bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Effectiveness Research in Managed‐care Systems: Lessons from the Pediatric Asthma Care PORT
Authors: Finkelstein Jonathan A. , Lozano Paula , Streiff Kachen A. , Arduino Kelly E. , Sisk Cynthia A. , Wagner Edward H. , Weiss Kevin B. , Inui Thomas S. 
Published: March 2003

Objective. To highlight the unique challenges of evaluative research on practice behavior change in the “real world'' settings of contemporary managed‐care organizations, using the experience of the Pediatric Asthma Care PORT (Patient Outcomes Research Team).Study Setting. The Pediatric Asthma Care PORT is a five‐year initiative funded by the Agency for Healthcare Research and Quality to study strategies for asthma care improvement in three managed‐care plans in Chicago, Seattle, and Boston. At its core is a randomized trial of two care improvement strategies compared with usual care: (1) a targeted physician education program using practice based Peer Leaders (PL) as change agents, (2) adding to the PL intervention a “Planned Asthma Care Intervention'' incorporating joint “asthma check‐ups'' by nurse‐physician teams. During the trial, each of the participating organizations viewed asthma care improvement as an immediate priority and had their own corporate improvement programs underway.Data Collection. Investigators at each health plan described the organizational and implementation challenges in conducting the PAC PORT randomized trial. These experiences were reviewed for common themes and “lessons'' that might be useful to investigators planning interventional research in similar care‐delivery settings.Conclusions. Randomized trials in “real world'' settings represent the most robust design available to test care improvement strategies. In complex, rapidly changing managed‐care organizations, blinding is not feasible, corporate initiatives may complicate implementation, and the assumption that a “usual care'' arm will be static is highly likely to be mistaken. Investigators must be prepared to use innovative strategies to maintain the integrity of the study design, including: continuous improvement within the intervention arms, comanagement by researchers and health plan managers of condition‐related quality improvement initiatives, procedures for avoiding respondent burden in health plan enrollees, and anticipation and minimization of risks from experimental arm contamination and major organizational change. With attention to these delivery system issues, as well as the usual design features of randomized trials, we believe managed‐care organizations can serve as important laboratories to test care improvement strategies.
Cost of living, real wages and real incomes in thirteen Canadian cities, 1900–1950
Authors: Emery J. C. Herbert , Levitt Clint 
Published: March 2003

Price indices for thirteen Canadian cities for 1900 to 1950 demonstrate large regional differences in cost of living until 1914. After 1914 regional price levels converged. Before the war, western Canadian cities had the highest cost of living. After 1920 cities in Ontario had the highest cost of living. Accounting for these trends in regional costs of living reveals that regional real wage and real income structures have been present and stable since at least 1901. Thus, regional wage and income disparities are long‐standing and persistent features of the Canadian economy. Coût de la vie, salaires réels et revenus réels dans treize villes canadiennes. Les indices de prix pour treize villes canadiennes entre 1900 et 1950 montrent qu’il y avait de fortes différences dans le coût de la vie jusqu’en 1914. Après 1914, il y a convergence des niveaux de prix régionaux. Avant la guerre, les villes de l’ouest canadien avaient le coût de la vie le plus élevé. Après 1920, des villes de l’Ontario vont avoir le plus haut coût de la vie. Si l’on tient compte de ces tendances régionales dans les niveaux du coût de la vie, il appert que des structures de salaires et de revenus réels ont été en place et stables depuis 1901. Donc, les disparités régionales de salaires et de revenus sont des caractéristiques déjà anciennes et persistantes de l’économie canadienne.
Variable Rational Partisan Business Cycles: theory and some evidence
Authors: Heckelman Jac C. 
Published: March 2003

The Variable Rational Partisan Business Cycle model is developed, where agents face uncertainty regarding the timing and outcome of the next election. The model predicts that partisan influences on the economy persist throughout the government’s rule and are further influenced, in the opposite direction, by which party ruled in the previous period. Party popularity also has a causal effect on the business cycle. Finally, the effects from changes in election timing expectations are dependent on which party ruled in the previous period. Empirical results for output and unemployment in Canada, Germany, and United Kingdom yield mixed support for the model. JEL Classification: D72, E32 Le modèle des cycles d’affaires variables fondé sur le comportement du partisan rationnel : théorie et résultats. Le modèle de cycles d’affaires variables fondé sur le comportement du partisan rationnel est développé pour le cas où les agents font face à de l’incertitude quant au moment du déclenchement des élections et quant aux résultats des prochaines élections. Le modèle prédit que les influences partisanes sur l’économie persistent tout au long du mandat du gouvernement, et qu’elles sont influencées, dans la direction opposée, par le type de parti au pouvoir au cours du mandat antérieur. La popularité du parti a un effet de causalité sur le cycle d’affaires. Enfin les effets des changements dans les anticipations du moment du déclenchement des élections dépendent de quel parti était au pouvoir au cours de la période antérieure. Les résultats empiriques de la calibration du modèle pour la production et le chômage au Canada,en Allemagne et au Royaume Uni donnent des résultats mitigés.
LFA-1 is required for retention of effector CD8 T cells in mouse lungs
Authors: Thatte Jayant , Dabak Vrushali , Williams Mark B. , Braciale Thomas J. , Ley Klaus 
Published: March 2003

