Biomedical subjects
Publications and source records attributed to J Summers.
Unless healthcare reform changes circumstances dramatically, you will feel some pressure to know and report the activities of your competitors. This is especially true for materiel managers because of the sheer number of contacts they have.
Those of us in the healthcare industry have done a good job in demonstrating the value of our services in relationship to other activities government might undertake. We have done less well in recognizing the demands of individuals to make decisions about their own lives and the healthcare benefits they want. We continue to believe we know best, even to the point that we distrust the public to make appropriate decisions on their own behalf. A major part of freedom is the opportunity to learn from mistakes. When professionals restrict our freedom to choose, we all lose important rights. As the various bills make their way through Congress, we should look beyond our healthcare blinders and see that the public will reject industry-driven plans with almost the same level of suspicion given to the government and business.
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We have conducted three audits of the number of fractions used within our department to treat symptomatic bone metastases. The initial audit identified 133 patients treated for bone metastases in a 3-month period using 538 fractions (mean number of fraction = 4.1, range 1-14). These figures were presented at our audit meeting along with a literature review which provided no evidence of any advantage of multiple fractions over single fractions. Departmental guidelines recommending the use of single fractions were established. A subsequent audit identified 149 patients treated with 520 fractions (mean number of fractions = 3.5, range 1-11). A third audit identified 148 patients treated with 335 fractions (mean number of fractions = 2.3, range 1-10). Audit has resulted in a reduction in the number of fractions used to treat bone metastases in our department. The major effect was seen after the second audit.
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Some allied health programs consume more resources than they generate. Decision makers are often required to evaluate the need for continuing such programs. This paper presents a methodology for analysis of programs that do not cover their costs with the revenue that they generate. Although the subject presented is a clinical laboratory science program, the methodology and the examples provide a model and instruction on how to conduct a similar analysis for any allied health program, and a summary of the types of conclusions such an analysis might afford.
We have examined the consequences on duck hepatitis B virus DNA synthesis of deleting the 5' and 3' copies of the 12 base sequence, DR1, from the viral pregenome. With the wild-type virus, reverse transcription initiates at nt 2537 within the 3' copy of DR1. When this sequence was deleted, initiation of reverse transcription was found at two other sites located closer to the 3' end of the pregenome (nt 2576 and nt 2644). The 3-base motif UUA was the only sequence common to these sites as well as the wild-type initiation site in DR1. Deletion of the 5' copy of DR1 did not alter minus strand synthesis, but led to aberrant priming of plus strand synthesis to generate predominantly linear rather than relaxed circular, double-stranded viral DNA, in agreement with the recent report by Loeb et al. (EMBO J. 10, 3533-3540, 1991). A mutant lacking only the 3' copy of DR1 rapidly converted to wild type in transfected cells. This apparently occurred as a consequence of conversion of newly synthesized relaxed circular to covalently closed circular (CCC) DNA, which might then serve as a template for the synthesis of wild-type viral RNAs. A mutant lacking only the 5' copy of DR1 did not exhibit this behavior. These results support the conclusion that amplified CCC DNA serves as transcriptional template.
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We describe experiments demonstrating that after transfection into permissive cells, the RNA pregenome of an avian hepadnavirus, the duck hepatitis B virus, is infectious. Using a Sindbis virus expression vector, we showed that cytoplasmic synthesis of the pregenome resulted in hepadnaviral DNA synthesis. Moreover, complete infectious virus was produced from cells transfected with hepadnaviral pregenomic RNA. We conclude that the pregenome of hepadnaviruses can express all the proteins required for DNA synthesis as well as serve as a template for reverse transcription and that DNA resulting from pregenome expression can be utilized to establish a productive infection in pregenome-transfected cells.