bluuebunny/crossref_metadata_2025 huggingface dataset:
ENDOBACTERIA IN THE DIATOM PINNULARIA (BACILLARIOPHYCEAE). II. HOST CELL CYCLE‐DEPENDENT TRANSLOCATION AND TRANSIENT CHLOROPLAST SCARS1
Authors: Schmid Anna‐Maria M.
Published: March 2003

Rod‐shaped bacteria were found together with the “secondary chloroplast” in the endoplasmic reticulum (ER) in the pennate diatom Pinnularia. During the host interphase, bacteria bore cavities into the chloroplast and interacted with thylakoids, forming a functional unit with the plastid of the engulfed and reduced eukaryotic endocytobiont, without perforating the relict cell membrane and the chloroplast envelope. Fluorescently labeled antibodies directed against the large subunit of RUBISCO elicited the same pattern as DAPI–DNA complexes. In pre‐prophase, bacteria started to dissociate from the plastids and left scars at their previous locations. In profile, scars appeared as granular amorphous regions interrupting several stacks of thylakoids, whereas images of glancing sections showed foci of circumscribed spiral domains. The vortex pattern was interpreted as the result of a screwing movement of the bacteria during their withdrawal, initiated while structurally still connected to the thylakoids. Scars became effaced, and thylakoids reoriented during prophasic translocation of the complex plastid from the girdle to the valve. In the transition to prophase, bacteria were found as clusters inside ER cisternae near the nucleus, where the microtubule‐organizing center was accompanied by the spindle precursor. Microtubules were seen to be aligned with ER profiles (containing bacteria). TEM images indicated that intracellular long‐distance transport is controlled by the host cytoskeleton acting upon the ER. Restricted to this stage, bacteria appeared to divide and occasionally bore tentacle‐like appendages. Their intraluminal localization at the nucleus in prophase, near the new plasmalemma after cleavage, and their return to the chloroplasts shortly afterward revealed a cell cycle‐dependent translocation with the ER as circulatory system and, together with the obvious retardation of their division cycle, a domestication by the host.
Palatability and Chemical Defenses of Macroalgae in the Antarctic Peninsula
Authors: Amsler C. D. , Amsler M. O. , McClintock J. B. , Iken K. B. , Hubbard J. M. , Baker W. J.
Published: March 2003

We examined palatability of 37 species of nonencrusting macroalgae from the Antarctic Peninsula. This represents approximately 30% of the entire antarctic macroalgal flora and 75% of the 49 nonencrusting species we collected. Organic extracts from most species were also prepared and mixed into artificial foods. We examined palatability using feeding bioassays with three common, macroalga‐consuming animals (an omnivorous antarctic rockfish, Notothenia coriiceps; an omnivorous sea star, Odontaster validus; and a herbivorous amphipod, Gondogenia antarctica). Thallus pieces from 23 of 34 macroalgal species tested with the fish (68%) were rejected. Of the 23 species rejected as thallus, organic extracts of 16 were bioassayed using the fish with 9 (56%) unpalatable. Thallus pieces from 21 of 36 macroalgal species tested with the sea star (58%) were rejected. Of the 21 species rejected as thallus, organic extracts of 20 were bioassayed using the sea stars and 14 (70%) were unpalatable. Overall, 28 of the 37 species assayed as thallus (76%) were rejected by either or both the fish and sea stars. The amphipod assay was not suitable for use with thallus but was utilized with organic extracts of 23 macroalgal species that were rejected as thallus by either or both the fish and sea stars. Of these, 14 (61%) of the species' extracts were rejected by the amphipods. Unpalatability was highest among the brown algae examined with only an ephemeral, ectocarpoid species not rejected as thallus out of 10 species tested. Of the remaining nine brown algal species, six of seven tested were also unpalatable as extracts, including all the ecologically dominant, perennial species in the area. We conclude that unpalatability to herbivores is common in antarctic macroalgae and that chemical defenses may play an important role in the unpalatability of many algal species (NSF OPP9814538, OPP9901076).
Mycosporine‐Like Amino Acids in Harmful Marine Microalgae
Authors: Wulff A. , Appelgren M.
Published: March 2003

Two current environmental issues are the increasing occurrence of harmful algal blooms and the increasing level of ultraviolet radiation. The objective of this ongoing project is to investigate whether there is a coupling between these two phenomena, i.e. to test the hypothesis that UV‐B radiation functions as a selective pressure favoring surface‐blooming toxic/harmful marine microalgal species capable of producing UV‐absorbing compounds (mycosporine‐like amino acids, MAAs). A series of experiments were designed to test if the light environment induces the production of MAAs. Treatments were PAR with and without the addition of UV‐B radiation. Preliminary results show a different response for different species. Most species increased their production of MAAs when exposed to an increased PAR intensity (300 µmol photons/m2/s) and in, e.g. Alexandrium ostenfeldii and Gyrodinium aureolum a further increase was observed upon exposure to UV‐B radiation. The content and composition of MAAs for a number of potentially harmful marine microalgae will be shown. In addition, the outcome of small changes in the HPLC method used will be discussed.
Macroalgae of the Hawaiian Islands: 23 Additional Stream Segments
Authors: Filkin N. R. , Sherwood A. R. , Vis M. L.
Published: March 2003

