been associated with ovalbumin.

Carbohydrates↗

PubMed2000

Taking antiretroviral therapy for HIV infection: learning from patients' stories.

OBJECTIVE: To describe how people with HIV understand and experience the problem of adhering to antiretroviral medication regimens. DESIGN: We performed a qualitative study based on interviews with HIV-infected patients, including 46 clients of AIDS service organizations, who were sampled according to age, ethnicity, and injection drug use history, and a convenience sample of 15 patients. Interviews were conducted in English or Spanish and were audiotaped and transcribed. PARTICIPANTS: Of 52 respondents who had prescriptions for antiretroviral therapy, 25 were randomly selected for in-depth analysis. Of these, 5 reported having an AIDS diagnosis, 15 reported symptoms they attributed to HIV, and 5 reported having no symptoms of HIV disease. MEASUREMENTS AND MAIN RESULTS: Investigators prepared structured abstracts of interviews to extract adherence-related data. One investigator compared the abstracts with the original transcripts to confirm the interpretations, and used the abstracts to organize and classify the findings. Most subjects (84%) reported recent nonadherent behavior, including ceasing treatment, medication "holidays," sleeping through doses, forgetting doses, skipping doses due to side effects, and following highly asymmetric schedules. Initially, most reported that they were not significantly nonadherent, and many did not consider their behavior nonadherent. Only a minority clearly understood the possible consequences of missing doses. Most said they had not discussed their nonadherence with their physicians. CONCLUSIONS: Many people rationalize their difficulty in adhering to HIV treatment by deciding that the standard of adherence they can readily achieve is appropriate. Physicians should inquire about adherence-related behavior in specific detail, and ensure that patients understand the consequences of not meeting an appropriate standard.

Adult↗

PubMed1999

Fucose in N-glycans: from plant to man.

Fucosylated oligosaccharides occur throughout nature and many of them play a variety of roles in biology, especially in a number of recognition processes. As reviewed here, much of the recent emphasis in the study of the oligosaccharides in mammals has been on their potential medical importance, particularly in inflammation and cancer. Indeed, changes in fucosylation patterns due to different levels of expression of various fucosyltransferases can be used for diagnoses of some diseases and monitoring the success of therapies. In contrast, there are generally at present only limited data on fucosylation in non-mammalian organisms. Here, the state of current knowledge on the fucosylation abilities of plants, insects, snails, lower eukaryotes and prokaryotes will be summarised.

Animals↗

PubMed1999

Optimizing care for persons with HIV infection. Society of General Internal Medicine AIDS Task Force.

Treatment advances and outcomes data have raised new concerns about how to optimize care for patients with HIV infection. This paper reviews evidence on 1) the relation between experience and type of training and patient outcomes, 2) the relation between the components of primary care and patient outcomes, and 3) primary care physicians' basic HIV knowledge and skills in screening and prevention. Several studies indicate that greater experience in HIV care leads to improved patient outcomes. The relation between outcomes and type of training (subspecialist or generalist) is less clear, and studies have not distinguished between type of training and experience. Less experienced physicians may be able to provide high-quality care if appropriate consultation from expert physicians is available. Components of primary care, including accessibility, continuity, coordination, and comprehensiveness, are associated with better patient outcomes. Optimal care of HIV infection requires a combination of disease-specific expertise and primary care skills and organization. Criteria for expertise in HIV management should focus on actual patient care experience and HIV expertise rather than on subspecialty training per se. The management of HIV has become sufficiently complex that primary care physicians cannot be routinely expected to have extensive specialized knowledge in this area. However, many primary care physicians have weaknesses in the basic HIV-related skills that are needed in most settings, such as HIV test counseling and recognition of important HIV-related symptom complexes. Primary care physicians need to strengthen these basic HIV-related medical skills.

Clinical Competence↗

PubMed1999

Development of recombinant, immobilised beta-1,4-mannosyltransferase for use as an efficient tool in the chemoenzymatic synthesis of N-linked oligosaccharides.

