Severe life-threatening Ehrlichia chaffeensis infections transmitted through solid organ transplantation.

BACKGROUND: Donor-derived infections from organ transplantation are rare occurrences with preoperative screening practices. Ehrlichia chaffeensis, a tick-borne illness, transmitted through solid organ transplantation has not been reported previously to our knowledge. We present cases of 2 renal allograft recipients who developed severe E. chaffeensis infection after receipt of organs from a common deceased donor. METHODS: The 2 renal transplant patients who developed E. chaffeensis infection are reported in case study format with review of the literature. RESULTS: Approximately 3 weeks after renal transplantation, both patients developed an acute febrile illness and rapid clinical decline. Recipient A underwent an extensive infectious workup that revealed positive E. chaffeensis DNA from polymerase chain reaction on peripheral blood. Recipient B's clinical team obtained acute and convalescent antibody titers for E. chaffeensis, which demonstrated acute infection. Recipients A and B were treated with doxycycline and tigecycline, respectively, with clinical cure. CONCLUSIONS: These cases demonstrate that tick-borne pathogens, such as E. chaffeensis, can be transmitted through renal transplantation. E. chaffeensis can be associated with excessive morbidity and mortality, commonly owing to delay in diagnosis and poor response to non-tetracycline antibiotics. In populations with endemic tick-borne illness, donors should be questioned about tick exposure, and appropriate antibiotics can be administered if indicated.

Effects of exercise intensity on gut microbiome composition and function in people with type 2 diabetes.

Exercise is positively associated with higher microbial diversity, but there is limited information on exercise intensity's effect on gut microbiome composition and function in clinical populations. This study examines whether different intensities of exercise exert differential effects on gut microbiome composition and function in low active people with type 2 diabetes. This is a sub-study of the Exercise for Type 2 Diabetes Study, a single centre, prospective, randomised controlled trial. Participants (n = 12) completed 8-weeks of combined aerobic and resistance moderate intensity continuous training (C-MICT) or combined aerobic and resistance high-intensity interval training (C-HIIT). Faecal samples were collected before and after intervention to measure gut microbiome composition and metabolic pathways (metagenome shotgun sequencing) and short-chain fatty acids. Post-exercise α-diversity was different between groups as was the relative abundance of specific taxa was (p < .05). Post-exercise relative abundance of Bifidobacterium, A. municiphila, and butyrate-producers Lachnospira eligens, Enterococcus spp., and Clostridium Cluster IV were higher at lower exercise intensity. Other butyrate-producers (from Eryspelothrichales and Oscillospirales), and methane producer Methanobrevibacter smithii were higher at higher exercise intensity. Pyruvate metabolism (ko00620),COG "Cell wall membrane envelope biogenesis" and "Unknown function" pathways were significantly different between groups and higher in C-MICT post-exercise. Differential abundance analysis on KO showed higher expression of Two-component system in C-HIIT. Transcription factors and "unknown metabolism" related pathways decreased in both groups. There were no significant between group changes in faecal short chain fatty acids. Exercise intensity had a distinct effect on gut microbiome abundance and metabolic function, without impacting short-chain fatty acid output.HighlightsEvidence of exercise effect on gut microbiome outcomes is limited to healthy and athletic populationsIn low active people with type 2 diabetes, different exercise intensities increased specific health promoting and butyrate producers species, and showed differentially abundant gut microbiome metabolic pathways.Further investigation is warranted, and if this supports the present findings, then specific exercise intensities may be promoted to target specific species and optimise gut health.

Histone occurrence in chromatin from Peridinium balticum, a binucleate dinoflagellate.

Peridinium balticum is one of two dinoflagellates known to have dissimilar nuclei together in the same cell. One nucleus (dinokaryotic) has permanently condensed chromosomes, while the other (eukaryotic) does not have morphologically distinct chromosomes. Acid extracts of chromatin prepared from a mixture of dinokaryotic and eukaryotic nuclei and purified eukaryotic nuclei give four bands that co-migrate with four of the five histones from calf thymus when analyzed in urea-containing polyacrylamide gels.

