Biomedical subjects
Publications and source records attributed to J D Olson.
The most sensitive assay possible is desired for quantitation of total DNA and DNA probe binding. To reduce background signal, which may reduce assay sensitivity, it is desirable to employ low antibody concentrations. This requires the use of a specific antibody with a high affinity for DNA.
Brightness of uniform fields during normal and stabilized viewing was determined as a function of adapting luminance, field size, and luminance gradient of the edges of the adapting field. In one set of experiments, it was found that, over a range of adapting luminances from 6 to 9600 td, a uniformly-illuminated 7.5 deg hemifield appeared about 1 log unit brighter in normal viewing than when it was retinally-stabilized. In the second set of experiments, it was found that the loss of brightness due to stabilized viewing was significantly greater for large fields with raised cosine edges than for small fields with step edges. Both sets of results can be accounted for by a two-stage model of light adaptation previously proposed to account for the fading time of stabilized images.
BACKGROUND: Very little is known about the determinants of blood transfusions in patients undergoing coronary artery bypass graft surgery. STUDY DESIGN AND METHODS: To identify factors that influenced the transfusion of red cells, platelets, plasma, and cryoprecipitate, statistical methods were used to study 2476 consecutive diagnosis-related group 106 and 107 patients in five teaching hospitals who underwent coronary artery bypass surgery between January 1, 1992, and June 30, 1993. RESULTS: The likelihood of red cell transfusion was significantly associated with 10 preoperative factors: 1) admission hematocrit, 2) the patient's age, 3) the patient's gender, 4) previous coronary artery bypass surgery, 5) active tobacco use, 6) catheterization during the same admission, 7) coagulation defects, 8) insulin-dependent diabetes with renal or circulatory manifestations, 9) first treatment of new episode of transmural myocardial infarction, and 10) severe clinical complications. Platelet and/or plasma transfusions were strongly associated with the dose of red cells transfused. Transfusion requirements and other in-hospital outcomes were associated with patient characteristics, surgical procedure (reoperation vs. primary procedure), and the conduits used for revascularization (venous graft only, venous and internal mammary artery graft, or internal mammary artery graft only). Blood resource use and donor exposures were evaluated with respect to the risk to patients of contracting hepatitis C virus and human immunodeficiency virus infections. CONCLUSION: The classification of coronary artery bypass graft patients on the basis of attributes known preoperatively and by conduits used yields subsets of patients with distinctly different transfusion requirements and in-hospital outcomes.
Minimizing the interlaboratory variability of the International Normalized Ratio (INR) for patients receiving coumarin therapy will require local laboratory calibration of individual coagulation instrument/reagent systems. However, some laboratories possess multiple coagulation instruments of the same model, and it is unclear if each instrument would require separate calibration. To address this question, a controlled study was performed that examined the interinstrument variability of the INR on three separate Coagamate X2 coagulometers (Organon Teknika, Durham, NC) using the Simplastin Excel reagent (Organon Teknika) (International Sensitivity Index = 2.14). The interinstrument coefficient of variation (CV) of the INR among the three instruments was 3.4% and 3.5% for patient control plasmas (n = 20) and coumarin plasmas (n = 40, INR range 1.5-4.6), respectively. The number of discordant INRs between paired instruments (one INR within and one INR out of the therapeutic range, plus a difference of at lest 0.4 INR units) was very low (0%). The interinstrument INR CVs for three commercial quality control plasmas were 2.6% (INR = 0.92), 4.1% (INR = 2.1), and 6.3% (INR = 4.5), and correlated well with the low CVs for patient samples. This study showed that the Coagamate X2/Simplastin Excel system is capable of very low interinstrument INR variability, and surpasses the interlaboratory CVs reported in the literature. Formal calibration of a single instrument may be adequate for laboratories possessing multiple instruments of the same model.
Fetal calf serum asialofetuin was assayed in the sandwich format using biotinylated and fluoresceinated ricin toxin (B-RCA and F-RCA). The sandwiched species was captured on a biotin-BSA coated nitrocellulose membrane with streptavidin. Anti-fluorescein antibody-urease conjugate was bound to the complex, and detected and quantitated under microvolume conditions using the light addressable potentiometric sensor. As little as 250 pg of asialofetuin was detectable whereas fetuin gave no response at conditions as high as 32 ng. Using a competitive inhibition assay, we established that the binding constant for the asialofetuin-ricin complex was 3.6 x 10(8) M-1. This is in good agreement with data published using glycopeptides derived from asialofetuin, and RCA and the ricin agglutinin, RCA-120.
