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Biomedical subjects

M Schlesinger

Publications and source records attributed to M Schlesinger.

At least 73 records · Page 4Linked to original sources
PubMed1997

The determinants of dumping: a national study of economically motivated transfers involving mental health care.

OBJECTIVE: To examine the prevalence and determinants of economically motivated transfers (aka "dumping") from hospitals treating mental illness. DATA SOURCES: A composite data set constructed from three national random-sampled surveys conducted in 1988 and 1989: (1) of hospitals providing mental health care, (2) of community mental health centers, and (3) of psychiatrists. STUDY DESIGN: The study uses reports from administrators of community mental health centers (CMHCs) to assess the extent of patient dumping by hospitals. To assess the determinants of dumping, reported perceptions of dumping are regressed on variables describing the catchment area in terms of the proportion of for-profit hospitals, intensity of competition among hospitals, extent of utilization review, and capacity of the local treatment system, as well as competition among community mental health centers. To assess if dumping is motivated by factors distinct from those affecting other aspects of access, comparable regressions are estimated with ease of hospital admission as the dependent variables. PRINCIPAL FINDINGS: Economically motivated transfers of psychiatric patients were widespread in 1988: according to the reports of CMHC administrators, 64.7 percent of all hospitals providing inpatient mental health care engaged in transfers of this sort. The extent of dumping was higher in catchment areas with more competition among hospitals, more proprietary hospitals, and less inpatient capacity in the public sector. Dumping appeared to be more sensitive to capacity in the public sector but less sensitive to involvement by for-profit hospitals than were other measures of access to care. CONCLUSIONS: Economically motivated transfers of patients with mental illness were widespread in 1988 and likely have increased since that time, affecting the viability of the community mental health care system.

Adolescent↗
PubMed1996

The mechanism of interleukin 4-induced down-regulation of CD38 on human B cells.

Exposure of Farage, a human B-cell line, to interleukin 4 (IL4) reduced the amount of CD38 antigen on the surface of the cells and in cell lysates. No evidence was obtained for accelerated breakdown, shedding, or internalization of CD38 molecules following IL4 treatment, nor the accumulation of CD38 molecules in the cell interior. The inhibition of protein synthesis with cycloheximide (CXM) diminished the down-regulation of CD38 induced by IL4. CXM decreased the expression of CD38 in Farage cells with arrested mitosis, and IL4 failed to further reduce CD38 expression. Staurosporine, an inhibitor of serine/threonine protein kinases, and H7 (1-(5-isoquinolinylsulfonyl)-2-methylpiperazine), a preferential inhibitor of protein kinase C (PKC), abrogated the effect of IL4 on CD38, while inhibitors of other serine protein kinases W7 (N-(aminohexyl)-5-chloro-1-naphthalenesulfoamide) and H8 (N-(2-[methylamino]ethyl)-5-isoquinolinesulfonamide) failed to interfere with the effect of IL4. Phorbol 12-myristate 13-acetate (PMA), an activator of PKC, resembled IL4 in decreasing the expression of CD38, and either staurosporine or H7 abolished this effect. Genistein, an inhibitor of tyrosine kinases, increased the expression of CD38, but failed to abrogate the inhibitory effect of IL4 on CD38. It is concluded that serine/threonine protein kinases mediated the IL4-induced down-regulation of the expression of CD38 molecules in B cells.

ADP-ribosyl Cyclase↗
PubMed1996

The impact of managed care on patients' trust in medical care and their physicians.

Social trust in health care organizations and interpersonal trust in physicians may be mutually supportive, but they also diverge in important ways. The success of medical care depends most importantly on patients' trust that their physicians are competent, take appropriate responsibility and control, and give their patients' welfare the highest priority. Utilization review and structural arrangements in managed care potentially challenge trust in physicians by restricting choice, contradicting medical decisions and control, and restricting open communication with patients. Gatekeeping and incentives to limit care also raise serious trust issues. We argue that managed care plans rather than physicians should be required to disclose financial arrangements, that limits be placed on incentives that put physicians at financial risk, and that professional norms and public policies should encourage clear separation of interests of physicians from health plan organization and finance.

Cost Control↗
PubMed1996

Time domain dielectric spectroscopy study of human cells. I. Erythrocytes and ghosts.

