Beyond relevance--characteristics of key papers for clinicians: an exploratory study in an academic setting

OBJECTIVE: The purpose of this study was to determine what factors beyond relevance influence a clinician's decision to choose to read one journal article over another in satisfying an information need. DESIGN: Seventeen health care providers were interviewed and then surveyed regarding the characteristics of key articles (those they would not want to miss). On a Likert scale, the clinicians graded forty-two characteristics for importance in the decision process. Relevance was assumed and not at issue. SETTING: The study took place in an academic health science center. SUBJECTS: The subjects were seventeen clinicians, all with patient care responsibilities. There were four internists, four surgeons, three family practitioners, three pediatricians, two psychiatrists, and one clinical psychologist. RESULTS: Factors beyond relevance that most often influenced the decision process pertained to methodological rigor, authors and their institutional affiliations, document types, and population studied. CONCLUSIONS: Among the clinicians surveyed, factors beyond topicality influenced judgments as to what constitutes an important article. The emphasis respondents gave to certain attributes is echoed in other published work and highlights the need for more intensive investigation of these non-subject indicators as search parameters. Improved searching capabilities might well lead to a significant reduction in the clinician's information overload.     

DR/CLIP (class II-associated invariant chain peptides) and DR/peptide complexes colocalize in prelysosomes in human B lymphoblastoid cells

In APCs, MHC class II molecules (MHC class II) bind antigenic peptides after HLA-DM mediated removal of CLIP. To characterize intracellular sites of peptide loading in human B lymphoblastoid cell lines, we conducted immunoelectron microscopy studies with Abs recognizing MHC class II associated with CLIP or bound peptide, respectively, together with Abs to HLA-DM and endocytic markers. The distribution of these molecules indicates that peptide binding occurs in compartments with characteristics of normal late endosomes, and in compartments that show characteristics of late endosomes, but are not detectably accessed by endocytosed BSA-gold. The latter compartments may represent or give rise to recycling vesicles that deliver peptide-loaded class II molecules to the cell surface. In addition, we have compared cells in which HLA-DM and HLA-DR interaction is defective with cells in which this interaction is intact, and find that DM/DR interaction is not required for the proper localization of either molecule to peptide-loading compartments.     

Cataracts in cichlid fish

Bilateral cataracts were detected in a group of aquarium-raised tilapia (Sarotherodon mossambicus). Vision impairment was manifested as random swimming into objects, but the fish appeared to function normally otherwise. Most of the lens was opaque, with the outer extent of the cortex and subcapsular region remaining transparent. Skeletal abnormalities, ie, deformed fins, abnormal jaws, and curvature of the spine, were observed in affected individuals. Histologically, there was progressive degeneration of the cataractous portion as the affected fish matured. Preliminary breeding experiments indicated that the condition may be inherited.     

Posterior fast atrioventricular node pathways: implications for radiofrequency catheter ablation of atrioventricular node reentrant tachycardia

OBJECTIVES: This study sought to present evidence that fast atrioventricular (AV) node pathways with posterior exit sites may participate in typical AV node reentry. BACKGROUND: Catheter ablation of the slow AV node pathway in the posteroseptal right atrium is the preferred therapeutic approach in patients with AV node reentrant tachycardia. Despite the success achieved with this approach, electrophysiologic changes consistent with fast pathway ablation are occasionally observed. One potential explanation is the presence of an aberrant posterior fast pathway. METHODS: The location of fast and slow AV node pathways was determined by atrial activation mapping along the tricuspid valve annulus during tachycardia and was further confirmed by the effect of radiofrequency catheter ablation. RESULTS: Seven patients with AV node reentrant tachycardia had evidence of a posterior fast pathway near the coronary sinus os. Abolition of anterograde and retrograde fast pathway conduction followed radiofrequency ablation in the posteroseptal region in six patients. Consistent with fast pathway ablation, the AH interval increased from 70 +/- 24 to 195 +/- 35 ms (mean +/- SD), and tachycardia was no longer inducible. Selective slow pathway ablation was performed in one other patient with a posterior fast pathway. CONCLUSIONS: Functionally fast AV node pathways may be located in the posteroseptal right atrium, where slow pathway modification is performed. These data delineate the limitation of an anatomically guided slow pathway ablative approach and emphasize the importance of detailed mapping and localization of the retrograde fast pathway exit site before ablation. Failure to recognize the presence of posterior fast AV node pathways may account for sporadic examples of AV block, complicating posteroseptal ablation in patients with AV node reentry.     

The choice of the method for the surgical treatment of bladder exstrophy

129 children with exstrophy of the bladder underwent primary surgical reconstruction according to G. A. Bairov. Morphofunctional findings in these children gave grounds for determination of three degrees of the bladder congenital defects. 39 patients had defect of the 1st degree, 53 of the 2nd and 37 of the 3d degree. The results of plastic reconstruction of the bladder with local tissue support the validity of such procedure only for patients with the congenital defect degree I. For degree II the benefit is relative. In degree III plastic surgery in contraindicated.     

Patient compliance in mobile screening mammography

RATIONALE AND OBJECTIVES: We assessed the follow-up behavior of women who had abnormal results of screening mammograms taken on a mobile van. METHODS: A retrospective cohort study was conducted between 1988 and 1991 of all women served by a mobile mammography van in rural North Carolina. Compliance with radiologist recommendations for follow-up was assessed through review of patient records and mail surveys of patients with incomplete records. RESULTS: Compliance was 44% for negative or benign mammograms, 57% for indeterminate mammograms, and 62% for probably malignant or malignant mammograms. Women who had a previous mammogram or had a malignant finding were more likely to comply with follow-up recommendations (p < .0001) than women with normal or benign results and no history of mammography. Compliers and noncompliers did not differ with respect to family history of breast cancer or personal history of breast discomfort. CONCLUSION: Compliance with recommendations in this setting was lower than expected. This may be because rural women using mobile van mammography have limited access to the resources needed for appropriate follow-up. Further research is needed to examine explanations for poor compliance in this setting.     

Long-term placement of dependent children from the client's point of view

This article presents data regarding the backgrounds and attitudes of 396 dependent children in Israel who had been living in boarding institutions for almost three years, and were at least 10 years old at the time of the research interview. Parents of the children were also interviewed, and background [corrected] information regarding the family and its experience with placement was abstracted from welfare department records. This detailed information, collected nearly a decade ago, was then compared with several very recent Israeli studies of institutionalized dependent children and it was found that many problematic features of placement still persist. Among these are lack of long or short-term planning by welfare agencies, poor agency follow-up after placement, and little personal contact with either the child or his family. More older children were accepting placement than were younger children, and the majority of the parents did not contemplate the child's return home, being quite satisfied with placement in the institution. The findings from this study should have direct implications for child welfare policy and practices.     

PGM3 locus and its genetic polymorphism in lymphocytes of the pig

PGM3 activity was investigated by means of horizontal starch gel electrophoresis. In the pig of the German Landrace three different phenotypes have been recognized: F, S and FS. Family studies suggest the occurrence of at least two alleles--PGM3F and the PGM3S at an autosomal locus.