Characterization of arsenic compounds formed by Daphnia magna and Tetraselmis chuii from inorganic arsenate.

Experiments to grow Tetraselmis chuii (a marine alga) and Daphnia magna in the presence of inorganic arsenate are described. The algae incorporate arsenic rather efficiently and form a lipid-soluble organic arsenic compound. T. chuii has been successfully mass cultured in a medium containing 10 ppm arsenic as arsenate. Daphnia magna was cultured in a medium containing 74As-labeled H3AsO4 and 1 ppm Na2HAsO4 expressed as arsenic. The arsenic metabolites were extracted with a chloroform-methanol solution and isolated by using column and thin-layer chromatography. TLC analysis of the metabolites revealed the presence of a 74As-containing product which migrated with phosphatidylethanolamine. This product was hydrolyzed with the phospholipases A, C, and D. The experimental results are not inconsistent with the presence of an arsenocholine moiety in the lipids. Arsenocholine, arsenobetaine, and acetylarsenocholine have been synthesized and will serve as reference substances in the chromatography experiments. The preparation of arsenocholine-containing lipids is in progress.

Analytic dimensions of a prescription-medication benefit in medicare.

BACKGROUND: Many analysts believe that the lack of coverage for outpatient prescription medications represents a conspicuous deficiency in the Medicare benefits package. OBJECTIVE: This paper uses insurance theory to design and estimate the costs of a Medicare catastrophic-medication outpatient benefit. RESULTS: For efficiency and equity purposes, and to accommodate the tradeoff between the cost to the federal government and the insurance value of such a benefit to Medicare enrollees, we favor a benefit that would be means-tested by employing deductibles, coinsurance rates, and catastrophic limits, all of which would be progressively graduated for 7 household income classes. For equity reasons, we propose that the government's share of the medication benefit be financed from the general tax fund, using the progressive income tax. Another source of potential savings within the Medicare program that could pay for a medication benefit would be elimination of fraud, waste, and abuse. CONCLUSIONS: Because our proposal addresses both the efficiency and equity dimensions of a Medicare outpatient medication benefit, we believe it is worthy of serious consideration by both policymakers and Congress.

A review of cost-of-illness studies on obesity.

This paper reviews the published cost-of-illness studies on obesity. The medical literature has demonstrated that obesity is an independent risk factor for a number of medical conditions, including diabetes mellitus, hypertension, coronary heart disease, elevated cholesterol levels, depression, musculoskeletal disorders, gallbladder disease, and several cancers. Since these conditions can be costly to treat, obesity clearly has a substantial economic impact. Epidemiologic estimates of the aggregate economic costs associated with specific obesity-related diseases in the United States indicate that the annual burden to society totals in the billions of dollars, representing 5.5% to 7.8% of total health-care expenditures. Although estimates of the costs attributable to obesity differ across studies, the one common finding is that these costs are substantial from a health-policy perspective. The objective of this paper is to identify and review the obesity cost-of-illness literature, address study limitations, and identify key areas for future economic research. This review indicates that the economic burden of obesity has been estimated using a prevalence-based cost-of-illness framework. Areas for future research include estimating the economic burden of obesity using an incidence-based cost-of-illness framework and modeling the association between health-care expenditure and level of obesity using individual-level data, such as medical and pharmacy claims data.

The economics of multiple sclerosis. Distribution of costs and relationship to disease severity.

The introduction of expensive disease-modifying agents for the treatment of multiple sclerosis (MS) has created the potential for patients with MS to become higher contributors to healthcare spending. In an attempt to make formulary and reimbursement choices for these agents, decision-makers may look to the literature for guidance. This critical review attempts to decipher a consistent message from the available economic literature regarding the relationship between disease severity and cost in MS. In the 2 studies that have examined MS disease severity, a positive correlation with total (direct and indirect) cost, indirect cost and some, if not all, components of direct cost was reported. In studies taking the societal perspective, the majority of total costs were indirect. This paper documents the high burden of MS on society and serves to guide the decision-maker in interpreting the MS economic literature such that this information can be optimally utilised to make informed resource allocation decisions.

