[Cooperation between nursing homes and intellectual disability care services : State of affairs in Flanders]. / Samenwerking tussen woonzorgcentra en voorzieningen voor personen met verstandelijke beperkingen : Een stand van zaken in Vlaanderen.

Considering the increasing life expectancy of people with intellectual disabilities (ID), the importance of cooperation between services for people with ID and elderly care services has been stressed in Flanders and the Netherlands, as well as internationally. However, the prevalence, intensity and content of such a cooperation are yet unknown. In order to gain information to address this issue, an online-survey was delivered to directors of all nursing homes in Flanders (n = 781). 229 surveys were completed.In more than 75% of the nursing homes, people with ID were among the residents over the past decade. However, at the same time a lack of expertise has been identified as a barrier to provide them optimal care and support. Hence, the respondents point out that a cooperation with ID care services could be beneficial. Nevertheless, those partnerships only arose in a quarter of the nursing homes so far, primarily for the purpose of exchange of expertise. Intersectoral multidisciplinary consultations and intersectoral care team consultations have been taking place as well, be it mainly in the context of a persons' transition from an ID care service to a nursing home. Until now, radical cooperations which involve an exchange of staff, seem to be rather rare.

Biomechanical potential of the temporal muscle in brachyfacial and dolichofacial subjects: a study on dry mandibles.

OBJECTIVES: To measure the lengths of the force and resistance arms, in order to calculate the mechanical advantage and muscular work of the human temporalis muscle (TM) in brachyfacial (BR) and dolichofacial (DO) subjects. SETTING AND SAMPLE POPULATION: Mandibles from 49 subjects of both genders (BR n = 9; DO n = 40) from the collection of the Laboratory of Human Anatomy at Universidade de Santa Cruz do Sul, Rio Grande do Sul, Brazil, were analyzed. MATERIAL AND METHODS: The distance between the condylar process and the coronoid process (insertion site of the TM) represented the length of the force arm (LFA ) of the TM. The distance between the condylar process and the mental protuberance represented the length of the resistance arm (LRA ). Thus, the mechanical advantage of the TM was obtained using the following ratio: LFA /LRA , while the muscular work (LRA /LFA ) of the TM was obtained using the inverse of this ratio. RESULTS: When compared with the DO, the parameters of the BR are significantly greater, as shown by the LFA (6.0%) and mechanical advantage (8.2%; p = 0.0078). By contrast, our results show that in the DO, the LRA was 2.4% longer and the muscular work was 10.4% greater (p = 0.0087). CONCLUSION: The mechanical advantage of the TM in BR subjects is significantly greater than in DO subjects. Moreover, this greater mechanical advantage may explain, at least in part, the higher incidence of temporomandibular dysfunctions in BR subjects.

Comparison of Droplet Size, Coverage, and Drift Potential from UAV Application Methods and Ground Application Methods on Row Crops.

Worldwide, the use of uncrewed aerial vehicles (UAVs) for pesticide application has grown tremendously in the past decade. Their adoption has been slower for Midwestern row crops. This study compared droplet size, coverage, and drift potential of sprays from UAV application methods to those from ground (implement) sprayer methods on corn in the Midwest. Droplet sizes measured during UAV spray trials [geometric mean diameters of 179 and 112 µm for UAV (boom) and UAV (no boom), respectively] were substantially smaller than those deposited during implement spray trials [mean diameters of 303 and 423 µm for implement (regular) and implement (pulse)]. Droplet coverage was high and localized in the middle swath of the field for the UAV with boom (10 to 30 droplets cm-2) and with no boom (60 droplets cm-2). Droplet coverage was broader, covering the entire field width for the implement methods (10 to 40 droplets cm-2). Vertical coverage of droplets was more uniform for UAV methods than implement methods. Although the UAVs produced smaller droplets than the implement methods, we still observed greater potential for downwind pesticide drift during the implement spray trials. Because localized application may be beneficial for pest control and drift reduction, the findings indicate a strong potential for "spot" or "band" spray coverage using UAV methods. This is likely due to the smaller size, reduced spray volumes, and increased agility of UAVs as compared to more conventional methods.

