Do Patient Assessments of Hospital Quality Correlate With Kidney Transplantation Surgical Outcomes?

BACKGROUND: Currently, transplant patients have limited metrics available to understand transplant center quality. Graft and patient survival do not capture the patient experience, and patients may use more general consumer assessments of hospital care to help select transplant centers. We evaluated whether consumer assessments of hospital quality correlate with short- and long-term kidney transplant center performance. MATERIALS AND METHODS: CMS uses the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to publicly report patients' perspectives on hospital care. We merged 2012 SRTR kidney transplant (n = 200 centers), HCAHPS and American Hospital Association survey data. Center performance was determined by variation in observed-to-expected (O/E) ratios for 1-month and 1-year graft failure. We used multivariate regression to determine whether HCAHPS measures correlate with center performance, after risk-adjusting for structural characteristics and volume. RESULTS: Center-specific graft failure varied significantly (30 day O/E range: 0-4.1). At 30 days, compared to average centers, cleanliness (OR = 1.26, P = .001), patient recommendation (OR = 1.18, P = .005), and high overall ratings (OR = 1.11, P = .036) predicted high performance. Poor nursing-patient communication (OR = 0.70, P = .030), lower cleanliness (OR = 0.67, P < .001), poor overall ratings (OR = 0.79, P = .038), and no recommendation (OR = 0.68, P = .019) correlated with average/low performance. There was no significant correlation between HCAHPS measures and 1-year outcomes. CONCLUSIONS: The association between hospital consumer assessments of hospital care and center performance after kidney transplantation is limited. More specific metrics oriented to capturing transplant patient perspectives may be valuable in further defining transplant quality.

Regulation of the calcium-activated neutral proteinase (CANP) of bovine brain by myelin lipids.

Since calcium-activated neutral proteinase (CANP; calpain) activation occurs at the plasmalemma and the enzyme is found in myelin, we examined myelin lipid activation of brain CANP. Purified lipids were dried, sonicated and incubated with purified myelin CANP. The CANP was assayed using [14C]azocasein as substrate and the Ca2+ concentration ranged from 2 microM for muCANP to 5 mM for mCANP. Phosphatidylinositol (PI), phosphatidylserine (PS) and dioleoylglycerol stimulated the mCANP activity by 193, 89 and 78%, respectively. PI stimulated both m- and muCANP in a concentration-dependent manner, while phosphatidylcholine was least effective. Cerebroside and sulfatide at higher concentrations (750 microM) were stimulatory. The phospholipid (PL)-mediated activation was inhibited by the PL-binding drug trifluoperazine. PI reduced the Ca2+ requirement for CANPs significantly (20-fold). These results suggest that acidic lipids and particularly acidic phospholipids activate membrane CANP.

Purification and characterization of protease activated by sulfur mustard in normal human epidermal keratinocytes.

A membrane-bound protease induced by sulfur mustard in cultured normal human epidermal keratinocytes (NHEK) was purified and partially characterized. Maximum enzyme stimulation occurred at 16 hr after normal human epidermal keratinocytes were exposed to 300 microM sulfur mustard. Purification to homogeneity of the protease was accomplished by Triton X-100 solubilization, ultracentrifugation, and dialysis, followed by ion-exchange chromatography through DEAE-cellulose and finally hydrophobic column chromatography through phenyl Sepharose. Analysis of the purified enzyme by SDS-PAGE revealed a single polypeptide at the 80 kDa region. Further investigation of biochemical properties showed that a synthetic serine-specific Chromozym TRY peptide and the physiological protein laminin were good substrates for this enzyme. Moreover, this enzyme was inhibited mostly by the serine-protease inhibitors leupeptin and di-isopropyl fluorophosphate and not by the cysteine protease inhibitor E-64 or the metalloprotease inhibitor 1,10-phenanthroline (Component H, CH), indicating the serine protease nature of this enzyme. This enzyme had a pH optimum in the range of 7.0 to 8.0. Amino acid sequencing of the purified enzyme revealed that this enzyme belongs to the endopeptidase family (serine protease), and is homologous with a mammalian-type bacterial serine endopeptidase that can preferentially cleave K-X, including K-P. These results suggest that serine-protease stimulation may be one of the mechanisms of mustard-induced skin blister formation, and that some specific serine-protease inhibitors may be useful for the treatment of this sulfur mustard toxicity.

