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1.
Child Care Health Dev ; 44(4): 630-635, 2018 07.
Article in English | MEDLINE | ID: mdl-29761533

ABSTRACT

AIM: The aims of this study were to adapt an adult wheeled mobility outcome measure, the Functional Mobility Assessment, for use with children (FMA-Family Centred) and establish the new measure's content validity, test-retest reliability, and internal consistency. BACKGROUND: Although several tools exist to measure a child's ability to operate and move a wheeled mobility device, none focus on the ability of the wheeled mobility device to support children and their families as they perform daily activities. METHODS: After adapting the FMA items with examples relevant to children aged 3-21, parent/caregiver and therapist stakeholder groups recommended adaptations relevant for families with children who cannot respond for themselves. RESULTS: Six of the initial FMA items were retained with child-appropriate examples, and 4 new items were developed. CONCLUSION: The content validity of the FMA-Family Centred was strongly supported, and internal consistency and test-retest reliability met accepted psychometric standards.


Subject(s)
Brain Injuries/rehabilitation , Chronic Disease/rehabilitation , Disabled Persons/rehabilitation , Patient Satisfaction/statistics & numerical data , Wheelchairs , Activities of Daily Living , Adolescent , Brain Injuries/psychology , Child , Chronic Disease/psychology , Disabled Persons/psychology , Female , Humans , Male , Mobility Limitation , Outcome Assessment, Health Care , Parents , Psychometrics , Reproducibility of Results , Young Adult
2.
Child Care Health Dev ; 42(4): 513-20, 2016 07.
Article in English | MEDLINE | ID: mdl-27196946

ABSTRACT

AIM: The purpose of this study was to establish the validity, reliability, stability and sensitivity to change of the family-centred Movement Assessment of Children (MAC) in typically developing infants/toddlers from 2 months (1 month 16 days) to 2 years (24 months 15 days) of age. BACKGROUND: Assessment of infant/toddler motor development is critical so that infants and toddlers who are at-risk for developmental delay or whose functional motor development is delayed can be monitored and receive therapy to improve their developmental outcomes. Infants/toddlers are thought to be more responsive during the MAC assessment because parents and siblings participate and elicit responses. METHODS: Two hundred seventy six children and 405 assessments contributed to the establishment of age-related parameters for typically developing infants and toddlers on the MAC. The MAC assesses three core domains of functional movement (head control, upper extremities and hands, pelvis and lower extremities), and generates a core total score. Four explanatory domains serve to alert examiners to factors that may impact atypical development (general observations, special senses, primitive reflexes/reactions, muscle tone). Construct validity of functional motor development was examined using the relationship between incremental increases in scores and increases in participants' ages. Subsamples were used to establish inter-rater reliability, test-retest reliability, stability and sensitivity to change. RESULTS: Construct validity was established and inter-rater reliability ICCs for the core items and core total ranged from 0.83 to 0.99. Percent agreement for the explanatory items ranged from 0.72 to 0.96. Stability within age grouping was consistent from baseline to 6 months post-baseline, and sensitivity to change from baseline to 6 months was significant for all core items and the total score. CONCLUSION: The MAC has proven to be a well-constructed assessment of infant and toddler functional motor development. It is a family-centred and efficient tool that can be used to assess and follow-up of infants and toddlers from 2 months to 2 years.


Subject(s)
Child Development , Developmental Disabilities/diagnosis , Child Development/physiology , Child, Preschool , Discriminant Analysis , Female , Follow-Up Studies , Humans , Infant , Male , Movement , Observer Variation , Parents , Reproducibility of Results
3.
Psychol Med ; 43(4): 801-11, 2013 Apr.
Article in English | MEDLINE | ID: mdl-22846332