Substrates of Hageman factor. I. Isolation and characterization of human factor XI (PTA) and inhibition of the activated enzyme by alpha 1-antitrypsin.

Unactivated partial thromboplastin antecedent (PTA) has been purified by sequential chromatography of plasma on quaternary aminoethyl Sephadex, sulphoprophyl Sephadex, Sephadex G-150, and passage over an anti-IgG immunoadsorbant. The preparation gave a single band after alkaline disc gel electrophoresis, sodium dodecyl sulfate (SDS) gel electrophoresis and isoelectric focusing in acrylamide gels and was found to have a mol wt of 175,000 by gel filtration, 163,000 by SDS gel electrophoresis, and an isoelectric point of 8.8-9.4 (peak 9.0-9.1). Pre-PTA was activated directly by activated Hageman factor or by Hageman factor prealbumin fragments. Its coagulant activity was inhibited by DFP, soybean trypsin inhibitor and trasylol but not by lima bean trypsin inhibitor or ovomucoid trypsin inhibitor indicating that activated PTA possesses the same inhibition profile utilizing these reagents as does plasma kallikrein. A major plasma inhibitor of activated PTA was found to be a 65,000 mol wt alpha-globulin which was isolated free of alpha(1)-chymotrypsin inhibitor, inter alpha-trypsin inhibitor, alpha(2)-macroglobulin, and the other known inhibitors of activated PTA, the activated first component of complement (C1 INH), and antithrombin III. Its physicochemical properties were identical to alpha(1)-antitrypsin, and it was absent in alpha(1)-antitrypsin-deficient plasma thereby identifying this PTA inhibitor as alpha(1)-antitrypsin.

Recent advances in X-ray imaging of breast tissue: From two- to three-dimensional imaging.

Breast cancer is a globally widespread disease whose detection has already been significantly improved by the introduction of screening programs. Nevertheless, mammography suffers from low soft tissue contrast and the superposition of diagnostically relevant anatomical structures as well as from low values for sensitivity and specificity especially for dense breast tissue. In recent years, two techniques for X-ray breast imaging have been developed that bring advances for the early detection of breast cancer. Grating-based phase-contrast mammography is a new imaging technique that is able to provide three image modalities simultaneously (absorption-contrast, phase-contrast and dark-field signal). Thus, an enhanced detection and delineation of cancerous structures in the phase-contrast image and an improved visualization and characterization of microcalcifications in the dark-field image is possible. Furthermore, latest studies about this approach show that dose-compatible imaging with polychromatic X-ray sources is feasible. In order to additionally overcome the limitations of projection-based imaging, efforts were also made towards the development of breast computed tomography (BCT), which recently led to the first clinical installation of an absorption-based BCT system. Further research combining the benefits of both imaging technologies is currently in progress. This review article summarizes the latest advances in phase-contrast imaging for the female breast (projection-based and three-dimensional view) with special focus on possible clinical implementations in the future.

Selective immunoreactivities of kidney basement membranes to monoclonal antibodies against laminin: localization of the end of the long arm and the short arms to discrete microdomains.