A method, allowing correction of electrode polarization effect in case of cell suspensions of small volume fraction is proposed. The dielectric behavior of human erythrocytes and erythrocyte ghosts suspensions was studied by time domain dielectric spectroscopy (TDDS) and the estimation of the dielectric constants of cell's structural parts (membrane, cytoplasm) on the basis of suitable models are presented. It was shown that in the case of small volume fraction of cells in suspension, the electrode polarization effect can be taken into account by the additional measurement of the corresponding supernatant. The optimal volume fraction of cells in suspensions in the TDDS measurements was found to be 3%-10%. The erythrocyte and erythrocyte ghost suspensions were found to demonstrate a single dispersion which can be described by the Debye equation. The membrane dielectric constant of different erythrocytes and ghosts was distributed near 5.

Algorithms↗
PubMed1996

Preferential cytotoxic effect of Newcastle disease virus on lymphoma cells.

Susceptibility of lymphoma cells (Daudi, HD-Mar) to Newcastle disease virus toxicity was found to be higher than that of lymphoblastoid cells (Milstein) and of resting peripheral blood lymphocyte (PBL). Phytohemagglutinin- and/or pokeweed-mitogen-activated PBL however, exhibited, elevated sensitivity, similar to that of lymphoma cells. The level of cytotoxicity was monitored by cell viability, inhibition of DNA synthesis and release of 51Cr. When Daudi cells were mixed with PBL they were significantly more sensitive to the killing effect of the virus (70% mortality compared to 30% 30 h after infection, P < 0.05). The degree of sensitivity to viral cytotoxicity was unrelated to the efficacy of adsorption, which was similar for all cell lines as shown by immunofluorescent staining and flow cytometry. Also an influenza strain A/PR/8/34 (H1N1) adsorbed but did not affect the viability of any of the cells tested. Our results demonstrate that New-castle disease virus caused preferential damage to lymphoma cells as compared to non-cancerous normal cells.

Burkitt Lymphoma↗
PubMed1996

The expression of CD8 on B lymphocytes in HIV-infected individuals.

In HIV-1 infected individuals the CD8 + T lymphocyte population is markedly activated as reflected by increased expression of the CD38 and CD45RO activation markers and elevated serum levels of soluble CD8 antigen. We have previously shown that in vitro activation of peripheral blood lymphocytes results in the appearance of T cell markers on B cells. In the present study B lymphocytes from HIV-1-infected individuals were tested for the expression of the CD8 T cell antigen, using F(ab')2 fragments of antibodies against the CD8 and CD19 antigens. The proportion of CD19 + B cells which co-expressed CD8 was significantly elevated among 55 HIV-infected individuals (7.20 +/- 1.24%, mean +/- S.E.) as compared with among 22 normal controls (3.32 +/- 0.70%). The proportion of CD4 + cells decreased significantly in HIV-infected individuals in accordance with the progression of the infection, but no significant change in the level of CD8 + CD19 + B cells was seen in different stages of the disease. In contrast, the proportion of CD8 + B cells showed a significant correlation with the proportion of CD8 + cells.

Antigens, CD19↗
PubMed1996

Managed care constraints on psychiatrists' hospital practices: bargaining power and professional autonomy.

OBJECTIVE: The increasing involvement of insurers and hospitals in monitoring patient care is encroaching on the psychiatrist's autonomy in making clinical decisions. This study examined the prevalence of constraints on psychiatric inpatient practices, as well as how characteristics of psychiatrists affect the type and the degree of these external pressures. METHOD: About 2,500 psychiatrists with active hospital affiliations were surveyed by mail, as a subset of APA's 1988 national survey of psychiatrists. They were questioned about whether the hospital or insurers had pressured them to change their inpatient practices or had attempted to discourage admission of certain types of patients. Characteristics of the psychiatrists' background, available from the main survey, were used as independent variables in a set of regression models, with frequency of different constraints as the dependent variables. RESULTS: More than three quarters of those surveyed reported pressure from insurers for early discharge; nearly two-thirds said hospitals limited length of stay; and about half had been discouraged from admitting severely ill patients, the uninsured, or Medicaid recipients. Characteristics of psychiatrists, such as length of time in practice, income, sex, and medical school education outside the United States, were associated with the prevalence of external pressures. CONCLUSIONS: Constraints on psychiatrists' practices are widespread. Their ability to resist pressures depends on their bargaining power, which seems to be lowest for those who have relatively little experience, who are female, or who have gone to medical school outside the United States. Psychiatrists appear to be willing to trade off more constraints for higher incomes. Severely ill patients and those with little or no insurance are more likely than others to be affected by these limits on psychiatrists' autonomy.

Female↗
PubMed1996

Charity and community: the role of nonprofit ownership in a managed health care system.