The preparation of the conserved core structure of asparagine-linked oligosaccharides found in eukaryotic glycoproteins is an important step towards the synthesis of homogeneous neoglycoproteins. So far, however, the convenient generation of the Manbeta4GlcNAcbeta4GlcNAc (Gn2M) core trisaccharide has proved to be a major obstacle because of the inherent difficulties associated with the synthesis of beta-mannosides. Here we report the overproduction in Escherichia coli of full-length and transmembrane-deleted yeast beta-1, 4-mannosyltransferases as novel N-terminal fusions bearing a decahistidinyl sequence and the minimal human Myc epitope. The recombinant enzymes were highly active and were amenable to immobilisation by nickel(II) chelation and to immunodetection with an anti-Myc monoclonal antibody. The immobilised, transmembrane-deleted enzyme exhibited an apparent Km of 14 microM for the synthetic acceptor substrate analogue, phytanyl-pyrophosphoryl-alpha-N,N'-diacetylchitobioside (PPGn2), under saturating donor conditions. This figure is comparable to those previously reported for native and recombinant yeast beta-1, 4-mannosyltransferases with, respectively, the natural dolichyl-linked acceptor and PPGn2. The validity of the reaction product was confirmed by chromatographic and spectroscopic analysis.

Carbohydrate Sequence↗

PubMed1999

Typing of Leishmania lipophosphoglycans by electrospray mass spectrometry.

A method has been developed to identify the repeating phosphosaccharide units of Leishmania lipophosphoglycans using electrospray mass-spectrometry (ES-MS). Cone voltage-induced fragmentation of intact lipophosphoglycan was found to be as effective as analysis of mild acid hydrolysates in identifying the degree of modification of the repeating units of lipophosphoglycans derived from Leishmania mexicana and Leishmania major. This finding was exploited in a 'rapid-analysis' method in which a crude organic extract of approximately 2 x 10(9) L. major promastigote cells was loaded onto a reverse-phase cartridge for immediate elution into the mass-spectrometer. Using this approach, it was possible to identify the repeating units by total ion scanning and scanning for parents of the m/z 79 (PO3-) fragment ion. This approach is suitable for quick-typing of lipophosphoglycan repeats and was shown to detect alterations in repeat side chains caused by: (1) culturing L. major promastigotes in the presence of L-fucose; and (2) in vitro metacyclogenesis of L. major promastigotes. It is anticipated that the method will be applicable to small samples of cultured field isolates or genetically-manipulated strains.

Animals↗

PubMed1999

Clinical understanding and clinical implications of response shift.

The purpose of this paper is to provide clinical understanding and clinical context for the concept of response shift. First, the paper describes a variety of target constructs or dimensions of health-related quality of life that are important in clinical medicine, including biological and physiological measures, symptoms, functioning, general health perceptions and overall quality of life. It is argued that insight into response shift can be gained by assessing the ways in which measures on these different dimensions change relative to each other. Second, somatization and hypochondriasis are presented as examples of clinical circumstances in which appropriate and adaptive response shifts do not occur. Third, placebo effects are defined and it is argued that response shift is one subtype of placebo effect. Finally, the role of response shift in routine clinical care and its implication for the physician-patient relationship are discussed. Although it cannot and should not replace careful attention to and appropriate treatment of abnormal biological and physiological processes, there are times when explicit attempts to produce response shifts may complement these biomedical therapies. Producing response shift probably involves understanding the psychological, social and cultural context of the illness; may be mediated by the physician-patient relationship and may facilitate coping processes in ways that improve health-related quality of life.

Adaptation, Psychological↗

PubMed1999

Insect cells as hosts for the expression of recombinant glycoproteins.

