A library of human gut bacterial isolates paired with longitudinal multiomics data enables mechanistic microbiome research.

Our understanding of how the gut microbiome interacts with its human host has been restrained by limited access to longitudinal datasets to examine stability and dynamics, and by having only a few isolates to test mechanistic hypotheses. Here, we present the Broad Institute-OpenBiome Microbiome Library (BIO-ML), a comprehensive collection of 7,758 gut bacterial isolates paired with 3,632 genome sequences and longitudinal multi-omics data. We show that microbial species maintain stable population sizes within and across humans and that commonly used 'omics' survey methods are more reliable when using averages over multiple days of sampling. Variation of gut metabolites within people over time is associated with amino acid levels, and differences across people are associated with differences in bile acids. Finally, we show that genomic diversification can be used to infer eco-evolutionary dynamics and in vivo selection pressures for strains within individuals. The BIO-ML is a unique resource designed to enable hypothesis-driven microbiome research.

Publicly disclosed information about the quality of health care: response of the US public.

Public disclosure of information about the quality of health plans, hospitals, and doctors continues to be controversial. The US experience of the past decade suggests that sophisticated quality measures and reporting systems that disclose information on quality have improved the process and outcomes of care in limited ways in some settings, but these efforts have not led to the "consumer choice" market envisaged. Important reasons for this failure include limited salience of objective measures to consumers, the complexity of the task of interpretation, and insufficient use of quality results by organised purchasers and insurers to inform contracting and pricing decisions. Nevertheless, public disclosure may motivate quality managers and providers to undertake changes that improve the delivery of care. Efforts to measure and report information about quality should remain public, but may be most effective if they are targeted to the needs of institutional and individual providers of care.

What are Medicare managed care plans doing to measure and improve quality of care?

To explore managed care plans' efforts to assess and improve quality of care for Medicare beneficiaries, the authors surveyed managed care plans with risk contracts for Medicare beneficiaries in 20 large metropolitan areas in January 1998. The survey inquired about: (1) the health plans' efforts to assess and improve quality of care for specific underuse, overuse, and misuse problems; (2) how the health plans assessed functional status of enrollees, and (3) the quality improvement program they believed had the greatest impact on the health of enrollees. The managed care plans reported a heterogeneous mix of quality improvement activities ranging from poorly developed to very sophisticated. The vast majority of the more sophisticated programs addressed problems with underuse of services rather than overuse or misuse.

Endogenous Klebsiella endophthalmitis: case report.

A case of endogenous Klebsiella pneumoniae endophthalmitis, cryptogenic in origin, is presented. It was treated initially with success, only to recur three months later with loss of the eye. Common sites of Klebsiella infection are reviewed. This organism rapidly destroys retinal photoreceptors. A link between Klebsiella and acute anterior uveitis has been suggested but is not supported by prospective data.

Aminocaproic acid treatment of recurrent postoperative hyphemas.

Three patients were treated with aminocaproic acid for medically uncontrolled hyphemas that developed after cataract extractions. In all three patients the bleeding stopped after a course of aminocaproic acid was begun. This happened despite a very short course of therapy in two patients. All three patients had to have treatment discontinued because of side effects, in part contributed to by preexisting medical problems, appeared.

Fusarium solani endophthalmitis without primary corneal involvement.

A 45-year-old woman developed a fungal endophthalmitis caused by Fusarium solani. No primary corneal lesion existed. Therefore, the focus of infection was considered endogenous. Although disseminated systemic infections with Fusarium species have been described in compromised hosts, including a patient with metastatic panophthalmitis, we believe this is the first report of an endogenous endophthalmitis caused by F. solani in a healthy individual.

Bilateral amyloidosis of the vitreous body: report of a case without systemic of familial involvement.

Amyloidosis of the vitreous body is an uncommon and often misdiagnosed condition that causes progressive visual loss. It is usually associated with primary familial systemic amyloidosis. The patient described in this report has amyloidosis of both vitreous bodies; her case is unusual because no other family members are affected and because there has been no evidence of systemic involvement over a seven-year observation period. After part of the vitreous body of her right eye was removed surgically, visual acuity improved from light perception to 20/60. New concepts regarding the nature, classification, and histochemical identification of amyloid are discussed.

Contusion angle deformity in prizefighters.

Ophthalmic examinations of 55 retired boxers showed nine eyes with contusion angle deformities and no cases of secondary glaucoma due to the trauma, despite an average duration of 33 years since injury. The subjects with chamber angle recessions had more proptotic eyes (average, 19.7 mm) than those without recessions (average, 17.9 mm). The difference between the means was not significant (P less than .05).