To examine the ultrastructural distribution of laminin within kidney basement membranes, we prepared rat anti-mouse laminin mAbs to use in immunolocalization experiments. Epitope domains for these mAbs were established by immunoprecipitation, immunoblotting, affinity chromatography, and rotary shadow EM. One mAb bound to the laminin A and B chains on blots and was located to a site approximately 15 nm from the long arm-terminal globular domain as shown by rotary shadowing. Conjugates of this long arm-specific mAb were coupled to horseradish peroxidase (HRP) and intravenously injected into mice. Kidney cortices were fixed for microscopy 3 h after injection. HRP reaction product was localized irregularly within the renal glomerular basement membrane (GBM) and throughout mesangial matrices. In addition, this mAb bound in linear patterns specifically to the laminae rarae of basement membranes of Bowman's capsule and proximal tubule. This indicates the presence of the long arm immediately beneath epithelial cells in these sites. The laminae densae of these basement membranes were negative by this protocol. In contrast, the lamina rara and densa of distal tubular basement membranes (TBM) were both heavily labeled with this mAb. A different ultrastructural binding pattern was seen with eight other mAbs, including two that mapped to different sites on the short arms by rotary shadowing and five that blotted to a large pepsin-resistant laminin fragment (P1). These latter mAbs bound weakly or not at all to GBM but all bound throughout mesangial matrices. In contrast, discrete spots of HRP reaction product were seen across all layers of Bowman's capsule BM and proximal TBM. These same mAbs, however, bound densely across the full width of distal TBM. Our findings therefore show that separate strata of different basement membranes are variably immunoreactive to these laminin mAbs. The molecular orientation or integration of laminin into the three dimensional BM meshwork therefore varies with location. Alternatively, there may be a family of distinct laminin-like molecules distributed within basement membranes.

Inhibition of human neutrophil and Pseudomonas elastases by the amyloid P-component: a constituent of elastic fibers and amyloid deposits.

The amyloid P-component (AP), a ubiquitous component of amyloid fibrils, is also a plasma protein and a connective tissue constituent. Its proximity to elastin, in particular, suggested that AP might serve to protect elastic tissue from hydrolytic enzymes. The inhibition of pancreatic elastase by AP has been reported. In the present study, the effects of AP on human neutrophil elastase and Pseudomonas elastase were investigated, and AP was shown to interfere with the cleavage of soluble elastin. As indicated by Michaelis-Menten analysis, AP is acting as a noncompetitive inhibitor. C-reactive protein, which is structurally similar to AP, had no effect on either elastase. AP was also found to inhibit the degradation of secondary amyloid fibrils by neutrophil elastase when these structures were first partially purified and then reexposed to AP. AP's ability to inhibit elastase was compared with alpha-1 antitrypsin in the presence and absence of oxidizing agents. These substances, which are released by inflammatory cells, are known to abrogate alpha-1 antitrypsin's anti-protease capacity. This contributes to elevated levels of free proteases in the circulation and extravascular spaces during severe inflammation. AP is not susceptible to oxidation and remains a functional inhibitor under these conditions. The potential role of AP as an elastase inhibitor is discussed.

Laminin cleavage by activated human neutrophils yields proteolytic fragments with selective migratory properties.

We studied the interactions between human neutrophils, as well as the purified human neutrophil serine proteases elastase (HNE) and cathepsin G (HNCG), and laminin. Our results show that intact laminin and two proteolytic fragments generated by HNE bind to neutrophils and stimulate cell migration. Domain-specific antilaminin monoclonal antibodies, rotary shadowing electron microscopy, and Western blotting mapped the two promigratory fragments on the laminin cross to the apical three-armed region and long arm, respectively. In contrast, a fragment derived from the terminal ends of short arms neither bound to neutrophils nor stimulated migration. When neutrophils embedded in a reconstituted basement membrane gel were activated with phorbol myristate acetate, several stable, proteolytic laminin fragments were released into supernatants. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting showed that these fragments appeared identical to those generated after digestion of soluble laminin with HNE and HNCG. Furthermore, release of laminin fragments by embedded neutrophils was inhibited by diisopropyl fluorophosphate, and duplicated by incubating the basement membrane gel with purified HNE and HNCG. Our findings therefore suggest that neutrophils, through release of HNE and HNCG, are capable of digesting basement membrane laminin in vivo. In addition, the release of laminin fragments from damaged basement membranes may promote neutrophil migration and thereby accelerate inflammatory processes.

Human neutrophils do not degrade major basement membrane components during chemotactic migration.