The Hawaiian Islands are located 3700 km from the nearest continental land mass and as such provide an interesting research opportunity to study freshwater organisms intolerant of seawater. The freshwater biota have been only partially studied with little research on the stream macroalgae. The only previous study to focus solely on stream macroalgae, reported 25 new species to the Hawaiian Islands from 34 stream segments sampled. The purpose of our study was to expand the sampling of streams to better determine macroalgal distributions and species richness. Twenty‐three additional stream segments (seven on Oahu, eight on Kauai and eight on Hawaii) were sampled for macroalgae. The physical and chemical parameters of each stream were measured. Stream segments ranged greatly in size from 1.2 to 40 m in width. Water temperature was relatively uniform (about 21 °C) but other chemical parameters differed from site to site (pH 5.5–8.9, specific conductance 20–200 mS/cm). Mean species richness per stream segment was 3.9 with one to eight species collected per segment. Ninety populations of 44 infrageneric taxa were identified from the Cyanobacteria (20), Chlorophyta (18), Rhodophyta (3) and Chrysophyta (3). The most abundant taxa were Spirogyra sp. 2, Audouinella pygmaea and Phormidium retzii. All three of these species are cosmopolitan. Twenty‐two of the taxa are new records for streams in the Hawaiian Islands. The large percentage (50%) of new taxa suggests that more research is needed to fully catalog the Hawaiian stream macroalgal diversity.
The Diversity and Availability of Caulerpa Species Found in Retail Aquarium Outlets in Southern California, USA
Authors: Frisch S. M. , Murray S. N.
Published: March 2003

Biological invasions are recognized as a serious threat to marine biodiversity. Within the last 2 years, invasive populations of Caulerpa taxifolia were found in southern California's coastal waters as well as in New South Wales, Australia. In addition, two other seaweeds (Undaria pinnatifida and Caulacanthus ustulatus) also appear to have recently invaded southern California's warm temperate waters. The introduction of C. taxifolia has attracted much attention because this exotic seaweed is thought to have significantly altered the structure of Mediterranean marine ecosystems following its 1984 invasion. The southern California inoculation of C. taxifolia is believed to have resulted from the release of aquarium specimens. Besides C. taxifolia, other species of Caulerpa being sold for aquarium use also may have the potential to invade temperate waters. As a first step towards making this determination, the availability (% frequency) of Caulerpa species being sold in southern California for aquarium use was ascertained. Fifty retail saltwater aquarium stores were visited in three southern California counties between November 2000 and August 2001. Sixteen Caulerpa taxa were identified from the retail aquarium outlets. Caulerpa species were sold in 52% of these stores. C. taxifolia, ‘Mediterranean form’, was offered for sale in 10% of the visited stores; C. serrulata var. hummii (18%), C. racemosa (14%), and C. racemosa var. lamourouxii (14%) were the most commonly sold species. These data indicate that the aquarium industry is bringing into the region other species of Caulerpa besides C. taxifolia. Some of these species may also have the potential to invade temperate waters.
Relationship Between Periodic Resuspension Events and Planktonic Diatom Community Structure in Lake Michigan: A Field and Laboratory Investigation
Authors: Julius M. L.
Published: March 2003

Lake Michigan provides an ideal location for comparing episodic physical forcing events (storms) on phytoplankton processes and the more persistent seasonal variability of phytoplankton communities. This is due to the duration and extent of the highly turbid, recurrent coastal plume (RCP) in the lake during the winter/early spring. Although the RCP can coincide with the initiation of the basin wide spring diatom bloom, linkages between the duration and intensity of the plume and the prominent role of light availability in regulating Lake Michigan phytoplankton growth during the spring isothermal period have been postulated, but not verified. The concurrent physical and biological events provide a novel opportunity to examine phenomena associated with the RCP affecting the distribution and abundance of species in Lake Michigan's planktonic diatom flora. In this study, planktonic diatom assemblages from pre, post and active spring plume events were examined from stations along Lake Michigan's southern shoreline. Species abundance changed rapidly during storm events. Sediment resuspension via storm activity created a suboptimal growth environment. Post‐storm event diatom phytoplankton communities were floristically distinct from prestorm event communities, with resting cell‐forming taxa playing a significant role in these community‐restructuring periods. Laboratory simulations of resuspension events using Lake Michigan sediments were conducted under a variety of environmental conditions. Parameters varied included day length, temperature, and silica. The resulting assemblages were quantitatively counted. A statistically significant relationship was identified between day length and the vegetative growth of many resting cell‐forming diatom species. When day length was calculated for poststorm event field data, it revealed a high correlation between poststorm event communities and those predicted by the laboratory simulations. Timing of storm events and latitudinal position of the aquatic system are then important elements for consideration when predicting diatom phytoplankton community structure due to the relationship these factors have with day length.
Public Outreach Materials Regarding Harmful Algal Blooms and Their Possible Effects on Human Health
Authors: Kirkpatrick B. , Fleming L. E. , Stephan W. B. , Backer L. , Clark R. , Squicciarini D. , Weisman R. , Van De Bogart G.
Published: March 2003

