Effective reports for health care quality data: lessons from a CAHPS demonstration in Washington State.
Explore the source record for details and available documents.
Consumer Behavior↗
Biomedical subjects
V Wilson
Publications and source records attributed to V Wilson.
Expression of T protein in the primitive streak is necessary and sufficient for posterior mesoderm movement and somite differentiation.
A characteristic abnormality of chimeras composed of wildtype and T/T (Brachyury) mutant embryonic stem cells is the aggregation and accumulation of mutant cells in the primitive streak and its descendant, the tail bud (V. Wilson, L. Manson, W. C. Skarnes, and R. S. P. Beddington (1995). Development 121, 877-886). To demonstrate that this aberrant behaviour of mutant cells in the streak is due only to the absence of wild-type T protein and to investigate dosage effects of T function on cell deployment during gastrulation, a vector expressing T under the control of its own promoter (which results in T expression in the primitive streak but not in the notochord) was introduced into T/T mutant ES cells carrying a ubiquitous lacZ lineage marker. Four clones (TR clones) that express T appropriately in the streak and rescue abnormal chimeric morphology were recovered. In chimeras, these four clones fall into two distinct categories with respect to their ability to exit from the primitive streak and their subsequent tissue colonisation profile. TR1 and TR4 descendants no longer accumulated in the tail bud and gave rise to all types of mesoderm as well as colonising ventral neurectoderm. Interestingly, TR2 and TR5 cells (which express higher levels of T protein than TR1 and TR4 in vitro) tended to exit the streak prematurely, showed a marked reduction in posterior mesoderm colonisation, and were virtually excluded from ventral neurectoderm. However, while descendants of all four TR clones can colonise dermomyotome at all axial levels, the parent T/T mutant cells only contribute to this tissue rostral to the forelimb bud and are completely excluded from more caudal dermomyotome. These results show that the abnormal aggregation of mutant cells homozygous for the Brachyury deletion (approximately 200 kb) can be ascribed solely to the lack of wild-type T protein, as can the failure of T/T cells to colonise caudal dermomyotome. They also suggest that patterns of cell recruitment from the streak can be influenced by the level of T expression.
Animals↗
T promoter activity in the absence of functional T protein during axis formation and elongation in the mouse.
The T (Brachyury) gene, which encodes a transcription factor, is involved in the formation of posterior mesoderm. Although studies in Xenopus have shown that T gene expression is responsive to mesoderm inducing factors and furthermore suggest the existence of an autoregulatory loop involving T itself, eFGF, and the FGF receptor, little is known about the regulation of T expression in the mouse. We report here that in the mouse the expression of fgf-4, the putative homologue of Xenopus efgf, is not dependent on the presence of T protein during the first 48 hr of gastrulation. Furthermore, we address the question of autoregulation using a chimeric approach. Introduction of a T promoter-lacZ construct into T/T ES cells results in T promoter activity in the primitive streak and tail bud in the absence of functional T protein. Therefore, we suggest that a direct FGF and T autoregulatory loop is unlikely to operate during gastrulation and axis elongation in the mouse.
Animals↗
A DNA polymerase alpha accessory protein exhibits structural and functional similarities to SV40 large tumor antigen.
