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PubMed1994

Stroke rehabilitation outcome. A potential use of predictive variables to establish levels of care.

BACKGROUND AND PURPOSE: The most powerful predictors of functional recovery and eventual home discharge among stroke survivors are the initial severity of the stroke and the patient's age. We analyzed a large population of stroke rehabilitation admissions by stratifying subgroups with coherent outcomes in an attempt to define potentially more efficient patterns of providing rehabilitation care. METHODS: We retrospectively analyzed 520 consecutive patients admitted to a rehabilitation hospital (1 calendar year) with cerebral infarction or hemorrhage. Side of index stroke, age, and functional disability at admission were the independent variables. Change in functional disability and home versus nursing home discharge were the dependent measures. RESULTS: Recovery was overall most closely related to admission severity and age, but the relations between recovery and independent measures were complex. Patients aged < 55 years all were discharged home whatever their initial severity. Patients admitted with modest functional disability were almost all discharged home (96%), whatever their age. For the remainder of the patients, admission severity and age interacted to create two groups with very different prospects for home discharge (P < .0001). Within the groups that eventually returned home, there were very different rates of functional improvement that were directly related to length of hospital stay. CONCLUSIONS: Standard clinical measures available at rehabilitation admission carry enough predictive power to define management strategies for stroke survivors. A management algorithm is proposed that might increase the efficiency of stroke rehabilitation programs and might allow comparisons of efficacy between different treatment settings.

Activities of Daily Living↗
PubMed2003

A neutralizing monoclonal antibody (mAb A24) directed against the transferrin receptor induces apoptosis of tumor T lymphocytes from ATL patients.

Adult T-cell leukemia/lymphoma (ATL) is an aggressive lymphoid proliferative disease that exists under diverse clinical forms ranging from chronic to acute. Although leukemic cells from patients with ATL exhibit an intrinsic resistance to chemotherapy, monoclonal antibodies directed against CD25 (interleukin 2 receptor alpha [IL-2Ralpha] antibody) have been used as specific therapeutic agents. However, significant clinical results with these antibodies have been demonstrated only in chronic forms of ATL. In contrast to resting T cells, human T-cell lymphotropic virus type 1 (HTLV-1)-infected cells constitutively express high levels of surface transferrin receptor (TfR). Herein, we report the characterization of a new monoclonal antibody (mAb A24) directed against the human TfR and the evaluation of its capacity to block the proliferation of ATL cells ex vivo. We determined that A24 binds TfR with an equilibrium constant (K'd) of 2.7 nM and competes with transferrin for binding to TfR. A24 also inhibited [55Fe]-transferrin uptake in activated T cells and blocked T-cell proliferation. Moreover, A24 reduced and impaired TfR expression and recycling, respectively. Most important, we showed that A24 blocked the ex vivo proliferation of malignant T cells from both acute and chronic forms of ATL, through induction of programmed cell death. Therefore efficient therapeutic tools to treat acute forms of ATL might be derived from A24.

Antibodies, Monoclonal↗
PubMed2006

State of the art: refinement of multiple sequence alignments.

BACKGROUND: Accurate multiple sequence alignments of proteins are very important in computational biology today. Despite the numerous efforts made in this field, all alignment strategies have certain shortcomings resulting in alignments that are not always correct. Refinement of existing alignment can prove to be an intelligent choice considering the increasing importance of high quality alignments in large scale high-throughput analysis. RESULTS: We provide an extensive comparison of the performance of the alignment refinement algorithms. The accuracy and efficiency of the refinement programs are compared using the 3D structure-based alignments in the BAliBASE benchmark database as well as manually curated high quality alignments from Conserved Domain Database (CDD). CONCLUSION: Comparison of performance for refined alignments revealed that despite the absence of dramatic improvements, our refinement method, REFINER, which uses conserved regions as constraints performs better in improving the alignments generated by different alignment algorithms. In most cases REFINER produces a higher-scoring, modestly improved alignment that does not deteriorate the well-conserved regions of the original alignment.

Algorithms↗
PubMed2005

Chromatography paper strip sampling of enteric adenoviruses type 40 and 41 positive stool specimens.

BACKGROUND: The enteric subgroup F adenoviruses type 40 (Ad40) and 41 (Ad41) are the second most important cause of acute infantile gastroenteritis after rotaviruses. Repeated community outbreaks have been associated with antigenic changes among the Ad40 and Ad41 strains due to host immune pressure. Therefore large field epidemiological surveys and studies on the genetic variations in different isolates of Ad40 and Ad41 are important for disease control programs, the design of efficient diagnostic kits and vaccines against subgroup F adenoviruses. A novel method using sodium dodecyl sulphate SDS/EDTA-pretreated chromatography paper strips was evaluated for the collection, storage and shipping of Ad40/41 contaminated stool samples. RESULTS: This study shows that adenoviral DNA can be successfully detected in the filter strips by PCR after four months storage at -20 degrees C, 4 degrees C, room temperature (20-25 degrees C) and 37 degrees C. Furthermore no adenoviral infectivity was observed upon contact with the SDS/EDTA-pretreated strips. CONCLUSIONS: Collecting, storing and transporting adenovirus type 40 and 41 positive stool samples on SDS/EDTA-pretreated chromatography filter strips is a convenient, biosafe and cost effective method for studying new genome variants and monitoring spread of enteric adenovirus strains during outbreaks.

