B subgroup detection in a small hospital transfusion service.

The ABO blood group system includes phenotypes, or subgroups, that differ in the amount of A and B antigens present on the red blood cells (RBCs). These subgroups also differ in the A, B, or H substances present in secretions (for individuals who have the secretor phenotype). B subgroups are very rare and are less frequently reported than A subgroups. Usually, B subgroups are discovered during serologic testing when there is a discrepancy between RBC and serum grouping results. Subgroups of B are usually identified by a reference laboratory using molecular and adsorption-elution methods. This report details a case of a young, healthy, pregnant woman with a B subgroup detected by a small transfusion service using adsorption-elution methods. Serology and genotyping of the ABO gene was performed at a reference laboratory where the serology was consistent with a B subgroup, but no changes were identified in ABO gene sequencing. It is important to correctly identify B subgroups in donors and recipients to help resolve ABO discrepancies and potentially prevent ABO incompatibility in blood transfusion, thus minimizing transfusion reactions.The ABO blood group system includes phenotypes, or subgroups, that differ in the amount of A and B antigens present on the red blood cells (RBCs). These subgroups also differ in the A, B, or H substances present in secretions (for individuals who have the secretor phenotype). B subgroups are very rare and are less frequently reported than A subgroups. Usually, B subgroups are discovered during serologic testing when there is a discrepancy between RBC and serum grouping results. Subgroups of B are usually identified by a reference laboratory using molecular and adsorption-elution methods. This report details a case of a young, healthy, pregnant woman with a B subgroup detected by a small transfusion service using adsorption-elution methods. Serology and genotyping of the ABO gene was performed at a reference laboratory where the serology was consistent with a B subgroup, but no changes were identified in ABO gene sequencing. It is important to correctly identify B subgroups in donors and recipients to help resolve ABO discrepancies and potentially prevent ABO incompatibility in blood transfusion, thus minimizing transfusion reactions.

Clozapine administration in clinical practice: once-daily versus divided dosing.

OBJECTIVE: While it is recommended that clozapine be administered in a divided dosing regimen, it is unclear whether this recommendation is followed in real-world clinical practice. In two large datasets, we examined clozapine dosing frequency and patient characteristics across different dosing regimens. METHOD: We conducted a cross-sectional survey, collecting data on patients receiving clozapine in August/September 2015 from the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada, and The Zucker Hillside Hospital (ZHH) in New York, United States. RESULTS: Of 676 and 308 patients included in CAMH and ZHH datasets, clozapine was prescribed once daily in 75.1% and 74.4%, even though doses exceeding 200 mg/day were administered in 88.6% and 84.4% of the respective samples. No significant difference was found in the rates of positive symptom remission between once-daily vs. divided dosing (79.7% vs. 80.5%, P = 1.00). Higher clozapine dose and use of anticholinergic medications were significantly associated with divided dosing in both datasets. Older age or male gender was related to divided dosing in CAMH or ZHH dataset respectively. CONCLUSION: Despite the product monograph recommendation, clozapine is frequently prescribed once daily in North America. Further studies are needed to compare clinical outcomes between once-daily vs. divided clozapine dosing.

Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia.

WHAT IS KNOWN AND BACKGROUND: Social anxiety disorder (SAD) often follows a chronic course and is associated with substantial impairment in functioning. Although results from clinical trials clearly establish evidence for efficacy of cognitive behavioural therapy in treating this disorder, up to 50% of patients with SAD show little or no improvement. Thus, new approaches that have promised in improving the efficacy of treatment for SAD are needed. One such approach is the trial-based thought record (TBTR), which targets the restructuring of patients' core beliefs. OBJECTIVE: To determine whether patients receiving TBTR would report fewer symptoms of social anxiety and general psychiatric distress following treatment, relative to conventional cognitive therapy (CCT). METHODS: A two-arm randomized trial comparing TBTR (n = 17) with a set of CCT techniques (n = 19), which included the standard seven-column dysfunctional thought record and the positive data log in SAD patients according to DSM-IV. RESULTS: Scores on many outcome measures decreased significantly across the course of treatment in both groups (P < 0·001), including the Liebowitz Social Anxiety Scale, Fear of Negative Evaluation Scale (FNE), Social Avoidance and Distress Scale (SADS), Beck Anxiety Inventory, and Clinical Global Impression - Improvement. In addition, a one-way ancova, taking baseline values as covariates, showed that TBTR was significantly more efficacious than CCT in reducing the scores of FNE (P = 0·01 at mid-treatment and P = 0·004 at post-treatment), and SADS (P = 0·03 at post-treatment). WHAT IS NEW AND CONCLUSION: This study provides preliminary evidence that TBTR is at least as efficacious as CCT in reducing symptoms of SAD, pointing to the need for additional studies of TBTR in SAD and other psychiatric disorders.

