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Anaplasma marginale (order Rickettsiales, family Anaplasmataceae), a tick-borne pathogen of cattle, is endemic in tropical and subtropical regions of the world. Many geographic isolates of A. marginale occur in the United States and have been identified by major surface protein 1a (MSP1a), which varies in sequence and molecular weight due to different numbers of tandem 28- to 29-amino-acid repeats. The present study was undertaken to examine the genetic variations among isolates of A. marginale obtained during 2001 from infected cattle from east-central Oklahoma, where A. marginale is endemic. The gene and protein sequences of MSP1a and msp4 nucleotide sequences were used to infer the phylogenetic relationships among Oklahoma and New World isolates from Argentina, Brazil, Mexico, and the United States. All 11 A. marginale isolates collected from Oklahoma had different MSP1a sequences but identical MSP4 sequences. The phylogenies of the msp4 sequences of 13 isolates from Oklahoma in comparison with those of 7 Latin American isolates and 12 U.S. isolates by maximum-parsimony (MP) and maximum-likelihood (ML) analyses, with A. centrale and A. ovis sequences used as outgroups, provided strong bootstrap analysis support for a Latin American clade. Isolates of A. marginale from the southern United States (Florida, Mississippi, and Virginia) and the west-central United States (California, Idaho, Illinois, Oregon, Missouri, and Texas) also grouped into two clades. Both clades contained isolates from Oklahoma, suggesting extensive cattle movement. ML analysis of the msp4 sequences of isolates from Oklahoma provided bootstrap analysis support for east-central and north-central clades in Oklahoma, and both clades included isolates from Stillwater, Okla. Analysis of the codon and amino acid changes among the msp4 sequences of isolates with different phylogenies provided evidence that msp4 is not under positive selection pressure. In contrast, the phylogenies of the MSP1a DNA and protein sequences of 13 isolates from Oklahoma in comparison with those of 7 Latin American and 13 isolates from the United States by MP and ML analyses demonstrated no geographic clustering and provided evidence that this gene is under positive selection pressure. The results indicate that msp1alpha is not a marker for the characterization of A. marginale geographic isolates and suggest that the genetic heterogeneity observed among isolates of A. marginale within Oklahoma could be explained by cattle movement and the maintenance of different genotypes by independent transmission events.
The observations from this study seem to suggest that there are some correlations between education, experience, age, and sex on the level of preparedness in the practice domains identified. Specifically, this study finds that years of experience have a significant negative correlation with the practice domains of physical plant/building management, fiscal reimbursement, financial management, and overall preparedness in both Oklahoma and Connecticut respondents. Experience level further correlates negatively with all other practice domains (except licensing standards) in Oklahoma respondents. Education level, on the other hand, did not correlate with any practice domain (except licensing standards among Oklahoma respondents). Age correlated positively with financial management activities but only with Oklahoma respondents, while sex correlated positively with physical plant/building management (Oklahoma and Connecticut) and with financial management in Connecticut only. Sex, however, had a negative correlation with basic nursing activities among Connecticut respondents. This study suggests that the nursing home administrators from Connecticut in our study felt that they were more prepared in the practice domains identified as compared to those responding from Oklahoma. This can be attributed to the fact that Connecticut respondents had almost a 13 percent higher average of experience years. This was also demonstrated in the correlation table. Other factors such as sex, age at onset of administrator career, and educational level had no or very limited effect on the practice domains identified in the study (p greater than 0.05). This holds true for both Oklahoma and Connecticut respondents. Therefore, the hypothesis stating that education has a direct effect on job performance and preparedness of nursing home administrators does not hold true with this study. It is the years of experience that has a direct effect on performance and preparedness of nursing home administrators.
Anaplasma marginale, an ehrlichial pathogen of cattle and wild ruminants, is transmitted biologically by ticks. A developmental cycle of A. marginale occurs in a tick that begins in gut cells followed by infection of salivary glands, which are the site of transmission to cattle. Geographic isolates of A. marginale vary in their ability to be transmitted by ticks. In these experiments we studied transmission of two recent field isolates of A. marginale, an Oklahoma isolate from Wetumka, OK, and a Florida isolate from Okeechobee, FL, by two populations of Dermacentor variabilis males obtained from the same regions. The Florida and Oklahoma tick populations transmitted the Oklahoma isolate, while both tick populations failed to transmit the Florida isolate. Gut and salivary gland infections of A. marginale, as determined by quantitative PCR and microscopy, were detected in ticks exposed to the Oklahoma isolate, while these tissues were not infected in ticks exposed to the Florida isolate. An adhesion-recovery assay was used to study adhesion of the A. marginale major surface protein (MSP) 1a to gut cells from both tick populations and cultured tick cells. We demonstrated that recombinant Escherichia coli expressing Oklahoma MSP1a adhered to cultured and native D. variabilis gut cells, while recombinant E. coli expressing the Florida MSP1a were not adherent to either tick cell population. The MSP1a of the Florida isolate of A. marginale, therefore, was unable to mediate attachment to tick gut cells, thus inhibiting salivary gland infection and transmission to cattle. This is the first report of MSP1a being responsible for effecting infection and transmission of A. marginale by Dermacentor spp. ticks. The mechanism of tick infection and transmission of A. marginale is important in formulating control strategies and development of improved vaccines for anaplasmosis.