Adenoviridae↗
PubMed2004

Pax7 is necessary and sufficient for the myogenic specification of CD45+:Sca1+ stem cells from injured muscle.

CD45(+):Sca1(+) adult stem cells isolated from uninjured muscle do not display any myogenic potential, whereas those isolated from regenerating muscle give rise to myoblasts expressing the paired-box transcription factor Pax7 and the bHLH factors Myf5 and MyoD. By contrast, CD45(+):Sca1(+) isolated from injured Pax7( -/-) muscle were incapable of forming myoblasts. Infection of CD45(+):Sca1(+) cells from uninjured muscle with retrovirus expressing Pax7 efficiently activated the myogenic program. The resulting myoblasts expressed Myf5 and MyoD and differentiated into myotubes that expressed myogenin and myosin heavy chain. Infection of CD45(-):Sca1(-) cells from Pax7( -/-) muscle similarly gave rise to myoblasts. Notably, infection of Pax7-deficient muscle with adenoviral Pax7 resulted in the de novo formation of regenerated myofibers. Taken together, these results indicate that Pax7 is necessary and sufficient to induce the myogenic specification of CD45(+) stem cells resident in adult skeletal muscle. Moreover, these experiments suggest that viral transduction of Pax7 is a potential therapeutic approach for the treatment of neuromuscular degenerative diseases.

Adenoviridae↗
PubMed2006

Multidrug-resistant tuberculosis: a menace that threatens to destabilize tuberculosis control.

Multidrug-resistant tuberculosis (MDR-TB), caused by Mycobacterium tuberculosis that is resistant to both isoniazid and rifampicin with or without resistance to other drugs, is a phenomenon that is threatening to destabilize global tuberculosis (TB) control. MDR-TB is a worldwide problem, being present virtually in all countries that were surveyed. According to current World Health Organization and the International Union Against Tuberculosis and Lung Disease estimates, the median prevalence of MDR-TB has been 1.1% in newly diagnosed patients. The proportion, however, is considerably higher (median prevalence, 7%) in patients who have previously received anti-TB treatment. While host genetic factors may contribute to the development of MDR-TB, incomplete and inadequate treatment is the most important factor leading to its development, suggesting that it is often a man made tragedy. Efficiently run TB control programs based on a policy of directly observed treatment, short course (DOTS), are essential for preventing the emergence of MDR-TB. The management of MDR-TB is a challenge that should be undertaken by experienced clinicians at centers equipped with reliable laboratory services for mycobacterial cultures and in vitro sensitivity testing as it the requires prolonged use of costly second-line drugs with a significant potential for toxicity. The judicious use of drugs; supervised standardized treatment; focused clinical, radiologic, and bacteriologic follow-up; and surgery at the appropriate juncture are key factors in the successful management of these patients. With newer effective anti-TB drugs still a distant dream, innovative approaches such as DOTS-Plus are showing promise for the management of patients with MDR-TB under program conditions and appear to be a hope for future.

Antitubercular Agents↗
PubMed2002

The need for pedagogical qualifications for teaching cardiology to undergraduate students.

OBJECTIVE: To report a training program in cardiology emphasizing changes in its pedagogical practice. These changes were put into practice by some teachers at the Medical School of Porto Alegre of the University of Rio Grande do Sul (FAMED/UFRGS) aiming to make faculty and student activities more dynamic and to promote more efficacious learning. The training program is directed at 5th semester medical students and aims at a behavioral change in teachers and students to promote more interaction, to favor exchanges, and to make the teaching-learning process easier, always maintaining the patient in the center of the medical activity. METHODS: The program emphasizes the definition of general and specific objectives for each activity to be developed by the students, with training in the area of admission to the cardiology service, with special emphasis on behavioral change in the cognitive, motor, affective, and attitudinal areas. Knowledge was developed by means of interactive seminars with initial and final assessment tests to identify students' and teachers' performance. The students were evaluated in an immediate, continuous, and progressive way in their daily activities and through comparison of the results of 2 tests, one applied at the beginning of the training and the other at its end. These 2 tests contained the same questions. RESULTS: We systematically assessed 560 students over 4 years. The mean grades of the tests performed prior to and after the 244 seminars were 7.38+/-1.66 and 9.17+/- 0.82, respectively (p<0.0001). For the tests applied at the beginning and at the end of the training, the mean grades were 5.61+/-1.61 and 9.37+/-0.90, respectively (p<0.0001). CONCLUSION: The program proved to be efficient both for the students' learning and for assessing their performance in a systematic and objective way.