The effect of Parkinson's disease on interference control during action selection.

Basal ganglia structures comprise a portion of the neural circuitry that is hypothesized to coordinate the selection and suppression of competing responses. Parkinson's disease (PD) may produce a dysfunction in these structures that alters this capacity, making it difficult for patients with PD to suppress interference arising from the automatic activation of salient or overlearned responses. Empirical observations thus far have confirmed this assumption in some studies, but not in others, due presumably to considerable inter-individual variability among PD patients. In an attempt to help resolve this controversy, we measured the performance of 50 PD patients and 25 healthy controls on an arrow version of the Eriksen flanker task in which participants were required to select a response based on the direction of a target arrow that was flanked by arrows pointing in the same (congruent) or opposite (incongruent) direction. Consistent with previous findings, reaction time (RT) increased with incongruent flankers compared to congruent or neutral flankers, and this cost of incongruence was greater among PD patients. Two novel findings are reported. First, distributional analyses, guided by dual-process models of conflict effects and the activation-suppression hypothesis, revealed that PD patients are less efficient at suppressing the activation of conflicting responses, even when matched to healthy controls on RT in a neutral condition. Second, this reduced efficiency was apparent in half of the PD patients, whereas the remaining patients were as efficient as healthy controls. These findings suggest that although poor suppression of conflicting responses is an important feature of PD, it is not evident in all medicated patients.

Clozapine's critical role in treatment resistant schizophrenia: ensuring both safety and use.

INTRODUCTION: Clozapine was first introduced as an antipsychotic in the 1970's but a cluster of deaths, later linked to the drug's risk of agranulocytosis, led to its withdrawal in most countries. However, work in the 1980's established its unique efficacy in treatment resistant schizophrenia (TRS), which constitutes as many as 30% of those with the illness. Clozapine was reintroduced with this indication shortly thereafter, but because of this risk its use requires routine hematologic monitoring. AREAS COVERED: An update is provided regarding clozapine's risk of neutropenia, agranulocytosis, and associated mortality. In addition, updates are provided on other side effects, specifically myocarditis and bowel obstruction, as evidence suggests these are more common than agranulocytosis and associated with higher mortality rates. EXPERT OPINION: Clozapine remains the only treatment indicated in TRS, but it is dramatically underutilized. Clearly there are serious side effects associated with its use, and while the focus has historically been on hematologic concerns, we highlight other side effects that also demand systematic monitoring. Because it is the only effective treatment option we have for TRS, though, efforts must be implemented that ensure its use in this population while maximizing safety.

Novel molecular basis of an Inab phenotype.

The Cromer blood group system consists of ten high-prevalence and three low-prevalence antigens carried on decay-accelerating factor (DAF). DAF is found in the cell membranes of RBCs, granulocytes, platelets, and lymphocytes and is widely represented in other body tissues. Sequence analyses of DNA were performed on a blood sample from a 91-year-old Japanese woman whose serum contained an alloantibody to a high-prevalence antigen in the Cromer blood group system (anti-IFC). A blood sample from her daughter was also studied. Sequence analysis revealed a substitution of 508C7>T in exon 4 of DAF in the proband. The proband's daughter was heterozygous for 508C/T. This study describes an Inab phenotype in which the 508C>T nonsense mutation is predicted to change arginine at amino acid residue 136 to a stop codon. This change is in SCR 3 of DAF. This study reports on the molecular basis of a new proband with the Inab phenotype who had no history of intestinal disorders.

