The OKT3 Antibody Response Study: a multicentre study of human anti-mouse antibody (HAMA) production following OKT3 use in solid organ transplantation

Human anti-murine antibody titres following patient exposure to the monoclonal antibody Orthoclone OKT3 (muromonab-CD3) are determined by laboratories using diverse analytical methods which are not standardized and whose concordance is not established. A multicentre study group therefore compared testing for IgG anti-OKT3 antibody among seven laboratories. A set of 270 sera was obtained from 30 heart, 30 kidney and 30 liver transplant recipients with no previous exposure to OKT3 who were receiving OKT3 for induction immunosuppression. Sera were collected from each patient prior to and at 24 +/- 2 days and 31 +/- 2 days following initial OKT3 exposure. Identical aliquots of all 270 sera were tested for IgG anti-OKT3 antibody by each laboratory. In addition, the limit of detection of each laboratory's method was estimated by titration of an affinity-purified IgG anti-OKT3 reference material of known concentration. Anti-OKT3 antibody formation differed greatly among the three organ groups. Cardiac patients demonstrated the least sensitization and almost exclusively lower titres, while kidney recipients had more frequent and higher titre antibody formation. Liver recipients yielded the highest sensitization rate and the most frequent high titre sera. Importantly, the seven laboratories differed widely in the number of pretreatment sera reported as positive (ranging from 0% to 41% among laboratories), the number of post-OKT3 sera reported as positive (17-63%), the number of post-OKT3 samples with titre > or = 1000 (2-31%), and the number of patients sensitized 19-69%). Concordance among laboratories was highly variable, with interlaboratory agreement ranging from 38% to 83% on the sample titres assigned to 180 post-OKT3 sera. Many of the discordant results were consistent with differences in the limit of detection of the analytical methods, which ranged from 0.19 microgram/ml to > or = 15 micrograms/ml, a nearly 100-fold difference among laboratories. This study demonstrated the presence of both good concordance and significant discordance among laboratories in determining human anti-mouse antibody titres, and demonstrated that common titre categories (100, 1000, 10,000) were not equivalent among laboratories. The level of concordance among methods should be considered when comparing anti-OKT3 antibody results from different centres and their correlation with clinical events. Universal comparative testing, patterned after proficiency testing programmes, is needed to assess differences among laboratories and to bring uniformity and a sound interpretative basis to this field of testing.     

Psychogenic-organic symptom overlap: Considerations for nonmedical psychotherapists.

Discusses common presenting complaints and those of emergent significance that have an organic etiology. The following categories are discussed: head, eyes, ears, throat, neck, cardiac, respiratory, gastrointestinal, genito-urinary, musculoskeletal, and neurologic complaints. It is suggested that many therapists lack adequate medical information to suspect the presence of organic problems when symptoms are indistinguishable from psychogenic/psychosomatic problems. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuing nursing education: what resources do bedside nurses use?

Continuing nursing education (CNE) has traditionally been considered a formalized learning experience. However, the results of this study indicated nurses providing direct patient care in a tertiary care hospital seldom participate in such activities. The nursing staff do use a variety of resources, both material and personnel, to meet their immediate learning needs. Most of their CNE activities appear to be undertaken within their work environment. The results of this study provide nurse educators and managers insight into how they can augment "on-the-job" learning opportunities for staff nurses.     

Investigation of a spontaneous abortion cluster: development of a risk communication plan

A risk communication plan was developed for a group of payroll office workers who were investigated for a possible cluster of spontaneous abortions (SABs). Survey and focus group methods were used to assess the workers' attitudes, beliefs, and information preferences. We found that four features of the workforce needed to be considered in developing an effective plan: 1) subgroups of workers varied on their levels of concern, awareness, involvement, and definitions of the problem; 2) workers did not have the necessary knowledge concerning SABs or the scientific method to participate in a two-way communication; 3) workers were highly stressed; and 4) workers were distrustful that they would be told the truth about the SABs. A multicomponent risk communication strategy was developed to overcome these barriers. Specifically, we recommended that background information on SABs and the scientific method be presented before the report of the study results and that follow-up sessions should be conducted on job stress and the emotional aspects of miscarriages.     

