Search PubMed⌕ Search

Biomedical subjects

J Daley

Publications and source records attributed to J Daley.

160 records · Page 9Linked to original sources
PubMed1987

Expression of B cell activation antigens on normal and malignant B cells.

In an attempt to relate the functional events of B cell activation with changes in cell surface molecules, we have used a panel of monoclonal antibodies directed against cell surface antigens expressed on activated but not resting B cells, to determine a sequence of activation antigen expression following anti-immunoglobulin stimulation. Within the first 24 hr of culture with anti-Ig, resting splenic B cells were induced to express B5 and interleukin-2 receptor (IL-2R) and subsequently express T9 and BB1 by 48 hr. Maximum antigen expression was seen by day 3 with the majority of cells expressing B5, IL-2R, T9, and BB1, and fewer numbers of cells expressing Blast-1 and Blast-2. By day 6, the expression of these antigens significantly decreased. Dual fluorochrome staining of anti-Ig activated B cells demonstrated heterogeneity of activation antigen expression, suggesting the existence of subpopulations of activated B cells. In an attempt to relate the non-Hodgkin's lymphomas (NHLs) to this sequence of activation, 69 tumor samples from patients with B cell NHLs were then examined for expression of these activation antigens. Histologically defined subgroups of B cell NHLs demonstrated differential expression of activation antigens with B5, BB1, and T9 exhibiting the widest distribution, whereas IL-2R, Blast-1, and Blast-2 demonstrated more limited expression. The finding that no B cell malignancy phenotypically resembles the small resting B lymphocyte coupled with the observation that virtually all B cell NHLs examined expressed activation antigens suggests that these tumors may be the neoplastic counterparts of subpopulations of activated B lymphocytes.

Antibodies, Monoclonal↗
PubMed1987

Normal cellular counterparts of B cell chronic lymphocytic leukemia.

In an attempt to compare B cell chronic lymphocytic leukemia (B-CLL) with its normal cellular counterpart, the cell surface phenotype of 100 cases of B-CLL was determined by using a panel of monoclonal antibodies (MoAbs) directed against B cell-restricted and -associated antigens. The majority of B-CLL cells expressed Ia, B4 (CD19), B1 (CD20), B2 (CD21), surface immunoglobulin (sIg), and T1 (CD5) but lacked C3b (CD35) receptors. In contrast, the overwhelming majority of small unstimulated B cells expressed Ia, B4, B1, B2, sIg, and C3b receptors but lacked detectable T1. Small numbers of weakly sIg+ cells could be identified in peripheral blood and tonsil that coexpressed the B1 and T1 antigens. Approximately 16% of fetal splenocytes coexpressed B1, T1, weak sIg, B2, and Ia but lacked C3b receptors and therefore closely resembled most B-CLL cells. With the phenotypic differences between the majority of small unstimulated B cells and B-CLL cells, we examined normal in vitro activated B cells and B-CLL cells for the expression of B cell-restricted and -associated activation antigens. Of 20 cases examined, virtually all expressed B5, and approximately 50% of the cases expressed interleukin-2 receptors (IL-2R) and Blast-1. Normal B cells were activated with either anti-Ig or 12-0-tetradecanoylphorbol-beta-acetate (TPA) and then were examined for coexpression of B1, T1, and the B cell activation antigens B5 and IL-2R. Only cells activated with TPA coexpressed B1 and T1 as well as B5 and IL-2R. B cells activated with either anti-Ig or TPA proliferated in the presence of IL-2, whereas B-CLL cells did not, although they all expressed the identical 60-kilodalton proteins by immunoprecipitation. These studies are consistent with the notion that B-CLL resembles several minor subpopulations of normal B cells including a population of B cells that are activated in vitro directly through the protein kinase C pathway.

Antibodies, Anti-Idiotypic↗
PubMed1985

The proprietary hospital industry: a financial analysis 1972-1982.

