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PubMed2005

A multidimensional differential proteomic platform using dual-phase ion-exchange chromatography-polyacrylamide gel electrophoresis/reversed-phase liquid chromatography tandem mass spectrometry.

Differential proteomic analysis has arisen as a large-scale means to discern proteome-wide changes upon treatment, injury, or disease. Tandem protein separation methods are required for large-scale differential proteomic analysis. Here, a novel multidimensional platform for resolving and differentially analyzing complex biological samples is presented. The platform, collectively termed CAX-PAGE/RPLC-MSMS, combines biphasic ion-exchange chromatography with polyacrylamide gel electrophoresis for protein separation, quantification, and differential band targeting, followed by capillary reversed-phase liquid chromatography and data-dependent tandem mass spectrometry for quantitative and qualitative peptide analysis. CAX-PAGE provides high protein resolving power with a theoretical peak capacity of 3570, extendable to 7600, a wide protein mass range verified from 16 to 273 kDa, and reproducible differential sample comparison without the added expense of fluorescent dyes and imaging equipment. Demonstrated using a neuroproteomic model, CAX-PAGE revealed an increased number of differential proteins, 137, compared with 82 found by 2D difference gel electrophoresis. When combined with RPLC-MSMS for protein identification, an additional quantification step is performed for internal validation, confirming a 2-fold or greater change in 89% of identified differential targets.

Animals↗
PubMed2005

Role of preexisting disease in patients' perceptions of health-related quality of life after intensive care.

OBJECTIVES: To find out how patients perceive their health-related quality of life after they have been treated in an intensive care unit and whether preexisting disease influenced their perception. DESIGN: : Follow-up, quantitative, dual-site study. SETTING: Combined medical and surgical intensive care units of one university and one general hospital in Sweden. PATIENTS: Among the 1,938 patients admitted, 562 were considered eligible (>24 hrs in the intensive care unit, and age >18 yrs). The effect of preexisting disease was assessed by use of a large reference group, a random sample (n = 10,000) of the main intake area of the hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During 2000-2002, data were collected from the intensive care unit register and from a questionnaire mailed to the patients 6 months after their discharge from hospital. Subjects in the reference group were sent postal questionnaires during 1999. Of the patients in the intensive care unit group, 74% had preexisting diseases compared with 51% in the reference group. Six months after discharge, health-related quality of life was significantly lower among patients than in the reference group. When comparisons were restricted to the previously healthy people in both groups, the observed differences were about halved, and when we compared the patients in the intensive care unit who had preexisting diseases with subjects in the reference group who had similar diseases, we found little difference in perceived health-related quality of life. In some dimensions of health-related quality of life, we found no differences between patients in the intensive care unit and the subjects in the reference population. CONCLUSIONS: Preexisting diseases significantly affect the extent of the decline of health-related quality of life after critical care, and this effect may have been underestimated in the past. As most patients who are admitted to an intensive care unit have at least one preexisting disease, it is important to account for these effects when examining outcome.

APACHE↗
PubMed2003

Adoption of retrospective Medicare maximization billing practices by state Medicaid home care programs.

Home care services funded by Medicare and Medicaid grew rapidly throughout most of the 1990s. During this period some state Medicaid programs transferred costs for home care claims to the Medicare program to reduce their liability and increase beneficiary access to Medicare coverage. This article reports the findings of the first national study of these Medicare maximization billing practices for home care services. Primary data were collected to determine which states conduct retrospective Medicare billing practices and the amounts recovered from Medicare. Our analysis indicates that seven states recovered as much as dollar 265 million from Medicare in state and federal dollars during the 1990s. Ratios of recovered expenditures-to-costs incurred for retrospective billing practices conducted in Connecticut, New York, and Massachusetts are between 5:1 and 7:1. While retrospective billing practices may aid states in reducing Medicaid outlays and potentially help dual Medicare beneficiaries gain coverage for their home care claims, they increase Medicare expenditures for home care at a time of concern for the long-term financial viability of Medicare and illustrate the need for reforming our national long-term care financing policy.

Costs and Cost Analysis↗
PubMed2006

Gait stability following concussion.