Multivariate analysis of health status scores: chronic airway disorders and the MOS SF-36.

Multivariate analysis of variance (MANOVA) with follow-up canonical discriminant analysis may be used to interpret differences in health-related quality of life measured by the Medical Outcome Study Short Form 36 (MOS SF-36). Due to the moderate correlations between the 8 health dimensions of the SF-36, MANOVA is theoretically a more appropriate method than traditional univariate approaches for detecting group differences on the SF-36. Additionally, canonical discriminant analysis presents a novel approach to understanding the relationship between health dimensions of the SF-36 and model-independent variables. Results from the MANOVA and canonical discriminant analysis provide evidence of the sensitivity of the SF-36 in cross-sectional, self-reported data. Significant differences in health status (alpha less than or equal to 0.05) were found for the variables of age, and primary physician visits, and between levels of disease severity, type of breathing problem, whether patients had seen a specialist or not, use of emergency room, the comorbid states of depression and arthritis, and income. No significant differences in health status were reported between males and females or racial groups.

Economic impact of cost-containment strategies in third party programmes in the US. Part II.

This is the second article in a 2-part series that examines the economic impact of several different strategies used to control costs in third party programmes. This article investigates 5 different methods: (a) formularies; (b) capitation; (c) drug utilisation review; (d) prior approval; and (e) drug product selection. The published literature indicates that use of formularies decreases drug expenditures, but these savings may be offset by expenditures in other areas of healthcare programmes. Capitation, though less well studied than other strategies, may show some effectiveness in reducing costs by increasing generic dispensing and promoting switching from prescription drug to over-the-counter. Drug utilisation review, as a systematic programme of claims data review, has been shown to yield positive economic return in a variety of areas, including both impersonal and face-to-face educational interventions with healthcare practitioners. Prior approval and drug product selection both result in savings when examined in isolation from other aspects of healthcare. Cost-shifting, administrative costs and costs incurred because of possible decreased access to care have yet to be fully accounted for.

Pharmacists' job satisfaction and perceived utilization of skills.

The relationship between job satisfaction and perceived utilization of skills among pharmacists practicing in institutional and ambulatory care settings in Arizona was studied, and factors thought to influence pharmacists' perceived utilization of skills were evaluated. Questionnaires on job satisfaction and perceived utilization of skills were mailed to a random sample of 600 pharmacists. Information on workplace factors such as hours worked, practice setting, and job title was collected. A 4-item measure of general job satisfaction and a 10-item measure of perceived utilization of skills were used. Responses were measured on a five-point Likert scale ranging from "strongly disagree" to "strongly agree." The response rate was 35%. There was a significant positive relationship between job satisfaction and perceived utilization of skills and between job satisfaction and adequate staffing, where "staffing" referred to factors such as competence of coworkers and workload. Pharmacists with training beyond a B.S. degree in pharmacy were more satisfied with their job than those whose highest degree was a B.S. in pharmacy. Pharmacists practicing in institutional settings, pharmacists with management titles, and older pharmacists perceived that they were utilizing their skills to a greater extent than did pharmacists practicing in ambulatory care settings, pharmacists with a general staff title, and younger pharmacists. Among a sample of Arizona pharmacists in institutional and ambulatory care settings, job satisfaction was influenced by perceived utilization of skills, staffing, and education; practice setting, job title, and age were significantly related to perceived utilization of skills.

Data sources for pharmacoeconomic and health services research.

