bluuebunny/crossref_metadata_2025 huggingface dataset:
DIEL RHYTHM OF ALGAL PHOSPHATE UPTAKE RATES IN P‐LIMITED CYCLOSTATS AND SIMULATION OF ITS EFFECT ON GROWTH AND COMPETITION1
Authors: Ahn Chi‐Yong , Chung An‐Sik , Oh Hee‐Mock
Published: March 2003

Oscillations in the phosphate (Pi) uptake rates for three species of green algae were examined in a P‐limited cyclostat. For Ankistrodesmus convolutus Corda and Chlorella vulgaris Beyerinck, the Pi uptake rates increased during the daytime and decreased at night. In contrast, Chlamydomonas sp. exhibited the opposite uptake pattern. Cell densities also oscillated under a light:dark cycle, dividing at a species‐specific timing rather than continuously. In general, the cell densities exhibited an inverse relationship with the Pi uptake rates. A competition experiment between A. convolutus and C. vulgaris in a P‐limited cyclostat resulted in the dominance of C. vulgaris, regardless of the relative initial cell concentrations. Chlorella vulgaris also dominated in a mixed culture with Chlamydomonas sp., irrespective of the initial seeding ratio and dilution rate. However, Chlamydomonas sp. and A. convolutus coexisted in the competition experiment with gradual decrease of Chlamydomonas sp. when equally inoculated. Mathematical expressions of the oscillations in the Pi uptake rate and species‐specific cell division gate were used to develop a simulation model based on the Droop equation. The simulation results for each of the species conformed reasonably well to the experimental data. The results of the competition experiments also matched the competition simulation predictions quite well, although the experimental competition was generally more delayed than the simulations. In conclusion, the model simulation that incorporated the effect of diel rhythms in nutrient uptake clearly demonstrated that species diversity could be enhanced by different oscillation patterns in resource uptake, even under the condition of limitation by the same resource.
CRYPTOMONAD EVOLUTION: NUCLEAR 18S rDNA PHYLOGENY VERSUS CELL MORPHOLOGY AND PIGMENTATION1
Authors: Deane James A. , Strachan Isabelle M. , Saunders Gary W. , Hill David R. A. , McFadden Geoffrey I.
Published: March 2003

A nuclear18S rDNA phylogeny for cryptomonad algae is presented, including 11 species yet to be investigated by molecular means. The phylogenetic positions of the cryptomonad generaCampylomonasandPlagioselmisare assessed for the first time.Campylomonasgroups most closely with morphologically similar species with the same accessory pigment from the genusCryptomonas. Plagioselmisgroups with the generaTeleaulaxandGeminigeraforming a clade whose members are united by unusual thylakoid arrangement. Nuclear 18S rDNA phylogeny divides cryptomonads into seven major lineages, two of which consist of the monospecific generaProteomonasandFalcomonas.Analysis of nuclear18S rDNA sequence supports suggestions that aFalcomonas‐like cryptomonad gave rise to all other blue‐green cryptomonads. New sequence from the plastid‐lacking cryptomonad genusGoniomonasis also included, and the order of divergence of the major cryptomonad lineages is discussed. The morphology, number, and pigmentation of the cryptomonad plastidial complex are congruent with nuclear 18S rDNA phylogenies. Host cell features, such as periplast type, furrow/gullet system, and cell shape, can be more variable and may be markedly different in species that are closely related by nuclear 18S rDNA phylogeny. Conversely, some species that are not closely related by molecular phylogeny may display a very similar, possibly primitive, periplast and furrow morphology.
DNA LIBRARIES FOR SEQUENCING THE GENOME OF OSTREOCOCCUS TAURI (CHLOROPHYTA, PRASINOPHYCEAE): THE SMALLEST FREE‐LIVING EUKARYOTIC CELL1
Authors: Derelle Evelyne , Ferraz Conchita , Lagoda Pierre , Eychenié Sophie , Cooke Richard , Regad Farid , Sabau Xavier , Courties Claude , Delseny Michel , Demaille Jacques , Picard André , Moreau Hervé
Published: March 2003

Ostreococcus tauri is a marine photosynthetic picoeukaryote presenting a minimal cellular organization with one nucleus, one chloroplast, and one mitochondrion. It has the smallest genome described among free‐living eukaryotic cells, and we showed by pulsed‐field gel electrophoresis (PFGE) that it is divided between 15 bands ranging from 1.2 to 0.15 Mb, giving a total size of 9.7 Mb. A Bacterial Artificial Chromosome (BAC) library was prepared from genomic DNA extracted from a culture of O. tauri. A total of 2457 clones was obtained with an average insert size of around 70 kb, representing an 18‐fold coverage of the genome. The library was spotted on high density filters, and several probes of coding sequences were hybridized to both the high density BAC library filters and directly to the dried PFGE gels of the O. tauri genomic DNA. These hybridizations allowed a preliminary organization of the library and the localization of several markers on the chromosomes. Randomly selected fragments were also sequenced, representing 12% of the O. tauri genome. Many sequences showed significant similarities in data banks, mainly with plant and algae sequences. About 1000 coding sequences could be identified. These data confirmed the position of O. tauri in the green lineage and the hypothesis of a very compact organization of its genome.
Phylogenetic Analyses of the Species of Chlorosarcinopsis and Neochlorosarcina (Chlorophyceae)
Authors: Watanabe S. , Mitui K. , Nakayama T. , Inouye I.
Published: March 2003