INTRODUCTION: The need to identify functional impairment following a brain injury is critical to prevent reinjury during the period of recovery. However, little is known about the effect of concussion on dynamic motor function. PURPOSE: The purpose of this study was to examine the effect of concussion on a dynamic motor task under conditions of divided and undivided attention over the course of 28 d. METHODS: Fifteen subjects with concussions (CONC) and 15 uninjured controls (NORM) were observed while walking with undivided attention and while concurrently completing simple mental tasks. The CONC were assessed within 48 h of injury and again at 5, 14, and 28 d postinjury. The NORM were evaluated at the same time intervals. Whole-body motion data were collected to examine displacement and velocity of the center of mass (COM) and the maximum separation between the COM and center of pressure (COP). Three-way repeated-measures mixed-design ANOVA and Tukey post hoc tests were completed to determine differences between group, task, and testing day (P<0.05). RESULTS: Several aspects of gait stability were compromised in the CONC group for up to 4 wk after injury. CONC were found to walk significantly slower during dual tasks on all testing days when compared with the uninjured controls. The injured subjects were also found to have greater sway and sway velocity than controls when attention was divided for up to 28 d postinjury. CONCLUSION: The findings of this study suggest that concussion may have long-term observable and measurable effects on the control of gait stability.

Adult↗
PubMed1982

Consumer choice between dental delivery systems.

This study has attempted to identify the issues on which consumer choice of dental plan depends and to point out the implications both for dentists continuing a traditional fee-for-service practice in the community and those organizing a prepaid group plan. The past decade has been a phenomenal growth in dental insurance and the emergence of alternatives in dental care delivery. Dual choice plans are now available in several areas of the nation, and the growth of these plans has been proceeding slowly but steadily. The future balance between prepaid group plans and fee-for-service plans will depend on the consumer's preference.

Adult↗
PubMed1999

Paternal involvement in child care as a function of maternal employment in nuclear and extended families in India.

Paternal involvement in childcare as a function of family structure and maternal employment status was assessed in 92 dual-wage and 103 single-wage Indian families with preschool-aged children residing in different areas of New Delhi, India. Mothers and fathers completed Radian's Paternal Involvement in Child Care Index (PICCI). Data showed that parents in single-wage families spent more time in primary care-giving compared with parents in dual-wage families. Fathers' involvement scores on the different components of the PICCI did not vary as a function of mother's employment status or family structure. Data are discussed with respect to the rigidity of men's role in a historically patriarchal society.

Asia↗
PubMed2003

Business orientation and the willingness to distribute dental tasks of Dutch dentists.

AIM: Dentists have a dual professional role: they have to focus on good oral health in their patients and, at the same time, they have to organise their practices. The aim of this analysis was to assess the extent to which dentists can be seen as business-oriented and/or willing to delegate to dental team members and others, and to investigate which personal and practice characteristics of dentists can be regarded as determinants for these two aspects of their professional role. METHOD: The data were collected in 2000 by means of a written questionnaire sent to a random stratified sample of 790 dentists. RESULTS: 607 (77 per cent) dentists responded. Multivariate regression analysis showed that business oriented dentists distinguish themselves by having larger practices and a higher level of professional satisfaction. Furthermore, although to a lesser extent, on a regular basis, they treat patients from colleagues in the practice. There are proportionately fewer women dentists in this category. Dentists oriented on task distribution can also be typified by working in larger practices, but in addition they have a greater preventive treatment philosophy and have more hours of support provided by oral hygienists. CONCLUSION: Among Dutch dentists there exist clear differences in the way they take on their role as dentists with regard to business orientation and their willingness to distribute dental tasks.

Attitude of Health Personnel↗
PubMed2001

Domain structure of the NRIF3 family of coregulators suggests potential dual roles in transcriptional regulation.

The identification of a novel coregulator for nuclear hormone receptors, designated NRIF3, was recently reported (D. Li et al., Mol. Cell. Biol. 19:7191-7202, 1999). Unlike most known coactivators, NRIF3 exhibits a distinct receptor specificity in interacting with and potentiating the activity of only TRs and RXRs but not other examined nuclear receptors. However, the molecular basis underlying such specificity is unclear. In this report, we extended our study of NRIF3-receptor interactions. Our results suggest a bivalent interaction model, where a single NRIF3 molecule utilizes both the C-terminal LXXIL (receptor-interacting domain 1 [RID1]) and the N-terminal LXXLL (RID2) modules to cooperatively interact with TR or RXR (presumably a receptor dimer), with the spacing between RID1 and RID2 playing an important role in influencing the affinity of the interactions. During the course of these studies, we also uncovered an NRIF3-NRIF3 interaction domain. Deletion and mutagenesis analyses mapped the dimerization domain to a region in the middle of NRIF3 (residues 84 to 112), which is predicted to form a coiled-coil structure and contains a putative leucine zipper-like motif. By using Gal4 fusion constructs, we identified an autonomous transactivation domain (AD1) at the C terminus of NRIF3. Somewhat surprisingly, full-length NRIF3 fused to the DNA-binding domain of Gal4 was found to repress transcription of a Gal4 reporter. Further analyses mapped a novel repression domain (RepD1) to a small region at the N-terminal portion of NRIF3 (residues 20 to 50). The NRIF3 gene encodes at least two additional isoforms due to alternative splicing. These two isoforms contain the same RepD1 region as NRIF3. Consistent with this, Gal4 fusions of these two isoforms were also found to repress transcription. Cotransfection of NRIF3 or its two isoforms did not relieve the transrepression function mediated by their corresponding Gal4 fusion proteins, suggesting that the repression involves a mechanism(s) other than the recruitment of a titratable corepressor. Interestingly, a single amino acid residue change of a potential phosphorylation site in RepD1 (Ser(28) to Ala) abolishes its transrepression function, suggesting that the coregulatory property of NRIF3 (or its isoforms) might be subjected to regulation by cellular signaling. Taken together, our results identify NRIF3 as an interesting coregulator that possesses both transactivation and transrepression domains and/or functions. Collectively, the NRIF3 family of coregulators (which includes NRIF3 and its other isoforms) may play dual roles in mediating both positive and negative regulatory effects on gene expression.

