Analysis of sulfated peptides using positive electrospray ionization tandem mass spectrometry.

Presented is a method for analyzing sulfated peptides, and differentiating the post-translational modification (PTM) from its isobaric counterpart phosphorylation, using quadrupole time-of-flight (Qq/TOF) mass spectrometry (MS) and positive ion nanoelectrospray MS/MS. A set of commercially available sulfo- and phosphopeptide standards was analyzed via in-source dissociation and MS/MS to generate fragmentation signatures that were used to characterize and differentiate the two modifications. All of the phosphorylated peptides retained their +80 Da modifications under collision-induced decomposition (CID) conditions and peptide backbone fragmentation allowed for the site-specific identification of the modification. In sharp contrast, sulfated peptides lost SO3 from the precursor as the collision energy (CE) was increased until only the non-sulfated form of the peptide was observed. The number of 80 Da losses indicated the number of sulfated sites. By continuing to ramp the CE further, it was possible to fragment the non-sulfated peptides and obtain detailed sequence information. It was not possible to obtain site-specific information on the location of the sulfate moieties using positive ion MS/MS as none of the original precursor ions were present at the time of peptide backbone fragmentation. This method was applied to the analysis of recombinant human B-domain deleted factor VIII (BDDrFVIII), which has six well-documented sulfation sites and several potential phosphorylation sites located in two of the sulfated regions of the protein. Seven peptides with single and multiple +80 Da modifications were isolated and analyzed for their respective PTMs. The fragmentation patterns obtained from the BDDrFVIII peptides were compared with those obtained for the standard peptides; and in all cases the peptides were sulfated. None of the potential phosphorylation sites were found to be occupied, and these results are consistent with the literature.

Looking into tomorrow. Health workforce issues confronting physician assistants.

An important issue facing the physician assistant (PA) profession is how it can achieve a balance between supply of, and demand for, the services that PAs provide in the health workforce of the future. Recently, there has been debate and discussion about the implications of the recent expansion of the supply of PAs. In this article, we review and discuss (1) workforce data on physicians, PAs, and nurse practitioners and (2) projections of the number of these clinicians who will be trained in the future. We then analyze (1) data that describe the past 11 years of PA education and (2) data that address the experience of recent graduates of PA education programs who have sought employment. Some evidence suggests that, although demand has kept pace with expanding supply, a perception clearly exists that the PA job market may be tightening in some regions of the United States.

Evaluating the potential of international medical graduates as physician assistants in primary care.

The need to increase the nation's primary care workforce, and the presence of large numbers of international medical graduates (IMGs) who encounter barriers to licensure as physicians, have led to consideration of ways that IMGs might practice as physician assistants (PAs). Several states have explored regulatory changes that would allow IMGs to obtain PA certification through equivalency mechanisms or accelerated educational programs. In California, surveys in 1980, 1993, and 1994 collected information about the interest and preparedness among IMGs seeking PA certification. These surveys revealed that few of the IMGs were interested in becoming PAs as a permanent career, and few could show a commitment to primary care of the underserved. Of the 50 IMGs accepted into California's PA programs in recent years, 62% had academic or personal difficulties. Only 34 IMGs became certified, and all accepted jobs in primary care specialties. Two preparatory programs in California have assessed the readiness of unlicensed IMGs to enter PA programs, and they have shown that the participants did not demonstrate knowledge or clinical skills equivalent to those expected of licensed PAs. Therefore, policymakers should not consider that IMGs are or can easily become the equivalent of PAs without additional professional training in accredited PA programs. Preparatory programs appear to lessen the barriers to PA training for a few IMGs. In times of scarce resources for training, however, these programs may not be the best use of public funds to increase the primary care workforce.

Blessed are the flexible: the George Team.

Our educational efforts produced several intersecting interdisciplinary groups: faculty, students, faculty/students and our community sites, with faculty, clinical staff, and students. As we worked through the issues, these interdisciplinary teams found that commitment to change, caring for patients, and open, honest communication were essential to keeping the project teams on track. We have increased our understanding of both the complexity and value of interdisciplinary collaborative education. The LIT faculty provided the initial guidance and support, the students energized the process, and our community sites made our learning and our contributions readily available to our patient populations. It is not easy to learn and teach the language and tools of continuous improvement, but doing so infinitely improves the educational process and the clinical outcome. We must learn to carefully listen to each other so that our patients can fully reap the benefits of our interdisciplinary team efforts. As a result of what we learned, the members of the George Team have expanded our motto to "Blessed Are the Flexible--and the Perseverant!"

