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1.
Sci Rep ; 13(1): 18439, 2023 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-37891179

RESUMO

Mucopolysaccharidosis III (MPSIII, Sanfilippo syndrome) is a devastating lysosomal storage disease that primarily affects the central nervous system. MPSIIIA is caused by loss-of-function mutations in the gene coding for sulfamidase (N-sulfoglucosamine sulfohydrolase/SGSH) resulting in SGSH enzyme deficiency, a buildup of heparin sulfate and subsequent neurodegeneration. There is currently no cure or disease modifying treatment for MPSIIIA. A mouse model for MPSIIIA was characterized in 1999 and later backcrossed onto the C57BL/6 background. In the present study, a novel immune deficient MPSIIIA mouse model (MPSIIIA-TKO) was created by backcrossing the immune competent, C57BL/6 MPSIIIA mouse to an immune deficient mouse model lacking Rag2, CD47 and Il2rg genes. The resulting mouse model has undetectable SGSH activity, exhibits histological changes consistent with MPSIIIA and lacks T cells, B cells and NK cells. This new mouse model has the potential to be extremely useful in testing human cellular therapies in an animal model as it retains the MPSIIIA disease phenotype while tolerating xenotransplantation.


Assuntos
Mucopolissacaridose III , Animais , Humanos , Camundongos , Mucopolissacaridose III/genética , Mucopolissacaridose III/patologia , Camundongos Endogâmicos C57BL , Hidrolases/genética , Fenótipo , Modelos Animais de Doenças
3.
Vet Med Sci ; 7(1): 141-147, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32864895

RESUMO

An outbreak of 92 abortions out of 1,700 pregnant cows (5.41%) in a period of 3 weeks (19 May to 05 June 2019) occurred in a Georgia Dairy, USA, in cattle that were between 3 and 7 months of gestation. Two sets of samples (aborted fetuses' organs, placental tissues, aborted cows blood) were submitted for laboratory investigations at the Tifton Veterinary Diagnostic and Investigational Laboratory, College of Veterinary Medicine, University of Georgia (TVDIL, Tifton, GA, USA). An abortion panel testing for the major abortion-causing agents [e.g. Bovine Viral Diarrhoea Virus (BVDV), Infectious Bovine Rhinotracheitis Virus/ Bovine Herpes Virus-I (IBR/ BHV-I), Brucella spp., Leptospira spp.] was conducted on several of the samples. On the first set of samples, microbial cultures, serology and PCR tests for the common abortifacient agents revealed the presence of Neospora caninum (N. caninum) DNA, which was positive by PCR on the placenta and fetal tissues. The second set of diagnostic investigations also identified two out of three submitted freshly aborted fetuses to be positive for N. caninum by PCR and immunohistochemistry. Moreover, all three dams were also sero-positive for N. caninum. The entire herd was being fed on grass silage harvested from a pasture where feral pigs were hunted previously and carcasses were left behind. As a consequence of this action a large population of wild coyotes were attracted to these carcasses, and likely contaminated the pasture with potential N. caninum-infected feces. After the abortion outbreak was resolved, it was recommended that the farmers should avoid disposal of cadavers of hunted animals in the wild, as it could attract carnivorous and omnivorous animals that may potentially spread the disease to the cattle and other wildlife.


Assuntos
Aborto Animal/epidemiologia , Doenças dos Bovinos/parasitologia , Coccidiose/veterinária , Surtos de Doenças/veterinária , Neospora/isolamento & purificação , Aborto Animal/parasitologia , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Coccidiose/epidemiologia , Coccidiose/parasitologia , Indústria de Laticínios , Georgia/epidemiologia
4.
Exp Physiol ; 103(6): 916-923, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29663576