Quantitative determination of serum methemalbumin.

We have devised a simple, sensitive quantitative method for the determination of serum methemalbumin. The method uses a modified Allen correction to correct the alpha band of methemalbumin at 623 nm for background turbidity. The technique is robust and is more sensitive than Schumm's test.

Mid-thoracic tenderness: a comparison of pressure pain threshold between spinal regions, in asymptomatic subjects.

Palpation for tenderness forms an important part of the manual therapy assessment for musculoskeletal dysfunction. In conjunction with other testing procedures it assists in establishing the clinical diagnosis. Tenderness in the thoracic spine has been reported in the literature as a clinical feature in musculoskeletal conditions where pain and dysfunction are located primarily in the upper quadrant. This study aimed to establish whether pressure pain thresholds (PPTs) of the mid-thoracic region of asymptomatic subjects were naturally lower than those of the cervical and lumbar areas. A within-subject study design was used to examine PPT at four spinal levels C6, T4, T6, and L4 in 50 asymptomatic volunteers. Results showed significant (P<0.001) regional differences. PPT values increased in a caudal direction. The cervical region had the lowest PPT scores, that is was the most tender. Values increased in the thoracic region and were highest in the lumbar region. This study contributes to the normative data on spinal PPT values and demonstrates that mid-thoracic tenderness relative to the cervical spine is not a normal finding in asymptomatic subjects.

Identification of adult populations at high risk for dental caries using a computerized database and patient records: a pilot project.

OBJECTIVES: The purpose of this study is to test the usefulness of dental insurance claims history, supplemented with radiographic caries diagnoses, as a means of identifying caries-active and caries-inactive working adults, as determined by bacterial levels. Computerized identification of at-risk groups may facilitate subject selection for clinical trials designed to test caries-preventive strategies. METHODS: Two groups of subjects were initially selected from an insurance database based upon their dental service utilization during a one-year period: a "low restorative" group of individuals defined as persons who had received no restorative treatment, and a "high restorative" group comprised of individuals who had received at least three multisurfaced restorations. A chart review confirmed a diagnosis of caries in the high restorative group and an absence of caries in the low restorative group. Subjects were then approached for saliva collection. The low and high restorative groups were compared for salivary mutans streptococci and lactobacilli levels, stimulated flow rate, and buffer capacity (n = 48). RESULTS: The high and low restorative groups differed in mutans streptococci levels, but not on other measures. CONCLUSIONS: A group of subjects who had recently received multisurfaced restorations that were placed for reasons of caries had significantly higher levels of mutans streptococci and potential for continued caries activity when compared to a group of subjects who had received no restorations and were caries free.

Quality of beef loin steaks as influenced by animal age, electrical stimulation and ageing.

The tenderness of beef M. longissimus dorsi muscles from cattle about 1 8 months (0-2 tooth) and 54 months (8 tooth) old at the time of slaughter was investigated. The influence of electrical stimulation on the mechanical and sensory panel assessments obtained for loin steaks was examined at 24 h post slaughter and also after ageing three weeks. Effective electrical stimulation of the carcasses produced, at 24 h from slaughter, steaks from both age groups which were uniform, acceptable and predictable in tenderness. The colour of loin steaks from the younger animals was lighter than loin steaks from older animals, while the weep in the vacuum packages was less for meat from the older animals than that from the younger ones.

A comparison of fat composition of Japanese and long-term grain-fed Australian steers.