Studies on beta-endorphin and membrane-bound calcium interaction using chlorotetracycline (CTC) as a fluorescence probe.

Studies on the in vitro interaction of beta-endorphin with different biomembrane preparations, measured in terms of Ca2+ induced chlorotetracycline (CTC) fluorescence alterations indicate that beta-endorphin causes release of calcium ion from both synaptosomal and erythrocyte membrane stores but not from rat brain mitochondria. It seems that the binding pattern or interaction of beta-endorphin with synaptosomes and erythrocytes are characteristically different from that of mitochondria, indicating some functional significance of this differential interaction.

Distribution of calcium-activated neutral proteinase activity in quaking mouse brain: a subcellular study.

The distribution of calcium-activated neutral proteinase (CANP) activity was examined in the subcellular fractions of quaking and control mouse brain. The CANP activity was determined in purified myelin, cytosol and pellet (P2, consisting of nuclei, mitochondria and microsomes) fractions using [14C]azocasein as substrate. The enzyme activity in quaking brain was 1.3-fold greater than control. Fifty-seven percent of the control brain activity was in purified myelin compared to only 7% in quaking myelin. The specific activity of the control purified myelin was 4-fold greater than homogenate while that of the quaking was two-fold greater. In contrast, 51% of the quaking brain activity was present in cytosol compared to only 18% in the control. Triton X-100 greatly increased the control brain activity (10-fold) while the quaking brain activity was increased by only 1.2-fold. The total calcium content in the quaking brain was greatly elevated (6-fold) compared to control. Approximately 30% of the brain 2',3'-cyclic nucleotide 3'-phosphohydrolase (CNPase) activity was in quaking myelin while 77% of the CNPase activity in control brain was in myelin. These results suggest that in quaking brain much of the CANP is not incorporated into the myelin membrane and remains cytosolic.

Calcium-activated neutral proteinase (calpain) in rat brain during development: compartmentation and role in myelination.

The activity of both forms (microM and mM Ca(2+)-sensitive) of calcium-activated neutral proteinase (calpain) was determined in developing rat brain. Triton X-100 did not affect mcalpain activity at the earlier ages (1-5 days postpartum) whereas mcalpain activity significantly increased at 16 days and older. The mcalpain activity in brain was negligible at earlier ages (1-7 days) and the peak activity occurred between 16 and 30 days after birth. The peak activity of mcalpain in myelin was found between 16 and 30 days of age and myelin from rats older than 30 days contained 40-50% of the brain mcalpain activity. In contrast, 70-80% of the brain mcalpain activity was in cytosol at younger ages (1-10 days) and decreased to 30% with increasing age (90 days). On the other hand, mu calpain was found mainly (65-75%) associated with a membrane fraction (microsomes) before 10 days and the majority of the activity was found in cytosol (68%) between 16 and 30 days. Immunoblot studies revealed mcalpain in both myelin and cytosol from developing rat brain. These results indicate that mcalpain is present in myelin and suggest that it may be involved in the formation of myelin sheath.

Distribution of calcium activated neutral proteinase (mM CANP) in myelin and cytosolic fractions in bovine brain white matter.

The activity of calcium-activated neutral proteinase (mM CANP) was determined in homogenate, myelin and supernatant of bovine brain corpus callosum. The enzyme activity in homogenate and myelin was increased eleven and thirteen-fold respectively by Triton X-100. Myelin prepared by the method of Norton and Poduslo as well as by a modified method, was shown to contain most (more than 50%) of homogenate mM CANP activity. The specific activity was highest in myelin, and increased almost three times more than the homogenate. Supernatant only contained 17% of enzyme activity. It is concluded from these studies that mM CANP is tightly bound to the membrane and predominantly associated with the myelin sheath.

Selective extraction and photometric determination of trace vanadium with cinnamohydroxamic acid in MIBK and its application to steel and rock ore analysis.