The genus Chlorosarcinopsis forms sarcinoid packages of ?@ cells and reproduces by forming naked biflagellate zoospores. The genus Neochlorosarcina is distinguished from Chlorosarcinopsis in having a thin cell wall around zoospores. We analyzed phylogenetic relationships of seven species of Chlorosarcinopsis and four species of Neochlorosarcina using 18S rDNA sequence data. The species of the Chlorosarcinopsis were separated into two clades, and those of Neochlorosarcina formed a monophyletic branch, which was far from the Chlorosarcinopsis clades. Groover and Bold (1969) investigated physiological abilities of species of Chlorosarcinopsis (which included species of Neochlorosarcina), and showed that the species were roughly divided into three groups by usage of nitrogen and carbon components. These groups correspond two clades of Chlorosarcinopsis and a clade of Neochlorosarcina. This result gave a phylogenetic meaning to the differences in the physiological abilities, and supported the separation of Neochlorosarcina from Chlorosarcinopsis based on a morphological attribute.
The Single, Ancient Origin of Chromist Plastids
Authors: Yoon H. S. , Hackett J. D. , Pinto G. , Bhattacharya D.
Published: March 2003

Phylogenetic comparisons suggest that plastid primary endosymbiosis, in which a single‐celled protist engulfs and ‘enslaves’ a cyanobacterium, likely occurred once and resulted in the primordial alga. This photosynthetic cell diversified, through vertical evolution, into the ubiquitous green (Chlorophyta) and red (Rhodophyta) algae, and the more scarce Glaucophyta. However, some modern algal lineages have a more complicated evolutionary history involving a secondary endosymbiotic event, in which a protist engulfed an existing eukaryotic alga (rather than a cyanobacterium), which was then reduced to a secondary plastid. Secondary endosymbiosis explains the majority of algal biodiversity, yet the number and timing of these events is unresolved. Here we analyzed a five‐gene plastid dataset to show that a diverse group of chlorophyll c‐containing protists comprising cryptophyte, haptophyte, and stramenopiles algae (Chromista) share a common plastid that most likely arose from a single, ancient (about 1260 million years ago) secondary endosymbiosis involving a red alga. This finding is consistent with C. monophyly and implicates secondary endosymbiosis as a driving force in early eukaryotic evolution.
Relating Phytoplankton Dynamics to Environmental Forcing in the Lower St. Johns River Estuary: A Multivariate Assessment
Authors: Millie D. F. , Pigg R. J. , Bendis B. J. , Steidinger K. A.
Published: March 2003

The St. Johns River, a 300‐mile riverine and estuarine system located along the north‐eastern coastline of Florida, has undergone extensive eutrophication through point and nonpoint source nutrient inputs. Moreover, recent reports of sudden fish kills and a high incidence of fish with lesions suggest the potential for harmful algal blooms. As part of a NOAA‐funded project involving the characterization of water quality parameters in relation to water inflows and nutrient inputs and the development of species‐specific markers/probes for instrumental‐based monitoring efforts, we used primer‐based multivariate analyses to examine the relationship between abiotic variables and both total and phylogenetic‐group chlorophyll a concentrations (derived from photopigments and ChemTax matrix factorization of diagnostic carotenoids) during 2001. Seven sampling sites (identified through principle components ordination of physical/chemical parameters as ranging from oligo‐ to mesohaline) were sampled intensively over 2‐week periods on a seasonal basis. Chlorophyll a concentrations typically ranged from 5 to 35 µg/L with the greatest concentrations occurring at the oligohaline sites. Phytoplankton assemblages were dominated by diatoms, cryptophytes, and cyanobacteria, and together typically comprised up to 90% of the total chlorophyll a. Temporal variability in phytoplankton assemblages followed seasonal trends impacted by meteorological and hydrological forcing. Spatial variability in phylogenetic‐group abundance (illustrated through multidimensional scalar ordination of sample dissimilarity) was dramatic and associated with differences in abiotic variables along the estuarine gradient.
Muscle Size Responses to Strength Training in Young and Older Men and Women
Authors: Roth Stephen M. , Ivey Fred M. , Martel Greg F. , Lemmer Jeff T. , Hurlbut Diane E. , Siegel Eliot L. , Metter E. Jeffrey , Fleg Jerome L. , Fozard James L. , Kostek Matthew C. , Wernick David M. , Hurley Ben F.
Published: March 2003

OBJECTIVES: To examine the possible influences of age and gender on muscle volume responses to strength training (ST).

DESIGN: Prospective intervention study.

SETTING: University of Maryland Exercise Science and Wellness Research Laboratories.

PARTICIPANTS: Eight young men (age 20–30 years), six young women (age 20–30 years), nine older men (age 65–75 years), and ten older women (age 65–75 years).

INTERVENTION: A 6‐month whole‐body ST program that exercised all major muscle groups of the upper and lower body 3 days/week.

MEASUREMENTS: Thigh and quadriceps muscle volumes and mid‐thigh muscle cross‐sectional area (CSA) were assessed by magnetic resonance imaging before and after the ST program.

RESULTS: Thigh and quadriceps muscle volume increased significantly in all age and gender groups as a result of ST (P < .001), with no significant differences between the groups. Modest correlations were observed between both the change in quadriceps versus the change in total thigh muscle volume (r = 0.65; P < .001) and the change in thigh muscle volume versus the change in mid‐thigh CSA (r = 0.76, P < .001).