The potential interactions between marine and freshwater harmful algal blooms (HABs) and humans are increasing. Humans are exposed through food, drinking water, and recreational and occupational water use to an increasing number of organisms and their toxins. Nevertheless, the amount of clinical and epidemiologic research concerning acute and chronic human health effects from the HAB organisms and their toxins is relatively sparse. At the same time, the public is increasingly aware of and interested in the potential dangers associated with exposure to HABs. Public health authorities and researchers must respond to these public health concerns. The development of appropriate educational and outreach materials based on limited scientific databases is the challenge of informing the public concerning the possible human health effects of HAB organisms and their toxins, and their prevention. Educational materials developed by a group of researchers and public health personnel for general HABs, Florida Red Tide Toxins (brevetoxins), Cyanobacteria, and Ciguatera are discussed, as well as methods for their dissemination.
Green Algal Conquest of the Land: Many Conquests, One Victory?
Authors: Chapman R. L. , Delwiche C. F. , McCourt R. M.
Published: March 2003

Life on earth originated in a wet world and remained there for millions of years until the first terrestrial invaders made their initial forays into a new and unexploited terrestrial habitat. Although cyanobacteria, and perhaps fungi as well, were important participants in the conquest of the land, it was the evolution green algae into the initial land plants that started amazing evolution and diversification the terrestrial flora and fauna with which we are now familiar. Given the paradigm that life arose in the sea, it is perhaps surprising to find that freshwater green algae – not marine forms – were the successful conquerors, i.e. the algae that gave rise to the land plants. The first land colonizers were, of necessity, primary producers (i.e. food for organisms that arrived or evolved later) and were likely to have been cyanobacteria (blue‐green algae), followed by green algae (at least four separate invasions) and fungi, which also made a successful assault on land together with algae in the form of lichens. The symposium will survey recent studies on these groups and their habitats, and describe how these colonizers changed and were changed by adaptations to the new, dry world. It will explore the question: ‘Why did only one group of terrestrial green algae give rise to the land plants?’ The success of these colonizers is relevant to all subsequent terrestrial life (including ourselves), as well as the search for extraterrestrial life, which, if it exists, is presumed to have begun in an aquatic environment.
The Effects of Nitrogen Regime on Growth, [CHN], [DMSP], [Chlorophyll], [Protein] and Nitrogen Uptake Rate in Ulvaria Obscura and Ulva Fenestrata
Authors: Nelson T. A. , Van Alstyne K. L. , Ribarich H.
Published: March 2003

Ulva fenestrata and Ulvaria obscura are major constituents of ulvoid macroalgal blooms in the north‐eastern Pacific. These blooms have been associated with a variety of environmental problems and are thought to be caused by increased nitrogen concentration. We grew these algae at several nutrient concentrations in incubator and seawater table experiments. Growth rate and the concentrations of DMSP, C, H, and N in the tissues were determined for both kinds of experiments. Incubator experiments alone were used to measure nutrient uptake rate, chlorophyll a and b content, and protein content (as determined by far‐UV and bicinchoninic acid (BCA) techniques). Increasing nutrient concentration caused significantly more growth in the seawater table experiment but only a trend toward greater growth in the incubator. There was no significant interspecific difference in growth rate in the seawater table experiment, but Ulva grew significantly faster than Ulvaria in the incubator experiment. Tissue nitrogen increased significantly with increasing nutrient content in the growth medium in the incubator experiment and showed a similar (albeit not significant) trend in the seawater table experiment. Ulvaria had higher tissue nitrogen, protein, and chlorophyll a concentrations than Ulva in all experiments. The ratio of chlorophyll b : a was also higher in Ulvaria than in Ulva. Far‐UV and BCA techniques yielded equivalent protein concentration in Ulva but protein concentration determined by BCA was 2.5 times higher in Ulvaria than when determined by far‐UV. Nutrient uptake rates were similar between both species. DMSP concentration was not affected significantly by nutrient regime, but [DMSP] was higher in Ulvaria than in Ulva. These results help explain previous observations of these species. Ulvaria generally grows more slowly than Ulva because it requires more nitrogen to make chlorophyll and protein but has similar nitrogen uptake rates. Ulvaria is also shade adapted, while Ulva can acclimate to various conditions.
The Case for a Single‐Plastid Origin Revisited: Convergent Evolution in Organellar Gene Content
Authors: Stiller W. J. , Reel D. C. , Johnson J. C.
Published: March 2003

Three eukaryotic lineages generally are believed to have plastids that are primary in origin; that is, descended directly from a cyanobacterial endosymbiont. The recovery of these plastids as a monophyletic group in most molecular phylogenetic analyses, along with similarities in genome content and protein targeting mechanisms, have been cited as strong evidence in support of the hypothesis of a single endosymbiotic origin of all plastids. Although these data indeed are consistent with a single plastid origin, they also are consistent with the proposition of multiple endosymbiotic origins. Each hypothesis requires certain evolutionary assumptions in order to be reconciled with all existing data; at present, it is unclear which of these assumptions most likely reflect the historical process that gave rise to plastid diversity. Here we examine similarities in gene content among representatives of the three primary plastid lineages, using as a control the genome of a mitochondrion that almost certainly originated as an independent endosymbiotic association. To minimize metabolic constraints on gene retention we focus on two datasets, ribosomal protein and transfer RNA genes, neither of which is tied directly to specific organellar functions. Analyses of all possible pair‐wise comparisons among the three plastids and mitochondrion indicate that genomic similarities are most consistent with convergent evolution due to constraints on gene loss, rather than with hypothesized shared evolutionary histories. We find no evidence of phylogenetic signal in the pattern of gene loss overlying this convergence. In light of these results, we address other lines of evidence and arguments that have been raised in support of a single plastid origin.
Driving Cessation: What Older Former Drivers Tell Us
Authors: Dellinger Ann M. , Sehgal Meena , Sleet David A. , Barrett‐Connor Elizabeth
Published: March 2003

OBJECTIVES: To understand why older drivers living in a community setting stop driving.