A sensitive and selective photometric method for the trace determination of vanadium with cinnamohydroxamic acid extracted from 1.8 M HCl in methyl isobutyl ketone is described. The wine-red chelate formed under an optimum acidity of 1.3-2.6 M HCl absorbs with a maximum at 525 nm. Beer's law is obeyed in the range 0-8 ppm of vanadium(V) and the optimum range of determination of vanadium is found to be 1-8 ppm. The molar absorptivity and Sandell's sensitivity are 6.0 x 10(3) l mol(-1) cm(-1) and 0.0086 mug cm(-2) of vanadium(V) at 525 nm. The photometric determination of trace amounts of vanadium in materials such as alloys, minerals and rock ores is also reported. The solvent extraction methods are simple, rapid and highly selective with fluoride used as a masking agent for Fe and Ti. The standard deviations are minimal and the mean error is only 0.015%.

Solvent extraction and photometric determination of molybdenum (VI) with 2-aminobenzenethiol.

A new extractive photometric method is described for estimation of molybdenum with 2-aminobenzenethiol. The green complex in chloroform has its absorbance maximum at 700 nm and is stable for 2 hr when extracted from a solution of optimum pH range 1.4-2.8. The extraction is quantitative. The sensitivity is 0.0075 microg cm (2). Beer's law is obeyed over the range 0.25-10 ppm with optimum range 0.5-4.5 ppm. The molar absorptivity is 7.08 x 10(4) 1.mole(-1). cm(-1). The overall stability constant is 2.0 x 10(8) at 25 +/- 0.1 degrees.

Spectrophotometric estimation of molybdenum with disodiom cis-1,2-dicyanoetfaylene-1,2-dithiolate.

A rapid spectrophotometnc method is described for estimation of molybdenum by use of the molybdenum-dicyanoethytene dithiolate complex. The bright green complex has its absorption maximum at 665 nm and in 50% aqueous acetonitrilc is stable for several days at 3M hydrochloric add concentration, The estimation is more sélective if longer wavelengths and high acidity are used. Beer's law is obeyed over the range 1-16 ppm molybdenum, optimum range 4-16 ppm. The overall formation constant Of the complex with metal to ligand ratio of 1:4 is 5 +/- 2 x 10(18). The molar absorptivity is 5.05 x 10(3) l.mole(-1).cm(-1).

Extraction of vanadium(V) chelates with N-benzohydroxamic acid (BHA) and ammonium thiocyanate and its application in steel and rock analyses.

A mixed-ligand complex of vanadium(V) with N-benzohydroxamic acid and thiocyanate formed at various acidities can be extracted into methyl isobutyl ketone, and used for photometric determination of trace amounts of vanadium in materials such as alloy steels and rocks. The absorption maximum of the violet mixed-ligand complex is at 535 nm. The values for the simple complex are 505 nm and molar absorptivity 7.4 x 10(3)l.mole(-1).cm(-1).

Isolation of Vibrio cholerae 0139 phages to develop a phage typing scheme.

Five V. cholerae 0139 phages isolated from different parts of India have been used for phage typing study. A strain isolated from Nagpur city (NPR-4) was used as the host for phage propagation. All but one of the 260 strains of V. cholerae 0139 were found to be typeable and could be clustered into 8 distinct phage types as revealed by lytic patterns. Phage type 1 was the predominant type (61.15%) followed by type 2 (18.46%). The strains isolated from Madras exhibited 7 out of 8 phage types. These newly isolated phages could be adopted for phage typing of V. cholerae 0139 strains as an epidemiological tool.

Biological activity & interaction of Vibrio cholerae bacteriophages in rabbit ileal loop.

A set of ten V. cholerae EITor phages is in routine use for phage typing of V. cholerae O1 biotype EITor strains. These phages were used in rabbit ileal loop experiment to investigate whether these phages have any prophylactic value as regards their lytic capability on V. cholerae strains. The phages were found to have no prophylactic use as they were unable to lyse the standard bacterial strain V. cholerae MAK 757.

Distribution of phage type of Vibrio cholerae O1 biotype ElTor in Indian scenario (1991-98).