Alternative Splicing↗
PubMed1988

[The 1986 Test of Adjustment Related Operations in Central Los Angeles County].

The author presents the methodology and results of a 1986 test census conducted in Central Los Angeles County, California, to examine the feasibility of adjusting the census for the estimated undercount using a post-enumeration survey. "The results of the dual-system estimates are presented for the test site by the three major race/ethnic groups (Hispanic, Asian, Other) by tenure, by age and by sex. Summaries of the small area adjustments of the census enumeration, by block, are presented and discussed."

Age Factors↗
PubMed2000

Bone status among postmenopausal women with different habitual caffeine intakes: a longitudinal investigation.

OBJECTIVE: Caffeine consumption has been proposed as a risk factor for bone loss in postmenopausal women. Past epidemiologic studies on caffeine and bone have been confounded by covariates including cigarette and alcohol use, differing levels of physical activity and hormone replacement therapy. The purpose of the study was to use a longitudinal design to determine the relationship between habitual dietary caffeine intake and postmenopausal bone status. METHODS: Data were collected at two time points separated by two years; 138 women with little or no exposure to tobacco or to drugs known to affect bone status were seen at Visit 1, and 112 returned for Visit 2. Ninety-two of these subjects had received no drugs known to affect bone status over the two-year interval and were kept in the sample. Nutrient and caffeine intake were assessed from three-day diet records. Bone measurements were made by dual energy x-ray absorptiometry (DXA). RESULTS: Correlation analyses indicated no association between dietary caffeine intake and total body or femoral neck bone density or bone mass. Similarly, no associations were found between caffeine consumption and longitudinal changes in total body or femoral neck bone measurements. These results held true both with and without statistical adjustment for calcium intake. CONCLUSIONS: This study does not support the idea that caffeine is a risk factor for bone loss in healthy postmenopausal women.

Absorptiometry, Photon↗
PubMed2003

Association of homozygous deletion of the Humhv3005 and the VH3-30.3 genes with renal involvement in systemic lupus erythematosus.

To investigate whether deletion of the Humhv3005 and the homologous VH3-30.3 (both share an identical amino acid sequence) genes is associated with susceptibility and/or certain clinical manifestations of systemic lupus erythematosus (SLE), DNA from 108 Korean SLE patients and 102 healthy subjects were analysed for the status of hv3005 gene by polymerase chain reaction-enzyme-linked immunosorbent assay. This method consists of amplification of selected germline VH3 genes with biotinylated primers, efficient capture of amplicons onto streptavidin-coated wells, and quantitative typing of bound VH3 gene with diagnostic oligonucleotides. We found that deletion of the hv3005 gene (including VH3-30.3) was more frequent in SLE patients than in healthy controls (26.9 versus 11.8%, P = 0.006, odds ratio 2.75). When clinical features were examined, patients with hv3005 deletion have a higher frequency of lupus nephritis (LN) (75.9 versus 44.3% for those without, P = 0.004), and higher activity index [median (range), 6 (2-14) versus 4 (1-16) for those without, P = 0.044] when biopsy-proven LN was studied. Collectively, our data suggest that deletion of the hv3005 and the 3-30.3 genes may predispose individual SLE patients to the development of LN.

Adolescent↗
PubMed1999

Association of human papillomavirus with HIV and CD4 cell count in women with high or low numbers of sex partners.