AbstractThe adhesion molecules involved in the migration and retention of activated effector CD8 T cells in the lung microcirculation and their recruitment into lung tissue are largely unknown. Here, we have analyzed the role of lymphocyte function–associated antigen-1 (LFA-1) and very late antigen-4 (VLA-4) on adhesion of influenza hemagglutinin (HA)–specific CD8 T-cell clone D4 under shear conditions in an in vitro binding assay and in an in vivo homing assay to the lungs of naive or transgenic Balb/c mice expressing HA (HA-Tg) by a lung-specific promoter. Blocking LFA-1 or intercellular adhesion molecule 1 (ICAM-1) significantly inhibited adhesion of D4 cells to lung vascular endothelium and parenchyma of lung sections. However, blocking VLA-4 or vascular cell adhesion molecule 1 (VCAM-1) had no effect on cell adhesion. Blocking LFA-1 in vivo significantly delayed lethal injury following adoptive transfer of D4 cells into HA-Tg mice as assessed by weight loss and histology. Residence time of adoptively transferred Indium 111 (111In)–labeled D4 cells in lungs of normal and HA-Tg mice as analyzed by dual modality imaging revealed a significantly shorter transit time of 4 hours for the D4 cells upon in vivo blockade of LFA-1. These results demonstrate a crucial role for LFA-1 in retention of activated CD8 T cells in normal mouse lungs and in the progression of lethal injury in HA-Tg mice.
Increases in eotaxin‐positive cells in induced sputum from atopic asthmatic subjects after inhalational allergen challenge
Authors: Zeibecoglou K , Ying Sun , Meng Q , Robinson Ds , Kay Ab , Macfarlane Aj , Barnes Nc , Pavord I 
Published: March 2003

Background: Eosinophils are believed to be critical proinflammatory cells in airway mucosal damage in asthma. Eotaxin is a C‐C chemokine with selective activity for eosinophils and basophils. Previous studies have shown increased expression of eotaxin in the airways of asthmatics at baseline. We aimed to investigate eotaxin expression during the late‐phase reaction to allergen inhalation in atopic asthmatics. Methods: Sputum induction was performed before and 24 h after inhalational allergen challenge in atopic asthmatics, and eotaxin protein was detected immunocytochemically. Results: Thirteen patients with a mean decrease in forced expiratory volume in 1 s of 28% (±1.5) during the early asthmatic reaction, and 39% (±4.7) during the late asthmatic reaction produced sufficient sputum for study. The percentage of eosinophils in sputum was increased 24 h after allergen challenge (P<0.004), and eosinophil percentages in sputum after challenge correlated with the magnitude of the late‐phase reaction (r=0.56, P=0.05). The percentage of eotaxin‐positive cells increased from 12.6% (range 2–43.8) to 24.3% (8.1–47.1, P<0.005). Allergen‐induced increases in eotaxin‐positive cells correlated with increases in eosinophils (r=0.63, P<0.01). Conclusions: These findings suggest that eotaxin may contribute to allergen‐induced recruitment of eosinophils to the airway in asthmatic subjects.
Nerve growth factor release with mast‐cell‐derived mediators in a patient with systemic mastocytosis after middle‐wave ultraviolet irradiation
Authors: Kurosawa M. , Inamura H. , Amano H. , Kanbe N. , Nagata H. , Nagai H. , Furukawa S. , Miyachi Y. 
Published: March 2003