BACKGROUND: Transfer of cardiac patients between hospitals is a complex process with many implications for quality of care. In the case of heart disease, specialized procedures such as coronary angioplasty, coronary bypass surgery, and valve replacement or repair require the performance of cardiac catheterization and coronary arteriography in a catheterization laboratory, as well as the availability of cardiac surgical services. The Department of Veterans Affairs Medical Center (DVAMC) at Muskogee, Oklahoma, transfers most cardiac patients requiring specialized diagnostic procedures and advanced cardiac care to DVAMC at Oklahoma City, Oklahoma. Concerns about the inefficiency of the transfer process led to the launch of a quality improvement project in late 1992. CHANGES IN THE TRANSFER PROCESS: Greater emphasis was placed on medical aspects compared to administrative aspects of transfer, and ready access to the physicians at DVAMC at Oklahoma City was provided. RESULTS: The time from request for transfer to the actual transfer decreased. Before the quality improvement project, only 33% of transfers of cardiac patients were completed within 24 hours-versus 78% in 1993 and 1994, 89% in 1995, and 84% in the first half of 1996. In addition, DVAMC-Muskogee physician satisfaction regarding services at DVAMC-Oklahoma City improved. CONCLUSION: Ongoing discussion between the cardiology team at the accepting hospital and physicians at the referring hospital expanded the continuum of care to both hospitals. Priority of transfers could be upgraded at any time without unduly jeopardizing patient safety or increasing resource utilization at the receiving center.
Community mortality surveillance for 1984-1988 was conducted by researchers of the Strong Heart Study, which examined the incidence, prevalence, and risk factors of cardiovascular disease in three American Indian populations, aged 45-74 years, in Arizona, Oklahoma, and South/North Dakota. All-cause and cardiovascular disease mortality rates were determined through the use of death certificate data. Cardiovascular disease deaths were confirmed by independent systematic review of medical records. In all three populations, men had higher all-cause and cardiovascular disease mortality rates than did women. Oklahoma exhibited slightly lower 5-year, age-adjusted, all-cause mortality (96/1,000) than did Arizona (107/1,000) and South/North Dakota (114/1,000). The leading cause of death among both sexes in Oklahoma and in South/North Dakota was cardiovascular disease. Diabetes mellitus led among Arizona women. The other major causes of death were cancer, liver disease including cirrhosis, and injury. When compared with the rates in each state, average annual all-cause mortality rates were higher for the American Indian populations in almost every age group. The all-cause annual mortality rates in the three Indian populations were close to rates in the US black population and higher than the rates of the entire US population and of US whites. This trend was amplified in the 45- to 64-year age group. Only in the 65- to 74-year age group did mortality rates in the Indian population approach those of the US population. Cardiovascular disease mortality rates were close to the US averages in Arizona and Oklahoma, but they were more than two times higher in South/North Dakota among those between 45 and 64 years of age. Thus, American Indians in Arizona, Oklahoma, and South/North Dakota exhibit high all-cause mortality rates. In particular, the South/North Dakota population cardiovascular disease death rate appears to present a potential target for community-based programs to intervene on known risk factors to promote healthy lifestyles.
As part of the Lipid Research Clinics (LRC) Program Prevalence Study of coronary heart disease risk factors, nutrient intakes of two US populations over 59 years of age were determined by 24-hour recalls in the 1970s. Characteristics of the populations were (1) California: suburban, upper-middle class, 95% high school graduates, 10% blue collar occupations; (2) Oklahoma: rural lower-middle class, 75% high school graduates, and 40% blue-collar occupations. Macronutrients consumed by both populations were similar, except for alcohol. For both men and women, energy intake was approximately 25 kcal/kg/day (body weight) sources of energy were approximately 40% from carbohydrate, 16% from protein, 37% from fat, and 4% from alcohol. The Oklahoma population, however, consumed significantly less alcohol than did Californians. Percentages of calories from fatty acids were approximately 14% from saturated and 6% from polyunsaturated, which yielded a polyunsaturated: saturated ratio of 0.48. The intake of cholesterol for women was 190 mg/1000 kcal and for men, 210 mg/1000 kcal. Between the ages of 60 and 69, the Oklahoma men consumed more energy than did the California men. Both sexes demonstrated lower energy intakes with advancing age and with increasing body mass index. The higher energy intake of the Oklahoma cohort aged 60-69 was attributed to the greater physical demands of their occupations, but this difference disappeared after age 70. The California and Oklahoma women had similar caloric intakes beyond age 60. In summary, the LRC findings suggest that geographically diverse American populations consumed in the late 1970s remarkably similar intakes of macronutients and cholesterol, with the only major exception being energy from alcoholic beverages.
