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Turner A, van Driel ML, Mitchell BL, Davis JS, Fielding A, Davey A, Holliday E, Ball J, Ralston A, Tapley A, Mulquiney K, Baillie EJ, Spike N, Clarke L, Magin P. Temporal patterns of antibiotic prescribing for sore throat, otitis media, and sinusitis: a longitudinal study of general practitioner registrars. Fam Pract 2023:7179275. [PMID: 37226282 DOI: 10.1093/fampra/cmad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Antibiotics provide minimal benefit for sore throat, otitis media, and sinusitis. Antibiotic stewardship, with reduced prescribing, is required to address antibiotic resistance. As most antibiotic prescribing occurs in general practice and prescribing habits develop early, general practitioner (GP) trainees (registrars) are important for effective antibiotic stewardship. OBJECTIVES To establish temporal trends in Australian registrars' antibiotic prescribing for acute sore throat, acute otitis media, and acute sinusitis. DESIGN A longitudinal analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study from 2010 to 2019. PARTICIPANTS ReCEnT is an ongoing cohort study of registrars' in-consultation experiences and clinical behaviours. Pre-2016, 5 of 17 Australian training regions participated. From 2016, 3 of 9 regions (42% of Australian registrars) participate. MAIN MEASURES The outcome was prescription of an antibiotic for a new acute problem/diagnosis of sore throat, otitis media, or sinusitis. The study factor was year (2010-2019). KEY RESULTS Antibiotics were prescribed in 66% of sore throat diagnoses, 81% of otitis media, and in 72% of sinusitis. Prescribing frequencies decreased between 2010 and 2019 by 16% for sore throat (from 76% to 60%) by 11% for otitis media (from 88% to 77%) and by 18% for sinusitis (from 84% to 66%). In multivariable analyses, "Year" was associated with reduced prescribing for sore throat (OR 0.89; 95%CI 0.86-0.92; p < 0.001), otitis media (OR 0.90; 95%CI 0.86-0.94; p < 0.001), and sinusitis (OR 0.90; 95%CI 0.86, 0.94; p < 0.001). CONCLUSIONS Registrars' prescribing rates for sore throat, otitis media, and sinusitis significantly decreased during the period 2010-2019. However, educational (and other) interventions to further reduce prescribing are warranted.
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Affiliation(s)
- Alexandria Turner
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
| | - Mieke L van Driel
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Benjamin L Mitchell
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Joshua S Davis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Alison Fielding
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Andrew Davey
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Anna Ralston
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Katie Mulquiney
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Emma J Baillie
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Australia
- School of Rural Health, Monash University, Clayton, Australia
| | - Lisa Clarke
- General Practice Training Tasmania, Regional Training Organisation, Hobart, Australia
| | - Parker Magin
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Mitchell BL, Carter J, Mitchell AE. A randomised controlled trial of SMS reminders for routine asthma care in an Australian general practice. Aust J Gen Pract 2020; 48:626-630. [PMID: 31476826 DOI: 10.31128/ajgp-02-19-4848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Asthma self-management strategies remain core components of evidence-based asthma care. Despite this, only 14% of Australian adults with asthma have written action plans. We aimed to evaluate whether targeted SMS reminders to attend an asthma review could improve asthma action plan and spirometry completions for general practice patients who do not have current asthma action plans. METHOD A randomised controlled trial comparing targeted SMS reminders with usual care was performed from May to September, 2016, in a metropolitan general practice in South East Queensland. RESULTS By the three-month follow-up, 35 of 79 patients allocated to intervention had completed action plans in comparison to five of 59 patients allocated to usual care (P < 0.0001). There were more recorded instances of spirometry per patient performed during the follow-up period for intervention (37/79), compared with usual care (8/59; P <0.0001). DISCUSSION SMS reminders may be a useful tool in the spectrum of care needed for optimal asthma management in general practice.