As American medicine has been transformed by the growth of managed care, so too have questions about the appropriate role of nonprofit ownership in the health care system. The standards for community benefit that are increasingly applied to nonprofit hospitals are, at best, only partially relevant to expectations for nonprofit managed care plans. Can we expect nonprofit ownership to substantially affect the behavior of an increasingly competitive managed care industry dealing with insured populations? Drawing from historical interpretations of tax exemption in health care and from the theoretical literature on the implications of ownership for organizational behavior, we identify five forms of community benefit that might be associated with nonprofit forms of managed care. Using data from a national survey of firms providing third-party utilization review services in 1993, we test for ownership-related differences in these five dimensions. Nonprofit utilization review firms generally provide more public goods, such as information dissemination, and are more "community oriented" than proprietary firms, but they are not distinguishable from their for-profit counterparts in addressing the implications of medical quality or the cost of the review process. However, a subgroup of nonprofit review organizations with medical origins are more likely to address quality issues than are either for-profit firms or other nonprofit agencies. Evidence on responses to information asymmetries is mixed but suggests that some ownership related differences exist. The term "charitable" is thus capable of a definition far broader than merely the relief of the poor. While it is true that in the past Congress and the federal courts have conditioned the hospital's charitable status on the level of free or below cost care that it provided for indigents, there is no authority for the conclusion that the determination of "charitable" status was always so limited. Such an inflexible construction fails to recognize the changing economic, social and technological precepts and values of contemporary society. -Circuit Court of Appeals, District of Columbia, Eastern Kentucky Welfare Rights Organization v. Simon (1974).

Charities↗
PubMed1996

The complement system in chronic lymphocytic leukemia: a possible role in autoimmune manifestations.

We describe the complement system of three CLL patients who developed autoimmune complications in the course of their disease. The complement profile was pathological in both CLL patients with active autoimmune diseases, while it showed no deficiency in the patient with quiescent autoimmunity. The complement profile could be an early marker for development of autoimmunity in CLL patients

Adult↗
PubMed1996

The complement system is defective in chronic lymphatic leukemia patients and in their healthy relatives.

The present study was aimed at analyzing the existence of an impaired complement system in CLL patients. For this purpose, the serum levels of the serum complement proteins C1q, C1r, C1s, C2, C3, C4, C5, C6, C7, C8, C9, Factor B and properdin were repeatedly evaluated by means of radial immunodiffusion assay in 26 CLL patients over a period of 2 years. At the time of diagnosis, 18 of the 26 CLL patients showed low serum levels in at least one of these complement proteins as compared to a group of sex- and age-matched healthy subjects (P < 0.0001). Complement defects affected either the classical and/or the alternative pathway components, and in some case low levels of late components (C5-C9) were also observed. A reduced level of properdin was the most frequent abnormality (11/18). The presence of such abnormalities were correlated with the stage of the disease, and they were found in 100% of the patients (11) in advanced stages (Rai II-IV), and in 40% of patients (15) in early stages (0-1) (P < 0.004). Severe infections occurred in five patients; four of them were in advanced stages of the disease and had decreased levels of at least one complement component, whereas the remaining patient was in an early stage and had normal levels of complement components. These data support the notion that an impaired complement system might be involved in the pathophysiology of CLL and its infectious complications. Although more work is needed to sustain this hypothesis, we discuss the possibility on the basis of data obtained in the first-degree relatives of CLL patients, that in some CLL patients the complement deficit might reflect a genetic predisposition.

Adult↗
PubMed1996

HIV infection and AIDS in Jerusalem: a microcosm of illness in Israel.

During the decade 1985-94, 158 individuals (124 males, 34 females) with HIV/AIDS were seen at the AIDS clinic of Hadassah University Hospital. They comprised 10% of the total reported number of HIV-infected Israelis and included 6% of all reported HIV-infected Ethiopians and all HIV-infected West Bank Palestinians. Most individuals (82%) were self-referred; 12% were detected through the local HIV screening clinic. Risk groups for AIDS were homo/bisexuality (39%), heterosexual relations (30%), intravenous drug abuse (15%), contaminated blood transfusions (9%), born to HIV+ mothers (1%), and hemophilia (< 1%). In 5% (all males) no risk factor was given. Of the 158 individuals 29 were Ethiopian immigrants, 25 West Bank Palestinians, and the rest were local Israelis and tourists. Of the 34 females seen, 21 acquired HIV heterosexually, 6 were intravenous drug abusers, 5 were recipients of contaminated transfusions, and 2 were infants. An initial clinical presentation with full-blown AIDS was observed in 30% of the individuals. The range of clinical presentations was similar to that seen in western countries, with Pneumocystis carinii pneumonia, cytomegalovirus retinitis, mycobacterial infections and Kaposi's sarcoma seen most frequently. One case of disseminated cutaneous leishmaniasis was observed. The mortality rate during the follow-up was 55%. In 35% of individuals the immediate cause of death was severe bacterial infections. The Palestinian subpopulation presented at an advanced stage of the disease with a high incidence of transfusion recipients, while most HIV-infected Ethiopians presented with asymptomatic disease transmitted heterosexually. HIV/AIDS as seen at Hadassah University Hospital during 1985-94 exhibited the mixed form of Euro-American AIDS with additional facets of recently introduced African infection.

