Biomedical subjects
Publications and source records attributed to M Burke.
As relative latecomers to the computer age, most preferred provider organizations are just beginning to see the value of automation in gaining a competitive advantage. In addition to using electronic data interchange to automate claims processing, some forward-thinking PPOs are using automation to provide quick confirmation of patient eligibility for coverage or to streamline utilization review.
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Emergency care is a most important component in general practice. Practitioners are often judged by their ability to deliver appropriate life saving care sometimes in difficult circumstances. An ever present challenge is the maintenance of knowledge and skills necessary to deal effectively with emergencies. Table 3 lists the many emergencies that general practitioners have to consider to be prepared for and that includes regular updating in the basic skills of resuscitation.
AIDS may be caused by two different retroviruses, HIV-1 and HIV-2. Hitherto only HIV-1 has been reported in Israel. We recently discovered HIV-2 as a solitary pathogen in the blood of two foreign workers from West Africa. In view of the relative ease of travel to Israel, it is essential to perform screening for both HIV viruses in all subjects with an enhanced risk, including visitors from countries with a high incidence of HIV-1 or HIV-2 infection and their contacts.
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The stable inheritance of ColE1-related plasmids and the normal partition of the E. coli chromosome require the function of the Xer site-specific recombination system. We show that in addition to the XerC recombinase, whose function has already been implicated in this system, a second chromosomally encoded recombinase, XerD, is required. The XerC and XerD proteins show 37% identity and bind to separate halves of the recombination site. Both proteins act catalytically in the recombination reaction. Recombination site asymmetry and the requirement of two recombinases ensure that only correctly aligned sites are recombined. We predict that normal partition of most circular chromosomes requires the participation of site-specific recombination to convert any multimers (arising by homologous recombination) to monomers.
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Preliminary axillary node sampling with intraoperative reporting of imprint cytology to detect positive nodes was assessed in 50 consecutive patients with T1 or T2 breast cancer undergoing axillary clearance, 21 of whom were histologically node positive. A mean of 3.5 (range 1-4) nodes were sampled. Axillary clearance yielded a mean of 11.7 (range 4-32) nodes. Of node-positive patients, sampled nodes detected 18 of 21 on immediate processing, one on subsequent paraffin sections, and failed to detect two (one of ten and one of 17 positive nodes). If the technique had been used during operation to select patients for axillary clearance, 29 of 50 would have avoided the operation, one of two node-positive patients would have required delayed axillary treatment and two of 21 with minimal axillary disease would not have received further axillary treatment or adjuvant therapy. The technique may be useful in reducing the morbidity of breast cancer surgery without increasing the risk of locoregional or distant recurrence.
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A trial of FAA and rIL-2 has been performed both to study the clinical efficacy of this combination and to determine whether they cause haemorrhagic necrosis by acting upon tumour vasculature. FAA and rIL-2 were given to 23 patients with progressing metastatic melanoma. FAA 4.8 gm m-2 was given as a 1 h infusion without urine alkalinisation on days 1, 8 and 15. rIL-2 (6-18 x 10(6) IU/m2/day) was given as a continuous infusion days 8-12 and 15-19 (nine patients) or days 8-12 only (14 patients). Treatment was repeated after 2 weeks unless there was disease progression. Of the 21 assessable patients there have been one complete (skin and liver) and two partial responses (skin and liver, skin and nodes) lasting 20 + 17 + and 15 months, overall response rate 14%. Unexpectedly severe hypotension after the third FAA, when given 2-4 days after RIL-2, was the major toxicity (8/15 grade 3 or 4). No alteration in coagulation parameters were seen during therapy of the first ten patients. No increase in tumour necrosis was seen in any of the 15 biopsies taken from ten patients after therapy. This suggests that FAA does not have similar vascular effects in human as it does in murine tumours.
With increasing age many elderly people experience personal and social losses. Physical health declines, there is a loss of vigour and an increased susceptibility to disease. Osteoarthritis, the most common form of arthritis in the elderly, is the greatest cause of disability and limitation of activity in older populations. The purpose of this descriptive study was to investigate how elderly women cope with the physical impairment and pain associated with osteoarthritis and to examine the relationship between coping strategies and health status. The sample consisted of 130 women over 75 years, living alone in one of five life care communities. Three instruments were used to collect data: The Ways of Coping Scale, The Arthritis Impact Measurement Scale and The Musculoskeletal Impairment Index. Pearson product-moment correlations and stepwise multiple regression were used to analyse data. The mean age of the sample was 83.2 years and over 40% had attained bachelor's degree or higher. The most utilized coping strategy was self-control. The study variables accounted for 49% of the variance in physical health and 20% in psychosocial health.
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The clinical and epidemiological aspects of HIV-1 seropositive homo/bisexuals at three AIDS screening clinics in Israel were analyzed retrospectively for the 4-year period 1986-92. Of 1,526 individuals who attended the clinics a total of 238 (15.5%) were found to be HIV-1 seropositive; 182 seropositives were followed for a mean of 3.3 (+/- 2.6) person-years. The incidence of AIDS in this cohort was 33% over 4 years, a rate of 9.8/100 person-years. Half of all HIV-1 seropositives are estimated to have been infected outside Israel. On initial presentation 144 (62%) were asymptomatic and 94 (38%) were symptomatic. CD4 levels were > 500 ml3 in 87 (36%), 200-500 ml3 in 66 (28%) and < 200 ml3 in 45 (19%) individuals. The pattern of clinical presentations was similar to that seen in the West, but mycobacterial infections were rare. A cohort of 86 homo/bisexuals with full-blown AIDS was followed for a mean of 2.2 person-years. The mortality rate in this group was 53.5% over 4 years, a rate of 26/100 person-years. Thus, HIV infection among Israeli homosexuals ceased to be a rarity as it took the pattern of AIDS in the West, with some special features such as the late presentation of patients for medical treatment and the paucity of mycobacterial diseases complicating the disease.
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