Tuberculosis in the workplace: OSHA''s compliance experience

OBJECTIVE: To assess the application of a Cole-Cole analysis of multiple frequency bioelectrical impedance analysis (MFBIA) measurements to predict total body water (TBW) and extracellular water (ECW) in humans. This technique has previously been shown to produce accurate and reliable estimates in both normal and abnormal animals. DESIGN: The whole body impedance of 60 healthy humans was measured at 496 frequencies (ranging from 4 kHz to 1 MHz) and the impedance at zero frequency, Ro, and at the characteristic frequency, Zc, were determined from the impedance spectrum, (Cole-Cole plot). TBW and ECW were independently determined using deuterium and bromide tracer dilution techniques. SETTING: At the Dunn Clinical Nutrition Centre and The Department of Biochemistry, University of Queensland. SUBJECTS: 60 healthy adult volunteers (27 men and 33 women, aged 18-45 years). RESULTS: The results presented suggest that the swept frequency bioimpedance technique estimates total body water, (SEE = 5.2%), and extracellular water, (SEE = 10%), only slightly better in normal, healthy subjects than a method based on single frequency bioimpedance or anthropometric estimates based on weight, height and gender. CONCLUSIONS: This study has undertaken the most extensive analysis to date of relationships between TBW (and ECW) and individual impedances obtained at different frequencies ( > 400 frequencies), and has shown marginal advantages of using one frequency over another, even if values predicted from theoretical bioimpedance models are used in the estimations. However in situations where there are disturbances of fluid distribution, values predicted from the Cole-Cole analysis of swept frequency bioimpedance measurements could prove to be more useful.     

A SHEAR STRESS BASED CRITICAL-PLANE CRITERION OF MULTIAXIAL FATIGUE FAILURE FOR DESIGN AND LIFE PREDICTION

Abstract— The use of a previously presented general criterion of failure for high cycle multiaxial fatigue, τ_a/ t _A,B+σ_n.max/2σ_T= 1, is extended to cases where the shear and normal stress on the critical plane are non-proportional and also to give life predictions in the range of 10⁴ to 10⁶ cycles. The criterion takes account of whether case A cracks, growing along the surface, or case B cracks, growing in from the surface, occur.     

Two kinds of assumed similarity between opposites.

In a series of recent studies, F. E. Fiedler has shown that a leader's "assumed similarity between opposites" (ASo) is an important correlate of his team's efficiency. Basketball teams and surveying teams were shown to be more efficient when the sociometrically most-chosen member attributed very different psychological traits to persons he regarded as good and bad coworkers. The efficiency of bomber and tank crews was also found to be related to the leader's ASo. This paper reports an investigation of some statistical and psychological properties of ASo. Forty-two members of an undergraduate class in psychology served as subjects (Ss) for this study. Ss responded to Fiedler's instrument consisting of 20 graphic rating scales, the ends of which were identified by polar terms. As is customary with this instrument, Ss rated themselves, a good co-worker, and a bad co-worker on each of the 20 scales. The results show that the conventional measure of ASo can be broken into two components which are logically and empirically independent of one another. Taken separately these two components sometimes correlate more highly with external variables than does ASo itself. Implications of these qualities of ASo are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of granulocyte colony-stimulating factor (Neupogen) starting day 1 vs day 7 post-autologous stem cell transplantation