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Affiliation(s)
- Benjamin L Mitchell
- BSc, MBBS, Senior Lecturer, Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Qld; General Practitioner, Banyo Clinic, Qld.
| | - John Carter
- MBBS, MMed(GP), General Practitioner, Banyo Clinic, Qld
| | - Amy E Mitchell
- BSc, BNursing, GradCert, PhD, Research Fellow, School of Psychology, The University of Queensland, Qld
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Brodribb WE, Mitchell BL, Van Driel ML. Postpartum consultations in Australian general practice. Aust J Prim Health 2017; 22:128-132. [PMID: 25586677 DOI: 10.1071/py14082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/25/2014] [Indexed: 11/23/2022]
Abstract
Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth. However, there is little information about GPs' understanding of their role in postpartum care and how it is undertaken. This cross-sectional survey of GPs in Southern Queensland, conducted between February and July 2013, describes the involvement of GPs in postpartum care. GPs were posted a 52-item questionnaire adapted from a previous Victorian GP study and were telephoned 2 weeks later. GPs completed the survey on paper or online. The response rate was 17.4% (163 GPs). Approximately 39% were uncertain whether women were happy with the GP-provided postpartum care. GPs' recommendations for the timing of postpartum reviews were inconsistent within and across birthing sectors and consultations took longer than anticipated. Developing guidelines around the timing and appropriate length of postpartum consultations could assist GPs in providing appropriate care for mothers and infants.
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Affiliation(s)
- Wendy E Brodribb
- Discipline of General Practice, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, Brisbane, Qld 4029, Australia
| | - Benjamin L Mitchell
- Discipline of General Practice, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, Brisbane, Qld 4029, Australia
| | - Mieke L Van Driel
- Discipline of General Practice, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, Brisbane, Qld 4029, Australia
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Brodribb WE, Mitchell BL, van Driel ML. Practice related factors that may impact on postpartum care for mothers and infants in Australian general practice: a cross-sectional survey. BMC Health Serv Res 2016; 16:244. [PMID: 27400740 PMCID: PMC4940844 DOI: 10.1186/s12913-016-1508-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/05/2016] [Indexed: 11/23/2022] Open
Abstract
Background While there is a significant focus on the health and well-being of women during pregnancy, labour and birth, much less emphasis is placed on the care of postpartum women and their infants in primary care following the birth. Some studies have investigated the role of GPs in postpartum care, and others examined facilitators and barriers to mothers accessing care. However there is little information available to investigate the effect of practice related factors on access to care of mothers and infants at this time. Methods A 20-item questionnaire for completion by the practice managers was mailed to 497 general practices in Southern Queensland, Australia between February and July 2013. Questionnaire items included practice demographics, practice procedures and personnel including appointment scheduling, billing, practice nurse function and qualifications and a free-text option for comments. Descriptive statistics are presented as numbers and percentages. Chi Squared test compared practice location with methods of identification of postpartum women, practice size with other Queensland data and ANOVA compared practice size with the number of postpartum appointments. Logistic regression was used to predict variables that were related to booked appointment times. Free text responses were grouped in common themes. Results The response rate was 27.4 %. At 67.2 % of the practices, mothers had to self-identify as needing a postpartum consultation and most consultations were allocated 15 minutes or less. Only 20 % of practices accepted the government insurance payment (bulk-billing) for all maternal and infant services, with more practices bulk-billing children only. Out-of-pocket expenses ranged from $10-$60. Nearly 80 % of practice nurses saw postpartum mothers or infants ‘nearly always’ or ‘sometimes’. Approximately 30 % had midwifery or child health training. There were higher odds of longer booked appointment times for solo practitioner practices (unadj OR 3.30 95%CI 1.03-10.57), but no other variables predicted booked appointment times Conclusions This study identified a number of practice related factors that, if addressed, could positively impact on postpartum care. These include ensuring ongoing practice relationships to assist with booking appropriate consultation times and guaranteeing that there are no financial impediments to women accessing care. Some factors can easily be adapted within practices. Others would require changes of policy at a local or national level. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1508-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wendy E Brodribb
- Discipline of General Practice, The University of Queensland, Health Sciences Building, Herston, Queensland, 4029, Australia.