Different types of databases available for health-related research, the data contained in these databases, and potential applications for pharmacists or researchers are discussed. Case studies that demonstrate uses for health databases are presented. Databases can be organized by facility, by health care provider, by disease or organ, or by sector. The types of data they contain include financial data, utilization data, demographic data, and outcomes data. Data can be obtained from the public sector, the private sector, or the researcher's own health system. The costs and time associated with using existing databases are often less than those required to collect data, but the quality and accessibility of the data must also be considered. The researcher's choice of database will depend on the research question. Health care databases can be used for health management and decision-making, quality review and evaluation, outcomes research, episode-of-illness studies, and evaluation of treatment protocols. Researchers must comply with patient-confidentiality and other agreements when accessing data. The format of the data needs to be matched with the hardware and software to be used in the analysis, and the data need to be loaded, verified, and cleaned before use. In deciding which of the many available data sources to use, researchers must determine the appropriate balance between external data and data available within their own health systems. The decision on whether to use existing data sources or to collect data prospectively will depend on the research question, the available resources, and the scope of the study.

Synchronized sexuality of an algal symbiont and its dinoflagellate host, Peridinium balticum (Levander) Lemmermann.

We report synchronized sexual reproduction between the chlorophyll c-containing algal endosymbiont and its dinoflagellate host in Peridinium balticum (Pyrrhophyta). This organism's importance lies in that it may represent an intermediate between primitive non-photosynthetic and advanced photosynthetic dinoflagellates. Fusion of the endosymbionts and their nuclei occurred concomitantly with syngamy of the host gametes. Significant morphological changes, including condensation of chromatin and crystalline rod formation, occurred in the symbiont nucleus during zygote development. These observations provide evidence that the endosymbiotic nucleus is not passive in sexual processes, as opposed to its reported passive state during mitosis. P. balticum may not only represent an intermediate in the evolution of chloroplast acquisition by dinoflagellates, but also, an intermediate in the evolution of the peridinian dinoflagellate sexual life history.

In vitro studies of the anticalculus efficacy of an improved whitening dentifrice.

Crystal growth inhibition and plaque biofilm calcification laboratory studies were conducted to confirm the anticalculus potential of an enhanced cleaning and whitening dentifrice, based upon a novel enamel-safe, abrasive-polishing silica and pyrophosphate tartar control source with sodium fluoride as the anticaries ingredient. Calcium hydroxyapatite crystal growth following direct supernate treatments was significantly inhibited by the advanced whitening dentifrice. Similarly, plaque biofilm calcification was significantly inhibited by supernate treatments of the advanced whitening dentifrice. In both protocols, the advanced whitening dentifrice produced activity similar to formulations clinically proven for antitartar activity. These results provide support for the antitartar clinical activity of this new dentifrice.

Effect of a stabilized stannous fluoride dentifrice on plaque acid (toxin) production.

A Plaque Glycolysis and Regrowth Method (PGRM) has been used to examine the effects of single brushing with a new stabilized stannous fluoride dentifrice on plaque acid production. Plaque samples collected 45 minutes after subject toothbrushing were compared with samples collected prior to toothbrushing for glycolytic activity (pH reduction in incubation media), and the composition and proportion of acids produced during metabolism (capillary electrophoresis). Subjects brushed with both active SnF2 and placebo dentifrices in a cross-over design. Acetic and lactic acid were found to be produced during PGRM metabolism. SnF2 dentifrice was observed to significantly inhibit plaque glycolysis, reducing the pH drop associated with acid production. and specifically inhibiting both lactic acid and acetic acid production. Control dentifrice had a modest inhibitory effect on acid production, primarily inhibiting acetic acid production. SnF2 dentifrice inhibited lactic acid production more effectively than control dentifrice, and this effect appeared to be related to SnF2 specificity in metabolic inhibition, as opposed to the components of control dentifrice, namely ionic fluoride and surfactant. These experimental results support the in vivo antimicrobial activity of SnF2 formulated in a new stabilized matrix (currently marketed as Crest Gum Care), and demonstrate the utility of the PGRM method in elucidating specific mechanisms of action for antimicrobial agents.