At sites of inflammation, circulating neutrophils (PMNs) migrate through microvessel walls into the subendothelial interstitium. While endothelial passage is mediated by adhesion proteins, including those of the integrin, selectin and immunoglobulin superfamily classes, the mechanisms used to cross the subendothelial basement membrane (BM) are unclear. Studies examining tumour cell invasion and lymphocyte extravasation suggest several possible mechanisms, including proteolysis. Different cells, however, may use different mechanisms to effect passage. To examine neutrophil-basement membrane interactions in more detail, human PMNs were embedded within reconstituted BM (Matrigel) and used in migration assays. The integrity of the gel following migration was assessed by assaying for the release of incorporated radiolabelled products and by-immunoblotting for specific matrix molecule epitopes. PMNs migrated through Matrigel in response to the chemotactic peptide FMLP. Degradation products of laminin, heparan sulphate proteoglycan or of gelatin, however, were not detected. In contrast, phorbol ester, which triggers activation without migration, released approximately 40% of incorporated HSPG, 30% of gelatin and 20% of laminin as intact molecules or degraded fragments. Electron microscopy of migrating cells demonstrated pseudopodia associated with channels within the Matrigel. Although the serine proteinase inhibitor DFP, plasma and a specific anti-neutrophil elastase IgG blocked degradation, these agents failed to inhibit migration. Migration was inhibited, however, when the Matrigel concentration was increased to 10 mg/ml. Thus, although PMNs will degrade matrix components they do not do so during migration, and proteolytic remodelling of the BM is not a pre-requisite for neutrophil passage.

Systemic capillary leak syndrome and monoclonal IgG gammopathy; studies in a sixth patient and a review of the literature.

The clincical and laboratory features of a sixth patient with periodic systemic capillary leak syndrome are reported. During an attack metabolic studies demonstrated a marked shift of plasma (10 to 70%) from the intravascular to the extravascular space resulting in hemoconcentration (highest hematocrit of 82). At the termination of the attack there was a return of the electrolytes, water and proteins to the intravascular compartment. The cardiovascular, renal and endocrine compensation was appropriate to this insult and no underlying abnormalities were demonstrated in these systems. The effector pathways of coagulation, complement, bradykinin generation, prostaglandins and histamine metabolism did not appear to be responsible for the altered capillary permeability. The patient was not missing inhibitors of these same pathways. The only persistently abnormal finding was a monoclonal IgG gammopathy. However, further studies of this paraprotein did not uncover a link between it and the abnormal capillary permeability. Five similar cases are reviewed; at least four and possibly all of these patients also had an IgG paraprotein. Treatment of these attacks was unsuccessful. Attemps to prevent the episodes with a wide variety of therapeutic agents failed. Treatment of the acute attacks with administration of intravenous fluids, did not maintain an adequate intravascular volume and may lead to fluid overload upon return of normal capillary integrity. Pressor agents were of no apparent value and may cause increased cardiac irritability. Although the clinical features and pathophysiology of the capillary leak syndrome have been defined, the etiology remains unknown.

Assessment of total immunoreactive lactoferrin in hematopoietic cells using flow cytometry.

Cell-associated lactoferrin (Lf) was analyzed using a new method involving cell permeabilization, indirect immunofluorescence staining, and flow cytometry. Statistical techniques to evaluate the results for percentage of positive cells, relative fluorescence and homogeneity of Lf distribution were also devised. Most normal adult neutrophils (97.1 +/- 0.3% (SEM), range 92.7-99.6%, n = 41) had brilliant fluorescence homogeneously distributed among the cells. There was significantly greater homogeneity of neutrophil Lf distribution in post-menopausal than pre-menopausal females. In chronic myelogenous leukemia (n = 13) and cord blood (n = 7), fractions of Lf-positive neutrophils were decreased (77.3 +/- 7.5%, range 13.3-96.3%; 71.4 +/- 9.3, range 32.0-95.6%, respectively). Normal monocyte-rich isolates had moderate fluorescence (28.7 +/- 3.6%, range 9.3-76.8%, n = 22). Among blood lymphocyte-rich preparations, 13.1 +/- 1.3% of cells had weak positivity (range 4.9-26.6%, n = 19); monoclonal B and T lymphocytes had similar parameters. No other cells had detectable Lf. Our results were significantly correlated with those obtained manually (r = 0.98, P less than 0.001), and are consistent with Lf quantity and distribution determined using other methods.