| | - Benjamin L Mitchell
- Discipline of General Practice, The University of Queensland, Health Sciences Building, Herston, Queensland, 4029, Australia
| | - Mieke L van Driel
- Discipline of General Practice, The University of Queensland, Health Sciences Building, Herston, Queensland, 4029, Australia
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Brodribb WE, Mitchell BL, Van Driel ML. Continuity of care in the post partum period: general practitioner experiences with communication. AUST HEALTH REV 2016; 40:484-489. [DOI: 10.1071/ah15144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/06/2015] [Indexed: 11/23/2022]
Abstract
Objectives Informational and management continuity of care assists in providing a seamless transition for women and infants from tertiary or secondary to primary care during the post partum period. Few studies have evaluated the interaction between different aspects of the health system following a woman’s discharge from hospital after the birth of her infant. The present study describes how general practitioners (GPs) experience communications with hospitals and other post partum care providers relevant to continuity of care. Methods In the present cross-sectional study, a 52-item questionnaire adapted from a previously used survey was mailed to 932 GPs in southern Queensland, Australia, between February and July 2013. Questionnaire items included participant demographics, the timeliness and usability of discharge summaries, communication with other post partum care providers and consultation practices. Results The response rate was 17.4%. Nearly one-quarter of participants never or rarely received a hospital discharge summary in a timely manner and most considered the summaries somewhat useful. Few GPs (14.3%) had contact with or received information from domiciliary midwives who conducted post partum home visits. A higher proportion (38%) had some communication with a Child and Family Health nurse in the month before the survey. Conclusions Information flow from hospital to general practice and between other post partum care providers is less than ideal and may affect ongoing care for mothers and infants, especially those at risk. Knowledge exchange between healthcare services and initiatives to improve information sharing needs to be developed and implemented. What is already known on this topic? Transitions from tertiary or secondary care to primary care and between primary care providers are often times of vulnerability for patients, including women and infants in the post partum period. There is little information documenting communications between different maternity services and GPs that facilitate ongoing care. What does this paper add? There are significant gaps in the exchange of information about post partum women and infants from hospitals to GPs and a lack of communication between GPs and other post partum care providers, such as domiciliary midwives and Child and Family Health nurses. What are the implications for practitioners? Improvements in the timeliness, presentation and content of hospital discharge summaries, as well as enhancing channels of communication, collaboration, cooperation and information sharing between providers of community post partum care, are necessary if mothers are to receive the best care possible.
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Haran C, van Driel M, Mitchell BL, Brodribb WE. Clinical guidelines for postpartum women and infants in primary care-a systematic review. BMC Pregnancy Childbirth 2014; 14:51. [PMID: 24475888 PMCID: PMC3906750 DOI: 10.1186/1471-2393-14-51] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/27/2014] [Indexed: 11/24/2022] Open
Abstract
Background While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care. Methods PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument. Results Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest. Conclusions Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.
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Affiliation(s)
| | | | | | - Wendy E Brodribb
- Discipline of General Practice, School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Level 8, Health Sciences Building, Herston 4029, Australia.