ABSTRACT

BACKGROUND: While bipolar disorder (BD) is a leading cause of disability, and an important contributor to disability in BD is cognitive impairment, there is little systematic research on the longitudinal course of cognitive function and instrumental activities of daily living (IADLs) in late-life. In this report, we characterize the 2-year course of cognitive function and IADLs in older adults with BD. Method We recruited non-demented individuals 50 years and older with BD I or BD II (n = 47) from out-patient clinics or treatment studies at the University of Pittsburgh. Comparator subjects ('controls') were 22 individuals of comparable age and education with no psychiatric or neurologic history, but similar levels of cardiovascular disease. We assessed cognitive function and IADLs at baseline, 1- and 2-year time-points. The neuropsychological evaluation comprised 21 well-established and validated tests assessing multiple cognitive domains. We assessed IADLs using a criterion-referenced, performance-based instrument. We employed repeated-measures mixed-effects linear models to examine trajectory of cognitive function. We employed non-parametric tests for analysis of IADLs. RESULTS: The BD group displayed worse cognitive function in all domains and worse IADL performance than the comparator group at baseline and over follow-up. Global cognitive function and IADLs were correlated at all time-points. The BD group did not exhibit accelerated cognitive decline over 2 years. CONCLUSIONS: Over 2 years, cognitive impairment and associated functional disability of older adults with BD appear to be due to long-standing neuroprogressive processes compounded by normal cognitive aging rather than accelerated cognitive loss in old age.


Subject(s)
Activities of Daily Living , Bipolar Disorder/physiopathology , Cognition Disorders/physiopathology , Disease Progression , Aged , Aged, 80 and over , Aging/physiology , Bipolar Disorder/complications , Bipolar Disorder/psychology , Case-Control Studies , Cognition , Cognition Disorders/etiology , Female , Humans , Interview, Psychological , Linear Models , Longitudinal Studies , Male , Middle Aged , Neuropsychological Tests/statistics & numerical data , Statistics, Nonparametric
4.
J Cell Biol ; 155(6): 991-1002, 2001 Dec 10.
Article in English | MEDLINE | ID: mdl-11739409

ABSTRACT

Storage proteins are deposited into protein storage vacuoles (PSVs) during plant seed development and maturation and stably accumulate to high levels; subsequently, during germination the storage proteins are rapidly degraded to provide nutrients for use by the embryo. Here, we show that a PSV has within it a membrane-bound compartment containing crystals of phytic acid and proteins that are characteristic of a lytic vacuole. This compound organization, a vacuole within a vacuole whereby storage functions are separated from lytic functions, has not been described previously for organelles within the secretory pathway of eukaryotic cells. The partitioning of storage and lytic functions within the same vacuole may reflect the need to keep the functions separate during seed development and maturation and yet provide a ready source of digestive enzymes to initiate degradative processes early in germination.


Subject(s)
Aquaporins , Plant Proteins/metabolism , Seeds/metabolism , Seeds/ultrastructure , Vacuoles/metabolism , Biomarkers , Cell Compartmentation/physiology , Cysteine Endopeptidases/analysis , Inorganic Pyrophosphatase , Intracellular Membranes/metabolism , Solanum lycopersicum , Membrane Proteins/analysis , Membrane Proteins/metabolism , Microscopy, Electron , Plant Proteins/analysis , Plants, Genetically Modified , Pyrophosphatases/metabolism , Seeds/genetics , Vacuoles/chemistry , Vacuoles/ultrastructure
5.
Acad Med ; 76(10): 1065, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11597851

ABSTRACT

Performances on a clinical skills OSCE of first- and second-year students were compared to measure the success of a new interviewing and physical examination component of the first-year curriculum.


Subject(s)
Clinical Competence , Education, Medical, Undergraduate , United States
7.
Arthritis Rheum ; 45(5): 410-8, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11642639

ABSTRACT

OBJECTIVE: To examine the constructs of task independence, safety, and adequacy. METHOD: Fifty-seven nondisabled (ND) and 56 osteoarthritis-disabled (OAK) women were observed performing daily tasks. RESULTS: Intercorrelations among the constructs of independence and adequacy were uniformly high, while the relationship of safety to these constructs was moderate and more variable, although stronger in the OAK group. Task performance of the OAK group was consistently less adequate and independent than that of the ND group; however, the groups were generally equivalent in safety. For individual tasks, adequacy best differentiated between the groups. In both groups, those who performed independently also performed safely, but fewer independent OAK participants also performed totally adequately. CONCLUSION: The majority of older women who perform tasks independently also perform them safely and adequately; for a clinically significant minority, independence is not always synonymous with safe and adequate performance. Patients may be placed at risk if independence is the only construct used to determine disability.