A prospective study of the postoperative kinetics of coagulation factors was undertaken in 23 burn patients and in six non-burn patients. All procedures resulted in a large volume blood loss. Fibrinogen, platelets and factors V, VIII and IX were measured serially. Burn patients returned all parameters to preoperative levels by 48 h postoperation, while non-burn patients showed a slower rate of return of platelets and factor V. This study suggests that burn patients may safely undergo re-operation at 48 h intervals for successive wound debridements if clinically necessary.
The purpose of this study was: 1) to define coagulation abnormalities in patients who receive red cell concentrates rather than whole blood for large volume blood loss (greater than 0.5 blood volume); and 2) to determine when coagulation abnormalities lead to increased bleeding in the massively transfused surgical patient. We studied 32 ASA physical status I or II patients (mean age 15.6 +/- 2.3 yr) who lost more than 50% of their blood volume during elective posterior spinal stabilization. Crystalloid solutions and packed red cell concentrates were used to replace blood and fluid losses. Invasive hemodynamic measures, urinary output, and serial hematocrit determinations were used to help maintain a constant intravascular volume and confirm the estimates of blood loss. The quality of hemostasis was assessed during operation. In 15 of the 32 patients, surgical hemostasis remained effective throughout posterior spinal fusion. A coagulation profile (prothrombin time [PT] and activated partial thromboplastin time [aPTT], platelet count, and fibrinogen) was measured at the conclusion of operation in these patients. In 17 patients, increased surgical bleeding as a result of decreased clot formation and increased bleeding from the wound was present. In these 17 patients at the time increased bleeding was diagnosed, hemostatic tests (PT, aPTT, fibrinogen, platelet count, and coagulation factor assays V, VIII, and IX) were obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
Ten patients with isolated right atrial tamponade complicating open heart surgery were identified over a 3.5-year period at three institutions. Clinical manifestations varied but were typically those of decreased perfusion with elevated central venous pressure. Hemodynamically these patients had systemic hypotension and tachycardia with elevated central venous pressure but without elevation of pulmonary artery or pulmonary artery wedge pressures. The correct diagnosis in each case was established by echocardiography; 7 via the transthoracic and 3 via the transesophageal approach. The typical echocardiographic feature was an extrinsic extracardiac mass compressing the atrium. Doppler findings included high flow velocities through the right atria, and color flow demonstrated narrow color jets through compressed, slit-like right atria. Surgical exploration confirmed these findings in each case. We conclude that the combination of clinical awareness and appropriate hemodynamic evaluation can alert the physician to the possibility of isolated right atrial hematoma causing decreased perfusion and/or shock following open heart surgery. Echocardiography using either the transthoracic or transesophageal approach can establish the diagnosis and lead to timely surgical intervention.
GOALS: The Information Network For Online Retrieval & Medical Management (INFORMM), health information system (HIS) for the University of Iowa Hospitals and Clinics (UIHC), was analyzed with regard to development of a Computer-Based Patient Record (CBPR) in a cost-effective manner. The analysis: i) profiles INFORMM system functionality; ii) displays INFORMM use and satisfaction among physicians, nurses, and other hospital employees; iii) characterizes dynamics affecting INFORMM growth; and iv) evaluates the cost of a system of internal-development of software. DATA SOURCES: INFORMM utilization for 1989, 1994, and 1995; service requests from users for the years 1985, 1990, and 1994; 1994 MECON-PEERx data; gap analysis user survey conducted by an independent consulting firm. MAIN RESULTS: 1) Physician use has been dominated by a single function: retrieval of laboratory results. 2) Nurse use of the system was more diverse. A recent surge of nurse and physician use resulted from the introduction of online documentation of nursing care. 3) Overall use has been predominantly by non-clinician users, no one function dominating their pattern of use. 4) User service requests were predominantly from the non-clinician group of users. Requests from non-physician groups have been coordinated by a limited number of representatives of those groups, unlike requests from physicians. 5) The UIHC HIS ranked high in user satisfaction. 6) The overall cost of the UIHC HIS system is relatively low as a percentage of the gross operating budget or as a ratio to the volume of patient activities in this medical center. CONCLUSIONS: Internal development of INFORMM has been a cost-effective solution to the information demands of nursing staff and other users. INFORMM system composition reflects the quantity and organization of user requests. Satisfying the needs of physicians requires a change in the manner in which physician needs are assessed.
Affinities of various monoclonal and polyclonal antibodies for fluorescein-containing antigens, saxitoxin and ricin, were determined by using a light addressable potentiometric sensor-based system (Threshold). The dissociation constants, determined from Scatchard plots, ranged from 2 x 10(-7) to approximately 3 x 10(-12) M. Dissociation constants for fluorescein and saxitoxin were compared with values determined by independent means. This technique was found to be quick, simple, reproducible, and accurate.