Azathioprine hypersensitivity. Case report and review of the literature.

Fever in a transplant recipient is an important sign of graft rejection or infection. Rarely, fever may result from an immunosuppressive agent used to prevent graft rejection. A case of fever, rigors, arthralgias, and myalgias is reported in a cardiac transplant recipient in whom azathioprine therapy was recently begun. These findings resolved on discontinuation of the azathioprine, recurred on rechallenge, and were most consistent with a hypersensitivity reaction. The clinical spectrum of reported azathioprine hypersensitivity reactions is reviewed.

Deletion of the distal long arm of chromosome 1: a definable syndrome.

Based on analysis of 15 cases, there appears to be a characteristic facial appearance and pattern of associated malformations that would allow clinical delineation of deletion of the distal bands of 1q. Characteristic manifestations include round face with prominent "cupid's bow" and downturned corners of the mouth, thin vermilion borders of lips, long upper lip with smooth philtrum, short and broad nose, epicanthal folds, apparently low-set ears, micrognathia, microcephaly, abnormal hands and feet, variable cardiac, genital, and other anomalies, moderate to severe mental retardation, and growth retardation. The deletion includes 1q42 or 1q43----qter and was a de novo defect in nine of 15 cases.

Immediate and delayed hypersensitivity skin test responses to the Dirofilaria immitis filarial skin test (Sawada) antigen in Wuchereria bancrofti filariasis.

In order to assess the immunodiagnostic utility of FST skin test antigen purified from Dirofilaria immitis, skin test responses were analyzed in 177 inhabitants of a South Pacific island hyperendemic for Wuchereria bancrofti filariasis. Although the distribution of immediate hypersensitivity skin test responses was similar to those found in other filarial endemic populations, individual immediate skin test reactions lacked the sensitivity and specificity to identify those with microfilaremia or those with any clinical or parasitologic evidence of filarial disease. Delayed hypersensitivity type skin test reactions were elicited by the antigen in 60% of people but again these delayed cutaneous reactions did not correlate with the presence or absence of stigmata of filariasis. These findings document the limitation of this antigen preparation in the immunodiagnosis of filariasis in residents of an endemic area.

Endemic filariasis on a Pacific island. I. Clinical, epidemiologic, and parasitologic aspects.

The clinical and parasitologic aspects of filariasis were investigated in 459 inhabitants of a South Pacific island endemic for subperiodic Wuchereria bancrofti filariasis. Episodes of filarial fevers, usually with concomitant lymphangitis and/or lymphadenitis, were experienced by 26%. Lymphobstructive lesions, manifest in the later decades of life, were present in 12 with elephantiasis and 24 with hydroceles. Microfilaremia was detectable by membrane filtration of 1 ml of blood in 33% of persons, with a quarter of these having less than 50 microfilariae/ml. Microfilaremia and filarial fevers were more frequent in males than females and in residents of the most inland villages. Neither presence nor magnitude of lymphadenopathy correlated with other manifestations of filariasis except that markedly enlarged inguinal-femoral nodes were more common in those with elephantiasis or hydroceles. A history of filarial fevers did not correlate with presence of microfilaremia. Over 70% of adults had microfilaremia and/or historical or physical manifestations of filariasis. The absence of detectable microfilaremia in many residents with clinical evidence of filariasis and the presence of asymptomatic microfilaremia emphasize the limitations in relying only on microfilaremia rates or clinical findings in the study of the prevalence or manifestations of filarial infection.

User evaluation of an arthritis information telephone service.

Arthritis patients are prone to misperceptions, forgetfulness, and the use of unproven remedies. They also may become noncompliant and be unaware of community resources. Informational or educational programs such as the Arthritis Information Service of Alabama may be useful for reducing these problems. There have been several reports concerning the use of telephone services (e.g.), for providing information about specific diseases but few concerning arthritis. An important step in the evaluation of a telephone information service is the surveying of user opinions concerning the service's procedures and its benefits. The purposes of the present study were to estimate the percentage of users who believed they had benefited from service usage, to identify the potential benefits of service usage, and to identify the groups most likely to report benefits.