Subject(s)
Activities of Daily Living , Disability Evaluation , Osteoarthritis, Knee/physiopathology , Aged , Aged, 80 and over , Female , Humans , Safety , Surveys and Questionnaires
8.
Fam Med ; 33(6): 435-40, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11411971

ABSTRACT

BACKGROUND AND OBJECTIVES: Little is known about the relationship between the length of a family medicine clerkship and its educational outcomes. After our family medicine clerkship time decreased from 6 weeks to 4 weeks in July 1997, we studied how this change in clerkship length affected educational outcomes. METHODS: Educational outcomes for the 2-year periods before and after the change were examined and compared whenever possible. Outcome measurements included student ratings of different aspects of the clerkship and student performance on clerkship examinations. RESULTS: Students' exposure to common clinical problems was unaffected by the change. For the 4-week clerkship, there was a slight increase in student ratings of the adequacy of number of patients seen, the opportunity to follow-up with patients, the ability to develop health promotion plans, and overall satisfaction. Because the combinations of examinations used differed each year, student performance on clerkship examinations could not be directly compared. CONCLUSIONS: Educational outcomes of the 4-week clerkship were similar to the 6-week clerkship. A few key outcomes improved. Various curricular and structural changes instituted for the 4-week clerkship contributed to the stability in outcomes. Reports from other medical schools may give additional insight into understanding this relationship.


Subject(s)
Clinical Clerkship/standards , Clinical Competence , Family Practice/education , Adult , Clinical Clerkship/methods , Curriculum/standards , Evaluation Studies as Topic , Female , Humans , Male , Texas , Time Factors
9.
Am J Geriatr Psychiatry ; 9(2): 113-35, 2001.
Article in English | MEDLINE | ID: mdl-11316616

ABSTRACT

Depression and anxiety disorders are associated with excess disability. The authors searched the recent geriatric literature for studies associating late-life depression or anxiety with physical disability. Studies showed depression in old age to be an independent risk factor for disability; similarly, disability was found to be a risk factor for depression. Anxiety in late life was also found to be a risk factor for disability, although not necessarily independently of depression. Increased disability due to depression is only partly explained by differences in socioeconomic measures, medical conditions, and cognition. Physical disability improves with treatment for depression; comparable studies have not been done for anxiety. The authors discuss how these findings inform current concepts of physical disability and discuss the implications for future intervention studies of late-life depression and anxiety disorders.


Subject(s)
Aged/psychology , Anxiety/etiology , Depression/etiology , Disabled Persons/psychology , Frail Elderly/psychology , Activities of Daily Living , Aged, 80 and over , Anxiety/psychology , Depression/psychology , Humans , Middle Aged , Research , Risk Factors
11.
J Cell Biol ; 150(4): 755-70, 2000 Aug 21.
Article in English | MEDLINE | ID: mdl-10953001

ABSTRACT

We identify new organelles associated with the vacuolar system in plant cells. These organelles are defined biochemically by their internal content of three integral membrane proteins: a chimeric reporter protein that moves there directly from the ER; a specific tonoplast intrinsic protein; and a novel receptor-like RING-H2 protein that traffics through the Golgi apparatus. Highly conserved homologues of the latter are expressed in animal cells. In a developmentally regulated manner, the organelles are taken up into vacuoles where, in seed protein storage vacuoles, they form a membrane-containing crystalloid. The uptake and preservation of the contents of these organelles in vacuoles represents a unique mechanism for compartmentalization of protein and lipid for storage.


Subject(s)
Organelles/physiology , Plant Proteins/biosynthesis , Plants/ultrastructure , Vacuoles/physiology , Amino Acid Sequence , Arabidopsis/genetics , Arabidopsis/physiology , Conserved Sequence , Cucurbitaceae/physiology , Endoplasmic Reticulum/physiology , Golgi Apparatus/physiology , Molecular Sequence Data , Organelles/ultrastructure , Plant Proteins/chemistry , Plant Proteins/genetics , Plants, Genetically Modified , Recombinant Fusion Proteins/analysis , Sequence Alignment , Sequence Homology, Amino Acid , Vacuoles/ultrastructure
12.
Int Psychogeriatr ; 12(2): 267-82, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10937545

ABSTRACT

Excess disability was examined in 17 nursing home residents with dementia by comparing their performance of morning care tasks under two activities of daily living (ADL) caregiving approaches-a dependence-supportive one under usual care and an independence-supportive one under functional rehabilitation. The results suggest that excess disability in severely cognitively impaired and functionally disabled residents can be reduced by increasing opportunities for independent activity, and substituting nondirective and directive verbal assists for physical assists. Further, the findings indicate that increased independence in ADL can be achieved without increasing disruptive behaviors and can foster appropriate requests for task-related help during caregiving. Functional rehabilitation, however, requires more time than usual care.