CONCLUSIONS: The results indicate that neither age nor gender affects muscle volume response to whole‐body ST. Muscle volume, rather than muscle CSA, is recommended for studying muscle mass responses to ST.
The Value of Serum Albumin and High‐Density Lipoprotein Cholesterol in Defining Mortality Risk in Older Persons with Low Serum Cholesterol
Authors: Volpato Stefano , Leveille Suzanne G. , Corti Maria‐Chiara , Harris Tamara B. , Guralnik Jack M.
Published: March 2003

OBJECTIVES: To investigate the relationship between low cholesterol and mortality in older persons to identify, using information collected at a single point in time, subgroups of persons with low and high mortality risk.

DESIGN: Prospective cohort study with a median follow‐up period of 4.9 years.

SETTINGS: East Boston, Massachusetts; New Haven, Connecticut; and Iowa and Washington counties, Iowa.

PARTICIPANTS: Four thousand one hundred twenty‐eight participants (64% women) age 70 and older at baseline (mean 78.7 years, range 70–103); 393 (9.5%) had low cholesterol, defined as ≤160 mg/dl.

MEASUREMENTS: All‐cause mortality and mortality not related to coronary heart disease and ischemic stroke.

RESULTS: During the follow‐up period there were 1,117 deaths. After adjustment for age and gender, persons with low cholesterol had significantly higher mortality than those with normal and high cholesterol. Among subjects with low cholesterol, those with albumin> 38 g/L had a significant risk reduction compared with those with albumin ≤38 g/L (relative risk (RR) = 0.57; 95% confidence interval (CI) = 0.41–0.79). Within the higher albumin group, high‐density lipoprotein cholesterol (HDL‐C) level further identified two subgroups of subjects with different risks; participants with HDL‐C <47 mg/dl had a 32% risk reduction (RR = 0.68; 95% CI = 0.47–0.99) and those with HDL‐C ≥47 mg/dl had a 62% risk reduction (RR = 0.38; 95% CI = 0.20–0.68), compared with the reference category; those with albumin ≤38 g/L and HDL‐C <47 mg/dl.

CONCLUSIONS: Older persons with low cholesterol constitute a heterogeneous group with regard to health characteristics and mortality risk. Serum albumin and HDL‐C can be routinely used in older patients with low cholesterol to distinguish three subgroups with different prognoses: (1) high risk (low albumin), (2) intermediate risk (high albumin and low HDL‐C), and (3) low risk (high albumin and high HDL‐C).
How Well Are Community‐Living Women Treated for Osteoporosis after Hip Fracture?
Authors: Bellantonio Sandra , Fortinsky Richard , Prestwood Karen
Published: March 2003

OBJECTIVES:

To examine whether women with recent hip fracture are receiving adequate treatment for osteoporosis. To examine patient and physician characteristics associated with adequate treatment for osteoporosis.

DESIGN:

Cross‐sectional study with prospective and retrospective data collection.

SETTING:

Hartford County, Connecticut.

PARTICIPANTS:

Sixty community‐living women age 65 and older identified from hospital databases with an International Classification of Diseases, Ninth Revision, code for nontraumatic hip fracture.

MEASUREMENTS:

Treatment for osteoporosis, healthcare utilization, primary care physician's specialty, Katz activities of daily living scale, Lawton instrumental activities of daily living scale, Short Portable Mental Status Questionnaire, Medical Outcomes Study Short Form 12, and Physical Activity Scale for the Elderly.

RESULTS:

Only 13% of participants were receiving adequate treatment for osteoporosis as defined by the National Osteoporosis Foundation (NOF) guidelines for osteoporosis, 47% reported partial treatment that did not meet NOF guidelines, and 40% were receiving no treatment for osteoporosis. No patient or physician characteristics were associated with the adequacy of treatment for osteoporosis in this small sample.

CONCLUSIONS:

Few of the women in our study were receiving adequate treatment for osteoporosis after hip fracture. There exists an opportunity to educate postmenopausal women and physicians about the importance of treatment for osteoporosis to increase the number of women offered and receiving osteoporosis treatment, especially older postmenopausal women with established, severe osteoporosis as evidenced by recent hip fracture.J Am Geriatr Soc 49:1197–1204, 2001.
The Development of a Palliative Care Program for Managed Care Patients: A Case Example
Authors: Gazelle Gail , Buxbaum Robert , Daniels Elisabeth
Published: March 2003

Palliative care is emerging as an important new field. Although programs are developing in hospital environments, little is known about development of programs in outpatient practices or those serving large managed care populations. This article provides a framework for the development of a comprehensive palliative care program in a large multispecialty group practice that serves managed care patients. The article addresses guiding principles, the need for obtaining baseline data, how the clinical consultation service was established, development of outcomes measures, and information on current program status. Five themes emerged as key to successful program development, most importantly the close collaboration between administrative and clinical staff in all aspects of program development.
Factors Relating to the Use of Physical Restraints in Geriatric Care Settings
Authors: Karlsson Stig , Bucht Gösta , Eriksson Sture , Sandman Per‐Olof
Published: March 2003

Physical restraints are commonly used on older persons living in geriatric care settings. The aim of this study was to investigate the influence of environmental and organizational variations and resident and staff characteristics on restraint prevalence. In this cross‐sectional study of 33 nursing home wards and 12 group living units for old persons with dementia in two municipalities in northern Sweden, 540 residents (mean age 82) and 529 staff members were evaluated for resident and staff characteristics and organizational and environmental variables. The proportion of residents with impaired mobility function, the number of behavioral disturbances, and nursing staff's attitudes towards use of restraints were the strongest discriminators between restraint‐free wards and wards that used restraints. A classification function analysis showed that these three variables could correctly classify the wards as restraint‐free, low‐use, and high‐use wards in 63.6% of the cases, with the highest figures for restraint‐free wards (91%). This study has shown that the use of physical restraints is strongly connected with residents' functional status and nursing staffs' attitudes toward their use.
Highlights of Papers in Clinical Investigations Section: Insulin Action After Resistive Training in Insulin‐Resistant Older Men and Women
Authors: Ryan AS , Hurlbut DE , Lott ME
Published: March 2003