DESIGN: A cross‐sectional study within a longitudinal cohort.

SETTING: A geographically defined community in southern California.

PARTICIPANTS: 1,950 respondents age 55 and older who reported ever being licensed drivers.

MEASUREMENTS: A mailed survey instrument of self‐reported driving habits linked to prior demographic, health, and medical information.

RESULTS: Of the 1,950 eligible respondents, 141 had stopped driving within the previous 5 years. Among those who stopped, mean age was 85.5 years, 65.2% were female, and the majority reported they were in very good (43.4%) or good (34.0%) health. Nearly two‐thirds reported driving less than 50 miles per week prior to stopping and 12.1% reported a motor vehicle crash during the previous 5 years. The most common reasons reported for stopping were medical (41.0%) and age‐related (19.4%). In bivariate analyses, age and miles driven per week were each associated with cessation (P≤ .001). Medical conditions, crashes in the previous 5 years, and gender did not reach statistical significance at the P≤ .05 level. Logistic regression results found that the number of medical conditions was inversely associated with driving cessation.

CONCLUSION: The relationship between medical conditions and driving is complex; while medical conditions were the most common reason given for driving cessation, those who stopped had fewer medical conditions than current drivers. This suggests that a broader measure of general health or functional ability may play a dominant role in decisions to stop driving.
The Effects of Patient Communication Skills Training on the Discourse of Older Patients During a Primary Care Interview
Authors: Cegala Donald J. , Post Douglas M. , McClure Leola
Published: March 2003

OBJECTIVES: To test the effects of a communication skills training intervention on older patients' discourse during a primary care interview.

DESIGN: A quasi‐experimental design involving two intervention conditions.

SETTING: The Family Practice Center of a university‐based clinic.

PARTICIPANTS: Thirty‐three patients averaging age 72 and 9 family practice physicians.

INTERVENTION: A communication skills training booklet received approximately 3 days before the scheduled appointment and a 30‐minute face‐to‐face follow‐up session before seeing the physician.

MEASUREMENTS: Patients' seeking, providing, and verifying of information were coded from transcripts of the 33 interviews.

RESULTS: Trained patients engaged in significantly more seeking and providing of information than untrained patients. Additionally, trained patients obtained significantly more information from physicians than did untrained patients, both in terms of the number of total information units and the number of units per question asked.

CONCLUSION: Patient communication skills training appears to be an effective means of enhancing patients' participation in the medical interview without increasing the overall length of the interview.
ACE Gene Polymorphism and Insulin Action in Older Subjects and Healthy Centenarians
Authors: Paolisso Giuseppe , Tagliamonte Maria Rosaria , De Lucia Domenico , Palmieri Francesco , Manzella Daniela , Rinaldi Carmela , Bossone Anna , Colaizzo Donatella , Margaglione Maurizio , Varricchio Michele
Published: March 2003

OBJECTIVES: To evaluate the possible relationship between angiotensin‐converting enzyme (ACE) insertion‐deletion (ID) genotype and insulin resistance in a population of healthy older Italian subjects.

DESIGN: Prospective recruitment of a convenience sample.

PARTICIPANTS: One hundred twenty‐five subjects age 62 to 105 in good health and not taking any drug known to interfere with glucose metabolism.

RESULTS: In the sample population, the relative frequencies of the ACE genotypes deletion‐deletion (DD) (0.424), ID (0.400), and insertion‐insertion (II) (0.176) were not significantly different from values predicted by Hardy‐Weinberg equilibrium. The genotype distribution was similar in men and women. Subjects carrying the II genotype had a higher FPG (P < .001) and FPI (P < .001) than did subjects with DD or ID genotype. Subjects with II genotype also had a significantly higher HOMA index than did subjects with DD or ID genotype (P for trend < .002). In a multivariate stepwise regression analysis, the ACE ID polymorphism was significantly and independently associated with the HOMA index (P < .001). The same result was confirmed performing multivariate analysis in the younger group and centenarians separately.
Rapid Emergency Department Intervention for Older People Reduces Risk of Functional Decline: Results of a Multicenter Randomized Trial
Authors: McCusker Jane , Verdon Josée , Tousignant Pierre , De Courval Louise Poulin , Dendukuri Nandini , Belzile Eric
Published: March 2003

OBJECTIVES:

To determine the effectiveness of a two‐stage (screening and nursing assessment) intervention for older patients in the emergency department (ED) who are at increased risk of functional decline and other adverse outcomes.

DESIGN:

Controlled trial, randomized by day of ED visit, with follow‐up at 1 and 4 months.

SETTING:

Four university‐affiliated hospitals in Montreal.

PARTICIPANTS:

Patients age 65 and older expected to be released from the ED to the community with a score of 2 or more on the Identification of Seniors At Risk (ISAR) screening tool and their primary family caregivers. One hundred seventy‐eight were randomized to the intervention, 210 to usual care.

