The first laboratory-confirmed rabid pig in Maryland, 2003.

This article is the first to describe the clinical picture and potential human health impact of laboratory-confirmed rabies infection in a pet Vietnamese pot-bellied pig in Maryland. Although cases of confirmed rabies infection have been infrequently reported in pet or agricultural during the past 10 years in the United States, exposure to rabies-positive animals remains a public health concern particularly for veterinarians, pet owners and other animal caretakers. It is important that individuals who are in a high-risk rabies exposure group remain vigilant to this potential public health threat in all mammal species.

A prospective cohort study comparing the African and European hernia.

INTRODUCTION: The prevalence of inguinal hernia in Ghana, western Africa, is as high as 7.7% of the population. The elective operation rate is significantly lower because many of the hernias are repaired as emergencies. This discrepancy results in a pool of longstanding large hernias. PATIENTS AND METHODS: This prospective cohort study compared consecutive patients having day case local anaesthetic inguinal hernia repairs under the Plymouth Hernia Service, UK, and in Ghana, Africa. Assessment was made of hernia size and subscapular skin-fold thickness. In the Ghanaian group, data were collected on patient age, type of inguinal hernia, duration of the hernia, and disability caused. RESULTS: A total of 241 patients were included in the study (UK: n = 106, Ghana: n = 135). The mean age of the UK group was 62 years (range 28-91 years) and of the Ghanaian group 34 years (range 2 months-80 years). One hundred and twelve (82.9%) of the Ghanaian hernias were indirect. Ninety (67%) of the Ghanaian hernias extended into the scrotum compared with 7 (6.0%) in the UK group. The Ghanaian hernias were significantly larger (P = 0.01) and the patients significantly thinner (P = 0.02). In the Ghanaian group, 22 (16%) of the patients were unable to work due to their hernia, and in a further 87 (64%) patients, the hernia limited daily activity. One hundred and fifteen (85%) of the Ghanaian hernias were present for more than 1 year, and of those, 50 (37%) had been present for more than 5 years. CONCLUSION: In Ghana (a developing country), the hernia is larger than the UK hernia. The majority of Ghanaian hernias are indirect and occur in a young population. This places an economic burden on the country. Appropriate management is needed to reduce the pool of these hernias.

Understanding the financial impact of MS-DRGs.

Steps hospitals should take to prepare for changes to Medicare's inpatient prospective payment system include: Analyze the data within product lines to identify trends (by physician or by specific Medicare severity diagnosis-related group). Determine which product lines will be most affected. Develop action plans to proactively manage the resulting changes in revenue.

A nucleotide polymorphism in ERCC1 in human ovarian cancer cell lines and tumor tissues.

We studied the DNA sequence of the entire coding region of ERCC1 gene, in five cell lines established from human ovarian cancer (A2780, A2780/CP70, MCAS, OVCAR-3, SK-OV-3), 29 human ovarian cancer tumor tissue specimens, one human T-lymphocyte cell line (H9), and non-malignant human ovary tissue (NHO). Samples were assayed by PCR-SSCP and DNA sequence analyses. A silent mutation at codon 118 (site for restriction endonuclease MaeII) in exon 4 of the gene was detected in MCAS, OVCAR-3 and SK-OV-3 cells, and NHO. This mutation was a C-->T transition, that codes for the same amino acid: asparagine. This transition converts a common codon usage (AAC) to an infrequent codon usage (AAT), whereas frequency of use is reduced two-fold. This base change was associated with a detectable band shift on SSCP analysis. For the 29 ovarian cancer specimens, the same base change was observed in 15 tumor samples and was associated with the same band shift in exon 4. Cells and tumor tissue specimens that did not contain the C-->T transition, did not show the band shift in exon 4. Our data suggest that this alteration at codon 118 within the ERCC1 gene, may exist in platinum-sensitive and platinum-resistant ovarian cancer tissues.

Computer assisted clinical data analysis.

The Diagnosis Related Groups patient classification scheme coupled with desk top PC technology permits sophisticated analysis of patient medical data. Individuals with no programming knowledge can produce sophisticated analysis. The functionality and structure of the 3M Analytical Workstation are described and example analysis reports are presented.

Case-mix adjusted analyses of service utilization for a Medicaid health insuring organization in Philadelphia.

Health Insuring Organizations (HIOs) are capitated plans that serve all of the Medicaid beneficiaries in a defined catchment area. While this approach to capitation eliminates the incentive to enroll only the healthiest beneficiaries in the area, it does not alleviate concerns that the HIO will respond to the incentives for efficiency created by capitation payment by underproviding services. The authors studied change in service utilization patterns produced by the HIO by using a multivariate strategy to identify case-mix groups at the population level to adjust analyses of hospital and nursing home utilization for case mix. This approach was applied to service utilization data for Medicaid beneficiaries in Philadelphia who received medical services from an HIO and for two control groups. In addition to identifying changes in service use, they evaluated the performance of the HIOs on three dimensions--access to care, quality of care, and the efficiency with which the care was provided. While limitations on the information available in the billing files did not allow definitive statements to be made regarding these issues, case-mix adjusted patterns of service use (and mortality) across sets of service may enable Medicaid programs to identify areas where problems in one of these three critical areas exist. This would allow the program to target its limited utilization and quality review resources toward the areas, types of people, and/or providers where problems in one or more of these areas are more likely.