OBJECTIVE: To explore whether HIV serostatus (HIV-1, HIV-2, and dual (HIV-D) reactivity) and CD4 cell count affect human papillomavirus (HPV) in two groups of women from Côte d'Ivoire. METHODS: We conducted a cross sectional study of two groups of women. One group had low numbers of lifetime sex partners (maternal women, n = 258) and were enrolled based on HIV serostatus. The other group had high numbers of sex partners (female sex workers, n = 278) and all consenting self identified sex workers were admitted to this study. We collected epidemiological and clinical data, and cervicovaginal lavage for HPV testing. RESULTS: The groups had different distributions of HIV seroreactivity, but the rates of HPV DNA detection were similar. Most of the HPV DNAs detected in both groups were high risk types. A strong association of high risk HPV DNA and HIV-1 seropositivity was found in both maternal women (adjusted odds ratio (OR) 7.5 (95% CI 3.2-17.4)) and in sex workers (OR 5.0 (2.1-12.0)). The maternal group also showed an association of high risk HPV DNA detection with HIV-2 (OR 3.7 (1.6-8.5)) and HIV-D (OR 12.7 (4.3-37.5)) that was not observed in the sex workers. In addition, the association of high risk HPV DNA with HIV-1 in the maternal group was independent of low CD4 cell count, while in the sex workers the association depended on CD4 cell counts < or = 500 x 10(6)/l. CONCLUSIONS: We found that an association between HPV and HIV varied depending on the sexual behaviour and CD4 cell count of the population examined.

AIDS Serodiagnosis↗
PubMed1997

Reference data for ultrasonic bone measurement: variation with age in 2087 Caucasian women aged 16-93 years.

Data from the measurement of broadband ultrasonic attenuation (BUA) and speed of sound (SOS), using the Lunar Achilles ultrasonic densitometer, were collected for Caucasian women from five centres in the United Kingdom (Leeds, London, Nottingham, Lincoln and Sheffield). After correcting for machine variability at each site, the data were combined into a central reference database comprising 2087 women aged 16-93 years. The data are presented in 5-year bands and show a mean fall of 0.36% per year for BUA and 0.08% per year for SOS in the 60 years following the attainment of peak bone mass. This fall in BUA compares with that observed using dual energy X-ray absorptiometry studies of the lumbar spine and femoral neck of 0.32% per year and 0.44% per year, respectively, for the age range 25-65 years.

Adolescent↗
PubMed1999

Pacing and Implantable Cardioverter Defibrillator Options for the Elderly in Australia and New Zealand.

This review seeks to determine the extent to which age impacts the access to pacemaker and implantable cardioverter defibrillator (ICD) technology in Australia and New Zealand. The limited available data suggest a number of consistent trends: 1) implant rates for both pacemakers and ICDs are increasing in both Australia and New Zealand; 2) the elderly are increasingly well catered for in terms of pacemaker implantation, especially in Australia (54% of pacemaker recipients aged at or above 80 in 1997); 3) there is a progressive trend to more dual chamber pacing in the elderly in both countries; 4) age appears to be a barrier to the access to ICDs, especially in New Zealand, which is likely related to the high cost of these devices; and 5) limited data suggest that Australia physicians consider age less of a barrier to the access to high technology implantable devices, compared with their New Zealand counterparts, likely reflecting their greater prosperity and financial commitment to health care. Finally, this review clearly documents the need for improved prospective data collection in both countries. (c)1999 by CVRR, Inc.

Journal Article↗
PubMedDate not supplied

Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study.

BACKGROUND: An increasing proportion of deaths among human immunodeficiency virus (HIV)-infected persons with access to combination antiretroviral therapy (cART) are due to complications of liver diseases. METHODS: We investigated the frequency of and risk factors associated with liver-related deaths in the Data Collection on Adverse Events of Anti-HIV Drugs study, which prospectively evaluated 76 893 person-years of follow-up in 23 441 HIV-infected persons. Multivariable Poisson regression analyses identified factors associated with liver-related, AIDS-related, and other causes of death. RESULTS: There were 1246 deaths (5.3%; 1.6 per 100 person-years); 14.5% were from liver-related causes. Of these, 16.9% had active hepatitis B virus (HBV), 66.1% had hepatitis C virus (HCV), and 7.1% had dual viral hepatitis co-infections. Predictors of liver-related deaths were latest CD4 cell count (adjusted relative rate [RR], 16.1; 95% confidence interval [CI], 8.1-31.7 for <50 vs > or =500/microL), age (RR, 1.3; 95% CI, 1.2-1.4 per 5 years older), intravenous drug use (RR, 2.0; 95% CI, 1.2-3.4), HCV infection (RR, 6.7; 95% CI, 4.0-11.2), and active HBV infection (RR, 3.7; 95% CI, 2.4-5.9). Univariable analyses showed no relationship between cumulative years patients were receiving cART and liver-related death (RR, 1.00; 95% CI, 0.93-1.07). Adjustment for the most recent CD4 cell count and patient characteristics resulted in an increased risk of liver-related mortality per year of mono or dual antiretroviral therapy before cART (RR, 1.09; 95% CI, 1.02-1.16; P = .008) and per year of cART (RR, 1.11; 95% CI, 1.02-1.21; P = .02). CONCLUSIONS: Liver-related death was the most frequent cause of non-AIDS-related death. We found a strong association between immunodeficiency and risk of liver-related death. Longer follow-up is required to investigate whether clinically significant treatment-associated liver-related mortality will develop.