Adult↗
PubMed1996

Analysis of myeloid and lymphoid markers on the surface and in the cytoplasm of mononuclear bone marrow cells in patients with myelodysplastic syndrome.

Mononuclear cells of the bone marrow (BM) of patients in various subgroups of the myelodysplastic syndrome (MDS) were studied by flow cytometry for the expression of myeloid and lymphoid markers both on the surface and in the cytoplasm. A significantly higher percentage of the BM cells of MDS patients reacted with monoclonal antibodies (mAbs) to myeloid antigens (CD13, CD15 and CD33) by cytoplasmic staining as compared with cell surface staining. The percentage of BM cells expressing CD34 was markedly elevated in patients with RAEB-T. A distinct finding in MDS patients was the expression of myeloid antigens on mononuclear BM cells. The proportion of individuals whose mononuclear BM cells were positive for surface reactivity with anti-CD13 and anti-CD33 mAbs was highest among RAEB-T patients while none of the patients with RA expressed these surface antigens. Cytoplasmic staining significantly increased the percentage of CD13+ and CD33+ BM cells among RAEB and RAEB-T patients. The proportion of individuals whose BM cells possessed myeloid antigens was increased by cytoplasmic staining in all subgroups of MDS. The BM of a considerable proportion of RAEB-T and RAEB patients showed cells which coexpressed the CD7 and CD3 lymphoid markers along with the CD13 and CD33 myeloid antigens. The present study indicates the importance of comparative surface and cytoplasmic immunophenotyping with CD13 and CD33 mAbs for the diagnosis of subgroups of MDS. The coexpression of CD3 and CD7 with markers of the myeloid lineage may reflect derangement of the differentiation of pluripotent stem cells characteristic for MDS.

Acute Disease↗
PubMed1995

[Intussusception: diagnosis and treatment with saline enema under ultrasound].

Intussusception is the most common abdominal emergency of early childhood. In the past 100 years intussusception has been treated by both surgical and nonsurgical methods. The last few years have brought improved nonsurgical methods of treatment. We present the results of ultrasonic diagnosis, and of treatment by saline enema under ultrasound, in the first 7 infants in our series.

Enema↗
PubMed1995

In vitro activation leads to the binding of T-cell markers to the surface of B-lymphocytes.

The aim of the present study was to determine whether activation of human T-cells in vitro results in the expression of markers characteristic for T-cells on the surface of B-lymphocytes and to correlate antigenic changes with the release of soluble T-cell antigens. Peripheral blood lymphocytes (PBL) were exposed in vitro to phytohemagglutinin (PHA) for 3 days. Changes in the phenotype of the cells were determined by flow cytometry and the level of soluble T-cell antigens was assessed by ELISA. PHA-activated PBL released elevated quantities of soluble CD2, CD4, and CD8 compared with control cultures. Following PHA stimulation the proportion of CD4+ CD8+ and HLA-DR+ cells increased. In addition, after 3 days of activation with PHA about 80% of the CD19+ cells (B-cells) reacted with F(ab)2 fragments of CD2 monoclonal antibodies (MoAbs). A high proportion of B-cells in activated cultures also reacted with F(ab)2 fragments of anti-CD8 MoAb and anti-CD4 MoAb. The removal of either CD4+ or CD8+ T-cells from the cultures prior to stimulations with PHA drastically reduced the proportion of B-cells expressing CD4 or CD8, respectively. The attachment of T-cell markers to the surface B-lymphocytes may constitute a new mechanism for B-cell regulation by T-cells.

Antigens, CD↗
PubMed1995

Transient expression of human interleukin-2 and interferon-gamma genes is regulated by interaction between distinct cell subsets.