Aging is associated with decline in peripheral insulin sensitivity, in part because of decreased physical activity and increased central obesity, leading to a high risk for diabetes mellitus. This study assessed the impact of resistive training for 6 months on insulin action and determinants of changes in insulin action in 18 older men and postmenopausal women (11 normal and 7 impaired‐glucose‐tolerance subjects). Resistive training improved upper‐ and lower‐body muscular strength and increased fat‐free mass but did not change total body fat. Insulin action improved with resistive training, especially in subjects with insulin resistance.
Highlights of Papers in Clinical Investigations Section: The Appropriateness of Drug Use in an Older Nondemented and Demented Population
Authors: Giron MS , Wang H‐X , Bernstein C
Published: March 2003

Polypharmacy and inappropriate drug prescribing are major concerns for older people. In this study of 681 subjects age 80 years and older (mean 86.9) with or without dementia, the mean number of drugs used was 4.6 (4.5 for nondemented and 4.8 for demented subjects). Nondemented subjects were more commonly prescribed cardiovascular drugs and were more likely to be exposed to drug‐disease interactions. Demented subjects were more commonly prescribed neuropsychiatric drugs, exposed to drug duplication, and given drugs with potent anticholinergic properties. Multiple and inappropriate drug use places older people at high risk for adverse drug events.
Association Between Medical Comorbidity and Treatment Outcomes in Late‐Life Depression
Authors: Oslin David W. , Datto Catherine J. , Kallan Michael J. , Katz Ira R. , Edell William S. , TenHave Thomas
Published: March 2003

OBJECTIVES: Previous studies have demonstrated an association between major depression and physical disability in late life. The objectives of this study were to examine the relationship between specific medical illnesses and the outcomes of treatment for late‐life depression.

DESIGN: The study was a longitudinal assessment of medical illness, depression, and disability. Patients were assessed during an initial inpatient psychiatric hospitalization and 3 months postdischarge.

SETTING: All patients were initially evaluated after admission to one of 71 inpatient psychiatric treatment facilities.

PARTICIPANTS: A sample of 671 older patients who received inpatient treatment for depression was evaluated at entry into the hospital and 3 months after discharge.

MEASUREMENTS: Depressive symptoms were measured using the Geriatric Depression Scale. Disability was measured using the instrumental activities of daily living scale and the Medical Outcomes Study 36‐item short form. Medical illness was assessed using the medical illness checklist.

RESULTS: As previously reported, physical disability and the total number of medical illnesses were significantly related to change in depressive symptoms. In this study, we find that arthritis, circulatory problems, a speech disorder, or a skin problem, but not other general medical conditions, were related to a worse outcome with respect to depression symptoms. The effect of these problems was statistically and clinically significant. After controlling for pretreatment disability, arthritis and skin problems continued to predict a worse outcome. However, the apparent effect of each of these conditions was mediated by the residual disability after treatment.

CONCLUSION: The results of this study support the hypothesis that certain somatic disorders play a role in the treatment response of late‐life depression and suggest that the effect of specific illnesses on depression may be mediated by the presence of functional disability.
Age and the Risk of In‐Hospital Death: Insights from a Multihospital Study of Intensive Care Patients
Authors: Rosenthal Gary E. , Kaboli Peter J. , Barnett Mitchell J. , Sirio Carl A.
Published: March 2003

OBJECTIVES: To determine independent relationships between age and the risk of in‐hospital death.

DESIGN: Retrospective cohort study.

SETTING: Thirty‐eight intensive care units (ICUs) in 28 hospitals in a large Midwest metropolitan region.

PARTICIPANTS: One hundred fifty‐six thousand, one hundred thirty‐six consecutive admissions to medical, surgical, neurological, and mixed medical/surgical ICUs between March 1, 1991, and March 31, 1997.

MEASUREMENTS: In‐hospital death rates were compared at successive 5‐year age intervals, adjusting for gender, diagnosis, admission source, comorbidity, and acute physiology scores. Acute physiology scores were determined using a validated methodology based on abnormalities in 17 physiological measures collected during the first 24 hours of ICU admission.

RESULTS: The adjusted odds of death increased with each 5‐year age increment. For example, relative to patients younger than 35, adjusted odds of death in patients aged 40 to 44, 50 to 54, 60 to 64, 70 to 74, 80 to 84, and 90 and older were 1.51, 1.73, 2.38, 2.98, 3.86, and 4.74, respectively. In stratified analyses, age‐related increases in the odds of death were somewhat higher in surgical than medical patients or patients with lower severity of illness at admission. Although acute physiology scores had excellent discrimination in all age groups, discrimination decreased with age (e.g., c‐statistics of 0.928 and 0.835 in patients younger than 45 and 85 and older, respectively).