Explore the source record for details and available documents.
The addition of a uniform increment of luminance (L) to a faded retinally-stabilized target results in the subjective reappearance of the image with contrast opposite to that of the target. This phenomenon, called apparent phase reversal (APR), reveals a nonlinear gain mechanism in the adaptation process. The magnitude of the threshold increment to elicit APR (Lapr) is a measure of the state of stabilized adaptation. In the experiments reported here, Lapr was studied as a function of background luminance (Lo) and contrast (m) of the adapting stimulus. It was found that Lapr increases with increasing Lo, but does not depend on m. The data are analyzed within the context of a previously proposed model of stabilized image fading consisting of a multiplicative inverse gain followed by a subtractive process. It was found that the addition of a contrast processing stage was required to account for the relationship between Lapr and m.
Rapid, sensitive and flexible assay systems are needed for immunoassays, receptor-ligand binding studies and DNA probe assays. Filtration capture and sensor detection offer several advantages to these areas. Although dependent on the affinity of the specific binders employed, the sensitivity of these techniques can be in the order of 10(-12) M, and total assay time can be less than 15 minutes.
Some thromboplastin manufacturers are currently supplying the instrument-specific international sensitivity index (ISI) values of their reagents, allowing clinical laboratories to calculate instrument-specific international normalized ratio (INR) values on plasma samples from patients receiving coumarin therapy. However, the assumption that systematic interinstrument variability in the INR would be eliminated if manufacturer-determined ISI values were used remains unsubstantiated. This assumption was evaluated by comparing INR values obtained on one instrument that measures a mechanical endpoint (fibrometer) with one that measures a photo-optical endpoint (MLA-700). Three thromboplastin reagents with instrument-specific ISI values supplied by the manufacturer (ISI range, 1.23-2.79) were used. For two of three reagents, the fibrometer INR values were significantly higher than the MLA-700 INR values (P < .01). Analysis of log prothrombin time ratio plots showed that this systematic variability was caused by inaccurate manufacturer ISI values. Of clinical significance is that the inaccurate ISI values produced a high number of discordant INR values between these two instruments (> 47% of plasma samples had one INR value within and one out of the recommended therapeutic range). The implication of these findings for laboratory monitoring of oral anticoagulation is discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Platelet membrane glycoproteins Ib (GPIb) and IIb/IIIa (GPIIb/IIIa) bind soluble von Willebrand factor (vWf) after stimulation with ristocetin (GPIb) or with thrombin or ADP (GPIIb/IIIa). In fluid-phase, vWf does not bind to these platelet receptors without stimulation. In contrast, platelets adhere to solid-phase vWf without stimulation by ristocetin, adenosine diphosphate (ADP), or thrombin, and adhesion increases after stimulation by these agonists. The effect of monoclonal antibodies specific for GPIb (6D1) and GPIIb/IIIa (10E5 and HP1-1D) on platelet adhesion to solid-phase vWF was studied. Adhesion of radiolabeled, washed platelets (with washed red blood cells) aspirated at a constant wall shear rate of 1000 sec-1 through glass capillary tubes coated with purified human vWf was quantified. Unstimulated platelet adhesion was decreased 80% to 90% by blocking either the GPIb site or the GPIIb/IIIa site with 6D1 or 10E5, respectively, or with 6D1 and 10E5 together. Adhesion was not reduced significantly by HP1-1D (anti-GPIIb/IIIa). After stimulation with ADP or thrombin, the platelet adhesion was reduced by prior incubation with saturating concentrations of either 6D1 (61% reduction) or 10E5 (80% reduction), as well as with both 6D1 and 10E5 (80% reduction). After stimulation with ristocetin, the adhesion was reduced with either 6D1 (90% reduction) or 10E5 (90% reduction) or both 6D1 and 10E5 (90% reduction). Prior incubation with HP1-1D had minimal effect on platelet adhesion to vWF after stimulation with thrombin, ADP, or ristocetin.(ABSTRACT TRUNCATED AT 250 WORDS)
Fading time of a retinally-stabilized difference-of-Gaussian (DOG) stimulus depends on the background luminance, contrast and spatial frequency content of the stimulus. A model of the visual system including a nonlinear multiplicative, non-local and fast process followed by a linear subtractive, local and slower process accounts for these effects. Analysis of the fading time data allows us to estimate the spatiotemporal characteristics of the proposed adaptation processes. The model is consistent with recent models of normal light adaptation from the probe-flash paradigm.