The Strong Heart Study, a study of cardiovascular disease among American Indians, was conducted to determine cardiovascular disease rates and the prevalence of risk factors among members of 13 tribal groups in South Dakota/North Dakota (SD/ND), southeastern Oklahoma, and Arizona. From 1989 to 1992, 4,549 tribal members aged 45-74 years (62% of eligible participants) were surveyed and examined for cardiovascular disease and its risk factors. Mean total cholesterol concentrations were over 20 mg/dl lower among the men and 27 mg/dl lower among the women than national mean levels for the same age groups. Cholesterol levels varied by tribal group; Arizona Indians had mean levels more than 20 mg/dl lower than those of SD/ND Indians. The prevalence of hypercholesterolemia was almost twice as high among SD/ND Indians as among Arizona Indians, but the rates for all three groups were much lower than total US rates (all races). Mean levels of high density lipoprotein cholesterol were lower among Indian men and women than in the US population as a whole. The prevalence of hypertension among Arizona and Oklahoma Indians was higher than that for the entire United States. SD/ND Indians had significantly lower mean blood pressures and prevalence rates of hypertension than Oklahoma and Arizona Indians and the United States as a whole. The prevalence of cigarette smoking was higher for all Indian groups except Arizona women in comparison with US rates. Smoking rates were highest in SD/ND and lowest in Arizona. Indian smokers smoked fewer cigarettes per day than the average US smoker. Arizona Indians had the highest prevalence of diabetes mellitus; over 60% of those participants were diabetic. In Oklahoma and SD/ND, one third of the men and over 40% of the women were diabetic. In addition, 13-20% of the participants had impaired glucose tolerance. Proteinuria was also a common problem; almost half of the Arizona Indians had micro- or macroalbuminuria, and 20% of Oklahoma and SD/ND Indians had significant proteinuria. The prevalence of obesity was high in all three groups, with Arizona Indians having the highest rates and the highest mean body mass indices. The prevalence of current alcohol use was lower among Indians than in the nation as a whole, but binge drinking was common among those who used alcohol. These results indicate that cardiovascular disease risk factors vary significantly among tribal groups. Prevention programs tailored toward decreasing the prevalence of risk factors are recommended for long-term reduction of cardiovascular disease rates in American Indian communities.
Increasing microbial resistance to newly developed antibiotics has been a limiting factor in the therapeutic use of these agents. To determine the extent of the problem, in vitro antimicrobial susceptibility of 7,140 clinical isolates of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa to seven commonly used antibiotics was established at the 1,700-bed Riyadh Central Hospital in Saudi Arabia and compared with 5,513 isolates at the Oklahoma Memorial Hospital and Veterans Administration Medical Center, Oklahoma City, Oklahoma. Escherichia coli and Pseudomonas aeruginosa at Riyadh Central Hospital were generally more resistant to ampicillin, carbenicillin, gentamicin, and trimethoprim-sulfamethoxazole than those at Oklahoma Memorial Hospital and the Veterans Administration Medical Center. All 1,022 isolates of Klebsiella pneumoniae at Oklahoma Memorial Hospital were more sensitive to the antibiotics than those at Riyadh Central Hospital or the Veterans Administration Medical Center. The sensitivity pattern of Klebsiella pneumoniae at Riyadh Central Hospital and the Veterans Administration Medical Centers was similar.
Juniperus ashei pollen, a significant aeroallergen, has been recorded during December and January in Tulsa, Oklahoma, over the past 20 years. The nearest upwind source for this pollen is populations growing in southern Oklahoma and central Texas, at distances of 200 km and 600 km respectively. Long-distance dispersal of J. ashei pollen into the Tulsa area shows a strong correlation with the trajectories of wind blowing across southern populations before traveling north towards eastern Oklahoma. The strong tie between climatic conditions and the occurrence of this aeroallergen within the Tulsa, Oklahoma, atmosphere provided a unique opportunity to forecast the dispersal, entrainment, and downwind deposition of this significant aeroallergen. Forecasts of long-distance J. ashei pollen dispersal began during the winter of 1998/1999. Each forecast uses defined climatic parameters to signal pollination at each source site. Coupled to these estimates of pollen release, forecast weather conditions and modeled wind trajectories are used to determine the threat of dispersal to downwind communities. The accuracy of these forecasts was determined by comparing the forecast "threat" to aerobiological records for the same period collected in the "Tulsa region". Analysis of the two seasons revealed only a single occurrence of "high" or "very high" pollen concentrations in Tulsa not directly linked to "moderate" or "severe" forecast threats from the southern source areas.
