US estimates for dog bite injuries presenting to emergency departments.

OBJECTIVES: Dog bites are a frequent source of injury requiring emergency department (ED) management. We sought to evaluate the longitudinal burden of dog bites presenting to US EDs. STUDY DESIGN: Cross-sectional study of a complex survey. METHODS: We evaluated the National Hospital Ambulatory Medical Care Survey, a complex survey of non-federal US ED encounters between 2002 and 2017. Dog bites were identified via ICD-9-CM and ICD-10-CM codes. We report trends in dog bites (adjusted to US Census population data) overall and among patients younger than 18 years using the Spearman rank correlation test. RESULTS: Of 2.0 billion ED encounters, 6.6 million (0.3%, 95% confidence interval [CI] 0.3-0.4%) were for dog bites. There were 13.5 encounters per 10,000 population (all ages) and 20.8 per 10,000 among those younger than 18 years. Rates of bites increased over time for encounters younger than 18 years (rho = 0.54, 95% CI 0.08, 0.82), but not for those aged 18 years or older (rho = 0.44, 95% CI -0.08, 0.77). Among patients younger than 18 years, the rate of presentations increased from 17.7 to 22.3 per 10,000 encounters during the 16-year period. The highest rate of encounters was among patients aged 6-11 years, where 24.3 per 10,000 presented with dog bites and for which 59.3% (95% CI 49.1-69.6%) were boys. Overall, 75.3% (95% CI 72.3-89.3%) were provided with antibiotics and 4.1% (95% CI 2.5-5.7%) were diagnosed with skin/soft tissue infection. CONCLUSION: Dog bite presentations demonstrated a small but significant increase in rates of presentation over time among children and youth. Continued efforts are needed to curb this common injury.

Prescribing guidelines based on a flexible scope of practice.

Nurse practitioners (NPs) are in demand nationwide as primary care providers both in the inpatient and outpatient settings. Lack of prescriptive privileges and/or a narrow scope of practice can be practice limiting. This article provides a written template for prescribing authority, generic scope of practice, and furnishing policy, including evaluative process, for nurse practitioners who wish to obtain prescriptive privileges. Developed at the Palo Alto Veterans Affairs Health Care System, these documents can be used by NPs nationwide. They can be adapted to each provider's unique practice, whether in the hospital, clinic, or private practice setting.

Expanding nurse practitioner scope of practice within the Veterans Affairs Palo Alto Health Care System.

Healthcare priorities and use have changed dramatically over the last several years. Expansion of the nurse practitioner (NP) role has been a hallmark of the restructuring efforts, which have emphasized primary care and the use of nonphysician specialists. NPs are practicing in a wider range of settings than ever before, including acute hospital settings, outpatient clinics, and specialty services. While the Veterans Health Administration (VHA) has employed NPs since the early 1970s, their practice has been limited at many VHA medical centers. Such was the case at the Veterans Affairs Palo Alto Health Care System (VAPAHCS), when physicians produced a scope of practice (SOP) for NPs that was practice limiting. This article highlights the historical progress of NPs in defining their practice, discusses barriers to NP practice at the VAPAHCS, outlines strategies to overcome barriers, and discusses future possibilities for advanced practice nursing within the VA.

Cell line banks and their role in cancer research.

The utility of centralized cell banks in providing reference cultures for cancer research is reviewed. Procedures applied at The American Type Culture Collection in development, maintenance and expansion of such a resource are discussed for example, with emphasis on human tumor cell lines. The various categories of cell-line holdings are explained, and status with regard both to the numbers of lines available and distribution experienced are documented. The locations of other national cell repositories plus contact data are provided.

DLD-1 and HCT-15 cell lines derived separately from colorectal carcinomas have totally different chromosome changes but the same genetic origin.

Aneuploid DLD-1 and HCT-15 cell lines independently derived from a colon carcinoma by two researchers lacked a common marker chromosome or a concurrent numerical change. To further look into the genetic identity of these two cell lines, we used chromosome painting with fluorescence in situ hybridization (FISH) and confirmed the G-band identification on all chromosome changes. We have also found comparable results between these two cell lines on C-/Q- polymorphic bands of several chromosomes, and electrophoretic patterns of restriction fragment-length polymorphisms (RFLPs) from eight Y-chromosome-specific DNA probes with 13 restriction enzymes. These results strongly suggest that DLD-1 and HCT-15 are identical genetically. Clearly, cell lines bearing totally unrelated changes in karotypes can be generated from the same cancer specimen.