This paper evaluates the performance of both specific firms within the American for-profit hospital industry and the industry as a whole. First, traditional financial analysis is used to evaluate individual publicly traded for-profit chains. Then, industry performance from 1973 to 1982 is evaluated using a set of measures based on Modern Portfolio Theory. The traditional financial analysis indicates that the industry seems increasingly profitable as well as increasingly healthy from the perspective of utilizing its assets and reducing its collection period. However, the industry's rapid growth rate has strained its ability to use additional debt funding and has created a potentially dangerous liquidity position. Measures based on Modern Portfolio Theory indicate that the average return of the industry has improved over the past 5 years. However, its risk has also increased. Nevertheless, the increase in risk is more than offset by the increased average return. In addition, recent legislation designed 'to reward the efficient' has introduced a significant degree of uncertainty into the industry's performance for the coming years. Thus, hospitals' ability to maintain the substantial profitability and rate of growth they have experienced over the past decade will depend on how well they will adapt to the changing environment.

Cost Control↗
PubMed1985

The characteristics of training in ambulatory medicine in U.S. residencies.

To determine the characteristics of training in ambulatory internal medicine, all internal medicine residency programs in the United States were surveyed in 1981-82. Thirty-eight percent of 477 hospitals responded. Quantitative information was sought regarding the specific features of the ambulatory residency programs, formal teaching conferences, supervision of residents, and evaluation of residents in ambulatory care. According to the responses, the training of the small cadre of primary care residents does emphasize ambulatory medical experience, supervised by an increasing number of faculty members in general medicine. Formal post-clinic conferences, analogous to inpatient attending rounds, are held substantially more often in hospitals with primary care programs than in hospitals without primary care programs. Formal ambulatory teaching conferences stress both traditional topics important in internal medicine and psychosocial issues. However, the authors could detect little effect of these activities in primary care programs on the training of traditional internal medicine residents even within the same hospital.

Ambulatory Care↗
PubMed1983

Purification and characterization of fetal hematopoietic cells that express the common acute lymphoblastic leukemia antigen (CALLA).

Fetal hematopoietic cells that express the common acute lymphoblastic leukemia antigen (CALLA) were purified from both fetal liver and fetal bone marrow by immune rosetting with sheep erythrocytes coated with rabbit anti-mouse immunoglobulin and by fluorescence-activated cell sorting. Dual fluorescence techniques disclosed that these cells were heterogenous with respect to the expression of a series of differentiation and activation antigens defined by monoclonal antibodies. Thus, whereas all CALLA+ cells were Ia+ and expressed two activation antigens, J2 and T10, only 30-50% expressed B1 antigen. Furthermore, using methanol-fixed cells, it could be shown that approximately 20% contained intracytoplasmic mu chains (cyto-mu) and that approximately 15% were positive for the terminal transferase enzyme (TdT) marker. The CALLA+ fetal cells thus closely resemble the childhood acute lymphoblastic leukemia cell with respect to surface marker phenotype. A population of CALLA- cells devoid of mature erythroid and myeloid surface markers was found to contain higher numbers of TdT+ cells but lower numbers of cyto-mu, B1, and Ia+ cells than the CALLA+ subset. In vitro analysis of normal, purified CALLA+ cells demonstrated that incubation at 37 degrees C with J5 monoclonal antibody specific for CALLA resulted in the specific modulation of surface antigen. Similar results have previously been obtained with CALLA+ tumor cells. Although phenotypic analysis of CALLA+ cells suggests that these cells are relatively immature lymphoid cells, CALLA+ cells do not appear to contain either myeloid precursor cells (CFU-G/M) or the earliest lymphoid stem cells.

Antibodies, Monoclonal↗
PubMedDate not supplied

Predicting hospital-associated mortality for Medicare patients. A method for patients with stroke, pneumonia, acute myocardial infarction, and congestive heart failure.

We created a microcomputer-based system that uses characteristics of the patient at admission to predict death within 30 days of hospital admission for Medicare patients with stroke, pneumonia, myocardial infarction, and congestive heart failure. These conditions account for 13% of discharges and 31% of 30-day mortality for Medicare patients over 64 years of age. The system was calibrated on a stratified, random sample of 5888 discharges (about 1470 for each condition) from seven states, with stratification by hospital type to make the sample nationally representative. The predictors must be specially abstracted from the medical record. The cross-validated R2 for predictions is 0.14 to 0.25, which is better than the values for other systems for which we have data. Risk-adjusted predicted group mortality rates may be useful in interpreting information on unadjusted mortality rates, and patient-specific predictions may be useful in identifying unexpected deaths for clinical review.

Aged↗
PubMedDate not supplied

Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality?