Untransformed cells have been proposed to require a protein homologous to SV40 large tumor antigen (TAg) which functions as a component of the replicase complex during the initiation of DNA synthesis. By definition, this should be a phosphoprotein which interacts with the retinoblastoma protein (pRb) in G0 or early G1, and is capable of binding to and potentiating the activity of DNA polymerase alpha (pol alpha). This protein should also be an ATP-dependent helicase which interacts with the single-stranded DNA (ssDNA) binding protein, RP-A. Because of these requirements, a TAg homologous protein could be expected to contain epitopes with amino acid sequences similar to those of TAg at critical functional sites, such as ATP, pRb and pol alpha binding sites. TAg and a putative cellular homolog of TAg, DNA pol alpha accessory protein (alpha AP), were compared for pRb and pol alpha interaction, and for immunological identity. The analyses utilized immunoaffinity-purified TAg and pRb from a baculovirus expression system, and DNA pol alpha/primase and alpha AP chromatographically isolated from a mouse lymphocytic leukemia cell line. Monoclonal antibodies specific for the pol alpha or pRb binding sites on TAg interacted with alpha AP strongly enough to be employed for immunoaffinity purification of alpha AP. Anti-pRb and anti-TAg reciprocally coimmunoprecipitated pRb bound to TAg and pRb bound to alpha AP. The functional consequences of pol alpha interaction with TAg or alpha AP in the presence or absence of pRb was determined using pol alpha nucleotide incorporation assays. alpha AP exhibited the capacity to stimulate pol alpha activity, a capacity which was diminished in the presence of pRb. Lastly, TAg and alpha AP independently co-purified with pol alpha through a multi-step chromatographic protocol. These data indicate that a pol alpha accessory protein, alpha AP, exhibits functional and immunological similarities to SV40 TAg, suggest that alpha AP is involved in regulation of the initiation of DNA synthesis, and support the proposal that alpha AP may be a normal cell protein homologous to SV40 large T antigen.
Animals↗
Misexpression of Cwnt8C in the mouse induces an ectopic embryonic axis and causes a truncation of the anterior neuroectoderm.
Transgenic embryos expressing Cwnt8C under the control of the human beta-actin promoter exhibit duplicated axes or a severely dorsalised phenotype. Although the transgene was introduced into fertilised eggs all duplications occurred within a single amnion and, therefore, arose from the production of more than one primitive streak at the time of gastrulation. Morphological examination and the expression of diagnostic markers in transgenic embryos suggested that ectopic Cwnt8C expression produced only incomplete axis duplication: axes were always fused anteriorly, there was a reduction in tissue rostral to the anterior limit of the notochord, and no duplicated expression domain of the forebrain marker Hesx1 was observed. Anterior truncations were evident in dorsalised transgenic embryos containing a single axis. These results are discussed in the light of the effects of ectopic Xwnt8 in Xenopus embryos, where its early expression leads to complete axis duplication but expression after the mid-blastula transition causes anterior truncation. It is proposed that while ectopic Cwnt8C in the mouse embryo can duplicate the primitive streak and node this only produces incomplete axis duplication because specification of the anterior aspect of the axis, as opposed to maintenance of anterior character, is established by interaction with anterior primitive endoderm rather than primitive streak derivatives.
Actins↗
Increasing rehab utilization. A CQI approach.
As managed care stresses the bottom line, home care providers feel the pressure to achieve the best, most cost-effective outcomes possible. One provider in Colorado found a way to educate its staff on when it is appropriate to refer patients to rehabilitation specialists so they can recover more quickly and effectively.
Colorado↗
High frequency of K-ras codon 12 mutations in bronchoalveolar lavage fluid of patients at high risk for second primary lung cancer.
A high frequency of K-ras mutations may indicate preneoplastic changes in the bronchial epithelium as a result of genotoxic injury. With the use of sensitive detection techniques, we report a higher prevalence of K-ras mutations in bronchoalveolar lavage than has been reported previously for lung cancer. A PCR/ligase chain reaction technique was used to determine K-ras codon 12 mutations in a group of 52 bronchoalveolar lavage specimens from patients at risk of a second lung cancer. Of the specimens examined, 84% contained at least one mutation in K-ras codon 12, corroborated by an allele-specific hybridization method. These results suggest that point mutations in K-ras codon 12 are widespread in the bronchial epithelium. Based on these preliminary findings, further evaluation of this efficient sensitive assay to monitor K-ras status should be conducted in larger clinical cohorts where clinical outcomes will ultimately be available. Such a trial will define the utility of K-ras codon 12 mutation status as a marker of lung cancer.
Bronchoalveolar Lavage Fluid↗
Cardiovascular risk factors in British children from towns with widely differing adult cardiovascular mortality.
