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Stremming J, White A, Donthi A, Batt DG, Hetrick B, Chang EI, Wesolowski SR, Seefeldt MB, McCurdy CE, Rozance PJ, Brown LD. Sheep recombinant IGF-1 promotes organ-specific growth in fetal sheep. Front Physiol 2022; 13:954948. [PMID: 36091374 PMCID: PMC9452821 DOI: 10.3389/fphys.2022.954948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/28/2022] [Indexed: 01/14/2023] Open
Abstract
IGF-1 is a critical fetal growth-promoting hormone. Experimental infusion of an IGF-1 analog, human recombinant LR3 IGF-1, into late gestation fetal sheep increased fetal organ growth and skeletal muscle myoblast proliferation. However, LR3 IGF-1 has a low affinity for IGF binding proteins (IGFBP), thus reducing physiologic regulation of IGF-1 bioavailability. The peptide sequences for LR3 IGF-1 and sheep IGF-1 also differ. To overcome these limitations with LR3 IGF-1, we developed an ovine (sheep) specific recombinant IGF-1 (oIGF-1) and tested its effect on growth in fetal sheep. First, we measured in vitro myoblast proliferation in response to oIGF-1. Second, we examined anabolic signaling pathways from serial skeletal muscle biopsies in fetal sheep that received oIGF-1 or saline infusion for 2 hours. Finally, we measured the effect of fetal oIGF-1 infusion versus saline infusion (SAL) for 1 week on fetal body and organ growth, in vivo myoblast proliferation, skeletal muscle fractional protein synthetic rate, IGFBP expression in skeletal muscle and liver, and IGF-1 signaling pathways in skeletal muscle. Using this approach, we showed that oIGF-1 stimulated myoblast proliferation in vitro. When infused for 1 week, oIGF-1 increased organ growth of the heart, kidney, spleen, and adrenal glands and stimulated skeletal myoblast proliferation compared to SAL without increasing muscle fractional synthetic rate or hindlimb muscle mass. Hepatic and muscular gene expression of IGFBPs one to three was similar between oIGF-1 and SAL. We conclude that oIGF-1 promotes tissue and organ-specific growth in the normal sheep fetus.
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Affiliation(s)
- J Stremming
- Department of Pediatrics, Perinatal Research Facility, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - A White
- Department of Pediatrics, Perinatal Research Facility, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - A Donthi
- Gates Biomanufacturing Facility, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - DG Batt
- Gates Biomanufacturing Facility, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - B Hetrick
- Department of Human Physiology, University of Oregon, Eugene, OR, United States
| | - EI Chang
- Department of Pediatrics, Perinatal Research Facility, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - SR Wesolowski
- Department of Pediatrics, Perinatal Research Facility, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - MB Seefeldt
- Gates Biomanufacturing Facility, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - CE McCurdy
- Department of Human Physiology, University of Oregon, Eugene, OR, United States
| | - PJ Rozance
- Department of Pediatrics, Perinatal Research Facility, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - LD Brown
- Department of Pediatrics, Perinatal Research Facility, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Hesse H, Palmer C, Rigdon CD, Galan HL, Hobbins JC, Brown LD. Differences in body composition and growth persist postnatally in fetuses diagnosed with severe compared to mild fetal growth restriction. J Neonatal Perinatal Med 2022; 15:589-598. [PMID: 35342050 DOI: 10.3233/npm-210872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fetal growth restriction (FGR) is most commonly diagnosed in pregnancy if the estimated fetal weight (EFW) is < 10th%. Those with abnormal Doppler velocimetry, indicating placental insufficiency and pathological FGR, demonstrate reduced fat and lean mass compared to both normally growing fetuses and FGR fetuses with normal Dopplers. The aim of this study was to determine how severity of FGR and abnormal Doppler velocimetry impacts neonatal body composition. Among a cohort of fetuses with an EFW < 10th%, we hypothesized that those with abnormal Dopplers and/or EFW < 3rd% would have persistent reductions in lean body mass and fat mass extending into the neonatal period compared to fetuses not meeting those criteria. METHODS A prospective cohort of FGR fetuses with an estimated fetal weight (EFW) < 10th% was categorized as severe (EFW < 3rd% and/or abnormal Dopplers; FGR-S) versus mild (EFW 3-10th% ; FGR-M). Air Displacement Plethysmography and anthropometrics were performed at birth and/or within the first 6-8 weeks of life. RESULTS FGR-S versus FGR-M were born one week earlier (P = 0.0024), were shorter (P = 0.0033), lighter (P = 0.0001) with smaller weight-for-age Z-scores (P = 0.0004), had smaller head circumference (P = 0.0004) and lower fat mass (P = 0.01) at birth. At approximately 6-8 weeks postmenstrual age, weight, head circumference, and fat mass were similar but FGR-S neonates were shorter (P = 0.0049) with lower lean mass (P = 0.0258). CONCLUSION Doppler velocimetry abnormalities in fetuses with an EFW < 10th% identified neonates who were smaller at birth and demonstrated catch-up growth by 6-8 weeks of life that favored fat mass accretion over lean mass and linear growth.