INTERVENTION:

The intervention consisted of disclosure of results of the ISAR screen, a brief standardized nursing assessment in the ED, notification of the primary care physician and home care providers, and other referrals as needed. The control group received usual care, without disclosure of the screening result.

MEASUREMENTS:

Patient outcomes assessed at 4 months after enrollment included functional decline (increased dependence on the Older American Resources and Services activities of daily living scale or death) and depressive symptoms (as assessed by the short Geriatric Depression Scale). Caregiver outcomes, also assessed at baseline and 4 months, included the physical and mental summary scales of the Medical Outcomes Study Short Form‐36. Patient and caregiver satisfaction with care were assessed 1 month after enrollment.

RESULTS:

The intervention increased the rate of referral to the primary care physician and to home care services. The intervention was associated with a significantly reduced rate of functional decline at 4 months, in both unadjusted (odds ratio (OR) = 0.60, 95% confidence interval (CI) = 0.36–0.99) and adjusted (OR = 0.53, 95% CI = 0.31–0.91) analyses. There was no intervention effect on patient depressive symptoms, caregiver outcomes, or satisfaction with care.

CONCLUSION:

A two‐stage ED intervention, consisting of screening with the ISAR tool followed by a brief, standardized nursing assessment and referral to primary and home care services, significantly reduced the rate of subsequent functional decline. J Am Geriatr Soc 49:1272–1281, 2001.
Environmental Risk Factors for Delirium in Hospitalized Older People
Authors: McCusker Jane , Cole Martin , Abrahamowicz Michal , Han Ling , Podoba John E. , Ramman‐Haddad Leila
Published: March 2003

OBJECTIVES:

To evaluate the relationship of environmental risk factors in hospitals to changes over time in delirium symptom severity scores.

DESIGN:

Observational prospective clinical study with repeated measurements, several times during the first week of hospitalization and then weekly during hospitalization.

SETTING:

University‐affiliated general community hospital.

PARTICIPANTS:

Four hundred forty‐four patients age 65 and older admitted to the medical wards: 326 with delirium and 118 without delirium. Patients with prior cognitive impairment were oversampled.

MEASUREMENTS:

The severity of delirium symptoms was measured with the Delirium Index, a scale developed and validated by our group, based on the Confusion Assessment Method. Potential environmental risk factors assessed included isolation, hospital unit, room changes, levels of sensory stimulation, aids to orientation, and presence of medical (e.g., intravenous) or physical restraints.

RESULTS:

Controlling for initial severity of delirium and patient characteristics, variables significantly related to an increase in delirium severity scores included hospital unit (intensive care or long‐term care unit), number of room changes, absence of a clock or watch, absence of reading glasses, presence of a family member, and presence of medical or physical restraints.

CONCLUSION:

The associations of intensive care and medical and physical restraints with severity of delirium symptoms may be due to uncontrolled confounding by indication. However, the other factors identified suggest potentially modifiable risk factors for symptoms of delirium in hospitalized older people. J Am Geriatr Soc 49:1327–1334, 2001.
Advance Directive Completion Rates and End‐of‐Life Preferences in Hawaii
Authors: Braun Kathryn L. , Onaka Alvin T. , Horiuchi Brian Y.
Published: March 2003

To estimate rates of advance directive completion, preference for in‐home death and hospice services at life's end, and support for physician assistance in dying, questions were added to two statewide, random‐sample telephone surveys—the 1998 Behavioral Risk Factor Surveillance System (N = 2,153) and the 1999 OmniTrak health survey (N = 700). Data were compared across age, ethnic, and gender groups. Overall, 29% of Hawaii residents had a living will, 22% had a healthcare power of attorney, 65% said they would prefer a home death, 60% would want hospice services, 64% believed a person had a moral right to end his or her life when faced with an incurable illness, and 63% felt doctors should be allowed by law to end a patient's life if the patient and his or her family requested it. Advance directive completion rates increased with age, desire for an in‐home death varied by gender and ethnicity, and support of assisted‐death options varied by ethnicity. Despite a large minority population, end‐of‐life preferences among the general population in Hawaii are similar to those of U.S. mainlanders. However, age, gender, and ethnic differences exist. Clinicians are encouraged to ask patients directly about their preferences as a first step toward improving end‐of‐life care.
Self‐Reported Health Status, Prophylactic Medication Use, and Healthcare Costs in Older Adults with Asthma
Authors: Balkrishnan Rajesh , Christensen Dale B. , Bowton David L.
Published: March 2003

OBJECTIVES: To examine the relationship between self‐reported health status, prophylactic medication use, and healthcare service use in older adults with asthma.

DESIGN: A prospective longitudinal cohort study was conducted over a 2‐year postenrollment period in a population of asthmatic older adults enrolled in managed care. Patients completed a comprehensive health‐risk screen at time of enrollment in the plan.

SETTING: A Medicare health maintenance organization (HMO) in the southeastern United States with prescription benefit.

PARTICIPANTS: One hundred twenty‐nine older adults with asthma using inhaled corticosteroid therapy as prophylaxis and enrolled in a Medicare HMO were available for complete follow‐up.