Mycoplasma infection of cultured cells.

Mycoplasma contamination is tough to detect and even more difficult to eradicate. It is best to start over fresh from clean cell stocks, but several elimination options are available.

Intercellular karyotypic similarity in near-diploid cell lines of human tumor origins.

Intercellular karyotypic compositions were studied in seven near-diploid cultured cell populations (including six cell lines) of human colorectal and fibrosarcoma origins. Within each population, 50-88% of cells had the same cell-line-specific karyotype. In five of these seven populations, coexisting minor cell types could readily be identified, implicating the frequent occurrence of mosaicism in transformed cell lines. Nearly 90% of these cell types showed a single chromosome loss or gain from the modal cell karyotype. Parameters that may assist in the evaluation of karyotypic diversity of a transformed cell line are discussed briefly.

Karyotype consistency in human colorectal carcinoma cell lines established in vitro.

Karyotypes of nine human colorectal cell lines deposited with the ATCC were studied by trypsin-Giemsa banding. CCL 229,230,231 and 235 (Modal chromosome number, Sm, was 49, 68, 47, and 40, respectively) belong in the stable type that is characterized by karyotypes consisting mostly of normal chromosomes and stable markers. CCL 228, 234, and 238 (Sm=55,79, and 70 respectively) belong in the unstable type that has karyotypes consisting of numerous markers in addition to normal chromosomes and stable markers. The remaining intermediate type (CCL 233 and 237, Sm = 60 and 64, respectively) has karyotypic characteristics between the above two types usually with two or less unstable markers per cell. The stable markers (together with normal chromosomes) are constitutive components of a cell genome and are common to most cells within the same cultured population. Unstable markers, which generally constitute only a small portion of the total chromosome complement are the likely cause of karyotypic variations between cells and often are produced by balanced inter- or intrachromosome changes, or both. Consequently, total chromosome length per cell genome is remarkably consistent within a cell population, and karyotypes between cells, such as from four stable lines, are profoundly stable and mostly identical. Chromosome deletions and interhomologue exchanges (including isochromosomes) had the highest incidences among both stable and unstable markers. The complex markers occurred relatively infrequently. There were neither common markers nor unique chromosome breakages common to all of these established cell lines. However, chromosomes No. 7 and 1 had the highest incidence (15 and 12, respectively) of structural modifications resulting in the formation of stable markers (82 total exchanges in nine cell lines), and chromosomes No. 7 and 2 were involved at high incidence (21 and 15, respectively) in the formation of both stable and unstable markers (181 total exchanges). Moreover, No. 7 is overrepresented in eight of nine lines. The significance of chromosome changes involving No. 7 in this as well as other tumor pathotypes is briefly discussed.

Cultured cell lines for research on pulmonary physiology available through the American type culture collection.

Procedures are described by which cell lines of potential use for studies on pulmonary physiology were developed or otherwise obtained, characterized, and banked for distribution to the scientific community. Seventy-seven cell lines were submitted under this program. Forty-eight of these exhibited adequate doubling potential and were of sufficient interest and purity to permit accessioning and banking for distribution. An additional 12 lung cell lines had been added earlier during development of the Cell Repository. In all, 4 presumptive type II alveolar lines, 2 nonspecified epithelial-like lines, 2 endothelial lies, 1 mesothelial line, and 51 fibroblastlike lines are available. Eighteen species including humans, monkeys, and common laboratory animals are represented. An additional 19 lines were retained as token holdings because they either exhibited insufficient doubling potential or represented duplicate samples of differing passage levels. Ten lines were rejected because of poor viability, presence of contaminant microorganisms, or inappropriate species identification by the donor. The lines will be retained at the ATCC for distribution on request to the scientific community at large. As newly developed strains are identified and made available these may also be added to the existing collection. Appropriate cooperation from the scientific community and support from governmental funding agencies are required and acknowledge.