Subject(s)
Alzheimer Disease/diagnosis , Disability Evaluation , Homes for the Aged , Mental Health Services , Nursing Homes , Activities of Daily Living , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Female , Humans , Male , Neuropsychological Tests , Severity of Illness Index , Time Factors
13.
Plant Cell ; 12(4): 493-506, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10760239

ABSTRACT

How sorting receptors recognize amino acid determinants on polypeptide ligands and respond to pH changes for ligand binding or release is unknown. The plant vacuolar sorting receptor BP-80 binds polypeptide ligands with a central Asn-Pro-Ile-Arg (NPIR) motif. tBP-80, a soluble form of the receptor lacking transmembrane and cytoplasmic sequences, binds the peptide SSSFADSNPIRPVTDRAASTYC as a monomer with a specificity indistinguishable from that of BP-80. tBP-80 contains an N-terminal region homologous to ReMembR-H2 (RMR) protein lumenal domains, a unique central region, and three C-terminal epidermal growth factor (EGF) repeats. By protease digestion of purified secreted tBP-80, and from ligand binding studies with a secreted protein lacking the EGF repeats, we defined three protease-resistant structural domains: an N-terminal/RMR homology domain connected to a central domain, which together determine the NPIR-specific ligand binding site, and a C-terminal EGF repeat domain that alters the conformation of the other two domains to enhance ligand binding. A fragment representing the central domain plus the C-terminal domain could bind ligand but was not specific for NPIR. These results indicate that two tBP-80 binding sites recognize two separate ligand determinants: a non-NPIR site defined by the central domain-EGF repeat domain structure and an NPIR-specific site contributed by the interaction of the N-terminal/RMR homology domain and the central domain.


Subject(s)
Pisum sativum/chemistry , Plant Proteins , Receptors, Cell Surface/chemistry , Receptors, Cell Surface/metabolism , Vesicular Transport Proteins , Amino Acid Motifs , Amino Acid Sequence , Animals , Antibodies, Monoclonal/immunology , Antibodies, Monoclonal/pharmacology , Binding Sites , Cell Line , Cysteine Endopeptidases/chemistry , Cysteine Endopeptidases/metabolism , Disulfides/metabolism , Drosophila melanogaster , Endopeptidases/metabolism , Enzyme Precursors/chemistry , Enzyme Precursors/metabolism , Epidermal Growth Factor/chemistry , Fluorescent Dyes/metabolism , Ligands , Molecular Sequence Data , Molecular Weight , Pisum sativum/genetics , Peptide Fragments/chemistry , Peptide Fragments/metabolism , Protein Binding/drug effects , Protein Structure, Tertiary , Receptors, Cell Surface/genetics , Receptors, Cell Surface/immunology , Repetitive Sequences, Amino Acid , Sequence Deletion/genetics , Sequence Homology, Amino Acid , Substrate Specificity
14.
Plant Mol Biol ; 44(4): 463-76, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11197322

ABSTRACT

We have previously identified a rice gene encoding a 27 kDa protein with a single Ca2+-binding EF-hand and a putative membrane anchor. We report here similar genes termed caleosins, CLO, in other plants and fungi; they comprise a multigene family of at least five members in Arabidopsis (AtClo1-5). Northern hybridization demonstrated that AtClo2-4 mRNAs levels were low in various tissues, while AtClo1 mRNA levels were high in developing embryos and mature seeds. Analysis of transgenic Arabidopsis plants expressing the GUS reporter under control of the AtClo1 promoter showed strong levels of expression in developing embryos and also in root tip cells. Antibodies raised against AtCLO1 were used to detect caleosin in cellular fractions of Arabidopsis and rapeseed. This indicated that caleosins are a novel class of lipid body proteins, which may also be associated with an ER subdomain.


