Agreement in dry eye management between optometrists and general practitioners in primary health care in the Netherlands.

PURPOSE: To investigate the agreement in dry eye care management between general practitioners (GPs) and optometrists in the Netherlands. METHODS: A web-based survey was used to investigate the agreement in symptoms associated with dry eye, causes of developing dry eye, and investigative techniques used in practice, between GPs and optometrists. Additional questions surveyed knowledge of the latest research, and co-management of dry eye disease in primary healthcare. The anonymised questionnaire contained 16 forced-choice questions with Likert scales, and was sent to 1471 general medical practitioners and 870 registered optometrists. The response data was stored on an online database, and was converted directly to text format for analysis using SPSS 21 statistical analysis software. RESULTS: 138 optometrists and 93 GPs responded to the survey (Cronbach α=0.885, optometrists, and 0.833, GPs). Almost no agreement was found for all the questions: a statistically significant difference (Chi-square p<0.0001) was found between the optometrists and GPs in the use of investigative techniques, associating symptoms, causes of dry eye (p>0.0001), and dry eye symptoms, except for 'burning sensation of the eye' and 'irritation of the eye' as agreed symptoms, and agreement that dry eye is an age-related disease. CONCLUSIONS: As the optometrist and the GP are the gatekeepers for secondary healthcare, the fundamental differences in the methods of investigation and interpretation of dry eye-related symptoms, the possible cause of developing dry eye disease, and the therapy given by GPs and optometrists in the Netherlands, may have a significant impact on consistency of patient care.

Acute hemolytic transfusion reaction caused by anti-Coa.

Coa is a high-frequency blood group antigen in the Colton blood group system expressed on red blood cells (RBCs) of approximately 99.8 percent of random persons. Anti-Coa has been reported to cause delayed hemolytic transfusion reactions, hemolytic disease of the newborn, and accelerated clearance of RBCs in vivo. Acute hemolytic transfusion reactions (AHTRs) have not previously been reported. A 58-year-old man was hospitalized for vascular surgery. Initial blood bank evaluation revealed anti-Fya. The patient received six units of RBCs during his initial hospitalization and developed anti-E. A subsequent sample was sent to the reference laboratory when all units of RBCs appeared incompatible. Additional studies, including alloadsorptions, revealed the presence of anti-E, anti-Fya, and an apparent warm autoantibody. One unit of least-incompatible RBCs was transfused during surgery. The patient had an increase in temperature. Hemoglobinuria and a decrease in hematocrit were also noted. Due to the clinical impression of an AHTR, the pre- and postreaction samples were reevaluated in the reference laboratory and demonstrated the presence of anti-Coa in both. Based on clinical and laboratory evaluation this patient appears to have had an AHTR due to anti-Coa. This is the first known reported case of an AHTR caused by anti-Coa.

A reactive coordination scheme for a many-robot system.

This paper presents a novel approach for coordinating a homogeneous system of mobile robots using implicit communication in the form of broadcasts. The broadcast-based coordination scheme was developed for the Army Ant swarm-a system of small, relatively inexpensive mobile robots that can accomplish complex tasks by cooperating as a team. The primary drawback, however, of the Army Ant system is that the absence of a central supervisor poses difficulty in the coordination and control of the agents. Our coordination scheme provides a global "group dynamic" that controls the actions of each robot using only local interactions. Coordination of the swarm is achieved with signals we call "heartbeats". Each agent broadcasts a unique heartbeat and responds to the collective behavior of all other heartbeats. We generate heartbeats with van der Pol oscillators. In this application, we use the known properties of coupled van der Pol oscillators to create predictable group behavior. Some of the properties and behaviors of coupled van der Pol oscillators are discussed in detail. We emphasize the use of this scheme to allow agents to simultaneously perform an action such as lifting, steering, or changing speed. The results of experiments performed on three actual heartbeat circuits are presented and the behavior of the realized system is compared to simulated results. We also demonstrate the application of the coordination scheme to global speed control.

Extended in vivo half-life of human soluble complement receptor type 1 fused to a serum albumin-binding receptor.