OBJECTIVE: To examine whether cardiovascular risk factors differ in children from towns in England and Wales with widely differing adult cardiovascular death rates. DESIGN: School based survey conducted during 1994 in 10 towns, five with exceptionally high adult cardiovascular mortality (standardised mortality ratio 131-143) and five with exceptionally low adult cardiovascular mortality (64-75). Towns were surveyed in high-low pairs. SUBJECTS: 3415 white children aged 8-11 years with physical measurements (response rate 75%), including 1287 with blood samples (response rate 64%), of whom 515 had blood samples taken 30 minutes after a glucose load. RESULTS: Children in towns with high cardiovascular mortality were on average shorter than those in towns with low mortality (mean difference 1.2 cm; 95% confidence interval 0.3 to 2.1 cm; P = 0.02) and had a higher ponderal index (0.34 kg/m3; 0.16 to 0.52 kg/m3; P = 0.006). Mean systolic pressure was higher in high mortality towns, particularly after adjustment for height (2.0 mm Hg; 0.8 to 3.2 mm Hg; P = 0.009). Mean waist:hip ratio, total cholesterol concentration, and 30 minute post-load glucose measurements were similar in high and low mortality towns. The differences in height and blood pressure between high and low mortality towns were unaffected by standardisation for birth weight. CONCLUSIONS: The differences in height, ponderal index, and blood pressure between towns with high and low cardiovascular mortality, if persistent, may have important future public health implications. Their independence of birth weight suggests that the childhood environment rather than the intrauterine environment is involved in their development.
Adult↗
Cell fate and morphogenetic movement in the late mouse primitive streak.
A prospective fate map of the late gastrulation mouse primitive streak has been charted in 8.5 dpc mouse embryos developed in culture, using the lineage marker DiI to label groups of cells. As at earlier stages, the fate of cells in the 8.5 dpc primitive streak is regionalised such that successively more caudal regions of the streak give rise to more lateral mesoderm. While most labelled cells over a 24 or 48 h culture period exit from the primitive streak, some are consistently found to remain within it. The most conspicuous resident population is present in the node. To determine when ingression of ectoderm through the streak ceases, ectoderm cells of the streak and posterior neuropore of 8.5-10.0 dpc embryos were labelled. Involution of surface cells to form mesoderm continues until closure of the posterior neuropore but is not seen thereafter.
Affinity Labels↗
An accessory protein enhances both DNA binding and activity of DNA polymerase alpha isolated from normal, but not transformed, human fibroblasts.
DNA polymerase alpha/primase (pol alpha) isolated from fibroblasts established from a 66-year-old human donor (GM3529) exhibited decreased specific activity compared with pol alpha from either fetal-derived fibroblasts (WI38), or pSV3.neo-transformed GM3529 fibroblasts. The pol alpha specific activity decrease was correlated with a decreased proliferative capacity frequently seen in cells from aged donors. Pol alpha isolated from pSV3.neo-transformed GM3529 cells (GM3529T) exhibited a single isoform with about 10-fold higher specific activity than pol alpha from GM3529 cells. GM3529T pol alpha was immunoreactive with both anti-pol alpha and anti-SV40 large tumor antigen. Polymerases from GM3529 and GM3529T cells were treated with a pol alpha accessory protein, alpha AP, isolated from L1210 cells. Pol alpha from GM3529T cells showed no increase in activity in the presence of alpha AP, while pol alpha isolated from GM3529 cells exhibited about an 8-fold increase in activity after treatment with alpha AP. Double stranded SV40 DNA containing multiple ori sequences exhibited a greater decrease in electrophoretic mobility in the presence of GM3529T pol alpha than when treated with GM3529 pol alpha. In the presence of pol alpha from either GM35229 or GM3529T cells SV40 dsDNA exhibited a decrease in electrophoretic mobility, and in each instance addition of alpha AP resulted in an even greater decrease in DNA mobility. These data indicate that alpha AP increased pol alpha binding to SV40 dsDNA, or that alpha AP bound the DNA in addition to previously bound pol alpha. GM3529 pol alpha also bound non-specific, non-SV40, dsDNA, whereas GM3529T pol alpha with associated TAg did not bind the non-viral dsDNA unless alpha AP was added to the preparation. While not all human diploid fibroblast cell lines derived from aged human donors necessarily exhibit decreased proliferative capacity compared with cells from young donors, decreased specific activity associated with a decline in cellular DNA synthesis is typical of pol alpha from cells derived from aged human donors. We suggest that a decrease in endogenous alpha AP interaction with pol alpha may account, in part, for the loss of DNA binding affinity and specific activity of pol alpha from GM3529 cells derived from an aged donor.