Subject(s)
Calcium-Binding Proteins/genetics , Abscisic Acid/pharmacology , Amino Acid Sequence , Arabidopsis/drug effects , Arabidopsis/genetics , Arabidopsis/growth & development , Brassica/genetics , Calcium-Binding Proteins/metabolism , DNA, Plant/chemistry , DNA, Plant/genetics , Gene Expression Regulation, Developmental/drug effects , Gene Expression Regulation, Plant/drug effects , Lipid Metabolism , Molecular Sequence Data , Multigene Family , Phylogeny , Plant Proteins/genetics , Plant Proteins/metabolism , Plant Roots/genetics , Protein Isoforms/genetics , Protein Isoforms/metabolism , RNA, Messenger/genetics , RNA, Messenger/metabolism , Seeds/drug effects , Seeds/genetics , Seeds/growth & development , Sequence Alignment , Sequence Analysis, DNA , Sequence Homology, Amino Acid , Tissue Distribution
15.
Teach Learn Med ; 12(1): 28-32, 2000.
Article in English | MEDLINE | ID: mdl-11228864

ABSTRACT

BACKGROUND: There is an increased awareness of the importance of humanistic behavior and its education in the medical school curriculum. Relatively little is known about correlations between humanism and other performance measures. PURPOSES: To determine the correlation between humanism and other commonly used performance measures, and to determine if more humanistic students perform better, the same, or worse than less humanistic students. METHODS: During the Family Medicine clerkship, standardized patients (SPs) used the Physician Humanism Scale to assess 428 students for humanism. Clinical preceptors, SPs, written assignments, and a national knowledge examination also assessed student performance. The humanism scores were correlated with the SP and non-SP performance measures. RESULTS: Humanism scores were significantly and positively correlated to all of the performance measures, but the correlation coefficients were low, ranging from .12 to .31. Students in the lowest quartile for humanism consistently scored lower for all of the performance measures, including both local and national exams (two-tailed significance < .018). Students with very low humanism scores still passed other performance evaluations. CONCLUSIONS: The correlation between humanism and other performance measures is quite low, indicating that a separate measure for humanism provides different and additional information that current performance measures do not include. More humanistic students perform better than their less humanistic peers, but current performance measures do not identify students with the lowest scores on humanistic behavior. This study supports the inclusion of humanism as an additional, independent performance measure.


Subject(s)
Clinical Clerkship , Clinical Competence , Family Practice/education , Humanism , Humans , Physician-Patient Relations
16.
J Biol Chem ; 274(46): 32647-54, 1999 Nov 12.
Article in English | MEDLINE | ID: mdl-10551819

ABSTRACT

Voltage-gated sodium channels consist of a pore-forming alpha subunit associated with beta1 subunits and, for brain sodium channels, beta2 subunits. Although much is known about the structure and function of the alpha subunit, there is little information on the functional role of the 16 extracellular loops. To search for potential functional activities of these extracellular segments, chimeras were studied in which an individual extracellular loop of the rat heart (rH1) alpha subunit was substituted for the corresponding segment of the rat brain type IIA (rIIA) alpha subunit. In comparison with rH1, wild-type rIIA alpha subunits are characterized by more positive voltage-dependent activation and inactivation, a more prominent slow gating mode, and a more substantial shift to the fast gating mode upon coexpression of beta1 subunits in Xenopus oocytes. When alpha subunits were expressed alone, chimeras with substitutions from rH1 in five extracellular loops (IIS5-SS1, IISS2-S6, IIIS1-S2, IIISS2-S6, and IVS3-S4) had negatively shifted activation, and chimeras with substitutions in three of these (IISS2-S6, IIIS1-S2, and IVS3-S4) also had negatively shifted steady-state inactivation. rIIA alpha subunit chimeras with substitutions from rH1 in five extracellular loops (IS5-SS1, ISS2-S6, IISS2-S6, IIIS1-S2, and IVS3-S4) favored the fast gating mode. Like wild-type rIIA alpha subunits, all of the chimeric rIIA alpha subunits except chimera IVSS2-S6 were shifted almost entirely to the fast gating mode when coexpressed with beta1 subunits. In contrast, substitution of extracellular loop IVSS2-S6 substantially reduced the effectiveness of beta1 subunits in shifting rIIA alpha subunits to the fast gating mode. Our results show that multiple extracellular loops influence voltage-dependent activation and inactivation and gating mode of sodium channels, whereas segment IVSS2-S6 plays a dominant role in modulation of gating by beta1 subunits. Evidently, several extracellular loops are important determinants of sodium channel gating and modulation.