Cardiology↗
PubMed2000

[Health care for children: perspectives for community health services].

The study aims at analysing the community health nursing practice in the care of children and to point out the perspectives for the coming millennium. The study was conducted by review of the literature. It provides a brief synthesis of the current social context and a short historic reflection about health practices with children and community health nursing practice. It is observed that the practice of nursing is conducted according to the official Health Assistance Program for Children. Despite its goals, however, the program has not been efficient. In this way it will be valued the multiprofessional work in the accompaniment of the growth and development, domiciliary visit, and "groups of mothers" in which the nurse will be a co-participant of the staff, with the great contribution that health professionals with preventions and promotions background frequently offer.

Child↗
PubMed2000

Insecticide resistance and dominance levels.

Dominance has been assessed in different ways in insecticide resistance studies, based on three phenotypic traits: the insecticide concentration required to give a particular mortality (DLC), mortality at a particular insecticide dose (DML), and fitness in treated areas (DWT). We propose a general formula for estimating dominance on a scale of 0 to 1 (0 = complete recessivity and 1 = complete dominance). DLC, DML, and DWT are not directly related and their values depend on genetic background and environmental conditions. We also show that pest management strategies can have the consequence to increase DWT via the selection of dominance modifiers. Studies on resistance to Bacillus thuringiensis toxins provide the ultimate example of the complexity of the definition of the concept of dominance. Almost all studies have focused on calculation of DLC, which provides little information about the efficiency of pest management programs. For instance, one assumption of the high dose/refuge strategy is that Bacillus thuringiensis resistance must be effectively recessive (i.e., DML must be close to zero). However, DWT, rather than DML, is relevant to the resistance management strategy. Therefore, we strongly suggest that the time has come to focus on fitness dominance levels in the presence and absence of insecticide.

Animals↗
PubMed1988

The development of an efficient ambulatory in vitro fertilization (IVF) and embryo transfer (ET) program using ultrasonically guided oocyte retrieval.

Until recently most of the current in vitro fertilization and embryo transfer (IVF-ET) programs used laparoscopy for oocyte retrieval and included hospitalization in the treatment. The establishment of a successful ambulatory IVF program that uses ultrasonically guided oocyte aspiration, is described. Between August 1985 and February 1987, 384 percutaneous transvesical ultrasonically and transvaginally guided follicle aspirations were performed on 414 patients, following ovarian stimulation with hMG and hCG. Ninety two clinical pregnancies were confirmed by ultrasound. The clinical pregnancy rate was 26.8% when based on the number of embryo transfers. There were 16 multiple pregnancies (17.4%), 18 miscarriages (19.5%), and two tubal pregnancies (2.1%). The most important factors contributing toward the success of this program were rigid adherence to clinical and laboratory protocols, and the maintenance of a strict quality control. The ambulatory management was very well accepted by the patients, who during the entire period of ovarian stimulation had minimal disruption of their routine activities.

Adult↗
PubMed1988

Effects of feeder space on body weight uniformity of broiler breeder pullets during an alternate day feeding program.

The effect of feeder space on body weight uniformity of adolescent broiler breeder females during a feed restriction program was evaluated. From 2 to 20 wk of age, broiler breeder pullets were fed a starter/developer diet containing 16.0% protein and 2,944 kcal ME/kg feed. Feed allocations, predicated on mean pen body weight, were fed on an every other day basis. Feeder space was 45 or 90% of that recommended for use with a feed restriction program. The mortality, feed efficiency and body weight uniformity data all support the hypothesis that it is not necessary to provide enough feeder space to enable all birds to eat simultaneously. Broiler breeder pullets provided only 45% of the recommended feeder space responded as well as, or better than, those given 90% of the recommended feeder space.

Animal Husbandry↗
PubMed2006

Comparing observational software with paper and pencil for time-sampled data: a field test of Interval Manager (INTMAN).

In this article, we describe the Interval Manager (INTMAN) software system for collecting time-sampled observational data and present a preliminary application comparing the program with a traditional paper-and-pencil method. INTMAN is a computer-assisted alternative to traditional paper-and-pencil methods for collecting fixed interval time-sampled observational data. The INTMAN data collection software runs on Pocket PC handheld computers and includes a desktop application for Microsoft Windows that is used for data analysis. Standard analysis options include modified frequencies, percent of intervals, conditional probabilities, and kappa agreement matrices and values. INTMAN and a standardized paper-and-pencil method were compared under identical conditions on five dimensions: setup time, duration of data entry, duration of interobserver agreement calculations, accuracy, and cost. Overall, the computer-assisted program was a more efficient and accurate data collection system for time-sampled data than the traditional method.