Effects of a scaling gel on forces developed in debridement of supragingival calculus determined by means of a transducer-modified dental scaler: the Quanticalc.

The efficacy of a calculus scaling gel, SofScale (Dentsply, York, PA), has been examined in two protocols by the measurement of scaling forces developed in supragingival calculus debridement from the anterior dentition using hand scaling with a transducer-modified dental scaler, the Quanticalc. In one protocol, the effects of the scaling gel were compared to a placebo gel composed of conventional toothpaste in a double-blind, split-mouth design. In another protocol, the effects of the scaling gel were determined in comparison to non-treated calculus. Results demonstrated that the scaling gel had no apparent effects on the physical forces (work) involved in calculus removal. These results suggest that the application of the scaling gel provides no quantitative benefits in facilitating calculus debridement during manual tooth scaling.

A new Plaque Glycolysis and Regrowth Method (PGRM) for the in vivo determination of antimicrobial dentifrice/rinse efficacy towards the inhibition of plaque growth and metabolism--method development, validation and initial activity screens.

A new method, the Plaque Glycolysis and Regrowth Method (PGRM), is described for the evaluation of antimicrobial effects on plaque metabolism in vivo. The method relies on the experimental observation that in vivo sampled dental plaques, collected from different quadrants of the dentition, produce equivalent rates of metabolic activity and regrowth when similarly dispersed and normalized into incubation media. In applications of the technique to antimicrobial evaluations, overnight fasted dental plaque is collected from a non-treated quadrant of the dentition along the gingival margin. Topical formulations are used in vivo. Following this, dental plaques are collected from other dentition quadrants at extended times, allowing for the back diffusion, clearance and natural intraoral deactivation of antimicrobials within the oral cavity. In vivo treated and non-treated plaque samples are subsequently tested for metabolic and regrowth activity under controlled and standardized conditions in vitro following normalization for biomass. The technique thus combines the necessary biological factors important to the legitimate evaluation of antimicrobial effects in vivo, while benefiting from the improved precision and control provided by in vitro assessment of plaque activity. In this paper evidence is presented validating the PGRM method, and initial activity screens of commercial antimicrobial mouthrinses and toothpastes, including a new stabilized stannous fluoride dentifrice, are described.

Effects of nine weeks' use of a new stabilized stannous fluoride dentifrice on intrinsic plaque virulence expressed as acidogenicity and regrowth: a modified PGRM study.

A new stabilized stannous fluoride dentifrice, currently marketed as Crest Gum Care has been examined for its effects on intrinsic plaque metabolic and regrowth activity and effects on plaque resistance to SnF2 throughout nine weeks of toothbrushing. Subjects brushed their teeth 1 X, 2 X or 3 X/day with stabilized stannous fluoride dentifrice or placebo dentifrice for nine weeks, presenting in the morning on weeks 3, 6-9 for plaque sampling. Following nine weeks, subjects were crossed-over and repeated the experiment on their alternative assigned product (active SnF2/placebo). Sampled dental plaques were evaluated for standardized glycolysis and regrowth activity using the "Plaque Glycolysis and Regrowth Method" (PGRM). Following the second nine-week treatment period, subjects concluding either placebo or SnF2 toothbrushing participated in a single-treatment PGRM experiment using stabilized stannous fluoride dentifrice. Toothbrushing with stabilized stannous fluoride dentifrice in this experiment produced significant and sustained reductions in both plaque glycolytic and regrowth activity as compared to placebo treated plaques. In the concluding single-brushing PGRM experiment, SnF2 dentifrice was shown to produce equal inhibitory actions in plaque from subjects completing stannous fluoride or placebo treatments. This result confirmed that nine weeks toothbrushing with stabilized stannous fluoride dentifrice produced no development or resistance of plaque to SnF2 inhibition. These results support the strong in vivo antimicrobial actions of the stabilized stannous fluoride dentifrice, Crest Gum Care.