Baculovirus-mediated expression in insect cells has become well-established for the production of recombinant glycoproteins. Its frequent use arises from the relative ease and speed with which a heterologous protein can be expressed on the laboratory scale and the high chance of obtaining a biologically active protein. In addition to Spodoptera frugiperda Sf9 cells, which are probably the most widely used insect cell line, other mainly lepidopteran cell lines are exploited for protein expression. Recombinant baculovirus is the usual vector for the expression of foreign genes but stable transfection of - especially dipteran - insect cells presents an interesting alternative. Insect cells can be grown on serum free media which is an advantage in terms of costs as well as of biosafety. For large scale culture, conditions have been developed which meet the special requirements of insect cells. With regard to protein folding and post-translational processing, insect cells are second only to mammalian cell lines. Evidence is presented that many processing events known in mammalian systems do also occur in insects. In this review, emphasis is laid, however, on protein glycosylation, particularly N-glycosylation, which in insects differs in many respects from that in mammals. For instance, truncated oligosaccharides containing just three or even only two mannose residues and sometimes fucose have been found on expressed proteins. These small structures can be explained by post-synthetic trimming reactions. Indeed, cell lines having a low level of N-acetyl-beta-glucosaminidase, e.g. Estigmene acrea cells, produce N- glycans with non-reducing terminal N-acetylglucosamine residues. The Trichoplusia ni cell line TN-5B1-4 was even found to produce small amounts of galactose terminated N-glycans. However, there appears to be no significant sialylation of N-glycans in insect cells. Insect cells expressed glycoproteins may, though, be alpha1,3-fucosylated on the reducing-terminal GlcNAc residue. This type of fucosylation renders the N-glycans on one hand resistant to hydrolysis with PNGase F and on the other immunogenic. Even in the absence of alpha1,3-fucosylation, the truncated N-glycans of glycoproteins produced in insect cells constitute a barrier to their use as therapeutics. Attempts and strategies to "mammalianise" the N-glycosylation capacity of insect cells are discussed.

Animals↗

PubMed1999

Physician-patient communication about complementary and alternative medical therapies: a survey of physicians caring for patients with human immunodeficiency virus infection.

OBJECTIVE: To examine frequency and correlates of physicians' reports of discussions with patients with human immunodeficiency virus (HIV) about complementary and alternative medical (CAM) therapies. DESIGN: Mailed physician survey. SETTING: The setting was Eastern Massachusetts. PARTICIPANTS: Participants included 89 physicians caring for patients with HIV. MEASUREMENTS AND MAIN RESULTS: Physicians were asked how common the use of CAM therapies was among their patients, how useful these therapies were, how often they discussed the use of CAM therapies with new and follow-up patients, and whether they had used a CAM therapy themselves in the last year. We also collected information on physicians' sociodemographic and practice characteristics. Sixty-eight percent (89/130) of physicians responded, and 26% and 5% reported discussing CAM therapies with HIV-infected patients at most new and follow-up visits, respectively. Respondents' attitudes toward the use of CAM therapies were generally positive, and they believed their HIV-infected patients used CAM therapies more than their non-HIV infected patients. The majority (63%) believed that CAM therapies may be helpful for HIV-infected patients. Thirty-six percent (36%) had used a CAM therapy themselves in the last year. In multivariate analyses, only the belief that CAM therapies are helpful was correlated with discussion of CAM therapies (p = 0.006). Respondents' demographic characteristics, training, personal use of CAM therapies, reported visit length, and satisfaction with visit length were not associated with discussion of CAM therapies. CONCLUSIONS: Despite awareness that their HIV-infected patients commonly use CAM therapies and positive attitudes towards such therapies, most of these physicians did not routinely discuss CAM therapies with them. Barriers to physician-patient communication about CAM therapies merit further investigation.

Adult↗

PubMed1998

The effect of protease inhibitors on weight and body composition in HIV-infected patients.

