Function of minor polypeptides in foot-and-mouth disease virus and poliovirus.

Foot-and-mouth disease virus and poliovirus each contain several minor polypeptides, in addition to the four structural proteins. One of these, the viral RNA polymerase, can also act as a nuclease, hydrolysing the RNA and thus destroying viral infectivity. It is tightly bound to the RNA and may be the packaging signal for assembly of the particle.

Baculovirus expressed 2C of foot-and-mouth disease virus has the potential for differentiating convalescent from vaccinated animals.

Determining whether animals have been infected with foot-and-mouth disease virus or vaccinated is important because infected animals frequently become carriers of the virus, shed it intermittently and thus may be the source of new outbreaks of the disease. We had shown previously that the sera of convalescent animals contain antibodies to 2C, a highly conserved non-structural protein, whereas the sera of vaccinated animals do not. This is explained by observation that 2C is retained on the membranes of cells used for growing the virus for vaccine production. In contrast, the non-structural protein 3D, which is released into the medium, is not removed by centrifugation or filtration during vaccine production and therefore stimulates an immune response in both vaccinated and convalescent cattle. In this study we produced 2C and 3D in insect cells infected with recombinant baculoviruses. As demonstrated by serology and electron microscopy, 2C is also retained on the membranes of the insect cells. Both expressed proteins react with sera of convalescent animals, indicating that they are conformationally similar, but the 2C does not react with sera from vaccinated animals. The baculovirus expressed 2C appears to be a suitable antigen for the development of a reliable diagnostic test.

Regular pattern of preventive dental services--a measure of access.

Having a regular pattern of care should be an indicator of access to and periodic use of preventive and health maintenance services. The analyses reported in this study are intended to provide a better understanding of the factors related to having a regular pattern of preventive dental care. The data were collected in 1981 as part of a U.S. household survey, 'A Study of Dental Health Related and Process Outcomes Associated with Prepaid Dental Care', the most comprehensive cross-sectional data base available in dentistry. Descriptive analyses of a constructed variable, representing perceived and realized access and a preventive orientation, indicate that 53% of the population had a regular pattern of preventive care. Those with a regular pattern of care were more likely to be white, younger, have dental insurance, have no cost barriers, have more than 12 years of education, be dentate, have no perceived symptoms, and no fear of pain. Logistic regressions indicated that there was an increased probability of having a regular pattern of preventive care if individuals had no economic access problems, had positive attitudes, had higher income, reported few oral symptoms, and were non-Black. Overall, the descriptive models used suggested that individuals with resources in the form of finances and education, and a sense of self-efficacy as expressed in attitudes toward oral health, had the greatest probability of having a regular pattern of preventive care.

Peptide mapping of the group-specific antigens from the Australian bluetongue virus (BTV-20) and serotypes from southern Africa and North America.

The Australian bluetongue virus (BTV-20) was compared with six serotypes isolated in southern Africa and North America by peptide mapping of the virus proteins with group antigen properties. The p7 group antigens from each of the seven serotypes analysed did not have identical primary structures and a comparison of shared and unique tryptic peptides has been used as a means of estimating virus relationships. Whereas serological studies have suggested that BTV-20 is closely related to BTV serotypes 4 and 17, comparative peptide mapping of p7 indicates a different set of relationships with viruses from both southern Africa and North America. In contrast with cross-immune precipitation results, peptide mapping of p3 suggest that this protein is not a group specific antigen.

The decline in the Blue Cross Plan admission rate: four explanations.

Between 1968 and 1979, there occurred a steady decrease in the hospital admission rate for Blue Cross Plan members, in contrast to the steady increase in the admission rate for the under-65 U.S. population as a whole. Four general factors were studied to explore the reasons for this relative decrease: utilization control and cost containment activities instituted by Blue Cross Plans, the decline in Plan nongroup membership, duplicate coverage within families, and deficiencies in the family factor technique to estimate overall Plan membership. With some interesting exceptions within one of the factors, all four offer plausible explanations for the decline in the admission rate among Blue Cross Plan members.

The Providence Plan: prepaid health care for a voluntarily enrolled population.

In July 1979, Oregon Physicians' Service and Providence Medical Center (PMC) entered into a contract that established the Providence Plan, a prepaid health care delivery system. The most innovative feature of the plan is the method of paying for hospital service: PMC is paid a prospectively fixed amount per enrolled person per month to cover the total costs of hospital inpatient and outpatient care. From this capitation-based fund, PMC pays other hospitals for services it cannot provide directly. The Providence Plan marks the first cooperative effort in Portland between a single hospital, its active medical staff, and an insuring organization for the organization and operation of a fully functioning health care delivery system in competition with existing formal and informal delivery systems.

Medical expenditures of terminal cancer patients during the last year of life.

