Phylogenetic evidence of mitochondrial DNA introgression among pocket gophers in New Mexico (family Geomyidae)

Mitochondrial DNA (mtDNA) variation in the cytochrome b gene was determined for two divergent taxa of pocket gophers, Thomomys bottae actuosus and T. b. ruidosae. These two taxa hybridize in a narrow contact zone, but introgression of nuclear markers such as allozymes or chromosomes does not extend much beyond the hybrid zone (Patton et al. 1979). We found that despite their distinctness, the two subspecies shared very similar mtDNA haplotypes. By a comparison of phylogenetic histories derived from nuclear markers (allozymes) and from mtDNA haplotypes sampled in different populations of T. bottae from New Mexico, we show that apparent similarity is due to an introgression of T. b. ruidosae mtDNA into T. b. actuosus nuclear background. Evidence of introgression is not limited to the present-day contact zone between these two taxa, but extends at least 75 km away from it. The actuosus haplotype coexists along with the ruidosae mtDNA in the Gallinas Mts., which are inhabited by otherwise pure T. b. actuosus, while further north only typical actuosus haplotypes were detected. Of several potential mechanisms which could lead to such a geographical pattern of variation, we argue that a combination of range shifts due to climatic fluctuations, and genetic drift are most likely. Horizontal gene transfers due to hybridization are historical events which seem rather common among pocket gophers. Although they can be identified with careful phylogenetic study using independent data sets, the potential for misinterpreting a gene tree as an organismal tree is great in this and other groups of animals.

Walking through walls

By watching out for the community's most vulnerable people, Santa Fe's unique multiagency Crisis Response Task Force averts medical emergencies and unnecessary costs. They didn't know how to fix the turf issues, so they just started meeting.

Santa Fe provider network goes unchallenged by the DOJ

After careful consideration of possible anticompetitive harm and payer reaction, the Department of Justice has chosen not to challenge as unlawful a provider-controlled, nonexclusive physician network in Santa Fe, New Mexico, even though the network will include 70 percent of the area's pediatricians. Reasons for the DOJ's decision include evidence of substantial risk sharing by the physician members, an arrangement by the network to provide a different compensation system for non-member participating physicians, and the pediatricians' promise that they will participate in the network on a nonexclusive basis. In addition, the member pediatricians will be a small minority of the primary care physicians whose compensation will be paid out of one fixed revenue pool. The DOJ's decision thus signals support for a provider network model for smaller communities.

Educational collaboration and innovation. The nurse-midwifery and family nurse practitioner programs at the University of New Mexico

The University of New Mexico College of Nursing Nurse-Midwifery and Family Nurse Practitioner programs are successfully implementing an educational program founded on a shared vision and core. The curriculum design and methods of implementation facilitate study by students distant from the College, clinical learning experiences in rural areas, and dual preparation. Shared application of faculty resources results in availing students of a variety of expertise and cost-effectiveness.

Host preference of mosquitoes in Bernalillo County, New Mexico

Host preference of mosquitoes was determined using animal-baited traps. Hosts used in the study were cattle, chickens, dogs, and horses. Ten mosquito species representing 4 genera were collected from the animal-baited traps. Aedes vexans, Aedes dorsalis, Culex quinquefasciatus. Culex tarsalis, and Culiseta inornata were used as indicator species for data analysis. Greater numbers of Ae. vexans, Ae. dorsalis, and Cs. inornata were collected from cattle and horses than from chickens or dogs. In addition, engorgement rates were higher on mammals than on chickens. Engorgement and attraction data for Cx. quinquefasciatus suggested a preference for chickens and dogs over cattle and horses. A slight preference for chickens and dogs was seen with Cx. tarsalis, but the degree of host preference of Cx. tarsalis was less than that in either Ae. vexans or Cx. quinquefasciatus.

Temporal trends in diabetes mortality among American Indians and Hispanics in New Mexico: birth cohort and period effects