MEASUREMENTS: We measured self‐reported health perception, falls, lifestyle, depressive symptomatology, and pre‐enrollment healthcare service use using a comprehensive risk screen. We used the Med‐Total index and total annual healthcare charges as measures of postenrollment inhaled corticosteroid and healthcare service use.

RESULTS: After adjusting for the effects of other variables, we found that depressive symptomatology at baseline and increased comorbidity severity (using the Charlson comorbidity index) were associated with significant reductions in prophylactic medication possession (27% with depressive symptomatology and 6% with unit increase in Charlson's index, P < .05). Additionally, after adjusting for the effects of baseline health status, we found that a 10% increase in prophylactic medication possession was associated with a nearly 5% decrease in total annual healthcare charges in this population (P < .01).

CONCLUSION: There are strong but not fully explained associations between depressive symptoms at time of enrollment, decreased postenrollment prophylactic medication use and increased postenrollment healthcare service use in older adults with asthma.
Depressive Symptoms and Self‐Rated Health in Community‐Dwelling Older Adults: A Longitudinal Study
Authors: Han Beth
Published: March 2003

OBJECTIVES: To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self‐rated health and decrease the likelihood of subsequent improvement in self‐rated health.

DESIGN: A 2‐year prospective cohort study.

SETTING: Six thousand seven hundred fourteen community‐dwelling older persons who completed the first and second wave of the Asset and Health Dynamics among the Oldest‐Old Survey in the United States.

PARTICIPANTS: Community‐dwelling older people in the United States.

MEASUREMENTS: Baseline depressive symptoms were measured using a short‐form of the Center for Epidemiological Studies Depression Scale. Self‐rated health was measured using a single item of global health rating.

RESULTS: After adjustment for covariates, a high burden of depressive symptoms at baseline was predictive of greater decline in self‐rated health (odds ratio (OR) for decline in those with high burden of depressive symptoms vs those without = 1.47, 95% confidence interval (CI) = 1.26–1.70). Likewise, high burden of depressive symptoms at baseline predicted less improvement in self‐rated health (OR for improvement in those with high burden of depressive symptoms vs those without = 0.57, 95% CI = 0.50–0.65).

CONCLUSIONS: Depressive symptomatology is an independent risk factor for subsequent changes in self‐rated health in older adults. Thus, early prevention and intervention of depressive symptoms in community‐dwelling older adults might be critical to promote and maintain their self‐rated health.
Medical and Functional Consequences of Anemia in the Elderly
Authors: Lipschitz David
Published: March 2003

Anemia is a common problem in the elderly, accounting for significant morbidity and mortality in this population. It also has a negative effect on quality of life. Recent findings have shown that anemia can lead to cardiovascular and neurological complications, such as congestive heart failure and impaired cognitive function. In addition, anemia has been implicated in functional impairment and falls. Available data have shown that the successful management of this condition will not only improve patients' quality of life, but may also prevent the anemia from worsening.
Glycolytic enzymes of stored granulocytes
Authors: Lane T.A. , Beutler E. , West C. , Lamkin G.
Published: March 2003

A marked reduction of granulocyte chemotactic function accompanies the storage of granulocyte concentrates. Since chemotaxis is energy dependent, we studied energy metabolism in stored neutrophils. We and others have reported that stored neutrophils have a defect in their energy metabolism. We found that defective adenosine triphosphate maintenance in stored neutrophils was occult in resting cells, but was unmasked by an energy‐intensive stimulus, phagocytosis. In studies reported here, we sought to determine if defective adenosine triphosphate maintenance during granulocyte storage was related to altered glycolytic enzyme activity. We studied the activity of glycolytic enzymes in fresh and stored, resting and stimulated (opsonized zymosan) neutrophils. The following enzyme activities showed no major changes during storage, in resting or stimulated neutrophils: hexokinase, phosphofructokinase, aldolase, glucose phosphate isomerase, triose phosphate isomerase, glyceraldehyde phosphate dehydrogenase, phosphoglycerate kinase, phosphoglyceromutase, enolase, lactate dehydrogenase, glucose‐6‐phosphate dehydrogenase, glutathione reductase, and glutathione peroxidase. In contrast, pyruvate kinase activity consistently increased during storage. In 6 units, pyruvate kinase activity increased by 75 percent after 24 hours of storage at room temperature and by 198 percent after 48 hours. The storage‐ associated increase in pyruvate kinase activity was not inhibited by cycloheximide. Stimulation of neutrophils by phagocytosis of opsonized zymosan also produced striking increases in the pyruvate kinase activity of both fresh and stored cells. Additional studies indicated that the increases in pyruvate kinase activity observed during storage and after phagocytosis were associated with an increase in the availability of pyruvate kinase activity in the supernatant fraction of neutrophil sonicates. Total pyruvate kinase activity in sonicates of neutrophils was unchanged by storage or particle ingestion.(ABSTRACT TRUNCATED AT 250 WORDS)
A pilot study of surrogate tests to prevent transmission of acquired immune deficiency syndrome by transfusion
Authors: Simon T. L. , Bankhurst A. D.
Published: March 2003