The purpose of the study was to evaluate the effect of delayed granulocyte colony-stimulating factor (G-CSF) use on hematopoietic recovery post-autologous peripheral blood progenitor cell (PBPC) transplantation. Patients were randomized to begin G-CSF on day +1 or day +7 post transplantation. Thirty-seven patients with lymphoma or myeloma undergoing high-dose therapy and autologous PBPC rescue were randomized to daily subcutaneous G-CSF beginning on day +1 or day +7 post-transplant. Patients < or =70 kg received 300 microg/day and >70 kg 480 microg/day. All patients were reinfused with PBPCs with a CD34+ cell count >2.0 x 10(6)/kg. Baseline characteristics of age, sex and CD34+ cell count were similar between the two arms, the median CD34+ cell count being 5.87 x 10(6)/kg in the day +1 group and 7.70 x 10(6)/kg in the day +7 group (P=0.7). The median time to reach a neutrophil count of >0.5 x 10(9)/l was 9 days in the day +1 arm and 10 days in the day +7 arm, a difference which was not statistically significant (P=0.68). Similarly, there was no difference in median days to platelet recovery >20000 x 10(9)/l, which was 10 days in the day +1 arm and 11 days in the day +7 arm (P=0.83). There was also no significant difference in the median duration of febrile neutropenia (4 vs 6 days; P=0.7), intravenous antibiotic use (7 vs 8 days; P=0.54) or median number of red blood cell transfusions (4 vs 7 units; P=0.82) between the two arms. Median length of hospital stay was 11 days post-PBPC reinfusion in both groups. The median number of G-CSF injections used was 8 in the day +1 group and 3 in the day +7 group (P < 0.0001). There is no significant difference in time to neutrophil or platelet recovery when G-CSF is initiated on day +7 compared to day +1 post-autologous PBPC transplantation. There is also no difference in number of febrile neutropenic or antibiotic days, number of red blood cell transfusions or length of hospital stay. The number of doses of G-CSF used per transplant is significantly reduced with delayed initiation, resulting in a significant reduction in drug costs. For patients with an adequately mobilized PBPC graft, the initiation of G-CSF can be delayed until day +7 post-PBPC reinfusion.     

Long-term survival after retransplantation of the liver

OBJECTIVE: The authors determined the long-term outcome of patients undergoing hepatic retransplantation at their institution. Donor, operative, and recipient factors impacting on outcome as well as parameters of patient resource utilization were examined. SUMMARY BACKGROUND DATA: Hepatic retransplantation provides the only available option for liver transplant recipients in whom an existing graft has failed. However, such patients are known to exhibit patient and graft survival after retransplantation that is inferior to that expected using the same organs in naiive recipients. The critical shortage of donor organs and resultant prolonged patient waiting periods before transplantation prompted the authors to evaluate the results of a liberal policy of retransplantation and to examine the factors contributing to the inferior outcome observed in retransplanted patients. METHODS: A total of 2053 liver transplants were performed at the UCLA Medical Center during a 13-year period from February 1, 1984, to October 1, 1996. A total of 356 retransplants were performed in 299 patients (retransplant rate = 17%). Multivariate regression analysis was performed to identify variables associated with survival. Additionally, a case-control comparison was performed between the last 150 retransplanted patients and 150 primarily transplanted patients who were matched for age and United Network of Organ Sharing (UNOS) status. Differences between these groups in donor, operative, and recipient variables were studied for their correlation with patient survival. Days of hospital and intensive care unit stay, and hospital charges incurred during the transplant admissions were compared for retransplanted patients and control patients. RESULTS: Survival of retransplanted patients at 1, 5, and 10 years was 62%, 47%, and 45%, respectively. This survival is significantly less than that seen in patients undergoing primary hepatic transplantation at the authors' center during the same period (83%, 74%, and 68%). A number of variables proved to have a significant impact on outcome including recipient age group, interval to retransplantation, total number of grafts, and recipient UNOS status. Recipient primary diagnosis, cause for retransplantation, and whether the patient was retransplanted before or after June 1, 1992, did not reach statistical significance as factors influencing survival. In the case-control comparison, the authors found that of the more than 25 variables studied, only preoperative ventilator status showed both a significant difference between control patients and retransplanted patients and also was a factor predictive of survival in retransplanted patients. Retransplant patients had significantly longer hospital and intensive care unit stays and accumulated total hospitalization charges more than 170% of those by control patients. CONCLUSIONS: Hepatic retransplantation, although life-saving in almost 50% of patients with a failing liver allograft, is costly and uses scarce donor organs inefficiently. The data presented define patient characteristics and preoperative variables that impact patient outcome and should assist in the rational application of retransplantation.