Background: The symptoms of a 56‐year‐old man with systemic mastocytosis became worse with exposure to sunlight. We evaluated mast‐cell‐derived mediators and cytokines before and after exposure to ultraviolet light in the patient. Methods: The patient was irradiated with middle‐wave ultraviolet light, so‐called ultraviolet light B, and the levels of mediators and cytokines were measured serially. The point mutation Asp816Val in c‐kit was investigated by analyzing polymerase chain reaction products from the complementary DNA of peripheral blood mononuclear cells. Results: Before irradiation, the levels of mast‐cell‐derived mediators and metabolites were elevated. Among various cytokines measured, including soluble c‐kit and stem cell factor, only the level of nerve growth factor was elevated. After irradiation, the nerve growth factor level was further increased along with the levels of mast‐cell‐derived mediators and metabolites. The point mutation Asp816Val in c‐kit was not detected in peripheral blood mononuclear cells. Conclusions: Middle‐wave ultraviolet light may activate mast cells to release nerve growth factor and mediators in systemic mastocytosis.
Perceived prevalence of peanut allergy in Great Britain and its association with other atopic conditions and with peanut allergy in other household members
Authors: Emmett SE , Angus FJ , Fry JS , Lee PN 
Published: March 2003

Background: Despite increasing awareness of peanut allergy, little is known of its prevalence. We report on a two‐stage interview survey conducted in Great Britain. Methods: A total of 16 434 adults (aged 15+ years) reported their own allergies and atopies and named cohabitants with peanut allergy (stage 1). Follow‐up interviews were conducted with identified sufferers from peanut allergy (stage 2). Results: At stage 1, peanut allergy was reported in 58 respondents and 205 other household members. When we accounted for cases where peanut allergy was unconfirmed or newly reported at stage 2, the prevalence, based on 124 confirmed sufferers, was estimated as 0.48% (95% confidence interval 0.40%–0.55%). The prevalence in children (0.61%, 0.41%–0.82%) was slightly higher than in adults; age‐of‐onset was strikingly earlier. Prevalence was strongly associated with other atopies, particularly tree‐nut allergy. Cases tended significantly to cluster in households. Half of cases had never consulted a doctor. Exactly 7.4% reported being hospitalized after a reaction. Conclusions: Peanut allergy is reported by 1 in 200 of the population and is commoner in those reporting other atopies. The fact of similar rates in children and adults argues against a recent marked rise in prevalence. The frequency and potential lethality of this disorder emphasize the need for sufferers to receive correct medical advice on management.
Similarity in seasonal appearance between atmospheric birch‐pollen grains and allergen in paucimicronic, size‐fractionated ambient aerosol
Authors: Th F , Spieksma M , Nikkels AH 
Published: March 2003

Background: Specific allergen from various pollen types has been found to be carried through the outdoor air, not only by intact pollen grains, but also by much smaller, paucimicronic particles. There is no complete agreement on whether, for birch (Betula), the seasonal appearance of atmospheric pollen allergen follows the fluctuation pattern of the pollen season. Methods: Assessment of birch‐pollen allergen in size‐fractionated ambient aerosol was performed by descending elution of allergen from impaction strips of a five‐stage cascade impactor, and compared with atmospheric birch‐pollen concentrations as measured with a volumetric pollen trap. Results: An overall similarity in the courses of the seasonal presence was found for both birch pollen and allergen in particles of all paucimicronic size fractions, although some airborne allergen was detected before and after the birch‐pollen season. Conclusions: Transfer of pollen allergen to both natural and pollutant environmental dust particles is thought to be the probable explanation of secondary allergen carriage by paucimicronic particles. Until simple techniques for direct and rapid assessment of atmospheric pollen allergen become available, the pollen count gives sufficiently reliable information about the seasonal course of airborne pollen allergen.
Usefulness of UniCAP‐Tryptase fluoroimmunoassay in the diagnosis of anaphylaxis
Authors: Enrique E , García‐Ortega P , Gaig P , Richart C , Sotorra O 
Published: March 2003