Instruments and methods for the quantitative measurement of factors affecting hygienist/dentist efforts during scaling and root planing of the teeth.

Manual calculus debridement through scaling accounts for a significant proportion of hygienist efforts in dental and periodontal practices. Despite this, little is quantitatively known concerning the effects of instruments, technique and treatments on debridement (scaling) efficiency or efficacy. The total work effort expended by therapists in calculus debridement results from the sum of the efforts associated with each scaling stroke. Each scaling stroke, in turn, is affected by a variety of physical forces, including those in the control of the therapist and those intrinsic to the calculus substrate. The development of procedures and treatments to facilitate easier calculus removal requires consideration of the physical and technique-related factors which contribute to hygienist effort. Instruments have recently been developed which can quantitatively measure force dynamics associated with scaling procedures, including both therapist-applied forces and forces developed due to the extreme hardness and tenacity of supra- and subgingival calculus deposits. The scaling instrument developed to quantitatively record developed forces in scaling, the Quanticalc, can be used for the assessment of techniques and treatments which can soften calculus, facilitating easier debridement. The device can also be used to instruct therapists on factors contributing to surface roughness and tactile response to these factors. The scaling instrument developed to quantitatively measure therapist applied forces in scaling, the Zappa device, can be used for assessment of techniques which can increase the efficiency of calculus removal with minimal damage to sound root substance. In this paper, the force dynamics associated with manual scaling procedures of dental professionals are defined. These force dynamics account for the total work expended by hygienists and other professionals in the important task of calculus removal. Using this as a foundation, the design, use, calibration and clinical applications of these newly developed scaling-force measurement systems are described.

Crest Tartar Control benefits assessed by Quanticalc: clinical method and three-month results.

In this paper, a method is described for applying the Quanticalc (QC) dental scaler to the clinical assessment of tartar control dentifrice effects on supragingival calculus formation and therapist efforts required in subsequent calculus debridement. In a 3-month, randomized cross-over study, subjects using Crest Tartar Control were observed to form 25% less calculus than they formed in a similar period using Crest Regular non-tartar control dentifrice as placebo. QC measurements likewise revealed 25% savings in the developed force used to scale the anterior lingual surfaces, coupled with a 27% reduction in the number of strokes required to clean these surfaces free of supragingival calculus in subjects using tartar control dentifrice. The quantitative savings in professional effort amounted to 3 kg (developed forces saved) per subject using tartar control dentifrice. White subjects using placebo dentifrice for 3 months developed less calculus than shown at baseline (29% less calculus), this was not complemented by decreases in total force and strokes used in cleaning. This supports the hypothesis that the surface area coverage of calculus (e.g., the planimetric "area" of supragingival calculus on the tooth) does not contribute alone to the amount of effort as forces and strokes required in subsequent debridement. These results demonstrate that: 1) the QC dental scaler can be effectively used in the clinical assessment of scaling forces/efforts associated with supragingival calculus debridement; and 2) a tartar control dentifrice containing soluble pyrophosphate is clinically effective in reducing both the surface coverage of calculus and the therapist effort required in subsequent calculus debridement.

A Quanticalc clinical comparison of professional efficiency in manual supragingival calculus debridement.

The Quanticalc (QC) dental scaler permits the assessment of work effort expended by professionals in removing supragingival calculus from the teeth. The purpose of this study was to compare the efficiency of two professionals in scaling calculus under controlled clinical conditions in like populations. One-hundred and thirty-one subjects were randomly assigned to two professionals, A and B, for QC scaling of their six Volpe-Manhold Index (VMI) teeth. VMI assessments were carried out by a separate examiner prior to QC cleaning. The QC was used to record total developed force, total strokes and force/stroke used in calculus debridement. Results demonstrated significant differences in scaling efficiency between the two professionals. These results further demonstrate the potential utility of the QC and like devices in assisting in the instruction of professionals toward the development of more efficient manual scaling procedures.