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Mitchell BL. Out of the glass house: Robert Todd Lincoln's crucial decade. Timeline 2001; 5:2-17. [PMID: 11618215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Chace DH, DiPerna JC, Mitchell BL, Sgroi B, Hofman LF, Naylor EW. Electrospray tandem mass spectrometry for analysis of acylcarnitines in dried postmortem blood specimens collected at autopsy from infants with unexplained cause of death. Clin Chem 2001; 47:1166-82. [PMID: 11427446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Deaths from inherited metabolic disorders may remain undiagnosed after postmortem examination and may be classified as sudden infant death syndrome. Tandem mass spectrometry (MS/MS) may reveal disorders of fatty acid oxidation in deaths of previously unknown cause. METHODS We obtained filter-paper blood from 7058 infants from United States and Canadian Medical Examiners. Acylcarnitine and amino acid profiles were obtained by MS/MS. Specialized interpretation was used to evaluate profiles for disorders of fatty acid, organic acid, and amino acid metabolism. The analyses of postmortem blood specimens were compared with the analyses of bile specimens, newborn blood specimens, and specimens obtained from older infants at risk for metabolic disorders. RESULTS Results on 66 specimens suggested diagnoses of metabolic disorders. The most frequently detected disorders were medium-chain and very-long-chain acyl-CoA dehydrogenase deficiencies (23 and 9 cases, respectively), glutaric acidemia type I and II deficiencies (3 and 8 cases, respectively), carnitine palmitoyl transferase type II/translocase deficiencies (6 cases), severe carnitine deficiency (4 cases), isovaleric acidemia/2-methylbutyryl-CoA dehydrogenase deficiencies (4 cases), and long-chain hydroxyacyl-CoA dehydrogenase/trifunctional protein deficiencies (4 cases). CONCLUSIONS Postmortem metabolic screening can explain deaths in infants and children and provide estimates of the number of infant deaths attributable to inborn errors of metabolism. MS/MS is cost-effective for analysis of postmortem specimens and should be considered for routine use by Medical Examiners and pathologists in unexpected/unknown infant and child death.
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Affiliation(s)
- D H Chace
- Neo Gen Screening, PO Box 219, Bridgeville, PA 15017, USA.
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Shih WJ, Runge VV, Mitchell BL, Pulmano C. Comparison of bone SPECT, magnetic resonance imaging, and computed tomography in the demonstration of vertebral metastases from bronchogenic carcinoma: an autopsy-documented case. Clin Nucl Med 2000; 25:647-9. [PMID: 10944033 DOI: 10.1097/00003072-200008000-00025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- W J Shih
- Nuclear Medicine Service, Lexington VA Medical Center, 40511, USA.
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Gaweco AS, Mitchell BL, Lucas BA, McClatchey KD, Van Thiel DH. CD40 expression on graft infiltrates and parenchymal CD154 (CD40L) induction in human chronic renal allograft rejection. Kidney Int 1999; 55:1543-52. [PMID: 10201021 DOI: 10.1046/j.1523-1755.1999.00379.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND CD40-CD154 (CD40L) costimulatory signaling plays a pivotal role in the effector mechanisms of transplant graft rejection. In animal models, CD40-CD154 blockade induces long-term graft acceptance concurrent with an absence of chronic rejection (CR) lesions. Given the critical importance of CD40-CD154 interactions in the development of chronic transplant allograft rejection, the relevance of in situ CD40 and CD154 expression was assessed in human chronic renal allograft rejection. METHODS The expression of CD40, CD154, CD68, and T-cell receptor (TCR)alpha/beta was analyzed by immunohistochemistry. Serial cryostat sections of snap-frozen core renal allograft biopsies were obtained from 30 renal transplant patients. Biopsy specimens received diagnoses of CR (N = 23) according to the Banff classification and were compared with controls (N = 7) consisting of stable allografts and normal kidney tissue. RESULTS Striking CD40 staining of graft cellular infiltrates (P = 0.016) was observed in renal allografts with CR compared with controls. The CD40+ cellular infiltrates in CR were predominantly TCR alpha/beta + T cells and some CD68+ macrophages. These findings were contrasted by the low-level CD40 expression detected in glomeruli and tubules of CR and controls. However, glomerular induction of CD154 was observed in CR allografts (P = 0.028) as compared with controls. CD154 immunoreactivity was demonstrated on glomerular endothelial, epithelial, and mesangial cells. Moderate CD154 expression was detected on tubular epithelial cells, and only weak CD154 immunoreactivity was observed on the infiltrates in isolated CR cases. CONCLUSION In human chronic renal allograft rejection, CD40 is expressed on graft-infiltrating cells of the T cell and macrophage compartments. CD154 expression is induced on glomerular and tubular epithelial cells during CR, demonstrating another novel source of CD154 expression. The data substantiate the potential contributory role of an interaction between CD40+ graft-destructive effector T cells and macrophages with CD154+ renal allograft parenchymal cells in the development of chronic renal allograft rejection.