Subcutaneous and intermuscular fat samples were collected from carcases of four major breeds of steers in Japan: Wagyu, Wagyu × Angus, Dairy and Murray Grey. For comparison, we also collected subcutaneous fat samples from carcases of long-term grain-fed (350-455 days) Angus, Jersey and Angus × Hereford steers, and short-term grain-fed (70-100 days) Murray Grey steers in Australia. Fatty acid profiles were determined on all samples and triacylglycerol composition, thermal properties, fat cell size and lipid and connective tissue contents were determined on representative samples. Compared with the Japanese samples which were soft to very soft when assessed subjectively, samples of Australian fat were generally hard and somewhat fibrous in appearance. These tactile and visual differences in the hardness of the subcutaneous fat between the Japanese and Australian beef were confirmed by the physical and chemical properties determined. Markedly different melting patterns were observed for the Australian and Japanese fat samples. The Japanese fat had considerably less saturated and more unsaturated fatty acids resulting in much higher unsaturated/saturated ratios (1.9) compared with the Australian samples (1.0). This resulted primarily from the high contents of oleic and palmitoleic acids and the low content of stearic acid of the Japanese samples. The triacylglycerols from the Japanese fat had considerably less tri-saturated and di-saturated fatty acids and more di-monounsaturated and tri-monounsaturated fatty acids in their structure. Differences were observed when the Japanese subcutaneous fat samples were grouped by their meat quality grades. From Grade 5 to Grade 2, there was a significant decrease in marbling score (9.3 to 2.5) and in the ratio of palmitoleic to stearic acid (1.7 to 1.2) and an increase in the connective tissue content (1.5 to 2.1%). Compared with subcutaneous fat, intermuscular fat had a higher content of saturated and a lower content of unsaturated fatty acids resulting in a lower ratio of unsaturated to saturated fatty acids and of palmitoleic to stearic acid. It was concluded that the fatty acid composition and the triacylglycerol structure of fat plays the predominant role in determining the lustre, texture and properties of fat desired by the Japanese market: the soft character of fat from Japanese cattle results primarily from its low content of stearic acid and consequent lower melting temperatures. Fat cell size and the lipid and connective tissue contents of fat appear to be less important.

Consumer assessment of the effect of electrical stimulation on the colour and colour stability of Semimembranosus muscles.

The influence of effective low voltage electrical stimulation on the colour stability of beef topside (semimembranosus) muscles, during storage and retail display was studied using objective measurements and subjective assessments. Earlier results obtained from objective measurements demonstrated that during a three day retail display period, stimulated topsides had a greater loss of colour than non-stimulated topsides, and primal cuts aged for 33 days at 0 °C before display suffered faster changes to colour during retail presentation than cuts aged for 5 days. To relate results obtained using objective methods to consumer perceptions of meat quality, consumer perceptions of samples of meat displayed for 3 days in the retail cabinets of a major local supermarket were recorded. A total of 960 consumers were asked to evaluate topside steaks for meat and fat colour, meat discolouration and acceptability. During 3 days of retail display, consumers did not perceive differences in the extent of discolouration of topside steaks from electrically stimulated and non-stimulated carcasses; for the majority of the treatment groups (high or low pH muscles, 5 or 33 day ageing, 1-3 day retail display) there were no significant differences, for any of the scored attributes, between stimulated and non-stimulated samples. However, for samples in the fresh (5 days ageing), high pH (5.8-6.0) treatments group, lean meat colour and acceptability for the stimulated samples were, on some of the days on display, given significantly (P < 0.05) better ratings by the consumers than those from corresponding non-stimulated samples.

The colour and colour stability of beef Longissimus dorsi and Semimembranosus muscles after effective electrical stimulation.

The influence of effective low voltage electrical stimulation (ES) of beef on the colour and colour stability of longissimus dorsi (LD) and semimembranosus (SM) muscles, during storage and retail display was studied by tristimulus colorimetry and reflectance spectrophotometry. ES had no significant effect on the colour of the LD muscles, but some significant effects on SM muscles of ultimate pH 5·5-5·7. Three hours after slicing into steaks at 5 days post mortem, stimulated SM muscles had a paler/lighter colour than non-stimulated controls. During a retail display of 3 days, all steaks exhibited a loss of colour quality manifested in loss of redness and decreases in both hue and chroma (saturation). These changes were most marked in the stimulated SM muscles, and analysis indicated that they were due almost exclusively to the formation of metmyoglobin (metMb). Ageing the meat, as primals cuts, for 33 days at 0°C led to no significant differences in the perceived colour three hours after slicing. The colour changes observed during the 3-day retail display of steaks occurred more rapidly in both (ES and non-ES) 33 day-aged samples than in the 5 day-aged ones. The result of this was that the colour stability of non-stimulated steaks prepared at 33 days was similar to that of ES steaks prepared fresh (5 day post mortem). In SM muscles of pH 5·8-6·0 the apparent differences in colour of the ES and non-ES samples were not significant. However, meat of pH > 5·8, although darker than meat of lesser pH, had less tendency to form metmyoglobin during retail display. The present work also confirmed that seemingly small differences in display conditions, especially temperature, have a marked effect on metmyoglobin formation.