RESUMO

NEW FINDINGS: What is the central question of this study? Angiotensin-(1-7) decreases cerebral infarct volume and improves neurological function when delivered centrally before and during ischaemic stroke. Here, we assessed the neuroprotective effects of angiotensin-(1-7) when delivered orally post-stroke. What is the main finding and its importance? We show that oral delivery of angiotensin-(1-7) attenuates cerebral damage induced by middle cerebral artery occlusion in rats, without affecting blood pressure or cerebral blood flow. Importantly, these treatments begin post-stroke at times coincident with the treatment window for tissue plasminogen activator, providing supporting evidence for clinical translation of this new therapeutic strategy. ABSTRACT: As a target for stroke therapies, the angiotensin-converting enzyme 2-angiotensin-(1-7)-Mas [ACE2/Ang-(1-7)/Mas] axis of the renin-angiotensin system can be activated chronically to induce neuroprotective effects, in opposition to the deleterious effects of angiotensin II via its type 1 receptor. However, more clinically relevant treatment protocols with Ang-(1-7) that involve its systemic administration beginning after the onset of ischaemia have not been tested. In this study, we tested systemic post-stroke treatments using a molecule where Ang-(1-7) is included within hydroxypropyl-ß-cyclodextrin [HPßCD-Ang-(1-7)] as an orally bioavailable treatment. In three separate protocols, HPßCD-Ang-(1-7) was administered orally to Sprague-Dawley rats after induction of ischaemic stroke by endothelin-1-induced middle cerebral artery occlusion: (i) to assess its effects on cerebral damage and behavioural deficits; (ii) to determine its effects on cardiovascular parameters; and (iii) to determine whether it altered cerebral blood flow. The results indicate that post-stroke oral administration of HPßCD-Ang-(1-7) resulted in 25% reductions in cerebral infarct volumes and improvement in neurological functions (P < 0.05), without inducing any alterations in blood pressure, heart rate or cerebral blood flow. In conclusion, Ang-(1-7) treatment using an oral formulation after the onset of ischaemia induces significant neuroprotection in stroke and might represent a viable approach for taking advantage of the protective ACE2/Ang-(1-7)/Mas axis in this disease.


Assuntos
Angiotensina I/farmacologia , Neuroproteção/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Fragmentos de Peptídeos/farmacologia , Acidente Vascular Cerebral/tratamento farmacológico , 2-Hidroxipropil-beta-Ciclodextrina/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Circulação Cerebrovascular/efeitos dos fármacos , Endotelina-1/metabolismo , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/metabolismo , Masculino , Ratos , Ratos Sprague-Dawley , Sistema Renina-Angiotensina/efeitos dos fármacos , Acidente Vascular Cerebral/metabolismo
5.
Clin Sci (Lond) ; 132(5): 581-593, 2018 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-29500223

RESUMO

Significant neuroprotective effects of angiotensin II type 2 (AT2) receptor (AT2 receptor) agonists in ischemic stroke have been previously demonstrated in multiple studies. However, the routes of agonist application used in these pre-clinical studies, direct intracerebroventricular (ICV) and systemic administration, are unsuitable for translation into humans; in the latter case because AT2 receptor agonists are blood-brain barrier (BBB) impermeable. To circumvent this problem, in the current study we utilized the nose-to-brain (N2B) route of administration to bypass the BBB and deliver the selective AT2 receptor agonist Compound 21 (C21) to naïve rats or rats that had undergone endothelin 1 (ET-1)-induced ischemic stroke. The results obtained from the present study indicated that C21 applied N2B entered the cerebral cortex and striatum within 30 min in amounts that are therapeutically relevant (8.4-9 nM), regardless of whether BBB was intact or disintegrated. C21 was first applied N2B at 1.5 h after stroke indeed provided neuroprotection, as evidenced by a highly significant, 57% reduction in cerebral infarct size and significant improvements in Bederson and Garcia neurological scores. N2B-administered C21 did not affect blood pressure or heart rate. Thus, these data provide proof-of-principle for the idea that N2B application of an AT2 receptor agonist can exert neuroprotective actions when administered following ischemic stroke. Since N2B delivery of other agents has been shown to be effective in certain human central nervous system diseases, the N2B application of AT2 receptor agonists may become a viable mode of delivering these neuroprotective agents for human ischemic stroke patients.


Assuntos
Encéfalo/metabolismo , Mucosa Nasal/metabolismo , Receptor Tipo 2 de Angiotensina/agonistas , Acidente Vascular Cerebral/prevenção & controle , Sulfonamidas/farmacologia , Tiofenos/farmacologia , Animais , Isquemia Encefálica/complicações , Infarto Cerebral/prevenção & controle , Vias de Administração de Medicamentos , Sistemas de Liberação de Medicamentos/métodos , Humanos , Masculino , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/sangue , Fármacos Neuroprotetores/farmacologia , Ratos Sprague-Dawley , Receptor Tipo 2 de Angiotensina/metabolismo , Acidente Vascular Cerebral/etiologia , Sulfonamidas/administração & dosagem , Sulfonamidas/sangue , Tiofenos/administração & dosagem , Tiofenos/sangue
6.
J Bacteriol ; 200(11)2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29463606