Rates of diabetes mortality are disproportionately high among ethnic minorities in the United States. To describe ethnic trends and cohort effects in diabetes mortality in New Mexico, the authors examined the trends in mortality rates for non-Hispanic whites. Hispanics, and American Indians in the state during the period 1958-1994. Age-specific rates were examined graphically to qualitatively describe the contribution of calendar period and birth cohort effects to changes in the rates. The authors also fit age-period-cohort models to these data. Age-adjusted diabetes mortality rates for American Indians and Hispanics surpassed rates for non-Hispanic whites for all but the earliest two time periods. In the 1993-1994 period, the age-adjusted mortality rate for American Indians was 3.8 times higher for men and 5.6 times higher for women than for their non-Hispanic white counterparts. Rates for American Indian men and women increased sharply over the 37-year period, by 565% and 1,105%, respectively. Mortality rates increased among Hispanics over the period of study but less rapidly than did rates among American Indians. Graphical analyses of age-specific rates were consistent with birth cohort effects among both American Indians and Hispanics and also with a period effect among American Indians. Results from age-period-cohort models indicate a birth cohort effect starting with the 1912 cohort in American Indians and the 1902 cohort in Hispanics. A period effect was present during the 1960s in American Indians. American Indians have experienced an epidemic rise in diabetes mortality in New Mexico; if current trends continue, diabetes may become the leading cause of mortality among American Indians in the state.

Issues in establishing an aerosol radiological baseline for the waste isolation pilot plant near Carlsbad, New Mexico

The Department of Energy has constructed a deep geologic repository for defense transuranic waste disposal. The Waste Isolation Pilot Plant, located in Southeastern New Mexico, is slated to receive transuranic waste by truck delivery beginning in 1998. The Environmental Evaluation Group (EEG) provides an independent evaluation of the impact on the health and environment in New Mexico of the WIPP project. Since 1985, the EEG has operated a network of air monitoring sites around WIPP and in nearby communities. The radionuclide concentration data from these air samples have been assembled into a useful baseline data base after resolution of a number of methodological and quality assurance issues. Investigation thresholds for the principal radionuclides have been calculated from combined data collected from several sites. These action levels will provide a critical quantitative basis for decisions of whether future airborne radionuclide measurements are attributable to accidental releases.

Symptomatology of HIV-related illness and community-acquired illness in an HIV-infected emergency department population

STUDY HYPOTHESIS

Community-acquired infections and non-AIDS-related illnesses are a significant proportion of the final diagnoses in HIV-infected patients presenting to an emergency department. We hypothesized that emergency physicians over-diagnose opportunistic infections in the HIV-infected patient. We also hypothesized that the absolute CD4 lymphocyte level could be used to stratify patients by likelihood of HIV related disease.

METHODS

We retrospectively reviewed ED logbooks and medical records to find all ED patients with self-reported HIV seropositivity during a 19-month period. Age, sex, insurance status, chief complaint(s), ED assessment, and disposition were recorded from the ED logs; absolute CD4 lymphocyte counts, risk factors, and final diagnoses were recorded from the medical records. HIV-related disease was evaluated with the use of established Centers for Disease Control and Prevention criteria. Data were evaluated with the use of the chi 2 test, the chi 2 test for trend, and kappa-proportions.

RESULTS

Analysis of 344 ED visits demonstrated that decreasing absolute CD4 lymphocyte counts were associated with increasing incidence of HIV-related disease (P < .001), even when noninfectious causes were excluded. Only 34% of visits were related to HIV-associated illness. Emergency physicians exhibited high sensitivity (72.9%) and specificity (95.5%) in diagnosing HIV-related disease and conducted appropriate visit disposition.

CONCLUSION

ED visits by HIV-infected individuals are often not made for reasons of opportunistic infection, and the absolute CD4 lymphocyte count is inversely related to HIV-related disease.

Response forms reflect pharmacists' participation in retrospective DUR

This study examined pharmacists' responses to two different Medicaid retrospective therapeutic interventions (excessive use of beta 2-agonist inhalers and long-term use of sedatives) in New Mexico. It also examined the types of actions pharmacists reported taking, and the differences between actions taken by physicians and pharmacists in terms of response rate, tone of responses, and time spent responding to the intervention. The most frequent pharmacist action was to call the physician. Response rates for the drug use review (DUR) program were higher for physicians than for pharmacists; pharmacists also took twice as long as physicians to respond to both interventions. The study results indicate a need for better methods to document clinical services performed by pharmacists under the Medicaid DUR program to obtain reimbursement and justify therapeutic decisions. Pharmacists also need documentation methods that are relatively easy to use so that they can respond more quickly to interventions.

Nutrition and successful aging: a study of 520 elderly persons from the Toulouse and New-Mexico Aging Process Study

Epidemiological studies of aging are usually confronted with the presence of numerous pathologies or environmental factors which make it difficult to identify the effects of aging individually. One way of reducing the variability among individuals is to use well defined criteria to select the study population. This is the choice that was made for the New Mexico and Toulouse Aging Process Studies, which were particularly turned towards successful aging. In this study we have sought to explain the diversity of states of health of the subjects of these two studies by means of an aging classification exploring the medical history, balance and walking, and the cognitive functions. This reveals that the poorer health of certain subjects (about 10% and 30% of the populations of Toulouse and Albuquerque respectively) is slightly associated with changes in eating behaviour relative to subjects who age successfully. We have, however observed a decrease in vitamin E intake in Toulouse associated with a reduction of lipids in the food. But the poorer state of health is predominantly explained by advancing age and the occurrence of pathological states. This study confirms that aging was generally successful in the two populations studied.