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Affiliation(s)
- A S Gaweco
- Department of Medicine, Loyola University Medical Center, Loyola University Chicago, Maywood, Illinois, USA.
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Gaweco AS, Mitchell BL, Lucas B, McClatchey KD, Van Thiel DH. CD40 upregulation in TCR alpha/beta+ CD68+ cells and parenchymal CD40L induction and associated with NF-kappa B activation in chronic rejecting human renal allografts. Transplant Proc 1999; 31:1359-60. [PMID: 10083602 DOI: 10.1016/s0041-1345(98)02027-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A S Gaweco
- Department of Medicine, Loyola University Medical Center, Loyola University Chicago, Maywood, IL 60153, USA.
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Oakley BR, Rinehart JE, Mitchell BL, Oakley CE, Carmona C, Gray GL, May GS. Cloning, mapping and molecular analysis of the pyrG (orotidine-5'-phosphate decarboxylase) gene of Aspergillus nidulans. Gene 1987; 61:385-99. [PMID: 3328733 DOI: 10.1016/0378-1119(87)90201-0] [Citation(s) in RCA: 142] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We have modified the transformation procedures of Ballance et al. [Biochem. Biophys. Res. Commun. 112 (1983) 284-289] to give increased rates of transformation in Aspergillus nidulans. With the modified procedures we have been able to complement pyrG89, a mutation in the orotidine-5'-phosphate decarboxylase gene of A. nidulans, by transformation with a library of wild-type (wt) sequences in pBR329. We have recovered, by marker rescue from one such transformant, a plasmid (pJR15) that carries an A. nidulans sequence that complements pyrG89 efficiently. In three experiments, this plasmid gave an average of 1985 stable transformants/micrograms of transforming DNA. We have analyzed ten of these genetically and by Southern hybridization. In five transformants a single copy of the transforming plasmid had integrated at the pyrG locus, in one transformant several copies of pJR15 had integrated at this locus, in one transformant several copies of the plasmid had integrated into other sites, and in three transformants, the wt allele had apparently replaced the mutant allele with no integration of pBR329 sequences. Sequence and S1 nuclease protection analysis revealed that pJR15 contains a gene that predicts an amino acid sequence with regions of strong homology to the orotidine-5'-phosphate decarboxylases of Neurospora crassa and Saccharomyces cerevisiae. We conclude that this gene is the wt pyrG allele. Finally, we have compared the 5'- and 3'-noncoding sequences and intron splice sequences to other genes of A. nidulans and have mapped the pyrG locus to a region between the fpaB and galD loci on linkage group I.
