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Biomedical subjects

L M Day

Publications and source records attributed to L M Day.

28 records · Page 2Linked to original sources

A quality improvement management model for renal care.

The purpose of this article is to explore the potential for applying the theory and tools of quality improvement (total quality management) in the renal care setting. We believe that the coupling of the statistical techniques used in the Deming method of quality improvement, with modern approaches to outcome and process analysis, will provide the renal care community with powerful tools, not only for improved quality (i.e., reduced morbidity and mortality), but also for technology evaluation and resource allocation.

Humans↗

Subpopulations of mature murine thymocytes: properties of CD4-CD8+ and CD4+CD8- thymocytes lacking the heat-stable antigen.

The heat-stable antigen (HSA), recognized by the monoclonal antibodies M1/69, B2A2, and J11d, is low or absent on the surface of most murine peripheral T cells but present on all but 3% of thymocytes. The CD4-CD8+ and CD4+CD8- or "single positive" thymic populations may be divided into further subgroups based on surface HSA expression. One group, CD4-CD8+ and expressing very high levels of HSA (HSA++), is an immature, T cell antigen receptor (TcR) negative, outer cortical blast cell. However, a further subdivision of CD4-CD8+ and CD4+CD8- single positives may be made, into those negative to low for HSA (HSA-) and those expressing moderate amounts of HSA (HSA+). The proportion of HSA- single positives is low in the thymus of young mice, whereas the proportion of HSA+ single positives is similar to that of the adult. Both the HSA- and the HSA+ subsets of single positive thymocytes from adult mice are CD3+ and express the normal peripheral T cell incidence of V beta 8 determinants on the TcR. On stimulation with concanavalin A in limit-dilution culture both HSA- and HSA+ subsets of single positive thymocytes give a high frequency of proliferating clones, and the clones from both HSA- and HSA+ subsets of CD4-CD8+ thymocytes are cytotoxic. Thus both HSA- and HSA+ single positive thymocytes are functionally mature. The HSA- subsets of single positive thymocytes differ from the HSA+ subsets in being slightly larger in size, in expressing higher levels of MEL-14, in binding more peanut agglutinin, and in including a proportion of cells expressing high levels of the Pgp-1 glycoprotein. It is suggested that HSA- CD4-CD8+ and HSA- CD4+CD8- thymocytes are more mature than their HSA+ counterparts, and might represent a previously activated or "memory" thymic subpopulation.

Animals↗

Natural cytotoxic activity against cytomegalovirus-infected target cells following marrow transplantation.

Forty-five patients at high risk for cytomegalovirus (CMV) infection were studied during the first 100 days after marrow transplant to determine the relationship between cytotoxicity against CMV-infected HLA-mismatched target cells and CMV infection. Peripheral blood lymphocytes (PBL) from 35 patients who developed CMV infection had significantly lower cytotoxicity against CMV-infected targets 20-40 days transplant compared with PBL from normal controls (P = 0.003). Responses by PBL from 10 uninfected transplant recipients were not significantly decreased. The PBL that lysed CMV targets had phenotypic and E-rosetting characteristics consistent with natural killer cells. Cytotoxicity against CMV-infected targets by PBL from patients with acute graft-versus-host disease (GVHD) was reduced 20-40 days after transplant compared with responses by patients without GVHD (P = 0.04). Survival from CMV infection was longer in patients whose PBL had greater than or equal to 15% lysis of CMV-infected targets during the first 20-60 days after transplant (P = 0.04). This study suggests that natural cytotoxicity of CMV targets is an important correlate of the acquisition and outcome of CMV infection after marrow transplant.

Antibodies, Viral↗

Recurrent infection with herpes simplex virus after marrow transplantation: role of the specific immune response and acyclovir treatment.