CONCLUSION: Our findings demonstrate incremental increases in the risk of hospital death associated with age that was independent of severity of illness and other prognostic factors. Although the current results may be less biased by differences in treatment goals than studies of general hospitalized patients, the lower discrimination of physiology scores in older patients suggests that unmeasured factors (e.g., functional status, patient preferences for care, differences in physician practices) may be of greater prognostic importance in older than in younger patients.
Mini‐Mental State Examination and Mental Deterioration Battery: Analysis of the Relationship and Clinical Implications
Authors: Pasqualetti Patrizio , Moffa Filomena , Chiovenda Paola , Carlesimo Giovanni A. , Caltagirone Carlo , Rossini Paolo M.
Published: March 2003

OBJECTIVES: To explore the associative structure between a screening test for dementia, the Mini‐Mental State Examination (MMSE), and a neuropsychological battery for the detection of dementia, the Mental Deterioration Battery (MDB).

DESIGN: A retrospective analysis.

SETTING: Psychology unit of a general hospital in Rome, Italy.

PARTICIPANTS: Three hundred consecutive outpatients and inpatients referred to our hospital on the basis of suspected cognitive impairment and evaluated between January 1999 and March 2000.

MEASUREMENTS: MMSE and MDB.

RESULTS: Of the 300 subjects evaluated by the MMSE score, 142 (47.3%) were considered to be cognitively healthy, and 116 (38.7%) were mildly and 42 (14.0%) moderately impaired. Factor analysis of MDB extracted three factors able to account for 75% of the total variance: a visuospatial factor, verbal memory ability, and a language skill. Using MMSE as an independent variable, a linear regression model could account for the visuospatial and language factors and a cubic regression model for the verbal memory factor. Within the normal MMSE boundaries (24–30), a dramatic decrease of verbal memory could be documented, whereas the slope is less steep in the mild impairment group (16–23).

CONCLUSIONS: Our findings indicate the presence of a warning range within the normal MMSE interval. Thus, the traditional MMSE cutoff values may not be appropriate in detecting early phases of dementia. When patients score about 27 on MMSE, it should be of interest to check whether they fail only on long‐term memory tests, because this could be a first signal of a preclinical condition heralding clear dementia (e.g., mild cognitive impairment).
Mortality‐Related Factors and 1‐Year Survival in Nursing Home Residents
Authors: Flacker Jonathan M. , Kiely Dan K.
Published: March 2003

OBJECTIVES: To identify factors associated with 1‐year mortality in newly admitted and long‐stay (in nursing home longer than 1 year) nursing home residents by linking Minimum Data Set (MDS) information with data from the National Death Index and use these factors to create a useful tool for estimating risk levels for 1‐year mortality.

DESIGN: Retrospective cohort study with development and validation cohorts.

SETTING: All 643 Medicare and Medicaid certified nursing homes in New York State during the study period.

PARTICIPANTS: The study included data on residents collected during full MDS assessments from June 1994 through December 1997. A total of 100,669 nursing home residents met the inclusion criteria for the newly admitted resident analysis. The newly admitted development cohort included 60,341 residents, and the newly admitted validation cohort included 40,328 residents. A total of 36,125 nursing home residents met inclusion criteria for the long‐stay (residing in nursing home>1 year) cohort. The long‐stay development cohort included 22,749 residents, and the long‐stay validation cohort included 15,068 residents.

MEASUREMENTS: The analytical approach was similar for the newly admitted and long‐stay resident cohorts. Resident characteristics that were considered potential risk factors for mortality were examined individually in bivariate proportional hazards models, and factors with P < .05 were entered into a proportional hazards regression stepwise model. The strongest factors based on their chi‐square values were selected for entry into a multivariate proportional hazards analysis. Hazard ratios (HRs), 95% confidence intervals, and P‐values were derived from this model. A mortality risk index score was created for each resident by summing the value of each HR in the multivariate model for those who had the risk factor. A sensitivity analysis was performed to determine the effect of residents with an unknown death status. A similar analysis was performed on the validation cohort to validate the original results.

RESULTS: Major factors associated with 1‐year mortality were identified in both the newly admitted and long‐stay cohorts. In both newly admitted and long‐stay residents, a higher mortality risk index score was associated with increased 1‐year mortality in both the development and validation cohorts.

CONCLUSIONS: MDS data can identify major factors associated with 1‐year mortality in newly admitted and long‐stay nursing home residents. These factors can be used to stratify residents into risk categories for 1‐year mortality. This information could be important to residents, their families, and their physicians when developing care plans, as well as to agencies interested in healthcare resource planning.
Erythema multiforme following the infusion of hydroxyethyl starch
Authors: Klein R.E. , Mogollon G.
Published: March 2003

Approximately 18 hours after attempted leukocytapheresis, erythema multiforme developed in a normal 28‐year‐old woman. About 50 milliliters of 6 percent hydroxyethyl starch (HES) had been infused before the procedure was stopped because of difficulty with access to the veins of her other arm. Although she had donated platelets several times, this was her first leukocytapheresis and first exposure to HES. Preapheresis steroids had not been given.
Transient anti‐D in an Rh‐positive patient with congenital dyserythropoietic anemia type II
Authors: Krikler S.H. , Ferguson D.J. , Akabutu J.J. , Lomas C.G.
Published: March 2003

A multiply transfused Rh‐positive patient with congenital dyserythropoietic anemia type II or hereditary erythroblastic multinuclearity with a positive acidified serum test is described in whom a transient anti‐D was accompanied by a positive direct antiglobulin test. A brief review of the literature and possible mechanisms for this observation are presented.
The Rh antigen specificity of erythrocyte proteolipid
Authors: Sinor L.T. , Brown P.J. , Evans J.P. , Plapp F.V.
Published: March 2003