RESUMO

Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen with distinct acute and chronic virulence phenotypes. Whereas acute virulence is typically associated with expression of a type III secretion system (T3SS), chronic virulence is characterized by biofilm formation. Many of the phenotypes associated with acute and chronic virulence are inversely regulated by RsmA and RsmF. RsmA and RsmF are both members of the CsrA family of RNA-binding proteins and regulate protein synthesis at the posttranscriptional level. RsmA activity is controlled by two small noncoding regulatory RNAs (RsmY and RsmZ). Bioinformatic analyses suggest that RsmY and RsmZ each have 3 or 4 putative RsmA binding sites. Each predicted binding site contains a GGA sequence presented in the loop portion of a stem-loop structure. RsmY and RsmZ regulate RsmA, and possibly RsmF, by sequestering these proteins from target mRNAs. In this study, we used selective 2'-hydroxyl acylation analyzed by primer extension and mutational profiling (SHAPE-MaP) chemistry to determine the secondary structures of RsmY and RsmZ and functional assays to characterize the contribution of each GGA site to RsmY/RsmZ activity. Our data indicate that RsmA has two preferential binding sites on RsmY and RsmZ, while RsmF has one preferential binding site on RsmY and two sites on RsmZ. Despite RsmF and RsmA sharing a common consensus site, RsmF binding properties are more restrictive than those of RsmA.IMPORTANCE CsrA homologs are present in many bacteria. The opportunistic pathogen Pseudomonas aeruginosa uses RsmA and RsmF to inversely regulate factors associated with acute and chronic virulence phenotypes. RsmA has an affinity for RsmY and RsmZ higher than that of RsmF. The goal of this study was to understand the differential binding properties of RsmA and RsmF by using the RsmY and RsmZ regulatory small RNAs (sRNAs) as a model. Mutagenesis of the predicted RsmA/RsmF binding sites on RsmY and RsmZ revealed similarities in the sites required to control RsmA and RsmF activity in vivo Whereas binding by RsmA was relatively tolerant of binding site mutations, RsmF was sensitive to disruption to all but two of the sites, further demonstrating that the requirements for RsmF binding activity in vivo and in vitro are more stringent than those for RsmA.


Assuntos
Proteínas de Bactérias/metabolismo , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/genética , Pequeno RNA não Traduzido/metabolismo , Proteínas de Bactérias/genética , Sítios de Ligação , Fenótipo , Pseudomonas aeruginosa/patogenicidade , RNA Bacteriano/química , RNA Bacteriano/genética , RNA Bacteriano/metabolismo , RNA Mensageiro/química , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Pequeno RNA não Traduzido/química , Pequeno RNA não Traduzido/genética , Proteínas de Ligação a RNA/genética , Proteínas de Ligação a RNA/metabolismo , Virulência
7.
PLoS One ; 12(7): e0180738, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28671997

RESUMO

Activation of the angiotensin II type 2 receptor (AT2R) by administration of Compound 21 (C21), a selective AT2R agonist, induces neuroprotection in models of ischemic stroke in young adult animals. The mechanisms of this neuroprotective action are varied, and may include direct and indirect effects of AT2R activation. Our objectives were to assess the long-term protective effects of post-stroke C21 treatments in a clinically-relevant model of stroke in aged rats and to characterize the cellular localization of AT2Rs in the mouse brain of transgenic reporter mice following stroke. Intraperitoneal injections of C21 (0.03mg/kg) after ischemic stroke induced by transient monofilament middle cerebral artery occlusion resulted in protective effects that were sustained for up to at least 3-weeks post-stroke. These included improved neurological function across multiple assessments and a significant reduction in infarct volume as assessed by magnetic resonance imaging. We also found AT2R expression to be on neurons, not astrocytes or microglia, in normal female and male mouse brains. Stroke did not induce altered cellular localization of AT2R when assessed at 7 and 14 days post-stroke. These findings demonstrate that the neuroprotection previously characterized only during earlier time points using stroke models in young animals is sustained long-term in aged rats, implying even greater clinical relevance for the study of AT2R agonists for the acute treatment of ischemic stroke in human disease. Further, it appears that this sustained neuroprotection is likely due to a mix of both direct and indirect effects stemming from selective activation of AT2Rs on neurons or other cells besides astrocytes and microglia.