Analysis of science textbook recommendations provided for students with disabilities.

Teachers' manuals from three major elementary science textbook series were analyzed. These textbooks provided specific instructional recommendations for students with disabilities in mainstream classes. Findings reveal that (a) the textbooks did not provide recommendations for all categories of disabilities as defined in Public Law 94-142; (b) many recommendations did not specifically address the learning needs of the students for whom they were intended; and (c) there were no consistency in the nature of recommendations provided for any given category of disability. Results indicate that special education and mainstream teachers should monitor the usefulness of published materials that claim to meet the needs of students with disabilities.

Hospital physician assistants: past, present and future [corrected].

Expansion of the roles of PAs into the hospital setting has been the most significant recent trend in the healthcare field's use of these professionals. Initially intended to be primary-care providers, PAs have moved into the institutional domain with ease and in large numbers to assume roles as medical and surgical inpatient house-staff and as assistants to specialists and subspecialists. In most instances, they have adapted to these types of roles without formal training beyond the normal two-year educational period. PAs in hospitals have been proven to maintain or improve the existing level of quality and access to medical care, have been shown to be cost-effective in the delivery of inpatient services, and have displayed extensive clinical versatility among the various medical disciplines. Hospitals' use of PAs came about through changing forces in the health-personnel supply pool and mandated adjustments in the patterns of graduate medical education. Employing PAs has permitted hospitals to maintain the required levels of patient care in a cost-effective way, has allowed residency programs to balance the numbers of specialty-trained physicians, and has thereby contributed to a more balanced supply of specialists in overcrowded fields. The use of PAs has also contributed to increasing the continuity of care on hospital services and to measures that enrich the quality of residency education for physicians in training. To accommodate PAs as inpatient providers, medical-staff bylaws have been amended to recognize the education and expertise of PAs and to provide their institutional sanction to perform inpatient duties under the supervision of physicians.(ABSTRACT TRUNCATED AT 250 WORDS)

An examination of the reading performance of students with mild educational handicaps or learning disabilities.

Reading performance is a primary concern in both regular and special education. Reading is also the dominant medium through which educators conduct lessons, or students acquire information in subjects such as science and mathematics. Reading performance can be measured in a variety of ways. The present study examined the performance of students with mild educational handicaps (n = 28) or learning disabilities (n = 38) on a combination of norm-referenced and curriculum-based assessment (CBA) approaches that used science content. Overall, there were no significant differences between the samples on measures of word recognition, but significant differences favoring students with learning disabilities did occur in comprehension.

Vocational education and students with learning disabilities.

This inquiry focuses on the status of nearly 500 students with learning disabilities in 17 state-operated regional vocational-technical schools in a northeastern state. The inquiry addressed four primary concerns: patterns of assessment, career choice, school marks, and attendance. The data indicate that a variety of instruments were used in the assessment process and that the overall grade equivalent levels of attainment ranged between fifth- and seventh-grade levels. Children defined as learning disabled participated in a large number of vocational trade specialties and some 50% or more had school marks indicating that they were passing in these areas. Attendance was high. Many children with learning disabilities successfully perform in competitive vocational education programs designed to produce proficiency at the level of journey person.

Cross-sectional comparisons of the mathematical performance of children with learning disabilities: are we on the right track toward comprehensive programming?

This study examines the mathematical performance of 220 children from 8 years through 17 years of age diagnosed as having learning disabilities. Student records were searched for data indicating performance on standardized test instruments relating to mathematics. Data for the Woodcock-Johnson Psycho-Educational Achievement Battery math subtests and for the IQ scores from the Wechsler Intelligence Scale for Children-Revised were obtained. Comparisons were made among children at different ages and among specific age clusters. Primary attention was directed toward calculations and applications of math concepts and principles. Developmental patterns across the ages studied were discovered. Implications for long-term comprehensive programming are presented.

The acquired immunodeficiency syndrome: an update.

With the number of reported cases exceeding 15,000 as of December 1, 1985, the acquired immunodeficiency syndrome (AIDS) continues to spread with alarming frequency. Over 100 cases per week are reported to the Centers for Disease Control. PAs and other clinicians face a formidable task of keeping up with continual updates in the medical literature and lay press. This report summarizes current information on AIDS and highlights those clinical, epidemiologic and control features that are most relevant to primary care clinicians. Recognizing that it is impossible to be totally current, the authors have made every effort to report the most accurate and up-to-date information.