A new approach has been used to extend the T(1/2) of human soluble complement receptor type 1 (sCR1) in rats. The albumin-binding domains B2A3 (BA) and B1A2B2A3 (BABA) from Streptococcal protein G were fused to the carboxyl terminus of sCR1, and the recombinant genes were expressed and amplified in Chinese hamster ovary cells. Western blot analysis and surface plasmon resonance measurements demonstrated the binding of rat serum albumin to both sCR1-BA and sCR1-BABA but not to sCR1. The in vitro complement inhibitory activity of the fusion proteins was shown to be similar to that of sCR1, indicating that neither the albumin-binding domains nor the presence of bovine serum albumin interfere with sCR1 function. Pharmacokinetic analysis showed that the T(1/2) of the distribution phase (T(1/2alpha)) was 3.3, 20.0 and 6.0 min for sCR1, sCR1-BA and sCR1-BABA, respectively. The T(1/2) of the elimination phase (T(1/2beta)) was 103, 297 and 170 min for sCR1, sCR1-BA and sCR1-BABA, respectively. The plasma elimination of sCR1-BA and sCR1-BABA was significantly (P < .05) prolonged as compared to sCR1. The proteins showed similar tissue distribution; at 4-hr postdosing, the highest levels of 125I-radioactivity per gram of tissue were localized in the urine, blood, liver, stomach, and small intestine.

Cell surface expression of the C3b/C4b receptor (CR1) protects Chinese hamster ovary cells from lysis by human complement.

The C3b/C4b receptor, also known as complement receptor type 1 (CR1, CD35), is a single chain glycoprotein consisting of 30 repeating homologous protein domains known as short consensus repeats (SCR) followed by transmembrane and cytoplasmic domains. A series of recombinant proteins derived from CR1 has been prepared and assessed for the capacity to inhibit complement lysis of the host Chinese hamster ovary (CHO) cells. The full-length recombinant CR1 inhibited human complement-mediated CHO cell lysis, and the efficiency of inhibition was directly proportional to the number of receptors/cell. The SCR 15-18 of CR1, but not SCR 15-16, inhibited complement lysis of the host CHO cell, bound monomeric C3b (Kd,app = 6.5 x 10(-7) M), and dimeric C3b (Kd = 1.8 x 10(-8) M), and served as a cofactor in the proteolysis of C3b by factor I, confirming and extending the observations of Fearon and colleagues (Kalli, K. R., Hsu, P., Bartow, T. J., Ahearn, J. M., Matsumoto, A. K., Klickstein, L. B., and Fearon, D. T. (1991) J. Exp. Med. 174, 1451-1460). The SCR 1-4 of CR1, but not SCR 1-2, also inhibited complement lysis of the host CHO cell, indicating that more than two SCR are necessary and that four SCR are sufficient for optimal C4b binding to CR1. Thus, the structural requirements for C4b binding are analogous to those for C3b binding, namely, four SCR of CR1 form the binding sites for each of these proteins. CR1 has long been recognized to regulate extrinsic complement activation, that is, to bind to and promote the degradation of fluid phase C3b and of C3b attached to immune complex. These results demonstrate that CR1 is also an intrinsic regulator of complement activation in that, under appropriate conditions, CR1 inhibits complement-mediated lysis of the cell on which it is expressed.

The role of polymorphic HLA-DR beta chain residues in presentation of viral antigens to T cells.

The relative importance of 11 polymorphic positions in the HLA-DR7 beta 1 chain in T cell recognition of foreign antigens was investigated using transfectants expressing mutant DR7 beta 1 chains as APC for five rabies virus-specific T cell clones. The results indicate that multiple amino acids, located in both the beta-strands and alpha-helix of DR7 beta 1 in the model of a class II molecule, are involved in DR7-restricted T cell recognition of these antigens. Many of the substitutions appeared to reduce the affinity of an antigenic peptide for the mutant DR7 molecules but did not prevent binding. The heterogeneity of responses of the three G-specific T cell clones to presentation of the G11.3 peptide by several of the mutant DR7 molecules indicates that the T cell receptor (TCR) of each these clones requires a different view of the G11.3/DR7 complex and raises the possibility that the G11.3 peptide may bind to the DR7 molecule in more than one conformation.

Detection of equine infectious anemia virus in horse leukocyte cultures derived from horses in various stages of equine infectious anemia viral infection.

The enzyme-linked immunosorbent assay (ELISA) antigen-positive and agar-gel immunodiffusion test (AGID)-negative horses do not have infective equine infectious anemia (EIA) virus. The ELISA testing of horse leukocyte culture (HLC) supernatants did detect EIA virus in a HLC that was infected with the Wyoming strain of EIA virus and in HLC derived from horses in febrile, acute, or subacute stages of EIA infection. In supernatants of HLC derived from chronic and inapparent carrier horses, EIA virus was not detected with ELISA. Direct fluorescent antibody tests detected EIA virus in HLC infected with 10(6)TCID50 of the Wyoming strain of EIA virus and in 50% of the HLC from febrile acute or subacute horses. The direct fluorescent antibody testing of HLC derived from chronic and inapparent carrier horses did not detect cell-associated EIA virus. The pony inoculation test proved to be the most reliable and accurate method for detecting infective EIA virus in horses in various stages of EIA infection and accurately correlated with the AGID test.