OBJECTIVE: Incomplete coding of secondary diagnoses may bias assessments of patient risks of poor outcomes using administrative health care databases, most of which allow only five diagnoses. The Medicare program is expanding the number of possible diagnoses from five to nine, aiming to improve coding completeness. We examined the impact of having more diagnosis codes available on assessments of risk of death. DESIGN: We used 1988 computerized hospital discharge abstract data from California, which allow up to 25 diagnoses per discharge, to select a sample of hospitalized patients and assessed the relationship between the presence of 29 specific secondary diagnoses and the risk of in-hospital death. SETTING: Nonfederal acute-care hospitals in California. STUDY POPULATION: All patients at least 65 years of age who were hospitalized for stroke, pneumonia, acute myocardial infarction, or congestive heart failure in California in 1988 (N = 162,790). MAIN OUTCOME MEASURES: Relative risk of death for each specific secondary diagnosis. RESULTS: Many conditions that on a clinical basis would be expected to increase the risk of death, such as adult-onset diabetes mellitus, previous myocardial infarction, angina, and ventricular premature beats, were associated with a lower risk of in-hospital death. CONCLUSIONS: Bias against coding of chronic or comorbid conditions on the computerized discharge abstracts of patients who die best explains these results. Efforts to improve diagnosis coding completeness solely by increasing the number of available coding spaces may not succeed.

Aged↗
PubMedDate not supplied

Angina patients' ratings of current health and health without angina: associations with severity of angina and comorbidity.

OBJECTIVE: To investigate the relationship between chronic stable angina patients' ratings of two health states (current health and health free of angina), the difference between these two ratings (the "anticipated gain"), and measures of anginal severity and comorbidity. DESIGN: Cross-sectional interviews and questionnaires. SETTING: Out-patient clinics and medical inpatient service of a Veterans Affairs Medical Center. PARTICIPANTS: Patients with chronic stable angina with no prior history of a revascularization procedure attending clinic appointments (n = 44) or electively admitted for cardiac catheterization (n = 11). Measurements. Ratings of current health and health free of angina using a verbal rating scale in which 0 = death and 100 = perfect health, the MOS SF-36, the Index of Coexistent Disease (a validated measure of comorbidity), and a question on the severity of anginal symptoms. RESULTS: Mean (95% CI) rating of current health was 61.8 (59.2, 64.4) and that of health free of angina was 77.0 (74.5, 79.5). Median anticipated gain between the two health ratings was 10.0 (range 0-80). Correlations between ratings for both health states and subscales of the SF-36 were positive, with some reaching statistical significance. In regression models with rating of current health, rating of life without angina, and anticipated gain as the dependent variables, severity of comorbidity was highly significant in all three, whereas severity of angina was significant only in the current-health rating model. Severity of comorbidity had much greater explanatory power in all three models than did severity of angina. CONCLUSIONS: Severity of comorbidity was a better predictor of patients' current health rating, rating for angina-free health, and anticipated gain from relief of angina than was severity of angina. Since patient perceptions of a symptom may be distinct from self-reported symptom severity, treatment-outcome studies should assess patient preferences in addition to symptom severity. Comorbidity should also be measured in such studies. Having patients rate current health and symptom-free health may be a useful measure of treatment effectiveness for specific symptoms in clinical trials and patient care, and may help patients and clinicians prioritize multiple health problems.

Activities of Daily Living↗
PubMedDate not supplied

Interpreting hospital mortality data. The role of clinical risk adjustment.

This study uses national Medicare data as well as data that were abstracted to calibrate the Medicare Mortality Predictor System to assess the usefulness of a risk adjustment system in interpreting hospital mortality rates. The majority of variation in annual hospital death rates for the four conditions studied (stroke, pneumonia, myocardial infarction, and congestive heart failure) is chance variability that results from the relatively small numbers of patients treated in most hospitals in a year. For hospitals in the highest and lowest quartiles of observed death rates, the difference between observed rates and those predicted by the Medicare Mortality Predictor System is not quite on third smaller than the difference between observed rates and unadjusted national rates. Risk adjustment methods do not show whether the unexplained difference in mortality rates results from differences in effectiveness of care or unmeasured differences in patient risk at the time of admission. Risk-adjusted mortality rates, therefore, should be supplemented by review of the actual care rendered before conclusions are drawn regarding effectiveness of care.

Aged↗