OBJECTIVES: To determine the nutritional changes that occur in HIV-infected patients receiving protease inhibitor (PI) therapy and to determine the effects of PI treatment on physical functioning and health perceptions in patients with HIV infection. DESIGN: Longitudinal data analysis of 38 patients from a large Nutrition and HIV cohort. METHODS: Patients were included if they had started PI therapy after enrollment in the cohort, if they had taken the drug for at least 4 months without interruption and if data on weight, body composition and viral loads were available. RESULTS: Mean person-months of follow-up was 8.1 months before and 12.2 months after PI treatment. Weight (1.54 kg, P < 0.0001), body mass index (0.50 kg/m2, P < 0.0001), physical functioning (8.52 points, P = 0.0006) and current health perception (6.7 points, P = 0.01) increased significantly, and the daily caloric intake increase was close to significance (915.5 kJ/day, P = 0.06), after treatment with PI. Lean body mass did not change. Patients who responded to PI therapy with decreased viral load (n = 28) had significantly greater weight gain per month than non-responders. CONCLUSIONS: PI therapy of HIV infection is associated with weight gain and improvement in quality of life indices. The weight gain is mainly in fat mass, with no change in lean body mass (skeletal muscle). Optimal therapy of HIV-infected patients with weight loss may require highly active antiretroviral therapy combined with an anabolic stimulus such as exercise, anabolic steroids or human growth hormone.

Adult↗

PubMed1998

A conceptual model of the effects of health care organizations on the quality of medical care.

There has been a great deal of interest in recent years in developing measures of health care quality that can be used to characterize and study the effects of health plans. However, because of the recent emergence of diverse types of health care organizations, it is often difficult to know which parts of a plan should be combined for analysis purposes. Also, simple taxonomies of health maintenance organizations (eg, staff, independent practice associations, group, and network) no longer adequately describe the diverse types of organizations that have become common. In this article we describe these trends, explain why older taxonomies of health care plans are not adequate, and present a new framework for characterizing and studying the effects of diverse types of plans.

Capitation Fee↗

PubMed1998

Costs and outcomes of AIDS care: comparing a health maintenance organization with fee-for-service systems in the Boston Health Study.

OBJECTIVE: A 4-month observational cohort study was performed to compare the performance of one health maintenance organization (HMO) with two fee-for-service (FFS) systems in Boston, Massachusetts in treating 255 patients with AIDS. MAIN OUTCOME MEASURES: Total 4-month costs; cost subcomponents, including inpatient, outpatient, home care, and zidovudine costs; functional status (difficulties with activities of daily living); and satisfaction with care. RESULTS: Compared with FFS patients, HMO patients were better educated, more often white, less often on Medicaid, and more often reported homosexual or bisexual behaviors as HIV risk factors (all factors, p = .001). Both groups had similar duration of AIDS, baseline hemoglobin levels, and leukocyte counts. Total 4-month costs at the HMO were significantly lower than those in the FFS settings ($4799 U.S. versus $8540 U.S.; p = .013), as were outpatient costs ($1131 U.S. versus $1614 U.S.; p = .001), after adjustment for sociodemographic factors, baseline functioning, main HIV risk factor, and other clinical variables. Adjusted physical functioning (p = .32) and patient satisfaction (p = .82). were similar between systems. CONCLUSIONS: The HMO had significantly lower total costs without any observable decrement in functional outcomes or patient satisfaction. The largest component of these cost savings came from reduced spending on inpatient care, but the HMO also spent less on outpatient and home care. Better coordination of care at the HMO may have been responsible for these lower costs.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Concanavalin A binding and endoglycosidase D resistance of beta1,2-xylosylated and alpha1,3-fucosylated plant and insect oligosaccharides.