As a result of recurrent droughts and anthropogenic factors, the range of the lesser prairie-chicken (Tympanuchus pallidicinctus) has contracted by 92% and the population has been reduced by approximately 97% in the past century, resulting in the smallest population size and most restricted geographical distribution of any North American grouse. We examined genetic variation through DNA sequence analysis of 478 base pairs of the mitochondrial genome and by assaying allelic variation at five microsatellite loci from lesser prairie-chickens collected on 20 leks in western Oklahoma and east-central New Mexico. Traditional population genetic analyses indicate that lesser prairie-chickens maintain high levels of genetic variation at both nuclear and mitochondrial loci. Although some genetic structuring among lesser prairie-chicken leks was detected within Oklahoma and New Mexico for both nuclear and mitochondrial loci, high levels of differentiation were detected between Oklahoma and New Mexico populations. Nested-clade analysis of mitochondrial haplotypes revealed that both historic and contemporary processes have influenced patterns of haplotype distributions and that historic processes have most likely led to the level of differentiation found between the Oklahoma and New Mexico populations.
Big Moon Peyotism was introduced in the 1880s to the Delaware, Osage and Quapaw of Northeast Oklahoma by John Wilson, a Delaware-Caddo from Southwest Oklahoma. This form of Peyotism and the Little Moon ritual developed by the Apache, Kiowa, and Comanche of Southwest Oklahoma formed the basis of the two major variations of this religion as practiced by Native Americans throughout North America. An ethnographic and historic comparison of these religious traditions in Northeast Oklahoma presents these as health care delivery systems and highlights the importance of health care as a factor in the acceptance and persistence of Peyotism.
BACKGROUND AND OBJECTIVES: Because of the rapidly increasing number of people affected by acquired immune deficiency syndrome, an increasing number of health care providers are involved. The knowledge, experiences, and attitudes of hospital-based registered nurses can affect the quality and quantity of care provided people with acquired immune deficiency syndrome. GOALS: To determine the knowledge, experiences, and attitudes about acquired immune deficiency syndrome of registered nurses employed in hospitals in Oklahoma and delineate changes in that knowledge and attitudes over time. This should provide a measure of the preparedness of hospital-based registered nurses in Oklahoma to facilitate initial and continued care of people with acquired immune deficiency syndrome. STUDY DESIGN: This study surveyed hospital-based registered nurses in Oklahoma in 1986 and again in 1994. In 1986, 75 (51%) of the hospitals and 446 (68% response rate) of the registered nurses participated in the study. In 1994, 85 (53%) of the hospitals and 564 (74% response rate) of the registered nurses participated in the study. The study sample demographics closely matched the state and national populations of hospital-based registered nurses. RESULTS: The average scores on general and clinical knowledge tests increased significantly from 1986 to 1994. In general, infection control registered nurses had statistically significantly greater knowledge than did registered nurses assigned to other areas of work. However, deficiencies were evident in specific areas of knowledge. The attitudes of registered nurses toward people with acquired immune deficiency syndrome have become more positive since 1986. Some confusion and unjustifiable fear may exist among some registered nurses regarding certain aspects of acquired immune deficiency syndrome. CONCLUSIONS: The hospital-based registered nurses in Oklahoma have increased their preparedness to facilitate initial and continued care of people with acquired immune deficiency syndrome. Because of the representative sample of this study, that conclusion probably is applicable to the nation.
Motor vehicle collisions are a significant cause of morbidity and mortality in the Oklahoma population. The cost associated with this morbidity and mortality is exacerbated by the failure of individuals to use seat belts. Numerous organizations believe that seat belt compliance can be improved through physician counseling. This would allow medical resources to be redirected towards other health problems. Analysis was performed using the Oklahoma Department of Public Safety (ODPS) crash file and the hospital in-patient data discharge file from the Oklahoma State Department of Health (OSDH). These provide a profile of Oklahoma drivers who do not use seat belts. This analysis allows physicians to pinpoint and advise those individuals most likely to not utilize seat belts about the benefits of seat belt use. The results of the analysis show that non-seat belt-users tend to be young and male. Significant predictors of seat belt use are age, gender, alcohol use, time of day (day versus night), driver location (urban versus rural), vehicle type (pick up versus passenger car), and decreased hospital charges. These results show that increased seat belt use can lead to significant decreases in fatalities related to motor vehicle crashes and a decline in associated hospital charges for those who survive. Physicians should encourage seat belt use by their patients and inform them of the risks associated with failure to use seat belts.