To measure the patterns of medical expenditures under conventional modes of cancer care for the terminally ill, we examined Blue Cross and Blue Shield Plan claims records for care during the 12 months preceding the deaths of 1,054 nonelderly patients diagnosed as having breast, colon-rectal, or lung cancer. Expenditures averaged +21,219 for the terminal year and grew exponentially as death approached, with +6,161 (29%) being spent in the final month alone. We found very few significant differences in spending or utilization by diagnosis, age, or sex of the terminal patient, but sizable differences by state of residence and between nonmetropolitan and metropolitan area residents. Our findings represent a baseline against which experience under new hospital payment strategies and alternative delivery systems might be compared.

The Hospital Capitation Payment Project: new incentives and tools for cost containment.

Blue Cross of North Dakota, Blue Cross of Massachusetts, and the Blue Cross and Blue Shield Association, along with 10 hospitals, developed and implemented the Hospital Capitation Payment Project as a novel approach for containing escalating hospital costs. The hospital is paid a prospective, fixed amount for each person covered; in exchange, it assumes responsibility to provide or pay for all covered services needed by that individual. This responsibility extends to payment for covered care provided by other hospitals. The new tools and incentives created by the program, notably an innovative management information system, are designed to help hospitals better manage the health care needs and related costs of a defined population.

Oral health activities of U.S. children: results of a national health interview survey.

Data from the 1989 National Health Interview Survey show oral health activities for U.S. children aged 2-17. Key population subgroups neither received optimal preventive care nor visited a dentist regularly.

How older adults use oral health care services: results of a National Health Interview Survey.

This report describes the dental visit patterns of adults aged 65 and older. The analyses compare dental visit patterns by socioeconomic factors, perceived health status and dentate status.

Differentiating foot-and-mouth disease virus-infected from vaccinated animals with baculovirus-expressed specific proteins.

We had shown in preliminary studies with a small number of animals that antibodies against 2C could be detected in cattle and pigs which had been infected with FMDV but not in animals which had been vaccinated against the disease. To determine whether this test was generally applicable, sera from several hundred animals which had been vaccinated with different products in many countries have been tested in an ELISA using baculovirus expressed 2C. Our results show that only 1-2% of the sera gave a positive reaction by this method. In contrast, 100% of sera from convalescent animals gave a positive reaction. To be useful in differentiating between convalescent and vaccinated animals it is necessary to know how long these antibodies can be detected by our ELISA. We have determined the levels of antibodies against 2C and also other virus-specific proteins which are present in cattle and pigs following infection with FMDV. Our results show that levels of anti-3ABC antibodies could be detected by ELISA with baculovirus-expressed protein up to one year after infection. In contrast, the levels of anti-2C antibodies fell more rapidly than those against 3ABC indicating that the latter protein may be preferable for detecting convalescent animals. Nevertheless, we envisage that the final test format should include several virus-specific proteins to determine accurately the immune status of an animal.

CEO performance appraisal: review and recommendations.

CEO performance appraisal (PA) is very valuable to an organization, but the chances of obtaining a PA of high quality decrease as executive responsibility increases. The realities of CEO PA are that it: (1) is inevitable; (2) is creative and complex; (3) involves politics; and (4) has a significant effect on the organization and the executive. PA is conducted for legal and social requirements, to enhance communication, to provide opportunities for improvement, and to relate performance to compensation. This article discusses several problems with chief executive officer (CEO) PA and the contemporary approaches that seek to improve it. Three fundamental areas for evaluation are identified: (1) organizational success; (2) areawide health status; and (3) professional role fulfillment. These provide an outline for successful healthcare PA. In addition to a discussion of the strategic considerations behind a successful CEO PA system, several recommendations are offered for the implementation of the annual evaluation process. The final goal of CEO PA is to link its results to CEO incentive compensation. It is strongly recommended that some portion of the CEO's salary directly hinge on his performance in two critical areas: organizational effectiveness and community health status.

Antibody response to bacterial antigens covalently bound to biodegradable polymerized serum albumin beads.

Model vaccines have been made by covalently linking Clostridium botulinum type D toxin and Klebsiella pneumoniae capsular polysaccharide antigen to polymerized rabbit serum albumin beads. When injected into rabbits these bead vaccines induced an enhanced production of specific humoral antibody without causing adverse reactions. The adjuvant effect is due to a slow release from the bead structure and offers an alternative to oil emulsions and mineral salt adsorbents.

Managed care and ethical conflicts.

Managed care systems achieve efficiencies by rationing the resources used to deliver care. This rationing has led to widespread perceptions of patient abuse and neglect in the form of restricted access to care, denial of choice, and overall reduction in the quality of care delivered. Conflicts of interest and fundamental ethical principles are perceived as often compromised in the managed care environment. We argue that ethical issues are inherent in managed care and cannot be avoided. Recently, federal and state governments have passed legislation and regulations to deal with the issue.