Important characteristics of a director of medical education.

In osteopathic graduate medical education programs, the Director of Medical Education (DME) plays the key leadership role. This article outlines critical characteristics and skills that the DME should possess to successfully perform in this role. Central to this success is a passionate commitment to osteopathic medical education and a commitment to justice and fairness.

Comparison of the measurement of heart rate in adult free-range chickens (Gallus domesticus) by auscultation and electrocardiography.

OBJECTIVE: To compare the heart rates of adult free-range chickens (Gallus domesticus) measured by auscultation with a stethoscope with those measured simultaneously using electrocardiography (ECG). METHODS: With each bird in a standing position, estimation of the heart rate was performed by placing a mark on paper for every 4 beats for roosters and 8 beats for hens as detected by auscultation over 30 s, while simultaneous ECG was performed. RESULTS: Heart rates measured by auscultation showed a high correlation (r = 0.97) with those measured by ECG. CONCLUSION: There was a high correlation between the heart rates of adult free-range chickens measured by auscultation with a stethoscope and those measured simultaneously using ECG.

The effect of speed-accuracy strategy on response interference control in Parkinson's disease.

Studies that used conflict paradigms such as the Eriksen Flanker task show that many individuals with Parkinson's disease (PD) have pronounced difficulty resolving the conflict that arises from the simultaneous activation of mutually exclusive responses. This finding fits well with contemporary views that postulate a key role for the basal ganglia in action selection. The present experiment aims to specify the cognitive processes that underlie action selection deficits among PD patients in the context of variations in speed-accuracy strategy. PD patients (n=28) and healthy controls (n=17) performed an arrow version of the flanker task under task instructions that either emphasized speed or accuracy of responses. Reaction time (RT) and accuracy rates decreased with speed compared to accuracy instructions, although to a lesser extent for the PD group. Differences in flanker interference effects among PD and healthy controls depended on speed-accuracy strategy. Compared to the healthy controls, PD patients showed larger flanker interference effects under speed stress. RT distribution analyses suggested that PD patients have greater difficulty suppressing incorrect response activation when pressing for speed. These initial findings point to an important interaction between strategic and computational aspects of interference control in accounting for cognitive impairments of PD. The results are also compatible with recent brain imaging studies that demonstrate basal ganglia activity to co-vary with speed-accuracy adjustments.

From surveillance to action: early gains from the National Violent Death Reporting System.

OBJECTIVES: Drawing from the experiences of individual state programs that currently participate in the National Violent Death Reporting System (NVDRS), this article reviews some of the practical benefits that may accrue from the introduction of violent death surveillance systems. DESIGN: As a state-based surveillance system that uses multiple data sources and relies upon multiple stakeholders, the NVDRS program has fostered an array of initiatives within and among individual state programs. State-based initiatives highlighted in this article were selected on the basis of a purposive sampling strategy intended to illustrate key aspects of program development. SETTING: The NVDRS state programs are in Alaska, California, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin. RESULTS: The NVDRS has helped to build alliances and collaborative efforts between key stakeholders, facilitated the recognition of violent death as a public health problem through outreach and media attention, acted as a catalyst for new projects, enhanced surveillance of special populations and utility for evaluation, and identified key circumstances that will target interventions in state prevention planning. CONCLUSIONS: The NVDRS has implemented data collection efforts and is beginning to produce and analyze findings. In the process of implementing the data collection system and publicizing findings, state NVDRS programs are realizing other gains that strengthen their surveillance efforts. The use of data for prevention purposes will be the ultimate indicator of program success.