A proteolipid was purified from erythrocytes by chloroform‐methanol extraction and reconstituted into lipid micelles. This purified micellar proteolipid was used to demonstrate that different Rh antigens reside on the same protein molecule.
Function of irradiated polymorphonuclear leukocytes obtained by buffy‐ coat centrifugation
Authors: Wheeler J.G. , Abramson J.S. , Ekstrand K.
Published: March 2003

Several studies suggest that transfusion of polymorphonuclear leukocytes (PMNs) may be beneficial in the treatment of septic neonatal patients. Because of expense, donor availability, and the technical effort involved in obtaining PMNs by intermittent or continuous flow leukapheresis, buffy coat centrifugation of whole blood has been suggested as an alternative source. An in vitro study was performed to determine whether PMNs collected by this method have adequate oxidative and migratory function measured by chemiluminescence (CL) and chemotaxis under agarose (CT), respectively. Whole blood samples from six adult volunteers were drawn into citrate‐phosphate‐dextrose‐adenine‐ one and stored at 4 degrees C for 0 to 48 hours. One‐half of each sample was irradiated with 1500 rads. PMNs isolated from the buffy coat of these samples had greater than 80 percent normal CT and CL following 0 to 28 hours of storage in whole blood. Irradiation caused no depression in function. Units of whole blood yielded 1.11 +/− 0.40 × 10(9) PMNs per unit. This study indicates that transfusion of radiated PMNs obtained from stored whole blood that is less than 28 hours old is reasonable to use in studies involving PMN transfusions.
Altered blood group expression in a patient with congenital rubella infection
Authors: Sherman L.A. , Silberstein L.E. , Berkman E.M.
Published: March 2003

An infant with probable congenital rubella infection developed altered blood group expression. This was noted at 4 months of age. The child's blood was typed on seven separate occasions during the first 8 weeks of life as type A, but on repeat testing, her cells failed to agglutinate with anti‐A and anti‐A,B typing serum. The A antigen was present, however, because an eluate made after incubating her red cells with anti‐A contained anti‐A, and A antigen was demonstrated on buccal mucosa cells. Altered expression of blood group A (loss of agglutinability) has occurred previously only in association with hematologic malignancy.
Removal by centrifugation of leukocytes and red cells from apheresis platelets
Authors: Kiraly T , Kakaiya RM , Cable RG
Published: March 2003

Platelets prepared by discontinuous flow centrifugation contain significant numbers of leukocytes and red cells. Platelet products often are centrifuged further to remove this cellular “contamination.” A method is described by which platelet products obtained by cytapheresis were prepared using an additional slow centrifugation step (121 × g for 7.5 minutes). In a production environment, we removed an average of 97 percent of leukocytes and most of the contaminating red cells with this method, while retaining 89 percent of the platelets in the final product. This method is an improvement over methods described previously and was consistently effective in routine use.
Effect of perfluorochemical blood substitutes on human neutrophil function
Authors: Virmani R , Fink LM , Gunter K , English D
Published: March 2003

This investigation was undertaken to determine the influence of perfluorochemical blood substitutes (PFCs) on human neutrophil function. Neutrophils isolated from blood of healthy donors were incubated at 37 degrees C for 1 hour with 25 percent Oxypherol (perfluorotributylamine) or Fluosol‐DA (perfluorodecalin and perfluorotripropylamine) in the presence of fresh autologous serum. In comparison to cells incubated with Hank's balanced salt solution (buffer), neutrophils exposed to PFCs were markedly inhibited in their chemotactic and phagocytic responses. With 25 percent PFCs, chemotaxis to zymosan‐activated serum was inhibited to approximately 25 percent of control by Fluosol‐DA and 11 percent by Oxypherol. Phagocytosis of polystyrene beads in the presence of fresh serum was decreased to 52 and 50 percent of control by both Oxypherol and Fluosol‐DA, respectively. Neutrophils exposed to PFCs aggregated slower and with an extended activation time upon addition of phorbol myristate acetate (PMA). When activated with n‐formyl‐methionyl‐leucyl‐phenylalanine (FMLP), neutrophils exposed to PFCs aggregated at a faster rate but with a longer lag phase in comparison to control cells. Neutrophil superoxide (O‐2) release stimulated by PMA also was depressed by prior exposure of cells to Oxypherol (6 nmoles O‐2/1.5 × 10(6) neutrophils) compared to buffer (32 nmoles O‐2/1.5 × 10(6) neutrophils). PMA‐ stimulated neutrophil adherence was depressed significantly by prior exposure to Fluosol‐DA compared to control. In contrast, Oxypherol had insignificant influence on stimulated adherence. Since PFCs have a profound influence on several important neutrophil functions, patients receiving PFC should be monitored closely for possible infectious complications.
Preparation of antihemophilic factor and fibronectin from human plasma cryoprecipitate
Authors: Horowitz B , Lippin A , Chang MY , Shulman RW , Vandersande J , Stryker MH , Woods KR
Published: March 2003

Starting with human plasma cryoprecipitate, fibronectin was separated from antihemophilic factor (AHF) by fractional precipitation under mild conditions resulting in excellent recovery of AHF in the supernatant solution of the cryoprecipitate. Separation of fibronectin enabled accelerated sterile filtration of the supernatant solution containing AHF even after three‐ to fourfold concentration (by ultrafiltration) to desired potency. The sterile AHF concentrate, dispensed at 1000 u per vial and lyophilized, was completely dissolved within 3 minutes upon addition of 30 ml of pure water. The expected increment in circulating factor VIII and its hemostatic effects were found following intravenous infusion into factor VIII‐deficient patients. Yield of AHF of five successive batches, each starting with the cryoprecipitate from some 12,000 units of fresh‐frozen plasma, averaged 51 percent. The fibronectin precipitate was purified by affinity on insolubilized gelatin with chaotropic elution at pH 5.5 followed by removal of the chaotrope by diafiltration. Thermal denaturation of adventitious fibrinogen resulted in electrophoretically pure fibronectin which, following lyophilization and reconstitution with pure water, retained biological properties in an in vitro assay designed to reflect opsonic activity. The yield of fibronectin for seven successive batches, each starting with the cryoprecipitate from some 900 units of fresh‐frozen plasma, averaged 10 percent.
Protection against hemolysis in ABO mismatched renal transplantation
Authors: Mangal AK , Logan D , Sinclair M , Stillwell G
Published: March 2003