Because of reports that acquired immune deficiency syndrome (AIDS) might be transmissible by blood transfusion, we studied potential surrogate tests that could be used for screening donors. Male donors at one volunteer blood center and two plasma centers were screened for total lymphocyte count, OKT3, OKT4, OKT8, OKT11, LEU‐7, LEU‐M2, antibodies to hepatitis B core (anti‐HBc), cytomegalovirus (CMV), and herpes and circulating immune complexes. Total lymphocyte counts and the OKT11 were significantly lower in one plasma center. No significant differences were found for the other lymphocyte or monocyte tests. Low T4/T8 ratios, found in 20 percent of donors, did not correlate with other abnormalities. A small percentage (3.3%) of volunteer donors, 15.4 percent at one plasma center and 20.8 percent at a second plasma center, and 38.5 percent of the male homosexual donors were positive for anti‐HBc (significant when comparing the male homosexuals to the volunteers at p = 0.032). Positive CMV and herpes titers were similar in the groups. Circulating immune complex levels greater than two standard deviations above the mean were found in 20 percent of the volunteer donors, 7.7 percent at one plasma center and 8.3 percent at the second plasma center, and none in the male homosexual population. Pearson product moment correlations showed reasonably good agreement among the lymphocyte tests. However, the anti‐HBc, CMV, and herpes antibodies and circulating immune complex levels did not correlate with any of the other tests. Surrogate tests for AIDS are nonspecific and unlikely to be helpful in screening blood donor units.
The preparation of red cells depleted of leukocytes
Authors: Meryman H. T. , Hornblower M.
Published: March 2003

The most commonly used methods for depleting red cells of leukocytes are the inverted spin procedure, which results in excessive red cell loss and poor leukocyte depletion, and washing, which is expensive and yields a product with a 24‐hour shelf life. Clinical data now available suggest that nonhemolytic febrile transfusion reactions can be prevented in most clinical situations by microaggregate filtration of red cells during transfusion using the spin‐cool‐filter procedure with a screen filter. This procedure holds advantages for leukocyte removal, red cell recovery, cost, normal shelf‐life, and simplicity over other washing and buffy coat removal procedures currently used. For highly alloimmunized patients requiring virtually total leukocyte removal and where alloimmunization is to be avoided at any cost, adhesion filtration or freezing and deglycerolization should be used.
Automatic special case consultations in transfusion medicine
Authors: Tomasulo P. A. , Lenes B. A. , Noto T. A. , Klein H. G. , Menitove J. E.
Published: March 2003

In the past, consultations in immunohematology were usually delivered only when there was a blood or component shortage, or when the time required for compatibility testing was prolonged due to the presence of a difficult recipient antibody problem. More recently, transfusion medicine physicians have increased their role as clinical consultants concerned about the appropriate indications for blood transfusion. This communication presents a way to begin a sound program of clinical transfusion medicine consultation. The program can fit with community‐wide teaching efforts, community or hospital transfusion audits, and specific physician education programs. Automatic or unsolicited consultations appear to have been both accepted well and beneficial in large hospitals and in communities where they have been provided for more than 7 years.
Donath‐Landsteiner hemolytic anemia due to an anti‐Pr‐like biphasic hemolysin
Authors: Judd W. J. , Wilkinson S. L. , Issitt P. D. , Johnson T. L. , Keren D. F. , Steiner E. A.
Published: March 2003

Anemia, hyperbilirubinemia, and reticulocytosis subsequent to viral infection were present in a 32‐year‐old woman. The direct antiglobulin test was negative, and no unexpected antibodies were detected in pretransfusion tests. Rosettes of red cells (RBCs) around neutrophils were observed in peripheral blood smears, and a Donath‐Landsteiner (D‐L) test was positive. However, the patient did not show the classic features of paroxysmal cold hemoglobinuria (PCH). There was no hemoglobinuria, and in vivo hemolysis was not precipitated by cold. The D‐L antibody was IgG, but classic anti‐P specificity was not apparent. Rather, protease‐ or neuraminidase‐treated RBCs, as well as certain sialic acid deficient RBCs of uncommon MN phenotypes, were not hemolyzed in D‐L tests. Further, D‐L antibody activity could be inhibited by MN sialoglycoprotein. These data support a diagnosis of chronic D‐L hemolytic anemia, caused by an anti‐Pr‐like biphasic hemolysin.
Experience with 11,916 designated donors
Authors: CORDELL RUTH R. , YALON VINCENT A. , CIGAHN‐HASKELL CARLA , MCDONOUGH BRIAN P. , PERKINS HERBERT A.
Published: March 2003

Abstract: From June, 1984, through December, 1985, Irwin Memorial Blood Bank drew 11,916 designated donors. The original protocol, filled with barriers that the donors and patients had to follow, was changed to an open protocol that was easy to follow. Patients wanted to participate in the program regardless of the obstacles so we removed them, making it easier for the patients and donors as well as the staff at the blood bank. 3063 designated donors were compared to 3201 homologous and 3439 first‐time, non‐designated donors. The three groups did not differ in any of the comparisons, deferral rate, age, sex, race, blood type, and test results. We conclude that these designated donations were no safer but no less safe than donations not designated.
The efficacy of intensive plasma exchange in acquired von Willebrand's disease
Authors: Silberstein L.E. , Abrahm J. , Shattil S.J.
Published: March 2003

