Predictive parameters of joint disease in DBA/1 transgenic mice.

We recently reported an accelerated onset of collagen-induced arthritis in DBAII mice overexpressing a T cell receptor Valpha11.1/Vbeta8.2 transgene as a preclinical animal model for age-associated T cell dysfunction. The accelerated onset is due to a transgenically sensitized T cell population that reacts to bovine type 11 collagen without prior in vivo sensitization. The model presents a readily observable distal joint phenotype that would allow preliminary aging and intervention studies to be evaluated by monitoring the presence or absence or degree of phenotypic expression of disease. In order to characterize clinical signs, we evaluated 69 transgenic mice in six different experiments for anticollagen antibody levels, and assigned each a modified arthritic score based on the degree of redness or swelling of the digital joints. We also correlated these parameters with signs of distress, including weight bearing, activity levels, and body posture. The average onset of disease was consistently within a 28 to 35-day period. The average arthritic score at the time of onset was 8. We found that none of the parameters predicted the onset of joint disease, but the modified scoring system reflected the severity of joint disease and predicted the degree of distress associated with the acute inflammation. The ability to determine the severity of joint disease by gross physical examination is a useful clinical feature because a numerical score is reflective of the degree of inflammation. Because the transgenic mouse model is a T cell-driven disease, the effect of aging on T cell activity can be monitored easily. In addition, the use of our modified arthritic scoring system makes it possible to conduct mouse experiments in a humane manner.

Ionospheric modification at twice the electron cyclotron frequency.

In 2004, a new transmission band was added to the HAARP high-frequency ionospheric modification facility that encompasses the second electron cyclotron harmonic at altitudes between approximately 220 and 330 km. Initial observations indicate that greatly enhanced airglow occurs whenever the transmission frequency approximately matches the second electron cyclotron harmonic at the height of the upper hybrid resonance. This is the reverse of what happens at higher electron cyclotron harmonics. The measured optical emissions confirm the presence of accelerated electrons in the plasma.

Informed consent: myths and risk management alternatives.

The doctrine of informed consent, an enigma to many risk management personnel, is fuel for many malpractice claims. But the doctrine of informed consent is a rational, useful concept that can advance many of the goals of risk management. This article analyzes seven common "myths" or misperceptions about informed consent in relation to risk management and suggests five ways to address the risk management issues related to informed consent.

Antibiotic control in a municipal hospital.

The choice of an antibiotic for a patient is often a difficult decision. The clinician must contend with a bewildering variety of bacteria and use a number of expensive and toxic antimicrobial agents judiciously. To deal with the problems of excessive and inappropriate use, the medical staff of Coney Island Hospital established compulsory, prospective antibiotic control. Two years after initiation of this program, we analyzed changes in sensitivity patterns of hospital flora, physicians' prescribing habits and antibiotic use. A trend toward increasing resistance on the part of some Gram-negative isolates to certain beta-lactam antibiotics was noted. Antibiotic costs decreased an average of 38%, while prescribing skills improved.

Feasibility and implementation of a hospital-based group practice.

All sectors of the economy have been suffering from the current inflationary environment. In some businesses, such as health care, costs have increased more than thought possible in the past. Since hospitals are labor intensive, they have been drastically affected by the push toward higher pay and the often hidden cost of fringe benefits. It is not surprising, therefore, that in seeking relief from the cost, hospitals will examine a method which removes a large part of the salary burden from their budgets: conversion of hospital-based salaried physicians to private, fee-for-service groups. The first article in this two-part series, which appeared in Medical Group Management, November/December 1981, examined the financial and legal aspects of the conversion. This concluding article presents the operational and organizational issues which must be considered for a successful conversion.