Assuntos
Fármacos Neuroprotetores/farmacologia , Receptor Tipo 2 de Angiotensina/agonistas , Acidente Vascular Cerebral/fisiopatologia , Animais , Feminino , Masculino , Camundongos , Ratos , Ratos Sprague-Dawley
8.
Infect Immun ; 84(4): 1214-1225, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26857575

RESUMO

We demonstrate that mutation of xerC, which reportedly encodes a homologue of an Escherichia coli recombinase, limits biofilm formation in the methicillin-resistant Staphylococcus aureus strain LAC and the methicillin-sensitive strain UAMS-1. This was not due to the decreased production of the polysaccharide intracellular adhesin (PIA) in either strain because the amount of PIA was increased in a UAMS-1xerC mutant and undetectable in both LAC and its isogenic xerC mutant. Mutation of xerC also resulted in the increased production of extracellular proteases and nucleases in both LAC and UAMS-1, and limiting the production of either class of enzymes increased biofilm formation in the isogenic xerC mutants. More importantly, the limited capacity to form a biofilm was correlated with increased antibiotic susceptibility in both strains in the context of an established biofilm in vivo. Mutation of xerC also attenuated virulence in a murine bacteremia model, as assessed on the basis of the bacterial loads in internal organs and overall lethality. It also resulted in the decreased accumulation of alpha toxin and the increased accumulation of protein A. These findings suggest that xerC may impact the functional status of agr. This was confirmed by demonstrating the reduced accumulation of RNAIII and AgrA in LAC and UAMS-1xerC mutants. However, this cannot account for the biofilm-deficient phenotype of xerC mutants because mutation of agr did not limit biofilm formation in either strain. These results demonstrate that xerC contributes to biofilm-associated infections and acute bacteremia and that this is likely due to agr-independent and -dependent pathways, respectively.


Assuntos
Proteínas de Bactérias/metabolismo , Biofilmes/crescimento & desenvolvimento , Regulação Bacteriana da Expressão Gênica/fisiologia , Regulação Enzimológica da Expressão Gênica/fisiologia , Peptídeos Cíclicos/metabolismo , Recombinases/metabolismo , Staphylococcus aureus/enzimologia , Proteínas de Bactérias/genética , Staphylococcus aureus Resistente à Meticilina/enzimologia , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/metabolismo , Mutação , Óperon , Peptídeos Cíclicos/genética , Recombinases/genética , Staphylococcus aureus/genética , Staphylococcus aureus/metabolismo
9.
J Bacteriol ; 195(19): 4506-16, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23913326

RESUMO

ClpC is an ATP-dependent Hsp100/Clp chaperone involved in protein quality control in low-GC Gram-positive bacteria. Previously, we found that ClpC affected the expression of a large number of genes, including capsule genes in Staphylococcus aureus. Here we constructed a His-tagged ClpC variant (ClpC(trap)) with mutations within the Walker B motifs to identify the direct substrates of ClpC by copurification with ClpC(trap) followed by gel electrophoresis combined with liquid chromatography-tandem mass spectrometry proteomics. We identified a total of 103 proteins that are potential substrates of ClpC in strain Newman. The direct protein-protein interaction of ClpC with a subset of the captured proteins was verified in a bacterial two-hybrid system. The captured proteins could be grouped into various functional categories, but most were related to proteins involved in the stress response. Several known ClpC substrates were captured, including ClpP, TrfA/MecA, ClpB, DnaK, DnaJ, GroL, RecA, and CodY, supporting the validity of our approach. Our results also revealed many new ClpC substrates, including AgrA, CcpA, RsbW, MurG, FtsA, SrtA, Rex, Atl, ClfA, and SbcC. Analysis of capsule production showed that three of the captured proteins, which were not previously known to be transcriptional regulators, did affect capsule production.


Assuntos
Proteínas de Bactérias/metabolismo , Regulação Bacteriana da Expressão Gênica/fisiologia , Proteínas de Choque Térmico/metabolismo , Staphylococcus aureus/metabolismo , Sequência de Aminoácidos , Proteínas de Bactérias/genética , Proteínas de Choque Térmico/genética , Alinhamento de Sequência , Staphylococcus aureus/genética
10.
Water Sci Technol ; 67(1): 40-6, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23128619

RESUMO

In this study, we investigated use of microcosms to supplement field studies for establishing the size of wetlands required to mitigate nitrate pollution in agricultural watersheds. Wetlands investigated in this study were located in San Joaquin Valley (California, USA) and demonstrated mean nitrate-nitrogen mass removal efficiencies ranging between 10 and 34%. Mean areal nitrate removal rates (J) ranged from 142 to 380 mg-N m(-2) d(-1). First-order rate constants determined from field data had a high variance, with confidence intervals greater than 57% of mean values. Sediments and rooted plants from one site were placed in a flow-through microcosm and measurements of nitrate removal kinetics were made and compared with field results. The apparent half-saturation constant (K(m)) and maximum removal rate (J(max)) for nitrate-nitrogen were 43.8 mg/L and 4.11 g m(-2) d(-1) in the microcosm. The first-order rate constant from the microcosm (10.4 cm d(-1)) was in close agreement with the value for the field site (11.9 cm d(-1)) and had a confidence interval of less than 16%. Using this improved first-order rate constant, it was determined that between 1.3 and 3.6% of the land in the watershed should be managed as mitigation wetland, with the area required dependent on the level of nitrate reduction desired and how closely the wetland design approximates plug-flow.