Background: Serum tryptase level measured by RIA is the main in vitro tool to confirm the diagnosis of anaphylaxis. Methods: Serum tryptase levels were determined by UniCAP‐Tryptase fluoroimmunoassay (Pharmacia & Upjohn, Uppsala, Sweden), in 30 consecutive patients who presented at the emergency room with a clinical allergic reaction of less than 6‐h duration to assess the value of this method in the diagnosis of anaphylaxis. Anaphylaxis was established by clinical criteria and by immunoallergic study. Baseline tryptase levels were determined 1 month later in 21 patients. The receiver operating curve (ROC) was used to establish the best cutoff point of tryptase levels to confirm the diagnosis of anaphylaxis. Results: Seventeen patients were diagnosed with anaphylaxis. In this group, tryptase levels were higher than in the nonanaphylaxis group, composed mostly of patients with urticaria or angioedema (P<0.001). ROC established the best cutoff of tryptase levels at 8.23 ng/ml with a 94.12% sensitivity and 92.31% specificity, whereas the 13.5 ng/ml cutoff recommended by the manufacturers showed 35.29% sensitivity and 92.31% specificity. The reaction‐tryptase/baseline‐tryptase ratio was 2.85 in the anaphylaxis group and 1.29 in the nonanaphylaxis group. Conclusions: Serum tryptase levels of >8.23 ng/ml by UniCAP‐Tryptase fluoroimmunoassay identify anaphylaxis in patients with symptoms of less than 6‐h duration. The usefulness of this determination is higher if baseline tryptase levels are available.
Occupational IgE‐mediated asthma, rhinoconjunctivitis, and contact urticaria caused by Easter lily (Lilium longiflorum) and tulip
Authors: Piirilä P , Kanerva L , Alanko K , Estlander T , Keskinen H , Pajari‐Backas, and M , Tuppurainen M 
Published: March 2003

Background: We report on IgE‐mediated asthma, rhinoconjunctivitis, and contact urticaria to two Liliaceae plants, tulip and Easter lily (Lilium longiflorum), diagnosed in a floral shop worker. Methods: Occupational asthma was diagnosed according to patient history, PEF monitoring, and a work‐simulating provocation test. Flower‐specific IgE was studied, and RAST inhibition tests were performed. Results: Skin prick testing showed positive reactions to tulip, Easter lily, and chrysanthemum. Total IgE was 180 kU/l, and specific IgE to tulip was 2.6 and to Easter lily 6.5 kU/l. In the RAST‐inhibition test, no cross‐reactivity was found. Occupational asthma was diagnosed by peak flow monitoring at work and at home, as well as specific inhalation challenge with Easter lily, with an immediate 18% reduction in PEF. In addition, contact urticaria and conjunctivitis were diagnosed. After a 9‐year follow‐up without exposure to lilies, the skin prick tests to L. longiflorum and tulip were still positive, but the specific IgE had disappeared. Conclusions: A case of IgE‐mediated occupational asthma, rhinoconjunctivitis, and contact urticaria caused by L. longiflorum and tulip is presented. RAST inhibition tests indicated concomitant sensitization to the two Liliaceae plants.
Evaluation of IgE antibodies to recombinant pollen allergens(Phl p 1, Phl p 2, and Phl p 5) in a random sample of patients withspecific IgE to Phleum pratense
Authors: Rossi R. E. , Monasterolo G. , Operti D. , Operti R. , Berlen R. 
Published: March 2003

Background: We measured specific IgE levels against the recombinant allergens (RAs) rPhl p 1, rPhl p 2, rPhl p 5 in patients allergic to grass pollen, and examined the existence of different patterns of IgE production to RAs. The seasonal variations of IgE levels to rPhl p 1, rPhl p 2, and rPhl p 5 were considered, too. Methods: Blood was taken from 276 consecutive patients with allergy to grass pollen diagnosed by patient history and skin prick testing. Total and specific serum IgE was measured by the immunoenzymatic CAP FEIA System. Eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were assessed by radioimmunoassay according to the instructions of the manufacturers. Results: We observed eight different patterns of IgE production to rPhl p 1, rPhl p 2, and rPhl p 5 in patients with specific IgE to timothy grass. A significant difference between the values of IgE levels to timothy and the sum of each level of specific IgE to individual RAs was found (P=0.039, Wilcoxon matched pairs test) in the whole population (n=276 subjects). In four subgroups of patients, the sum of each level of specific IgE to individual RAs was equal to the levels of specific IgE to timothy grass extract. In one subgroup, the sum of IgE to RAs was lower than the levels of IgE to the natural counterpart (P=0.013). A lack of subjects in two subgroups did not permit comparison at all. Finally, three subjects with specific IgE to timothy did not show specific IgE to RAs. Out of 276 patients, blood was taken from two different groups of subjects at different time points: November–January and May–July, respectively. The median values were as follows: total IgE=139 kU/l, IgE to timothy=10.2 kUA/l; IgE to rPhl p 1=3.6 kUA/l, to rPhl p 2=<0.35 kUA/l, and to rPhl p 5=1.1 kUA/l; ECP=8.2 g/l; MPO=303 g/l (before exposure to grass pollen); total IgE=159 kU/l, IgE to timothy=57.2 kUA/l; IgE to rPhl p 1=22.1 kUA/l, to rPhl p 2=5.9 kUA/l, and to rPhl p 5=3.9 kUA/l; ECP=16.2/l, MPO=413.0/l (during the pollen season). There were significant variations of specific IgE levels between the patients exposed to pollen and the unexposed patients. Moreover, there were statistical differences in the IgE and inflammation mediator levels in sera from the pre‐to the pollen season (P<0.02). Conclusions: The results suggest that RAs allow establishment of the patient's IgE‐reactivity profile, encourage future research, and encourage manufacturers to produce further RAs for precise diagnosis and substantially improved immunotherapy injection of only those allergens against which significant amounts of specific IgE are produced.
Is there a role for immunoblots in the diagnosis of latex allergy? Intermethod comparison of in vitro and in vivo IgE assays in spina bifida patients
Authors: Grüber C. , Buck D. , Wahn U. , Niggemann B. 
Published: March 2003