The level of transient expression of human IL-2 and IFN-gamma genes, we show, is regulated by dynamic interaction between two functionally distinct cell populations. One is able to express these genes, while the other, bearing one of several specific surface markers, actively inhibits their expression. Defined cell subsets were isolated from PBMC and tonsil cells using immunomagnetic beads coated with monoclonal antibodies directed against surface markers. Depletion of CD8, CD11a (Leu15), or Leu8 subsets led to a pronounced superinduction of IL-2 and IFN-gamma gene expression when the remaining cell population was stimulated with mitogen (PHA) or antigen (SEB). Thus, a 10-fold increase in production of IFN-gamma was observed after removal of CD11a (Leu15) cells constituting only a small percentage of the total cell population. By contrast, depletion of cells expressing CD19, a B cell marker, did not yield any superinduction. Conversely, CD8, CD11a (Leu15), or Leu8 cell subsets, but not CD19 cells, each inhibited the induction of IL-2 and IFN-gamma gene expression almost completely in depleted or total cell populations from which they were derived. Gene expression occurring within one cell subset could be effectively inhibited by cells from a second subset. Introduction of inhibitory cells (Leu8) into a population that actively expressed IL-2 and IFN-gamma mRNA resulted in an immediate cessation of gene expression. This suppression involves a soluble mediator, since the culture medium in which such cells were activated exerted a similarly effective inhibition.

Blood Cells↗
PubMed1995

Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama.

A standardized elderberry extract, Sambucol (SAM), reduced hemagglutination and inhibited replication of human influenza viruses type A/Shangdong 9/93 (H3N2), A/Beijing 32/92 (H3N2), A/Texas 36/91 (H1N1), A/Singapore 6/86 (H1N1), type B/Panama 45/90, B/Yamagata 16/88, B/Ann Arbor 1/86, and of animal strains from Northern European swine and turkeys, A/Sw/Ger 2/81, A/Tur/Ger 3/91, and A/Sw/Ger 8533/91 in Madin-Darby canine kidney cells. A placebo-controlled, double blind study was carried out on a group of individuals living in an agricultural community (kibbutz) during an outbreak of influenza B/Panama in 1993. Fever, feeling of improvement, and complete cure were recorded during 6 days. Sera obtained in the acute and convalescent phases were tested for the presence of antibodies to influenza A, B, respiratory syncytial, and adenoviruses. Convalescent phase serologies showed higher mean and mean geometric hemagglutination inhibition (HI) titers to influenza B in the group treated with SAM than in the control group. A significant improvement of the symptoms, including fever, was seen in 93.3% of the cases in the SAM-treated group within 2 days, whereas in the control group 91.7% of the patients showed an improvement within 6 days (p < 0.001). A complete cure was achieved within 2 to 3 days in nearly 90% of the SAM-treated group and within at least 6 days in the placebo group (p < 0.001). No satisfactory medication to cure influenza type A and B is available. Considering the efficacy of the extract in vitro on all strains of influenza virus tested, the clinical results, its low cost, and absence of side-effects, this preparation could offer a possibility for safe treatment for influenza A and B.

Adolescent↗
PubMed1995

Increased expression of activation markers on CD8 lymphocytes in children with human immunodeficiency virus-1 infection.

The aims of the present study were to analyze the impact of perinatal human immunodeficiency virus (HIV)-1 infection on lymphocyte maturation in children, to determine the expression of activation markers on CD8+ cells, and to define predictors of survival in HIV-infected children. Seventy-one children presenting HIV-related symptoms were included in the study; 29 were less than 2 y old and 42 were 2 to 12 y of age. Results were compared with those obtained in normal children of a similar age. In HIV-infected children the proportion of CD4+ and CD8+CD45RA+ cells was significantly decreased, whereas that of CD8+, CD8+CD38+, and CD8+CD45RO+ cells was strikingly increased compared with controls. In children less than 2 y old the absolute number of CD4+ and CD8+CD45RA+ cells decreased, and the number of CD8+CD45RO+ cells increased significantly, whereas the number of CD8+ and CD8+CD38+ cells did not change. The absolute number of CD4+ T cells declined with age both among controls and among HIV-infected children. In contrast, the absolute number of CD8+ cells and CD8 subsets decreased with age only in controls but not in infected children. In HIV-1-infected children the expression of the CD38 and CD45RO markers on CD8+ cells was significantly correlated, indicating that these were activated cells. The survival of less than 2-y-old children with AIDS symptoms was positively correlated with the total number of CD8 cells and CD8+CD38+ cells at time of entry into the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