Focus groups reveal perils and promises of managed care for nurse practitioners

Decades of practice and research suggest that nurse practitioners (NPs) provide cost-effective and high-quality care. Managed care's emphasis on prevention and cost savings led some policy makers to view NPs as a way to meet the need for primary care providers. However, access to and utilization of NPs has increasingly been controlled by managed care organizations (MCOs) through their selection of providers for primary care panels. This study employed qualitative methodology to examine NPs' experiences with MCOs. Three focus groups, comprising 27 NPs in New York and Connecticut, revealed NPs' mixed reactions to managed care and a range of sentiments regarding NPs' efforts to be listed as primary care providers. The results reflected NPs' concerns about their perceived "invisibility," as well as their sense of "invincibility" in the ways in which NPs are responding to the barriers posed by MCOs. They identified barriers to, as well as ways to facilitate, being listed by MCOs, and described the importance of NPs working individually and collectively in negotiating with MCOs.     

Episodic gonadotropin-releasing hormone gene expression revealed by dynamic monitoring of luciferase reporter activity in single, living neurons

The existence of an intrinsic oscillator for pulsatile gonadotropin-releasing hormone (GnRH) secretion in normal and transformed GnRH neurons raises the question of whether the corresponding gene also is expressed in an episodic manner. To resolve this question, we used a modification of conventional luciferase technology, which enabled continuous monitoring of GnRH gene activity in single, living neurons. With this method, the relative rate of endogenous gene expression is estimated by quantification of photons emitted by individual neurons microinjected with a GnRH promoter-driven luciferase reporter construct. Immortalized GT1-1 neurons, which secrete the decapeptide GnRH in a pulsatile manner conceptually identical to that of their nontransformed counterparts in vivo, were chosen as the model for these studies. First, we injected individual cells with purified luciferase protein and established that the reporter half-life was sufficiently short (50 min) to enable detection of transient changes in gene expression. Next, we subjected transfected GT1-1 cells to continuous monitoring of reporter activity for 16 h and found that the majority of them exhibited spontaneous fluctuations of photonic activity over time. Finally, we established that photonic activity accurately reflected endogenous GnRH gene expression by treating transfected GT1-1 cells with phorbol 12-myristate 13 acetate (a consensus inhibitor of GnRH gene expression) and observing a dramatic suppression of photonic emissions from continuously monitored cells. Taken together, these results demonstrate the validity of our "real-time" strategy for dynamically monitoring GnRH gene activity in living neurons. Moreover, our findings indicate that GnRH gene expression as well as neuropeptide release can occur in an intermittent manner.     

Effect of limbic structure and striatum damage caused by kainic acid on seizure reactions in animals after intracranial injury

It has been established that hippocampus, enthorhinal cortex, amygdala and substantia nigra (pars reticulata) lesions before head injury lead to a decrease of kainic acid-induced behavioral and electrographic seizure expressions. It can be concluded that after head injury the activation of limbic structures excitability due to excitation of "inputs" to these formations takes place. The obtained data indicate the significant role of nucleus caudatus in activation of posttraumatic brain excitatory mechanisms.     

The diagnosis of drug allergies. Utilizing in vitro mast cell test and IgE inhibition test

With the ever-increasing use of pharmaceuticals and the relatively high risk of developing drug allergies, particularly for patients in hospitals and for ambulatory patients with a history of drug allergy, the need to develop in vitro assays for drug allergy is great. In the early 1970's a mast cell technique was developed for diagnosis of drug allergies. A PRIST inhibition assay has also recently been developed to detect IgE antibodies to drug allergens. This test has also been referred to as the Total IgE Inhibition Test by Specific Drug Allergen, and is a variant of the in vitro RAST Test. In vitro mast cell and IgE inhibition tests are applied for identification of drug and chemical allergens and for their cautious clinical trial to prevent future drug and chemical reactions. Over the last eight years, over 1,300 patients were examined utilizing the mast cell technique. Over 100 drugs were tested, with penicillin, barbiturates, "caine" derivatives and sulfonamides most frequently employed. Of 270 patients with well-defined drug reactions, 190 (70 per cent) gave a positive response to the mast cell test. Eighty-five per cent of sera tested with Type I reactions gave a mast cell response. Of these, a group of 30 patients was studied with PRIST inhibition as well. Procedures for comparative testing of necessary drugs and/or chemicals in cases of high anaphylaxis risk of reaction in the clinical setting, hospital or office are included in the study as well as individual case reports. Mast cell assay coupled with IgE inhibition has been successfully used to diagnose drug and chemical allergic reactions. The incidence of positivity is high when the offending drug causes a Type I allergic reaction. The cases reported indicate that both the Mast Cell and the PRIST inhibition assays are useful for diagnosing and setting the clinical treatment and clinical course of the patient. The mast cell assay would be potentially employed for patient use in hospitals where the incidence of drug allergy is highest and for occupational health in the chemical industry. The greatest potential would be in outpatient care applied to patients with multiple drug allergies in the selection of safe drugs (test negative by both methods, and other clinical studies) for future drug usage.     