Assuntos
Agricultura , Monitoramento Ambiental/métodos , Poluentes Químicos da Água/química , Áreas Alagadas , California , Fenômenos Geológicos , Cinética , Nitratos/química , Movimentos da Água
11.
BMC Res Notes ; 5: 5, 2012 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-22221385

RESUMO

BACKGROUND: Single-copy integration vectors based upon the site-specific recombination systems of bacteriophage are invaluable tools in the study of bacterial pathogenesis. The utility of such vectors is often limited, however, by the fact that integration often results in the inactivation of bacterial genes or has undesirable effects on gene transcription. The aim of this study is to develop an integration vector that does not have a detectable effect on gene transcription upon integration. FINDINGS: We have developed a single-copy integration system that enables the cloning vector to integrate at a specific engineered site, within an untranscribed intergenic region, in the chromosome of Staphylococcus aureus. This system is based on the lysogenic phage L54a site-specific recombination system in which the L54a phage (attP) and chromosome (attB) attachment sites, which share an 18-bp identical core sequence, were modified with identical mutations. The integration vector, pLL102, was constructed to contain the modified L54a attP site (attP2) that was altered at 5 nucleotide positions within the core sequence. In the recipient strain, the similarly modified attB site (attB2) was inserted in an intergenic region devoid of detectable transcription read-through. Integration of the vector, which is unable to replicate in S. aureus extrachromosomally, was achieved by providing the L54a integrase gene in a plasmid in the recipient. We showed that pLL102 integrated specifically at the engineered site rather than at the native L54a attB site and that integration did not have a significant effect on transcription of genes immediately upstream or downstream of the integration site. CONCLUSIONS: In this work, we describe an E. coli-S. aureus shuttle vector that can be used to introduce any cloned gene into the S. aureus chromosome at a select site without affecting gene expression. The vector should be useful for genetic manipulation of S. aureus and for marking strains for in vivo studies.

12.
Water Sci Technol ; 59(1): 9-14, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19151480

RESUMO

In the United States, environmentally impaired rivers are subject to regulation under total maximum daily load (TMDL) regulations that specify watershed wide water quality standards. In California, the setting of TMDL standards is accompanied by the development of scientific and management plans directed at achieving specific water quality objectives. The San Joaquin River (SJR) in the Central Valley of California now has a TMDL for dissolved oxygen (DO). Low DO conditions in the SJR are caused in part by excessive phytoplankton growth (eutrophication) in the shallow, upstream portion of the river that create oxygen demand in the deeper estuary. This paper reports on scientific studies that were conducted to develop a mass balance on nutrients and phytoplankton in the SJR. A mass balance model was developed using WARMF, a model specifically designed for use in TMDL management applications. It was demonstrated that phytoplankton biomass accumulates rapidly in a 88 km reach where plankton from small, slow moving tributaries are diluted and combined with fresh nutrient inputs in faster moving water. The SJR-WARMF model was demonstrated to accurately predict phytoplankton growth in the SJR. Model results suggest that modest reductions in nutrients alone will not limit algal biomass accumulation, but that combined strategies of nutrient reduction and algal control in tributaries may have benefit. The SJR-WARMF model provides stakeholders a practical, scientific tool for setting remediation priorities on a watershed scale.