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Affiliation(s)
- B R Oakley
- Department of Molecular Genetics, Ohio State University, Columbus 43210
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Simon MW, Mitchell BL, O'Connor WN, Noonan JA, Davis CA, Wyatt RJ. Glomerulonephritis, pulmonary hemorrhage and coagulopathy associated with Haemophilus parainfluenzae endocarditis. Pediatr Infect Dis 1985; 4:183-8. [PMID: 3982981 DOI: 10.1097/00006454-198503000-00015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Wyatt RJ, Julian BA, Bhathena DB, Mitchell BL, Holland NH, Malluche HH. Iga nephropathy: presentation, clinical course, and prognosis in children and adults. Am J Kidney Dis 1984; 4:192-200. [PMID: 6475950 DOI: 10.1016/s0272-6386(84)80071-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Eighty-two patients, 56 male and 26 female, biopsied since 1972 had IgA nephropathy. At the time of kidney biopsy, 24 patients were children and 58 were adults. In both groups the clinical course was documented in sufficient detail to allow prediction of disease outcome. Twenty-six (45%) of the adult patients had chronic renal insufficiency either at first evaluation or subsequently. Fourteen eventually required chronic hemodialysis. Hypertension as the initial sign of disease was seen more frequently in patients with chronic renal insufficiency. Adult males were more likely to have chronic renal insufficiency. The life table method was used to predict age at initiation of dialysis and kidney survival from date of onset of clinically apparent disease. Thirty-five percent of the male patients were predicted to require dialysis by age 40. Kidney death was predicted at 10 years from onset for 33% of male and 22% of all patients biopsied as adults. While all patients with progressive disease had over 2.0 g/24 h urinary protein excretion at least once, many individuals with serum creatinine concentration below 1.5 mg/dL showed marked fluctuation in degree of proteinuria, often exceeding 2.0 g/24 h. Thus, in some cases, degree of proteinuria was not a reliable predictor of outcome.
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Ellis AR, Mayers DL, Martone WJ, Mitchell BL, Atuk NO, Guerrant RL. Rapidly expanding pulmonary nodule caused by Pittsburgh pneumonia agent. JAMA 1981; 245:1558-9. [PMID: 7009903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Oleson FB, Mitchell BL, Dipple A, Lieberman MW. Distribution of DNA damage in chromatin and its relation to repair in human cells treated with 7-bromomethylbenz(a) anthracene. Nucleic Acids Res 1979; 7:1343-61. [PMID: 514816 PMCID: PMC342307 DOI: 10.1093/nar/7.5.1343] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We have examined the relationship between the distribution of DNA damage and repair in chromatin from confluent human fibroblasts treated with the carcinogen 7-bromomethylbenz (a) anthracene. Analysis of staphylococcal nuclease (SN)4 digestion kinetics and gel electrophoresis revealed that more total damage occurs in nucleosome core DNA (approximately 80-85% of chromatin DNA) than in SN sensitive DNA (APPROXIMATELY15-20%). Furthermore, over a 24 hr period, damage is removed at about the same rate from these two regions. In contrast, virtually all of the nucleotides incorporated during repair synthesis are initially SN sensitive even when measured at 12 hr after damage. With time many repair-incorporated nucleotides become SN resistant and coelectrophorese with nucleosome core DNA. To explain these data we propose a model whereby excision repair occurs in both linker and core DNA; however, in core DNA the repair process induces conformational changes resulting in temporarily increased SN sensitivity; subsequently, rearrangement occurs and results in the re-establishment of native or near-native nucleosome conformation and SN resistance.
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Koffsky RM, Litwak RS, Mitchell BL, Jurado RA. A simple left heart assist device for use after intracardiac surgery: development, deployment and clinical experience. Artif Organs 1978; 2:257-62. [PMID: 708287 DOI: 10.1111/j.1525-1594.1978.tb03462.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A simple left heart assist device (LHAD) has been developed and employed in nineteen patients with severe left ventricular dysfunction who could not be weaned from cardiopulmonary bypass following intracardiac surgery. It has been used when all other means of weaning, including maximum pharmacologic therapy and intra-aortic balloon counterpulsation (IABC), had failed. The device utilizes specially designed and constructed obturated cannulae in the left atrium and the ascending aorta, and an extracorporeal roller pump to partially bypass the left ventricle. With improved cardiac performance, the patient may be separated from the device without need for thoracic reentry. Of the nineteen patients having LHAD support (2-500 hours), thirteen were eventually weaned from the device and seven were discharged from the hospital. Five patients remain alive and well (18 to 50 months postoperatively).
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