The kidneys from a blood group O cadaver donor were transplanted into two patients whose blood groups were B and A2B. The former developed a positive direct antiglobulin test (DAT) and hemolysis due to anti‐B; the latter also developed a positive DAT, but due to anti‐A. However, this second patient, unlike the first, did not have any hemolysis. Both patients were on the same immunosuppression regimen with cyclosporine. The possible protective roles of patients' ABO subgroup and blood group substances in plasma are discussed.
A solid‐phase antiglobulin test
Authors: Rachel J. M. , Sinor L. T. , Beck M. L. , Plapp F. V.
Published: March 2003

A solid‐phase antiglobulin test was developed as an alternative to hemagglutination for compatibility testing. The solid‐phase endpoint of red cell adherence allowed results to be read visually or spectrophotometrically. This method was easier to perform than a hemagglutination antiglobulin test and had increased sensitivity without loss of specificity.
Neonatal Th activation
Authors: Cohen D. W. , Moncrieff R. E. , Silvergleid A. J.
Published: March 2003

A case is reported of a 1‐month‐old infant with bowel obstruction and suspected sepsis whose red cells were found to be Th activated during the course of evaluating weakened A antigen activity. Neither Th activation nor weakened A antigen activity was present on the red cells of either parent. The Th activation and the weak reactivity obtained with commercial anti‐A reagents were unrelated.
Comparison of a modified manual hexadimethrine bromide (Polybrene) and a low‐ionic‐strength solution antibody detection technique
Authors: Ferrer Zenaida , Wright John , Moore Brian P.L. , Freedman John
Published: March 2003

Manual hexadimethrine bromide (Polybrene) tests (Polybrene in low‐ionic medium) were used in parallel with manual low‐ionic‐strength solution (LISS) procedures for the routine testing of patient samples referred to a general hospital blood bank. Of 5646 consecutive sera tested, 5167 (91.5%) did not react with either technique; 320 sera (5.7%) reacted in both methods. The Polybrene technique detected 63 antibodies which did not react in the LISS methods. One hundred sera did not react in the Polybrene test, but did react in the LISS methods. Sera showing discrepant results between the two methods were further tested in a reference laboratory. Polybrene tests appeared to be better in avoiding reactions due to clinically nonsignificant antibodies. The LISS methods, however, appeared to be more sensitive in detecting antibodies of potential clinical significance.
Extended storage of platelets in a new plastic container
Authors: Grode G. , Miripol J. , Garber J. , Barber T. , Buchholz D. H.
Published: March 2003

A new polyvinyl chloride container plasticized with tri(2‐ethylhexyl) trimellitate (PL 1240 plastic) was evaluated for use in extended platelet storage. Six leukocyte‐rich platelet concentrates (mean, 0.6 × 109 white cells per bag; range, 0.3 to 1.0 × 109 per container) were prepared by removing as much of the platelet‐rich plasma from blood as possible. The cells were stored at 22°C on an end‐over‐ end agitator. An average of 1.04 ± 0.19 × 1011 platelets was recovered, and the mean pH dropped from 7.23 on day 0 to 6.68 by day 5. At the completion of the storage period. PO2 averaged 80 torr, PCO2 was 35 torr, bicarbonate concentration was 0.5 mM, and lactate concentration 29.5 mM. Thirty‐one additional units of platelet concentrates, not deliberately prepared to be leukocyte‐rich, on day 5 had a pH of 6.75 ± 0.39 (mean platelet yield, 0.97 ± 0.21 × 1011; PO2 and PCO2 averaged 50 and 48 torr, respectively). Following storage, the cells had an average phase microscopic morphology score of 244 (n = 17). Platelets appeared to be preserved well throughout storage when assessed by transmission and scanning electron microscopy. We conclude that platelets can be stored for 5 days in PL 1240 plastic containers with good preservation of pH and cell ultrastructure.
Influence of hydroxyethyl starch on humoral and cell‐mediated immune responses in mice
Authors: Lawrence D. A. , Schell R. R.
Published: March 2003