Assuntos
Monitoramento Ambiental , Recuperação e Remediação Ambiental , Eutrofização , Oxigênio/análise , Rios , Animais , Biomassa , California , Clorofila/análise , Clorofila/metabolismo , Clorofila A , Geografia , Modelos Biológicos , Oxigênio/metabolismo , Fitoplâncton/crescimento & desenvolvimento
13.
Med J Aust ; 186(2): 64-8, 2007 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-17223765

RESUMO

Mycobacterium ulcerans causes slowly progressive, destructive skin and soft tissue infections, known as Bairnsdale or Buruli ulcer (BU). Forty-six delegates with experience in the management of BU attended a 1-day conference in Melbourne on 10 February 2006, with the aim of developing a consensus approach to the diagnosis, treatment and control of BU. An initial draft document was extended and improved during a facilitated round table discussion. BU is an environmental infection that occurs in specific locations. The main risk factor for infection is contact with an endemic area. Prompt cleaning of abrasions sustained outdoors, wearing protective clothing, and avoiding mosquito bites may reduce an individual's risk of infection. BU can be rapidly and accurately diagnosed by polymerase chain reaction testing of ulcer swabs or biopsies. Best outcomes are obtained when the diagnosis is made early. To aid early diagnosis, health authorities should keep local populations informed of new outbreaks. BU is best treated with surgical excision, which, if possible, should include a small rim of healthy tissue. For small lesions this may be all that is required. However, there is a role for antibiotics for more extensive disease, and their use may allow more conservative surgery.


Assuntos
Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/terapia , Mycobacterium ulcerans , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/terapia , Humanos , Infecções por Mycobacterium não Tuberculosas/prevenção & controle , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/terapia , Úlcera Cutânea/prevenção & controle , Vitória
14.
J Am Med Inform Assoc ; 14(1): 10-5, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17068349

RESUMO

New reimbursement policies and pay-for-performance programs to reward providers for producing better outcomes are proliferating. Although electronic health record (EHR) systems could provide essential clinical data upon which to base quality measures, most metrics in use were derived from administrative claims data. We compared commonly used quality measures calculated from administrative data to those derived from clinical data in an EHR based on a random sample of 125 charts of Medicare patients with diabetes. Using standard definitions based on administrative data (which require two visits with an encounter diagnosis of diabetes during the measurement period), only 75% of diabetics determined by manually reviewing the EHR (the gold standard) were identified. In contrast, 97% of diabetics were identified using coded information in the EHR. The discrepancies in identified patients resulted in statistically significant differences in the quality measures for frequency of HbA1c testing, control of blood pressure, frequency of testing for urine protein, and frequency of eye exams for diabetic patients. New development of standardized quality measures should shift from claims-based measures to clinically based measures that can be derived from coded information in an EHR. Using data from EHRs will also leverage their clinical content without adding burden to the care process.


Assuntos
Diabetes Mellitus/terapia , Sistemas Computadorizados de Registros Médicos , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde , Pressão Sanguínea , California , Diabetes Mellitus/sangue , Planos de Pagamento por Serviço Prestado , Hemoglobinas Glicadas/análise , Humanos , Revisão da Utilização de Seguros , Medicare , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Proteinúria/diagnóstico , Qualidade da Assistência à Saúde
16.
Aust Fam Physician ; 34(9): 725-9, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16184203

RESUMO

BACKGROUND: Infants commonly present with failure to thrive. Psychosocial and nutritional causes are commonly responsible, but significant organic pathology requires exclusion in all children with failure to thrive. OBJECTIVE: This article discusses an approach to the assessment of infants presenting with failure to thrive, together with information on management and available resources. DISCUSSION: Close liaison between those involved in the management of infants presenting with failure to thrive--including family, maternal child health nurse, family doctor and paediatrician--should usually allow for appropriate intervention to correct the failure to thrive.


Assuntos
Insuficiência de Crescimento/diagnóstico , Insuficiência de Crescimento/terapia , Transtornos da Nutrição Infantil/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Medicina de Família e Comunidade/métodos , Feminino , Humanos , Lactente , Masculino , Anamnese/métodos , Doenças Metabólicas/diagnóstico , Pediatria/métodos , Exame Físico/métodos
17.
Proc AMIA Symp ; : 76-80, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12463790

RESUMO

An epidemic resulting from an act of bioterrorism could be catastrophic. However, if an epidemic can be detected and characterized early on, prompt public health intervention may mitigate its impact. Current surveillance approaches do not perform well in terms of rapid epidemic detection or epidemic monitoring. One reason for this shortcoming is their failure to bring existing knowledge and data to bear on the problem in a coherent manner. Knowledge-based methods can integrate surveillance data and knowledge, and allow for careful evaluation of problem-solving methods. This paper presents an argument for knowledge-based surveillance, describes a prototype of BioSTORM, a system for real-time epidemic surveillance, and shows an initial evaluation of this system applied to a simulated epidemic from a bioterrorism attack.


Assuntos
Inteligência Artificial , Bioterrorismo , Surtos de Doenças , Sistemas de Informação , Vigilância da População/métodos , Humanos
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