This study describes the response to therapeutic plasma exchange in a 60‐year‐old man with Waldenstrom's macroglobulinemia who developed a clinically severe bleeding disorder with laboratory features characteristic of acquired von Willebrand's disease. The patient's plasma levels of factor VIII coagulant activity, von Willebrand's factor antigen, and ristocetin cofactor activity were all less than 15 percent of normal, and the bleeding time was more than 20 minutes. In vitro studies did not demonstrate an inhibitor to factor VIII/von Willebrand factor, nor was a precipitating antibody to von Willebrand's factor antigen found in the patient's plasma. Neither infusions of cryoprecipitate nor combination chemotherapy corrected the clinical or laboratory abnormalities. In contrast, plasma exchange corrected the in vitro coagulation abnormalities and was effective in preventing surgical hemorrhage and controlling severe mucosal bleeding on 11 separate occasions. The current case demonstrates that the clinical and laboratory abnormalities in a patient with acquired von Willebrand's disease can be corrected completely by plasma exchange; it is recommended therefore that plasma exchange be considered as a mode of therapy in symptomatic patients with this disorder.
Metabolite‐specific (IgG) and drug‐specific antibodies (IgG, IgM) in two cases of trimethoprim‐sulfamethoxazole‐induced immune thrombocytopenia
Authors: Kiefel V. , Santoso S. , Schmidt S. , Salama A. , Mueller‐Eckhardt C.
Published: March 2003

Two cases of trimethoprim‐sulfamethoxazole (TMP‐SMX)‐induced immune thrombocytopenia are reported in which unusual drug‐dependent platelet antibodies were demonstrated by immunofluorescence and enzyme‐linked immunosorbent assay. Whereas two distinct sulfamethoxazole‐dependent antibodies of the IgG and IgM class were detectable in the serum of one patient, the serum of the other patient contained a platelet antibody exclusively reactive with N‐4‐acetyl‐sulfamethoxazole, a metabolite of sulfamethoxazole. Urine from a healthy volunteer collected after administration of therapeutic doses of TMP‐SMX proved to be an appropriate source of ex vivo metabolites for antibody testing. The results of this study stress the role of metabolite‐specific antibodies in drug‐dependent immune thrombocytopenia and underscore the necessity of including metabolite preparations of drugs in serologic analyses.
Risk of human immunodeficiency virus (HIV) transmission by anti‐HIV negative blood
Authors: Kleinman S. , Secord K.
Published: March 2003

ABSTRACT: We have estimated the risk of transmitting HIV infection from a unit of HIV seronegative blood collected in Los Angeles and Orange Counties, CA from March 1985 through February 1987. Our method consisted of lookback investigations and anti‐HIV testing of living recipients of HIV seronegative units donated by persons who later tested HIV seropositive at the time of a subsequent donation. During these investigations we have documented 3 cases of HIV transmission from HIV seronegative blood; using several assumptions, and extrapolating from this data, we have calculated that the risk of HIV transmission from an HIV seronegative unit was 1 in 51,000 to 1 in 102,000 (with a best guess of 1 in 68,000). We believe that our model can be applied in other geographic regions in an ongoing fashion in order to update our estimates of HIV transmission from HIV seronegative blood.
The safety and therapeutic effectiveness of human red cells stored at — 80°C for as long as 21 years
Authors: Valeri C. R. , Pivacek L. E. , Gray A. D. , Cassidy G. P. , Leavy M. E. , Dennis R. C. , Melaragno A. J. , Niehoff J. , Yeston N. , Emerson C. P. , Altschule M. D.
Published: March 2003

Human red cells frozen by various methods have been stored in the frozen state at —80°C for as long as 21 years. This report discusses: red cells frozen with 42 percent weight per volume (wt/vol) glycerol in an ionic medium in a polyvinylchloride (PVC) plastic bag using the Cohn method; red cells frozen with 45 percent wt/vol glycerol in a low ionic medium in a PVC plastic bag using the Huggins method; red cells frozen with 40 percent wt/vol glycerol in an ionic medium in a polyolefin plastic bag using the Meryman‐Hornblower method; and red cells frozen with 40 percent wt/vol glycerol in an ionic medium in a standard 600‐ml or an elongated 800‐ml PVC plastic primary collection bag with an adapter port using the Naval Blood Research Laboratory (NBRL) method. After frozen storage for as long as 21 years by the four methods described above, the thawed red cells were deglycerolized with 50 to 150 ml of 12 percent sodium chloride and 1.5 to 2.0 l of sodium chloride‐glucose or sodium chloride‐glucose‐phosphate solution. After washing and storage at 4°C for 24 hours, the red cells had a mean freeze‐thaw‐wash recovery value of 90 percent, a mean 24‐hour posttransfusion survival value of 85 percent, a mean index of therapeutic effectiveness of 75 percent, normal or slightly impaired oxygen transport function, and minimal hemolysis. When red cells frozen by the NBRL method in the standard 600‐ml or the elongated 800‐ml primary collection bag for as long as 5.7 years were stored after washing at 4°C for up to 3 days, these units had a mean freeze‐thaw‐wash recovery value of 90 percent, a mean 24‐hour posttransfusion survival value of 85 percent, a mean index of therapeutic effectiveness of 75 percent, normal or slightly impaired oxygen transport function, and minimal hemolysis. Cultures done after storage at 4°C for 1 week showed that the red cells remained sterile. The incidence of container breakage for red cells frozen in the standard 600‐ml or elongated 800‐ml primary collection bag was about 3 percent for units subjected to shipment and less than 1 percent for units that were not transported.