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M A Shelly

Publications and source records attributed to M A Shelly.

8 recordsLinked to original sources
PubMed1997

Comparison of pneumococcal polysaccharide and CRM197-conjugated pneumococcal oligosaccharide vaccines in young and elderly adults.

Conjugation of carbohydrate antigens to protein carriers significantly improves the immune response to many carbohydrates. In order to evaluate the potential for this approach to improve the performance of pneumococcal vaccine in the elderly, we evaluated pneumococcal polysaccharide-derived oligosaccharides conjugated to cross-reacting material 197 (CRM197) (CRM-OS) in 49 older adults over 60 years of age (median age, 66 years) and compared the results to those from 50 younger adults under age 45 (median age, 27 years). Subjects were randomly assigned to receive licensed 23-valent polysaccharide vaccine (PS) which contain 25 micrograms of polysaccharide per serotype, or 5-valent CRM-OS, which contains 10 micrograms of oligosaccharide per serotype, in double-blind fashion. Both vaccines were associated with moderate local pain on administration. Antibody responses to type 14 were seen in the majority of both younger and older subjects following administration of both CRM-OS and PS, and there was no significant improvement of responses with CRM-OS in either age group. Antibody responses in young adults to the less immunogenic type 6B were seen in only 36% of subjects receiving PS and in 56% of subjects receiving CRM-OS (P = 0.15), and the geometric mean 6B titer 1 month after vaccination was higher in CRM-OS recipients (10.9 versus 3.7 micrograms/ml; P = 0.04). However, 6B responses were poor following the administration of either vaccine to elderly adults and there was no difference between results with CRM-OS and those with PS in this age group. Relatively few subjects developed measurable mucosal immunoglobulin A responses in nasal secretions following administration of either vaccine. Revaccination of CRM-OS recipients with PS at 2 months did not result in significant additional responses to 6B or 14. Though CRM-OS is possibly more immunogenic in young adults, the formulation of the pneumococcal glycoconjugate vaccine used in this study does not appear to offer an advantage to the elderly for types 6B or 14.

Adjuvants, Immunologic↗
PubMed1996

Exploratory data analysis: data visualization or torture?

Exploratory Data Analysis offers a set of graphical and statistical tools to find the full meaning from data sets. The user visualizes, analyzes, and transforms data distributions with these tools. Graphs reveal relationships between variables; the residuals left after fitting data show the adequacy of the model. Without this careful examination and understanding of the data, rote data analysis using standard statistical tests can give misleading results. Exploratory Data Analysis has its own set of pitfalls and must be used with confirmatory statistics and studies. Increasing power and resolution in personal computers enables modern statistical software to make these methods widely accessible. By easily moving between data and their graphic representation, analysis can be comprehensive without being tedious. Exploratory Data Analysis can add an exciting and useful tool to the epidemiologist's repertoire. This article illustrates several tools from an evolving list.

Computer Graphics↗
PubMed1996

Pulmonary mycetoma due to Candida albicans: case report and review.

A pulmonary mycetoma is a round to oval-shaped mass of fungi situated within a cavity in the lung. Most mycetomas are caused by Aspergillus species. Other fungi have occasionally been reported to cause clinically and roentgenographically similar lesions. We report a case of pulmonary mycetoma caused by Candida albicans. Review of the literature suggests that pulmonary mycetoma due to this species is uncommon, and when it has been suspected, specific documentation has been lacking.

Candidiasis↗
PubMed1995

Polymicrobial gram-negative bacteremia associated with saline solution flush used with a needleless intravenous system.

BACKGROUND: During a 2-week period, seven cases of nosocomial polymicrobial gram-negative rod bacteremia occurred on a 39-bed medical and cardiac step-down unit. Combinations of Enterobacter cloacae (seven isolates), Klebsiella pneumoniae (five isolates), and Citrobacter freundii (two isolates) were isolated from blood cultures. METHODS: Concurrent and retrospective chart reviews were used to look for further cases and common exposures. Epidemiologic methods were used to refine determination of common exposure. Restriction enzyme DNA analysis was performed on the isolates. RESULTS: Concurrent and retrospective chart reviews revealed four additional possible cases during the same period. All case patients were exposed, through peripheral saline solution locks or central venous catheters, to saline solution "flush" from a central 0.9% saline solution bag and a needleless dispensing pin. Epidemiologic methods implicated probable extrinsic contamination of a single bag and pin used during a 24-48-hour period (Fisher's Exact Test, p < 0.002). There were no other common exposures. Restriction enzyme DNA analysis of the isolates further supported a common source for the outbreak. CONCLUSIONS: The introduction of needleless intravascular systems has been embraced for employee protection. Our report is the first to raise the question of patient safety with such systems. This outbreak highlights the inherent risks in rapid introduction of new technologies and points out the delicate balance among patient health, employee safety, and cost containment.

Bacteremia↗
PubMed1990

Zymosan-activated plasma-mediated thromboxane production by the perfused rabbit liver and isolated hepatocytes: involvement of calcium.

The present study investigates the mechanism of zymosan-activated plasma (ZAP)-mediated eicosanoid production by the isolated, perfused rabbit liver and described ZAP-mediated eicosanoid stimulation in cultured hepatocytes. Perfused livers receiving untreated plasma demonstrated no significant changes in portal venous pressure or the rates of release of lactic dehydrogenase or acid phosphatase activity (indicators of cellular injury). The control group livers demonstrated stable rates of release for 6-keto PGF1 alpha and thromboxane B2 (TXB2). In contrast, the infusion of ZAP alone resulted in a rapid but transient release of TXB2 from the livers. No significant changes in perfusion pressure or enzyme release were observed following ZAP administration. Perfusion of livers with a calcium-free buffer decreased the basal rates of both 6-keto PGF1 alpha and TXB2 production and significantly, but not completely, attenuated the ZAP-mediated increase in hepatic TXB2 production. Perfusion of livers with nifedipine (3 microM) had no effect on ZAP-mediated TXB2 production in this model. Isolated hepatocytes responded to ZAP-treatment with significant increases in TXB2 production. These data suggest that activated fluid phase complement components induce thromboxane production by specific cells within the liver and that this stimulation is partially dependent upon the release of intracellular calcium but independent of complement-mediated cellular injury.

6-Ketoprostaglandin F1 alpha↗