Subject(s)
Ion Channel Gating/genetics , Sodium Channels/genetics , Amino Acid Sequence , Animals , Cell Membrane/metabolism , Kinetics , Membrane Proteins/genetics , Membrane Proteins/metabolism , Microinjections , Molecular Sequence Data , Myocardium/metabolism , Oocytes , Patch-Clamp Techniques , RNA, Messenger/genetics , Rats , Recombinant Fusion Proteins/metabolism , Sodium Channels/chemistry , Xenopus
17.
J Am Geriatr Soc ; 47(9): 1049-57, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10484245

ABSTRACT

OBJECTIVES: This study examined the effectiveness of a behavioral rehabilitation intervention for improving the performance of morning care activities of daily living (ADL) of nursing home residents with dementia. DESIGN: Participants and their caregivers were observed for 5 days each under conditions of Usual Care (naturalistic) and Skill Elicitation (intervention), and for 15 days under Habit Training (intervention follow-up). Observations involved the ADL categories of DRESSING, OTHER ADL, and NO ADL. A 3 x 3 design (condition x ADL category) was used. SETTING: Observations occurred in five proprietary nursing homes in Pittsburgh, Pennsylvania. PARTICIPANTS: The participants were 58 women and 26 men, mean age 82 years (range = 64-97, SD = 6.3), with Probable Alzheimer 's disease (AD) (n = 19) and Possible AD (n = 65), with a mean MMSE score of 6.07. INTERVENTION: Condition 1, Usual Care, was the naturalistic caregiving condition. Condition 2, Skill Elicitation, consisted of an individualized behavioral rehabilitation intervention designed to identify and elicit retained ADL skills. Under Condition 3, Habit Training, the behavioral rehabilitation intervention was continued to reinforce and solidify retained skills and to facilitate further functional gains. MEASUREMENTS: A computer-assisted data collection system was used to document in real-time the assists used by caregivers, the participants' ADL performance, and the participants' responses to caregiving, including disruptive behavior. RESULTS: Compared with Usual Care, during Skill Elicitation participants increased the proportion of time engaged in nonassisted and assisted dressing significantly and increased their overall participation in ADL, with a concomitant significant decrease in disruptive behavior. These functional gains were demonstrated within 5 days of initiating the behavioral rehabilitation intervention and were maintained for 3 weeks during Habit Training. Physical assists were provided for significantly smaller proportions of a morning care session during Skill Elicitation and Habit Training compared with Usual Care. CONCLUSIONS: Even very severely cognitively impaired and functionally disabled nursing home residents can respond to a systematically implemented behavioral rehabilitation intervention. Their rapid response to this intervention suggests that it is alleviating excess disabilities brought on by care patterns rather than retraining ADL task performance. Residents with dementia benefit from behavioral rehabilitation by becoming more appropriately involved in their care and being less disruptive. However, behavioral rehabilitative care takes considerably more time than usual care.


Subject(s)
Activities of Daily Living , Dementia/rehabilitation , Nursing Homes , Aged , Aged, 80 and over , Behavior Therapy , Computers , Dementia/classification , Female , Humans , Male , Middle Aged , Pennsylvania , Rehabilitation/methods , Time Factors , Violence
18.
Arch Intern Med ; 159(9): 970-80, 1999 May 10.
Article in English | MEDLINE | ID: mdl-10326939