Aged↗
Chromosomal evolution in duiker antelope (Cephalophinae: Bovidae): karyotype comparisons, fluorescence in situ hybridization, and rampant X chromosome variation.
Fluorescence in situ hybridization (FISH) and conventional banding techniques were used to identify patterns of similarity among the genomes of six species of antelope, subfamily Cephalophinae. The G-banded euchromatic portions of the autosomes were invariable in all species; however, significant modifications of the X chromosomes were detected. Two of the taxa, Cephalophus maxwellii and C. monticola, were characterized by acrocentric X's, while X chromosome morphology varied from submetacentric to metacentric in the remaining species (C. dorsalis, C. natalensis, Sylvicapra grimmia, and C. silvicultor). The short arm of the X was heterochromatic in each species. Total genomic DNAs from these antelope were used as hybridization probes against Cephalophus metaphase chromosomes and resulted in robust fluorescence in the pericentromeric region of each autosome and in the heterochromatic short arm of the X chromosome, indicating complimentarity of DNA sequences in these regions. Conversely, chromosome painting involving genomic DNAs derived from the subfamilies Alcelaphinae (Pygargus dorcas) and Neotraginae (Oreotragus oreotragus) showed a marked absence of hybridization at these sites. Additionally, X chromosome comparisons between the Cephalophinae and Bovinae (represented by Bos taurus) revealed two euchromatic pericentric inversions which had occurred since their common ancestry. There is good G-band homoeology between the inverted cattle chromosome region Xq12 --> q34 and most of the proximal portion of Xq in duikers, as well as between the distal third of the duiker Xq and the cattle Xp. The latter rearrangement was further confirmed by in situ hybridization using a probe containing an insert spanning bands p12 to p14 of the cattle X chromosome.
Animals↗
A questionnaire study of 138 patients with restless legs syndrome: the 'Night-Walkers' survey.
After verifying the diagnosis of restless legs syndrome (RLS) in 105 patients who are part of a nationwide support group, we undertook a telephone survey of their symptomatology. We then compared the answers with those of 33 of our own RLS patients who had undergone a neurologic examination and had a periodic limb movement in sleep (PLMS) index of > 5 (number per hours of sleep). Although RLS has generally been considered to be a condition of middle to older age, the results for the support group, and for our patients, are similar in that more than a third of the patients in each group experienced their first symptoms before the age of 10. Initial lack of diagnosis or misdiagnosis by a physician were common and the symptoms were commonly thought to be psychogenic whatever the age of onset. In some cases, young age-onset RLS was severe from the start. For younger age-onset patients whose symptoms were severe enough to seek immediate medical attention, confounding or misdiagnosis included "growing pains" and attention deficit hyperactivity disorder. However, medical attention was generally not sought until the fourth decade. Most respondents stated that this was because their symptoms were mild at onset and then progressed. In the older age-onset patients, misdiagnoses also included skin irritation, arthritis, and malingering. A total remission of symptoms of a month or more was present in at least 15% of the individuals in all groups surveyed. More than 50% of the respondents know of one or more first-degree relatives affected by RLS. Five of our 33 patients had RLS initially triggered either by diabetic peripheral neuropathy or lumbosacral radiculopathy.
Adult↗
Missed opportunities for the prevention of cardiovascular disease among British hypertensives in primary care.