Herpes simplex virus (HSV) reactivation is common after marrow transplantation, with some patients developing frequent and severe recurrences. Sixty patients were studied to determine both the effect of the specific lymphocyte response to HSV on subsequent recurrences and the effect of acyclovir treatment on restoration of this response. Patients with a positive response after the first HSV recurrence had fewer second recurrences (13 of 28 vs. 18 of 19; P less than .01) and at a longer interval when they did recur (42 vs. 27 days; P less than .0001). Conversely, patients treated with acyclovir had more frequent second recurrences than did those not treated (18 of 21 vs. 13 of 26; P less than .05) and they were at a shorter interval when they did recur (27 vs. 36 days; P = .001). Treated patients also had lower specific lymphocyte responses to HSV. These data confirm the importance of the specific immune response to HSV in the determination of the course of HSV infection after marrow transplant.

Acyclovir↗

Recombinant leukocyte A interferon for the treatment of serious viral infections after marrow transplant: a phase I study.

Six marrow-transplant patients with serious virus infections (four with cytomegalovirus and two with adenovirus) were treated with recombinant leukocyte alpha interferon at daily doses of 6,000,000-50,000,000 units to determine safety and tolerance. Fever and gastrointestinal side effects attributable to interferon occurred in two patients each. Hepatic function abnormalities were observed in all six patients, although five had such abnormalities before treatment. Treatment of one patient was stopped because of apparent suppression of marrow activity. Natural cytotoxic activity increased in the four patients treated for cytomegalovirus infection. All six patients died of pneumonia, with four proven to have cytomegalovirus-related pneumonia at autopsy. Except for the presence of abnormal hepatic function, recombinant leukocyte alpha interferon was well tolerated after marrow transplantation. Efficacy remains to be established in treatment or prophylactic trials.

Adenoviridae Infections↗

A cost analysis of family planning in Bangladesh.

This article presents a step-down cost analysis using secondary data sources from 26 Bangladesh non-government organizations (NGOs) providing family planning services under a US Agency for International Development-funded umbrella organization. The unit costs of the NGOs' Maternal-Child Health (MCH) clinics and community-based distribution (CBD) systems were calculated and found to be minimally different. Several simulations were conducted to investigate the impact of alternative cost-reduction measures. The more general financial analysis proved more insightful than the unit cost analysis in terms of identifying means by which to improve the efficiency of the family planning operations of these NGOs. The analysis revealed that 56 per cent of total expenditures in the two-tiered umbrella's organizational structure are incurred in management operations and overheads. Of the remaining 44 per cent of project expenditures, 39 per cent is spent on the CBD program and 5 per cent on the MCH clinics. Within the CBD program, most resources are spent providing 4 million contacts (two-thirds of the annual total) which do not involve contraceptive re-supply. The clinics devote more resources to providing MCH services than to providing family planning services. The findings suggest that significant savings could be generated by containing administrative costs, improving operational efficiency, and reducing unnecessary or redundant fieldworker contacts. The magnitude of the potential savings raises a fundamental question about the continued viability and sustainability of this supply-driven CBD strategy.

Adult↗

Farm work related fatalities among adults in Victoria, Australia: the human cost of agriculture.

The purpose of this study was to review the patterns of, and trends in, farm work related fatalities among adults in one Australian state for the period 1985-1996. Fatality data was provided by the Victorian Workcover Authority Health and Safety Division. Trends were determined using regression techniques assuming a Poisson error structure for annual fatality rates. Results showed an annual average of eight deaths. Males, and those 60 years and over, were over-represented, compared to persons employed. Tractor incidents were the most common type of fatality (72%), with tractor roll overs accounting for 61% of all tractor incidents. Non tractor fatalities included being hit by a falling object and transport incidents. Statistical trend analyses revealed a non significant decrease in the tractor roll over fatality rate, and significant increases in the all farm (P = 0.004) and non tractor fatality rates (P = 0.036). The 3 year moving average rate for non tractor farm fatalities has increased to the point where it exceeds that for tractor roll over fatalities, and is approaching that for all tractor fatalities. Changes within the agricultural industry, coupled with the ageing of the farm workforce, appear to placing Victorian farmers at increased risk of farm work related death.

Adult↗