ABSTRACT

BACKGROUND: Although understanding the processes of care and medical outcomes for patients with community-acquired pneumonia is instrumental to improving the quality and cost-effectiveness of care for this illness, limited information is available on how physicians manage patients with this illness or on medical outcomes other than short-term mortality. OBJECTIVES: To describe the processes of care and to assess a broad range of medical outcomes for ambulatory and hospitalized patients with community-acquired pneumonia. METHODS: This prospective, observational study was conducted at 4 hospitals and 1 health maintenance organization in Pittsburgh, Pa, Boston, Mass, and Halifax, Nova Scotia. Data were collected via patient interviews and reviews of medical records for 944 outpatients and 1343 inpatients with clinical and radiographic evidence of community-acquired pneumonia. Processes of care and medical outcomes were assessed 30 days after presentation. RESULTS: Only 29.7% of outpatients had 1 or more microbiologic tests performed, and only 5.7% had an assigned microbiologic cause. Although 95.7% of inpatients had 1 or more microbiologic tests performed, a cause was established in only 29.6%. Six outpatients (0.6%) died, and 3 of these deaths were pneumonia related. Of surviving outpatients, 8.0% had 1 or more medical complications. At 30 days, 88.9% (nonemployed) to 95.6% (employed) of the surviving outpatients had returned to usual activities, yet 76.0% of outpatients had 1 or more persisting pneumonia-related symptoms. Overall, 107 inpatients (8.0%) died, and 81 of these deaths were pneumonia related. Most surviving inpatients (69.0%) had 1 or more medical complications. At 30 days, 57.3% (non-employed) to 82.0% (employed) of surviving inpatients had returned to usual activities, and 86.1% had 1 or more persisting pneumonia-related symptoms. CONCLUSIONS: In this study, conducted primarily at hospital sites with affiliated medical education training programs, virtually all outpatients and most inpatients had pneumonia of unknown cause. Although outpatients had an excellent prognosis, pneumonia-related symptoms often persisted at 30 days. Inpatients had substantial mortality, morbidity, and pneumonia-related symptoms at 30 days.


Subject(s)
Community-Acquired Infections/therapy , Pneumonia/therapy , Adult , Aged , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Pneumonia/diagnosis , Pneumonia/microbiology , Pneumonia/mortality , Prevalence , Prospective Studies , Treatment Outcome
19.
Top Health Inf Manage ; 19(3): 15-25, 1999 Feb.
Article in English | MEDLINE | ID: mdl-10346079

ABSTRACT

Computer and manual systems were used simultaneously to record observations of nursing home residents with dementia during a study designed to improve their dressing performance. This article differentiates the overlapping and unique features of the two data collection systems and discusses the clinical and research utility of each system. Although the computer system was more suited to clinical research and the manual system to clinical practice, when used in tandem each system provided data about the residents' performance that could be used for both clinical research and clinical practice, and complemented or expanded upon data generated by the other system.


Subject(s)
Activities of Daily Living , Data Collection/methods , Information Systems/organization & administration , Nursing Homes/organization & administration , Observation , Aged , Aged, 80 and over , Data Interpretation, Statistical , Dementia/nursing , Female , Frail Elderly/statistics & numerical data , Humans , Long-Term Care/organization & administration , Male , Medical Records , Pennsylvania , United States
20.
Plant J ; 18(1): 23-32, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10341441

ABSTRACT

Kex2p is the prototype of a Golgi-resident protease responsible for the processing of prohormones in yeast and mammalian cells. A Kex2p-like pathway was shown to be responsible for processing the fungal KP6 protoxin in transgenic tobacco plants. We previously described a chimeric integral membrane reporter protein that traffics through Golgi to the lytic prevacuole where it was proteolytically processed. As a first step to isolate and clone the Kex2p-like protease in plant cells, we designed and used a similar chimeric reporter protein containing Kex2 cleavage sites to assay the Kex2p-like activity and to determine its substrate specificity in tobacco cells. Here we demonstrate that the Kex2 cleavage sites of the reporter were specifically processed by a protease activity with a substrate specificity characteristic of yeast Kex2p. This Kex2p-like protease in tobacco cells is also a Golgi-resident enzyme. Thus, the reporter protein provides a biochemical marker for studying protein traffic through the Golgi in plant cells. These results additionally should allow the design of synthetic substrates for use in biochemical purification of the plant enzyme.


Subject(s)
Nicotiana/enzymology , Plants, Toxic , Proprotein Convertases , Saccharomyces cerevisiae Proteins , Subtilisins/metabolism , Amino Acid Sequence , Animals , Binding Sites/genetics , Brefeldin A/pharmacology , Cysteine Endopeptidases/chemistry , Cysteine Endopeptidases/genetics , Cysteine Endopeptidases/metabolism , Enzyme Precursors/chemistry , Enzyme Precursors/genetics , Enzyme Precursors/metabolism , Genes, Reporter , Golgi Apparatus/enzymology , Molecular Sequence Data , Mutation , Plants, Genetically Modified , Polysaccharides/chemistry , Protein Processing, Post-Translational/drug effects , Protein Synthesis Inhibitors/pharmacology , Recombinant Fusion Proteins/genetics , Recombinant Fusion Proteins/metabolism , Substrate Specificity , Nicotiana/genetics
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