The binding to concanavalin A (Con A) by pyridylaminated oligosaccharides derived from bromelain (Manalpha1,6(Xylbeta1,2) Manbeta1, 4GlcNAcbeta1,4(Fucalpha1,3)GlcNAc), horseradish peroxidase (Manalpha1,6(Manalpha1,3) (Xylbeta1,2)Manbeta1, 4GlcNAcbeta1,4(Fucalpha1,3) GlcNAc), bee venom phospholipase A2 (Manalpha1,6Manbeta1,4GlcNAcbeta1,4GlcNAc and Manalpha1,6(Manalpha1,3)Manbeta1,4GlcNAcbeta1,4 (Fucalpha1,3)GlcNAc) and zucchini ascorbate oxidase (Manalpha1,6(Manalpha1,3) (Xylbeta1,2)Manbeta1,4 GlcNAcbeta1,4GlcNAc) was compared to the binding by Man3GlcNAc2, Man5GlcNAc2 and the asialo-triantennary complex oligosaccharide from bovine fetuin. While the fetuin oligosaccharide did not bind, bromelain, zucchini, Man2GlcNAc2 and horseradish peroxidase were retarded (in that order). The alpha1,3-fucosylated phospholipase, Man3GlcNAc2 and Man5GlcNAc2 structures were eluted with 15 mM alpha-methylmannoside. It is concluded that core alpha1,3-fucosylation has little or no effect on ConA binding while xylosylation decreases affinity for ConA. In a parallel study comparing the endoglycosidase D (Endo D) sensitivities of Man3GlcNAc2, IgG-derived GlcNAcbeta1, 2Manalpha1,6(GlcNAcbeta1,2Manalpha1,3)Manbeta1,+ ++4GlcNAcbeta1,4(Fucalpha1,6)GlcNAc, the phospholipase Manalpha1,6(Manalpha1,3) Manbeta1, 4GlcNAcbeta1,4(Fucalpha1,3)GlcNAc, and horseradish and zucchini pyridylaminated N-linked oligosaccharides, it was found that only the Man3GlcNAc2 structure was cleaved. The IgG structure was sensitive only when beta-hexosaminidase was also present. Thus, in contrast to core alpha1,6-fucosylated structures, such as those present in mammals, the presence of core alpha1,3-fucose, as found in structures from plants and insects, and/or beta1,2-xylose, as found in plants, causes resistance to Endo D.

Animals↗

PubMed1998

Structural analysis of N-glycans from allergenic grass, ragweed and tree pollens: core alpha1,3-linked fucose and xylose present in all pollens examined.

The N-glycans from soluble extracts of ten pollens were examined. The pyridylaminated oligosaccharides derived from these sources were subject to gel filtration and reverse-phase HPLC, in conjunction with exoglycosidase digests, and in some cases matrix-assisted laser desorption-ionisation mass spectrometry. In comparison to known structures, it was possible to determine the major structures of the N-glycans derived from Kentucky blue grass (Poa pratensis), rye (Secale cerale), ryegrass (Lolium perenne), short ragweed (Ambrosia elatior), giant ragweed (Ambrosia trifida), birch (Betula alba), hornbeam (Carpinus betulus), horse chestnut (Aesculus hippocastanum), olive (Olea europaea) and snake-skin pine (Pinus leucodermis) pollen extracts. For grass pollens the major glycans detected were identical in properties to: [structure in text] Grass pollens also contained some minor structures with one or two non-reducing terminal N-acetylglucosamine residues. In the ragweed pollens, the major structures carried core alpha1,3-linked fucose with or without the presence of xylose. In tree pollen extracts, the major structures were either xylosylated, with or without fucose and terminal N-acetylglucosamine residues, with also significant amounts of oligomannose structures. These results are compatible with the hypothesis that the carbohydrate structures are another potential source of immunological cross-reaction between different plant allergens.

Allergens↗

PubMed1998

Core alpha1,3-fucose is a key part of the epitope recognized by antibodies reacting against plant N-linked oligosaccharides and is present in a wide variety of plant extracts.