During the period 1991-98, distribution of biotype, serotype and phage type of V. cholerae O1 strains isolated from different parts of the country and referred to the National Institute of Cholera and Enteric Diseases, Calcutta were studied. Of the 8101 strains received, 5613 (69.2%) were subjected to phage typing. All these strains belonged to the biotype ElTor and Ogawa was the predominant serotype (96.08%). The strains were clustered into only two types--types 2 and 4 and around 10 per cent strains remained untypable. However, using the new scheme, all these strains were found to be typable and 8 major types were recognized of which type number 27 was the predominant type (66.12%). The distribution of a common type throughout the country suggests that a particular clone of V. cholerae O1 is probably circulating all over India. A constant monitoring through phage typing is necessary to observe the emergence of any new clone of V. cholerae O1 in India.

Comparison between the multiplex PCR, sensitivity to biotype specific phages & polymyxin B for biotyping of Vibrio cholerae O1.

A total of 196 Vibrio cholerae O1 strains isolated between 1970 and 1996 were biotyped by multiplex PCR, susceptibility to polymyxin B and sensitivity to biotype specific phages. We modified the multiplex PCR by increasing the primer concentration of tcpA to improve the results. Comparison of the results of modified multiplex PCR and sensitivity to biotype specific phages and to polymyxin B showed that multiplex PCR was as efficient as phage typing for biotyping of V. cholerae O1. All the strains of V. cholerae O1 could be accurately distinguished based on polymyxin B sensitivity. Thus our results show that susceptibility of strains of V. cholerae O1 to polymyxin B is the easiest method to biotype V. cholerae O1 and is feasible in most laboratories when compared with multiplex PCR and sensitivity to biotype specific phages.

Trace elements in the sera of leprosy spectrum.

Serum zinc, copper, calcium and magnesium levels were estimated by atomic absorption spectrophotometry in 56 leprosy patients comprising 14 BT, 12 BB, 11 BL and 19 LL. These findings were evaluated in comparison to 42 normal subjects serving as controls. A significant elevation of serum copper was recorded while reduction in zinc, calcium and magnesium was noted throughout the leprosy spectrum. The findings of our study are of considerable importance and need to be taken note of in the light of delineating these alterations to be the cause or effect of the disease.

Electroacupuncture and its effect on rat hepatic functions.

The effect of single, acute (7 pulses/sec., 0.75 volt) and chronic (4 pulses/sec., 0.75 volt) electroacupuncture (EA) treatment on alternate days for a period of 21 days on hepatic functions of rats were studied at cellular and subcellular levels. The points used for EA were Shenshu, Dachangshu and Zusanli. After chronic treatment, (a) protein, RNA, phospholipid, and cholesterol contents of whole liver and liver microsomal fraction increased significantly, (b) liver microsomal G-6-Pase activity increased significantly, (c) microsomal lipid peroxidation value decreased, (d) lipase activity increased. After acute treatment, (e) phospholipid, and cholesterol contents of the whole liver and liver microsomal fraction increased significantly, (f) liver microsomal G-6-Pase activity increased significantly, (g) liver microsomal lipid peroxidation value decreased, (h) GPT and lipase activity of liver increased. The parameters unchanged in acute treatment were as follows: (i) protein, RNA content, (j) GOT activity of the liver, (k) SGOT and SGPT activity, (1) hepatic triglyceride. The parameters unchanged in chronic treatment were as follows: (m) GOT and GPT activity of the liver, (n) SGOT and SGPT activity, (o) hepatic triglyceride. No apparent harmful effect of EA on rat hepatic functions is obvious from present study.

Epidemiology of group-A streptococcal infection amongst children of different ethnic groups in Darjeeling.

The carrier rate of Group A Streptococcus (GAS) was studied amongst 932 children from 1+ upto 12 years of age in three major racial groups in the foothills of the Darjeeling district of West Bengal. It was altogether 13 per cent and was found to be evenly distributed in the three ethnic groups as Gurkhas: 11 per cent, Rajbanshis: 15 per cent and Cosmopolitans: 13 per cent, but the incidence of Rheumatic fever and/or Rheumatic heart diseases were unnoticed among the Gurkha children who also had significant low ASO titres.