Adult↗
PubMedDate not supplied

Lyme disease vaccine.

Subunit vaccines consisting of single recombinant outer surface proteins (Osp) of Borrelia burgdorferi have been highly successful in protecting mice against challenge by borrelial strains closely related to the strain from which the immunogen was derived. Humoral immunity is sufficient for protection. A dual mode of action for these vaccines has been suggested because serum factors ingested by the tick during the blood meal may begin to reduce the spirochete inoculum prior to transmission to the host. At present two different recombinant OspA vaccine preparations (monovalent) are being evaluated in humans in large-scale phase III efficacy trials in the United States. Local discomfort at the intramuscular injection site has been the principal adverse effect seen to date with these vaccines, but further data on safety are being collected. The greater heterogeneity of OspA among Lyme Borrelia in Europe implies that a vaccine preparation containing multiple antigens (multivalent) may be necessary there, although this is also a concern in the United States.

Animals↗
PubMed2004

Internal medicine-pediatrics residency training: current program trends and outcomes.

PURPOSE: Combined internal medicine-pediatrics (med-peds) residency programs have existed since 1967. Due to the rapid growth in the number and size of programs during the 1990s, most current med-peds physicians completed their residency in the last ten years, making older studies of med-peds programs obsolete. The authors sought to determine completion rates of med-peds residency programs and describe the initial career plans for five cohorts of graduating residents from combined med-peds training programs. METHOD: Program directors of all U.S. med-peds residency programs were asked to complete a Web-based survey and base their responses on the records of cohorts of residents completing their programs from 1998 through 2002. To allow sufficient time to complete both the American Board of Pediatrics (ABP) and American Board of Internal Medicine (ABIM) certification examinations, certification status was requested only for the cohort completing training in 1998. RESULTS: Responses were obtained from 92% (83/90) of the programs, reflecting 1,595 residents entering med-peds programs. Of these residents, 91% graduated from a med-peds program. Among the graduates, 82% were seeing both adults and children, 22% went on to subspecialty residencies, 21% began practice in rural or underserved areas, and 25% entered an academic position. ABIM and ABP pass rates for the 1998 cohort were 97% and 96%, respectively. Overall, 79% of the 1998 graduates are board certified in both specialties. CONCLUSIONS: Compared with previous studies, a greater proportion of residents who recently entered med-peds programs completed their dual training, and a larger percentage of graduates are seeing both adults and children. The proportion of residents entering subspecialty residencies has increased significantly, but the proportion of graduates in academic careers has remained stable.

Adult↗
PubMed2001

Quality of care in family planning clinics in Jamaica. Do clients and providers agree?

This paper uses data from 199 providers and 20 simulated clients collected at 50 public sector and Non Governmental Organization (NGO) health facilities islandwide in 1995 to compare the two groups' views on quality of care of family planning services. Each of the five components of quality of care studied can be improved in Jamaica. Nearly two-thirds of the simulated clients felt able to freely choose a contraceptive method; however, more adequate and appropriate information needs to be imparted to clients through improved counselling, including promotion of dual method use (against STD/HIV/AIDS and conception). The requirement that a woman must be menstruating to receive services has inadvertently resulted in many clients going away empty-handed (without counselling or condoms) when they visit family planning clinics. While providers generally treat clients well, training and service delivery practices need to be revised to improve the technical competence of providers. All of the providers would recommend these clinics to others, compared to a little over half of the simulated clients. Both the providers and simulated clients said that privacy should be strengthened, particularly in small facilities in rural areas. Many of these aspects of quality of care are being improved in Jamaica's public sector health facilities. Managers can learn more about quality of care by seeking the knowledge, opinions and experiences of both providers and clients.

Adult↗