Background: The best diagnostic method for latex allergy is still controversial. This investigation was designed to evaluate the diagnostic efficiency of immunoblotting in comparison with established in vitro and in vivo test systems.Methods: A total of 108 spina bifida patients were investigated by questionnaire and skin prick test (SPT). Specific serum IgE to latex was analyzed by the Pharmacia CAP FEIA immunoassay, DPC AlaSTAT microplate immunoassay, and DPC AlaBLOT immunoblot. Patients were regarded as latex allergic if they reacted positively to challenge by the latex glove wearing test.Results: Thirty‐four patients reacted positively to challenge. The sensitivity rates were 97% (SPT), 94% (immunoblot, CAP), 74% (AlaSTAT), and 35% (clinical history). The specificity rates were 92% (clinical history), 88% (AlaSTAT), 77% (SPT), 76% (CAP), and 69% (immunoblot). If two methods were combined, efficiency rates were highest for SPT combined with CAP (sensitivity 94%, specificity 82%), with AlaSTAT (sensitivity 74%, specificity 92%), or with immunoblot (sensitivity 91%, specificity 84%). The sera of challenge‐positive patients recognized more immunoblot bands than challenge‐negative patients, and the severity of symptoms correlated with the number of recognized bands.Conclusions: The diagnostic efficiency of immunoblotting is not superior to that of SPT. However, immunoblotting may serve as an additional tool to increase slightly the specificity of SPT and specific serum IgE tests.
Anti‐FcεRIα serum autoantibodies in different subtypes of urticaria
Authors: Zuberbier T. , Henz B. M. , Fiebiger E. , Maurer D. , Stingl G. 
Published: March 2003

Background: In recent years, a histamine‐releasing anti‐FcεRIα autoantibody has been demonstrated in about one‐third of patients with chronic urticaria. However, its clinical significance is still unclear. The objective was to detect a possible correlation between the occurrence of the anti‐FcεRIα autoantibody and the clinical type or cause of urticaria. Methods: Sera from 66 consecutively seen in‐ and outpatients with various types of urticaria and five healthy controls were examined for the presence of anti‐FcεRIα autoantibodies with a sandwich ELISA technique. In addition, basophil histamine release was studied in 13 autoantibody‐positive sera. Results: Anti‐FcεRIα autoantibodies were found in 17/48 patients with chronic urticaria, in 2/4 with angioedema, in 1/2 with urticarial vasculitis, and in 2/11 with dermographic urticaria. However, no anti‐FcεRIα autoantibodies were detected in acute, cold, or delayed‐pressure urticaria; in urticaria pigmentosa; or in normal controls. Of all chronic urticaria patients, 22 were classified as idiopathic since no underlying cause could be found. Of this group, seven were seropositive for anti‐FcεRIα. However, anti‐FcεRIα was also found in patients who went into remission after treatment of identified causes; namely, in one with type I allergy, one with drug intolerance, one with Helicobacter infection, and six with food intolerance. The autoantibody was also detected in 2/4 patients with associated autoimmune diseases. Functional activity was shown in basophil histamine release in 3/4 autoantibody‐positive sera of patients with chronic idiopathic urticaria and in 4/6 autoantibody‐positive sera of patients who went into remission after the treatment of underlying causes. Conclusions: These data confirm that anti‐FcεRIα autoantibodies in urticaria are mostly found in chronic urticaria. Furthermore, their detection independently of the apparent cause of the urticaria suggests that as yet unidentified mechanisms must be operative, possibly related to the chronic inflammatory process and/or individual predispositions that favor their induction.