The immunotoxicity of hydroxyethyl starch (HES), a reagent used in leukocytapheresis or as a plasma expander, was assessed. HES did not significantly alter host resistance to Listeria monocytogenes or Streptococcus pneumoniae. HES (4–32 ml/kg), as well as a physiological saline solution (32 ml/kg), did inhibit the in vitro lymphoproliferation of spleen cells from mice intravenously injected 1 hour prior to removal of the spleens; the proliferation induced by a T‐ cell and B‐cell mitogen was suppressed. However, this suppression was transient, in that, HES and saline injections given 4 and 24 hours prior to removal of the spleens produced no significant inhibition. Unlike the HES effects on lymphoproliferation, HES did suppress the in vivo humoral immune response to sheep erythrocytes (SRBC) when given 24 hours prior to antigen, but this inhibition was obtained only with the 32 ml per kg dose. Interestingly, a similar dose of mouse albumin significantly enhanced the response. In vitro analysis of humoral and cell‐mediated immune responsiveness with in vivo treated spleen cells produced results that were not dose dependent. Although HES was more suppressive than saline, both saline and HES were inhibitory. The lack of a dose‐dependent effect suggests that the in vitro analysis of in vivo treated cells was not a good index of their in vivo reactivities. The greater variability and apparent sensitivity of the in vitro analysis probably reflect the transient effects of in vivo dilution of serum factors by relatively large intravenous injections and/or the transient effects of injection trauma.
Mouse monoclonal antibodies reacting with M blood group‐related antigens
Authors: Fraser R. H. , Inglis G. , Mackie A. , Munro A. C. , Allan E. K. , Mitchell R. , Sonneborn H. H. , Uthemann H.
Published: March 2003

Four mouse monoclonal antibodies were produced with specificities related to human blood group M antigen. The antibodies react in direct hemagglutination systems, and their specificities were investigated by their reactions with variant and enzyme‐modified red cells. The effects of temperature and pH on their hemagglutination reactions also were investigated, and all four were murine IgG antibodies. Physicochemical and serologic investigations showed them to be four distinct antibodies, and each one could be used for M blood grouping under appropriate conditions.
Detection of human anti‐HTLV‐III antibodies by indirect immunofluorescence using fixed cells
Authors: Sandstrom E. G. , Schooley R. T. , Ho D. D. , Byington R. , Sarngadharan M. G. , MacLane M. E. , Essex M. , Gallo R. C. , Hirsch M. S.
Published: March 2003

Seropositivity to human T‐cell lymphotrophic virus‐III (HTLV‐III) can have profound implications for the individual in whom it is detected. Simple and reliable tests are needed to confirm positivity by screening assays. In this study, detection of human antibodies by indirect immunofluorescence (IFA) on acetone‐fixed HTLV‐III infected H9 cells was evaluated in blood donors, patients with infectious or auto‐immune diseases, and men with or at high risk for developing acquired immune deficiency syndrome (AIDS). Specific and nonspecific patterns of immunofluorescent reactivity were distinguished easily. None of 98 serums from blood donors was positive, while two of 33 serums from patients attending an infectious disease clinic, both homosexual men, were positive. Ninety‐six percent of 24 serums from men with AIDS, 87 percent of 70 serums from men with lymphadenopathy, and 50 percent of 135 serums from healthy gay men were positive. These results paralleled those obtained by Western blotting and membrane immunofluorescence. In contrast, 11 and 4 percent, respectively, of these serums were judged as borderline or not interpretable by an enzyme‐linked immunosorbent assay (ELISA). Of these serums, those that were positive by IFA were positive by Western blots, and 16 of the 17 IFA‐negative serums were negative by Western blots. These studies indicate that IFA is a sensitive and specific assay for HTLV‐III antibodies in human serums.
Modified fluid gelatin: An alternative macromolecular agent for centrifugal leukapheresis
Authors: Huestis D. W. , Loftus T. J. , Gilcher R. , Lichtiger B. , Rock G. , Price T. H. , Glasser L. , White R. F. , Robinson R.
Published: March 2003

We studied a French modified fluid gelatin (MFG), substituting it for hydroxyethyl starch (HES) in leukapheresis procedures using three currently available blood cell separators, and observing its effects on the function of platelets and granulocytes. As a cell‐collecting agent, we found MFG to be as effective as HES with intermittent flow centrifugation (Haemonetics), and slightly less so with one continuous flow device (IBM 2997). MFG was clearly less effective than HES with the Fenwal CS‐3000 continuous flow separator, although we have reason to believe it would be possible to improve efficiency with this machine by changing the operating variables. Tests of platelet and granulocyte function showed negligible alteration with either agent and no difference between them. MFG disappears much more rapidly from the circulation than HES (after a single injection, it is undetectable by the third day). Reaction frequency with MFG was about the same as that of HES, with perhaps somewhat more frequent allergic manifestations.
Treatment of hyperkalemia with exchange transfusion
Authors: Lorch V. , Jones F. S. , Hoersten I. R.
Published: March 2003

Exchange transfusions using whole blood less than 24 hours old and deglycerolized red cells reconstituted with fresh‐frozen plasma were performed in two premature infants for the treatment of hyperkalemia and cardiac arrhythmia. Improvement of their condition was immediate.
Immune thrombocytopenia in severe hemophilia A treated with high‐dose intravenous immunoglobulin
Authors: Panzer S. , Zeitelhuber U. , Hach V. , Brackmann H. H. , Niessner H. , Mueller‐Eckhardt C.
Published: March 2003

Five patients with severe hemophilia A receiving long‐term treatment with commercial factor VIII concentrates developed severe immune thrombocytopenia (ITP, platelet counts <20 × 109/l). Concomitantly, they presented with a marked elevation of serum IgG concentrations (mean, 2364 mg/dl; range, 1712–2954 mg/dl). In four patients, the T helper to suppressor cell ratio was below 1. Treatment with high‐dose intravenous immunoglobulin (IgG, 7s) at doses of 0.2g (n = 2) or 0.4 g (n = 3) per kg of body weight on 5 consecutive days was effective immediately. The bleeding tendency ceased and platelet counts rose transiently. In three cases, treatment was repeatedly effective and patients underwent uneventful splenectomies. Thus, high‐dose IgG therapy may serve as a life‐saving agent in patients with severe hemophilia complicated by ITP.