The effect of person-centered counseling on the psychological status of persons with systemic lupus erythematosus or rheumatoid arthritis: a randomized, controlled trial.

OBJECTIVE: We tested the effectiveness of a 6-month person-centered (PC), nondirective, telephone-based counseling intervention for improving the psychological status of persons with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). METHODS: The design was a parallel-group, randomized, controlled study comparing a PC counseling intervention (8 SLE, 28 RA patients) with usual care (7 SLE, 30 RA patients). The Arthritis Impact Measurement Scales was used to measure psychological dysfunction, physical dysfunction, and pain at baseline and at followup. RESULTS: The main finding was that the PC counseling intervention significantly improved the psychological status of the SLE patients (P < 0.05, effect size = 1.13, responsiveness = 0.77) in comparison to usual care. There was no evidence of a benefit for persons with RA or of improvements in physical function or pain for persons with either disease. CONCLUSIONS: PC counseling may be an effective intervention for improving the psychological status of persons with SLE, but may not be for those with RA.

Health outcome improvements in patients with systemic lupus erythematosus using two telephone counseling interventions.

OBJECTIVE: To examine the effectiveness of two telephone intervention strategies for improving the health outcomes of patients with systemic lupus erythematosus (SLE). METHODS: Fifty-eight SLE patients were randomly assigned to receive a 6-month telephone counseling intervention using either a treatment counseling (TC) or symptom monitoring (SM) strategy. Health outcomes were assessed using the Fatigue Severity Scale (FSS) and the Arthritis Impact Measurement Scales 2 (AIMS2). RESULTS: At the 6-month followup, the mean AIMS2 Physical Function scale and AIMS2 Social Support scale scores were significantly improved (P < 0.05) for the TC group compared to the SM groups. The mean FSS score, AIMS2 Affect score, and AIMS2 Pain score were significantly improved (P < 0.05) for both groups. CONCLUSIONS: Telephone interventions, especially using the TC approach, can be effective for improving the functional status of persons with SLE.

Confirmation of brain death with portable isotope angiography: a review of 204 consecutive cases.

Intravenous isotope angiography is a rapid, safe, and specific bedside test for confirming brain death by demonstrating the lack of critical cerebral perfusion that occurs in this condition, regardless of etiology. A review of 204 consecutive cases of suspected brain death studied with isotope angiography has reaffirmed our confidence in the specificity of the technique and has convinced us to make less stringent our radiographic criteria for confirming brain death by this method. A technically satisfactory single flow study that shows arrest of the carotid circulation at the base of the skull and absence of the intracranial arterial circulation may be considered confirmatory of a carefully established clinical diagnosis of brain death, even though there may be some visualization of the intracranial venous sinuses. Arbitrary waiting periods, withdrawal of sedative drugs, and electrophysiological studies are not needed when this technique is used.

Release of elastase from purified human lung mast cells and basophils. Identification as a Hageman factor cleaving enzyme.

Elastase, a serine protease, is capable of inducing severe lung destruction in experimental animal models. We now report that this proteinase exists preformed in neutrophil-free sonicates of purified human lung mast cells (greater than 98% purity) and in circulating peripheral blood basophils (greater than 97% purity). The elastase levels in both cell types (41-174 ng/10(6) cells) represents approximately 3-20% of those found in human neutrophils; both cell types released their elastase following anti-IgE and ionophore A23187 challenge. The apparent molecular size of the mast cell enzyme on Sephadex G-100 gel filtration, as well as its inhibition profile, was identical to that of purified human neutrophil elastase. This mast cell elastase is identical to our previously reported mast cell-derived Hageman factor cleaving activity. Mast cell-, basophil-, and neutrophil-derived elastases cleave Hageman factor into fragments of 52,000 and 28,000 Da; cleavage by all three enzymes is inhibited by preincubation with polyclonal antibodies directed against human neutrophil elastase.