Observations of Aggressive Children During Peer Provocation and With a Best Friend.

Observational methods were used to examine aggressive children's peer relations in 2 contexts: when being teased by a peer and when interacting with a best friend. Because aggressive children may have more difficulty than nonaggressive children in both peer contexts, the authors also examined whether relations between behaviors across contexts varied as a function of aggression. Results indicated that aggression was related to children's behavior when provoked. Children's behavior when provoked was associated with fewer positive and more negative interactions with their best friend, particularly for aggressive children. Results are discussed with respect to social norms in middle childhood and informing interventions for aggressive children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative Analysis of Chlorine Dioxide, Free Chlorine and Chloramines on Bacterial Water Quality in Model Distribution Systems

Drinking water utilities may be required to change disinfectant to improve water quality and meet more stringent disinfection regulations. This research was conducted to assess and compares chlorine dioxide to free chlorine and chloramines on bacterial water quality monitored within model distribution systems (i.e., annular reactors). Following colonization with nondisinfected water, annular reactors containing either polycarbonate or cast iron coupons were treated with free chlorine, chlorine dioxide or chloramines. Two disinfectant doses (low/high) were tested for each disinfectant. Under specific environmental conditions, bacterial inactivation varied as a function of the disinfectant type and dose, sample type (bulk water versus biofilm bacteria) and coupon material. The ranking by efficiency was as follows: chlorine dioxide > chlorine > chloramines. On preformed biofilms of 106–107?cfu/cm2, the continuous application of a disinfectant led to a log removal of heterotrophic bacteria concentrations for suspended and biofilm bacteria ranging from 1.1 to 4.0, and from 0.2 to 2.5, respectively. Doubling the amount of disinfectant doses led to an additional log inactivation of 1–2.5 of heterotrophic bacteria levels. This study demonstrates that bacterial inactivation in distribution systems is governed by various inter-related parameters. The data indicate that chlorine dioxide represents a viable alternative for secondary disinfection in distribution systems.     

Optimal Filters from Calibration Data for Image Deconvolution with Data Acquisition Error

Data acquisition errors due to dead pixels or other hardware defects can cause undesirable artifacts in imaging applications. Compensating for these defects typically requires knowledge such as a defective pixel map, which can be difficult or costly to obtain and which is not necessarily static. However, recent calibration data is readily available in many applications. In this paper, we compute optimal filters for image deconvolution with denoising using only this calibration data, by minimizing the empirical Bayes risk. We derive a bound on how the reconstruction changes as the number of dead pixels grows. We show that our approach is able to reconstruct missing information better than standard filtering approaches and is robust even in the presence of a large number of defects and to defects that arise after calibration.     

Phosphorylation Stoichiometries of Human Eukaryotic Initiation Factors

Eukaryotic translation initiation factors are the principal molecular effectors regulating the process converting nucleic acid to functional protein. Commonly referred to as eIFs (eukaryotic initiation factors), this suite of proteins is comprised of at least 25 individual subunits that function in a coordinated, regulated, manner during mRNA translation. Multiple facets of eIF regulation have yet to be elucidated; however, many of the necessary protein factors are phosphorylated. Herein, we have isolated, identified and quantified phosphosites from eIF2, eIF3, and eIF4G generated from log phase grown HeLa cell lysates. Our investigation is the first study to globally quantify eIF phosphosites and illustrates differences in abundance of phosphorylation between the residues of each factor. Thus, identification of those phosphosites that exhibit either high or low levels of phosphorylation under log phase growing conditions may aid researchers to concentrate their investigative efforts to specific phosphosites that potentially harbor important regulatory mechanisms germane to mRNA translation.