Behavioral Research↗
PubMed1995

Screening for diabetic retinopathy.

OBJECTIVES: To identify factors associated with a high risk of diabetic retinopathy in order to rank patients for urgency of examination by fundal photography. DESIGN: Retrospective case survey. PATIENTS: Eight hundred and eighty-eight consecutive diabetic patients who were routinely referred for mydriatic fundal photography to the Queen Elizabeth Hospital, Adelaide, between August 1987 and May 1992. OUTCOME MEASURES: The prevalence of non-proliferative and proliferative diabetic retinopathy and patient biochemical and demographic characteristics and urinary albumin excretion rate. RESULTS: The prevalences of nonproliferative and proliferative diabetic retinopathy were 18.1% and 2.4%, respectively. Multiple logistic regression analysis established that treatment with insulin or oral hypoglycaemic drugs was associated with the highest risk of diabetic retinopathy (odds ratio [OR], 14.7; 95% confidence interval [CI], 3.4-63.2), while duration of diabetes > or = 7 years (OR, 3.6; CI, 1.9-6.8), age 50-66 years (OR, 2.1; 95% CI, 1.1-4.0) and albumin excretion rate > or = 21 micrograms/min (OR, 2.2; 95% CI, 1.1-4.5) were also significant risk factors. Non-significant variables were hypertension, obesity and sex. CONCLUSIONS: Diabetic patients may be ranked for urgency of retinal photographic screening based on mode of treatment and duration of diabetes, thereby facilitating examination of patients at highest risk of asymptomatic diabetic retinopathy and increasing the efficiency of the screening program.

Adult↗
PubMedDate not supplied

Reaching out to America's immigrants: community health advisors and health communication.

PURPOSE: To describe clinical services and health communication needs for recent immigrants. METHODS: A review of relevant health behavior and policy research published in the past 20 years was conducted. RESULTS: Health coverage for primary care, prenatal and safety net services needs to be continued for all immigrants. Legislative bodies should repeal those aspects of welfare reform laws that diminish funding for health programs. English training provides efficient and effective access to health care and health communication. Finally, health communication messages mediated by community health advisors constitute an effective alternative to mainstream health communication. CONCLUSIONS: Societies whose populations consist primarily of immigrants need to be better prepared to promote the health of this group.

Acculturation↗
PubMed1983

Privacy Act of 1974; report of routine use--Social Security Administration. New routine use disclosure.

In accordance with the Privacy Act (5 U.S.C. 552a(e)(11)), we are issuing public notice of our intent to establish a new routine use of information we maintain in the majority of our systems of records. The proposed routine use will enable us to disclose information, as necessary, when utilizing a contractor or other Federal agency to assist in the efficient administration of our programs.

Civil Rights↗
PubMed1989

A cost-effective approach to managing infectious disease.

Outpatient intravenous therapy (OIT) offers a safe, practical, and cost-effective means for long-term antimicrobial treatment of certain infectious diseases. The author compares the efficacy, frequency of administration, and cost of the most suitable parenteral agents and cites criteria for patient selection. An efficient and safe OIT program requires a multidisciplinary approach that integrates support from the physician, nurse-educator, social services, and pharmacy. Several small studies indicate that OIT can result in an impressive savings when compared with inpatient costs.

Ambulatory Care↗
PubMed1983

Allocative medicine: efficiency, disease severity, and the payment mechanism.

Health care expenditures now account for nearly 10 percent of our gross national product, the highest share ever recorded. Concerned that this represents too many resources being devoted to health care, policymakers are searching for ways to control health care expenses. These include higher coinsurance and deductibles, measures to increase market shares of health maintenance organizations, and conversion from cost reimbursement to prospective reimbursement. These measures contain many incentives for patients and providers to alter use of health care services. However, aggregate resource use may or may not be lower and more efficient under these new programs. To determine whether limited resources would be devoted to maximizing the nation's health, incentives inherent in each policy option must be examined. This article describes a classification of types of disease and medical care outputs. The framework is then used to examine incentives offered to patients and providers by three alternative payment mechanisms--capitation, fee-for-service, and payment by diagnosis--regarding types of disease treated and mix of outputs produced. This type of analysis is required to select an appropriate payment mechanism for obtaining a socially acceptable allocation of resources.

Costs and Cost Analysis↗
PubMed1984

Health care expenditures for major diseases in 1980.

Health care expenditures in the United States were 10.5 percent of the gross national product in 1982, and growing rapidly. The magnitude and continuing growth make health care costs an important issue in public policy. Knowledge of costs for specific diseases is necessary for ascertaining the effectiveness and efficiency of various health programs. In this article, medical care expenditures for major diseases are estimated from readily available data and it is shown that expenditures for more specific disease categories can be derived.

Age Factors↗