The Reference Laboratory's quality quest

The reference laboratory began development of a Quality Assurance Program in 1991. This program evolved into Total Quality Management supported by strategies, systems, policies, and procedures. We also developed powerful Vision and Value Statements. We are proud of our accomplishments and of the Special Recognition awarded from the clinical laboratory management association for our Human Resources Management and Client Service/Education Programs.

Utilization of services in Arizona's capitated Medicaid program for long-term care beneficiaries

The Arizona Long-Term Care System (ALTCS), Arizona's Medicaid program for long-term care (LTC) beneficiaries, capitates contractors to provide a full range of acute and LTC services to financially-eligible beneficiaries determined to be at risk of institutionalization. This article compares the acute care utilization experience of LTC beneficiaries in ALTCS with those in a fee-for-service (FFS) Medicaid program, linking data from both the Medicare and the Medicaid program files. Patterns of use observed in Arizona seem more consistent with a managed care environment than those observed in the FFS comparison. Rates of acute care utilization observed for both the capitated and the FFS program should be of interest to States considering incorporating LTC beneficiaries into their Medicaid managed care program.

Does a physician visual assessment change triage?

A prospective comparative trial was conducted to determine the effect of a physician's visual assessment of emergency patients on triage categorization and ability at triage to predict admission. The setting was a university, county, referral center and residency training site. Participants were a consecutive sample of emergency department patients presenting between the times of 0700 and 2300 hours for 5 weeks. All patients were assigned a triage category by an emergency nurse (RN) who saw the patient and by an emergency physician (EP) who had the option of performing a visual assessment. Triage categorization was compared for interobserver agreement (Kappa [kappa] statistic) and by ability to predict admission (MacNemar's test). A total of 3,949 patients was entered. The patients that physicians visually assessed were triaged by nurses as more ill (P < .001). For triage categories visualized by the EP compared with RN categorization, interobserver agreement was 59.8%, kappa = .21. For triage categories not visualized by EP compared with RN categorization, interobserver agreement was 67.9%, kappa = .45 (P < .001). Sensitivity of EPs to predict admission is as follows: all RN triage, 41.3; not seen by EP, 54.9; seen by EP, 69.3. Specificity is as follows: all RN triage, 93.7; not seen by EP, 88.5, seen by EP, 83.9. When physician visual assessment was done, agreement between physicians and nurses decreased by more than half. Physicians who included visual assessment in patient triage were less likely to agree with RN categorization. A visual assessment by the physician improved the sensitivity for predicting admission with an only small cost in specificity.

Nitrogen dioxide and respiratory illness in children. Part IV: Effects of housing and meteorologic factors on indoor nitrogen dioxide concentrations

In a prospective study of infants' exposure to nitrogen dioxide (NO2)* and respiratory illness, NO2 concentrations were measured in more than 1,400 homes in Albequerque, NM, From January 1988 through June 1991 (Health Effects Institute Research Report Number 58, Parts I, II and III). This report characterizes the variability in indoor NO2 concentrations across seasons and years, and identifies factors associated with variation in concentrations between homes and across seasons. In regression analyses of winter data, NO2 levels in the infants' bedrooms were predominately determined by the presence of gas cooking ranges with continuously burning pilot lights, the presence of wall or floor furnaces, the use of the stove for space heating, and the square footage of the living space. These findings are consistent with previously published analysis of data from homes in other U.S. cities. Relatively small differences in seasonal NO2 levels were observed across years. The correlation coefficient (r) of bedroom NO2 levels obtained in the same homes was 0.66 over two winters and 0.48 over two summers. For homes that had gas cooking ranges with continuously burning pilot lights, the NO2 bedroom concentrations differed, on average, less than 5 parts per billion (ppb) across winters. These differences were hypothesized to be caused by differences in the use of indoor NO2 sources, ventilation, and ambient (outdoor) NO2 levels. We were, however, unable to demonstrate an association between year-to-year differences in seasonal indoor NO2 concentrations and reported use of cooking range, furnace, or heater, or ambient NO2 levels, or temperature.