Carbohydrates have been suggested to account for some IgE cross-reactions between various plant, insect, and mollusk extracts, while some IgG antibodies have been successfully raised against plant glycoproteins. A rat monoclonal antibody raised against elderberry abscission tissue (YZ1/2.23) and rabbit polyclonal antiserum against horseradish peroxidase were screened for reactivity in enzyme-linked immunosorbent assay against a range of plant glycoproteins and extracts as well as neoglycoproteins, bee venom phospholipase, and several animal glycoproteins. Of the oligosaccharides tested, Man3XylFucGlcNAc2(MMXF3) derived from horseradish peroxidase was the most potent inhibitor of the reactivity of both YZ1/2.23 and anti-horseradish peroxidase to native horseradish peroxidase glycoprotein. The reactivity of YZ1/2. 23 and anti-horseradish peroxidase against Sophora japonica lectin was most inhibited by a neoglycoconjugate of bromelain glycopeptide cross-linked to bovine serum albumin, while the defucosylated form of this conjugate was inactive as an inhibitor. A wide range of plant extracts was found to react against YZ1/2.23 and anti-horseradish peroxidase, with particularly high reactivities recorded for grass pollen and nut extracts. All these reactivities were inhibitable with the bromelain glycopeptide/bovine serum albumin conjugate. Bee venom phospholipase and whole bee venom reacted weakly with YZ1/2.23 but more strongly with anti-horseradish peroxidase in a manner inhibitable with the bromelain glycopeptide/bovine serum albumin conjugate, while hemocyanin from Helix pomatia reacted poorly with YZ1/2.23 but did react with anti-horseradish peroxidase. It is concluded that the alpha1, 3-fucose residue linked to the chitobiose core of plant glycoproteins is the most important residue in the epitope recognized by the two antibodies studied, but that the polyclonal anti-horseradish peroxidase antiserum also contains antibody populations that recognize the xylose linked to the core mannose of many plant and gastropod N-linked oligosaccharides.

Animals↗

PubMed1997

Clinical predictors of declines in physical functioning in persons with AIDS: results of a longitudinal study.

OBJECTIVE: This study was performed in an attempt to determine clinical correlates of declines in physical functioning in people with AIDS. DESIGN: An 8-month longitudinal cohort study was performed at three sites in Boston, Massachusetts: a private academic group practice, an AIDS clinic at a public teaching hospital, and a staff-model health maintenance organization. Intermediate activities of daily living (IADLs), 10 symptoms and symptom complexes, mental health, and weight loss were assessed by interview in 201 persons with AIDS. Clinical diagnoses, comorbidities, laboratory results, and use of selected medications were assessed by chart review. RESULTS: Participants were young (mean age, 36 years), 92% were male, 35% were nonwhite, and 27% had a history of injection drug use. The mean 8-month decrement in physical functioning was 9.6 points on a 100-point scale, and mean weight loss was 2.3 kg. After adjusting for baseline functioning, age, sex, race, and educational level, independent predictors of the 8-month IADL score included worsening fatigue (p = .0002), worsening neurologic symptoms (p = .001), weight loss (p = .0001), Candida esophagitis (p = .020), hypertension (p = .0005), depression (p = .004), and gastrointestinal (GI) disease (p = .018, model R2 = 0.56). CONCLUSIONS: Two symptom complexes (fatigue and neurologic symptoms), three comorbidities (hypertension, depression, and GI disease), and weight loss were significant independent predictors of 8-month IADL scores after statistically controlling for baseline IADL score and sociodemographic variables. These clinical factors are potential targets for interventions designed to improve physical functioning.

Acquired Immunodeficiency Syndrome↗

PubMed1997

The chemoenzymatic synthesis of the core trisaccharide of N-linked oligosaccharides using a recombinant beta-mannosyltransferase.

The chemical synthesis of the beta-mannosyl linkage of N-glycans has presented a great challenge to synthetic carbohydrate chemists. We have therefore investigated the application of beta-mannosyltransferases to the preparative synthesis N-linked core oligosaccharides. In this paper we report the chemoenzymatic synthesis of beta-D-mannopyranosyl-(1-->4)-2-acetamido-2-deoxy-beta-D-glucopyranosyl- (1-->4)-2-acetamido-2-deoxy-alpha-D-glucopyranose on a preparative scale using a phytanyl-linked acceptor in the presence of a recombinant beta-(1-->4)-mannosyltransferase.

Carbohydrate Sequence↗