BACKGROUND: High-risk strategies for the prevention of cardiovascular disease (CVD) among hypertensive patients require knowledge of the prevalence and interaction of modifiable risk factors to ensure effective targeting of interventions. Comparatively little is known of risk-factor profiles and their modification among hypertensives in primary care. AIM: The present study was designed to explore relationships between patients' knowledge of CVD risk factors, their perception of personal risk and health behaviours, and their use of lifestyle interventions. METHOD: A cross-sectional survey of 2676 men and women with mild to moderate hypertension (diastolic blood pressure 95-115 mmHg), and their general practitioners, recruited from 1044 general practices throughout the UK, was conducted. RESULTS: Levels of modifiable risk factors were high, although there was considerable variation by age and sex; most (98.5%) patients had at least one additional CVD risk factor. A lower standard of living was associated with a higher prevalence of 'unhealthy' behaviours. Out of those with a current lifestyle problem, 85% of obese patients, 59% of smokers, 47% of excess drinkers, 49% of those with dietary risk factors and 32% of inactive patients claimed to have adopted healthier behaviours within the past 3 months. Older subjects and those with a lower standard of living were less likely to acknowledge risks, and those who did were less likely to report improving their lifestyles. While 71% of patients recalled receiving lifestyle advice, the coverage and targeting of specific interventions was generally poor. Overall, 60% of the sample had received advice on weight control, 47% on diet, 38% on exercise, 38% on smoking and 36% on alcohol. Women and older people were less likely to be given relevant counseling, and there was no evidence of targeting with respect to subjects' social class, level of hypertension or duration of diagnosis. CONCLUSION: Lifestyle interventions are welcomed and are viewed as helpful by patients receiving them. Potential health gains among high-risk hypertensives are being lost because of poor targeting and coverage of those at greatest risk.
Adult↗
Patient satisfaction and dentist evaluation of dentures in South Africa.
Denture satisfaction of 100 indigent South Africans, with a mean age of 70.36 years was assessed. Patient satisfaction was compared with measures of occlusion and stability as determined by a dentist. The mean age of the upper and lower dentures was 20 and 21 years respectively. The quality and function of most of the dentures were regarded by the dentists as poor. Of the 59 per cent upper and 49 per cent lower dentures regarded as satisfactory by the elderly, only 17.5 per cent and 5 per cent respectively were evaluated as having good stability. Sixty-nine per cent of those with complete upper and lower dentures said they could eat with their dentures, while only 11 per cent of this group were rated by the dentist as having good occlusion. There existed a big discrepancy between determinants of patient satisfaction and the dentist's evaluation of good stability and occlusion, indicating that patient satisfaction encompasses qualities other than the measures used by the dentist. Once the threshold of satisfaction was achieved, ill-fitting and looseness of dentures took on lesser importance.
Aged↗
BPV E1 protein alters the kinetics of cell cycle entry of serum starved mouse fibroblasts.
A stable bovine papillomavirus E1 expressing cell line (C2E1) was used to investigate the effects of E1 protein on the requirement for growth factors during serum-induced reentry from quiescence to proliferation. Flow cytometric bivariate DNA/PCNA analysis was utilized to study the expression of proliferating cell nuclear antigen (PCNA) concomitant with this transition. C2E1 cells, unlike the control cells (CNEO), were able to reenter the cell cycle when stimulated with low serum (1%). Stimulation with 10% serum revealed that C2E1 cells entered the first cell cycle faster than CNEO, indicating that E1 protein decreased the time of progression from G0 stage upon serum activation. It was also shown that PCNA expression started earlier in C2E1 cells than in CNEO cells after quiescent cells were stimulated with 10% serum. Addition of 1% serum was able to induce PCNA expression in C2E1 but not in CNEO cells in the first 24 h after stimulation. Using Triton X-100 treatment, it was found that the distribution between bound and unbound forms of PCNA was altered in E1-expressing cells compared to CNEO cells. Based on these results, it is suggested that E1 might possess mitogen-like properties.
Animals↗
Mortality associated with wines, beers, and spirits. Inappropriate groups were used to calculate relative risk.
Explore the source record for details and available documents.
Alcohol Drinking↗
Murder-suicide involving BC doctor raises troubling questions about euthanasia.
The deaths last September of a British Columbia physician and his wife have raised troubling questions about euthanasia and Alzheimer's disease. Police described the deaths of Dr. Tom Powell and his wife Dr. Lorraine Miles, a retired dentist, as a murder-suicide. Friends of the couple wonder if more lenient laws concerning euthanasia and assisted suicide might have saved Miles' life.
Adult↗
Handling controlled substances: upgrading the system.
To provide safe patient care and to meet legal standards, an automated medstation replaced the manual controlled substances system. Using the medstation streamlines documentation, captures patient charges and reduces floor stock's inventory carrying charges.
Drug and Narcotic Control↗