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Affiliation(s)
- H Hesse
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - C Palmer
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - C D Rigdon
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - H L Galan
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J C Hobbins
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - L D Brown
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Brown LD, Permezel M, Holberton JR, Whitehead CL. Neonatal outcomes after introduction of a national intrapartum fetal surveillance education program: a retrospective cohort study. J Matern Fetal Neonatal Med 2016; 30:1777-1781. [PMID: 27534984 DOI: 10.1080/14767058.2016.1224839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the impact of a multidisciplinary fetal surveillance education program (FSEP) on term neonatal outcomes. METHODS A retrospective cohort study of term neonatal outcomes before (1998-2004) and after (2005-2010) introduction of a FSEP. Clinical data was collected for all term infants admitted to a neonatal intensive care unit (NICU) in Australia between 1998 and 2010. Infants with congenital abnormalities were excluded. Neonatal mortality and severe neonatal morbidity (admission to a NICU, respiratory support, hypoxic encephalopathy) were compared before and after the FSEP was introduced. The rates of operative delivery during this time were assessed. RESULTS There were 3 512 596 live term births between 1998 and 2010. The intrapartum hypoxic death rate at term decreased from 2.02 to 1.07 per 10 000 total births. More neonates were admitted to NICU after 2005 (10.6 versus 14.6 per 10 000 live births), however fewer babies admitted to the neonatal unit had Apgar scores < 5 at five minutes (55.1-45.5%, RR 0.82, 95% CI 0.7-0.87); and rates of hypoxic ischemic encephalopathy fell from 36% to 30% (RR 0.83, 95% CI 0.76-0.90). There was no increase in rates of emergency in labour caesarean sections (11.7% pre versus 11.1% post, RR 0.95, 95% CI 0.95-0.96). CONCLUSIONS Introduction of a national FSEP was associated with increased neonatal admissions but a reduction in intrapartum hypoxia, without increasing emergency caesarean section rates.
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Affiliation(s)
- L D Brown
- a Department of Obstetrics and Gynaecology , Mercy Hospital for Women , Heidelberg , Victoria , Australia
| | - M Permezel
- a Department of Obstetrics and Gynaecology , Mercy Hospital for Women , Heidelberg , Victoria , Australia.,b Department of Obstetrics and Gynaecology , University of Melbourne, Mercy Hospital for Women , Heidelberg , Victoria , Australia , and
| | - J R Holberton
- c On behalf of the Australian and New Zealand Neonatal Network , Lismore , NSW , Australia
| | - C L Whitehead
- b Department of Obstetrics and Gynaecology , University of Melbourne, Mercy Hospital for Women , Heidelberg , Victoria , Australia , and
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Brown LD, Abdulaziz R, Simons S, Inman D, Brett DJL, Shearing PR. Predominance diagrams of uranium and plutonum species in both lithium chloride–potassium chloride eutectic and calcium chloride. J APPL ELECTROCHEM 2013. [DOI: 10.1007/s10800-013-0611-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reilinger RE, Citron GP, Brown LD. Recent vertical crustal movements from precise leveling data in southwestern Montana, western Yellowstone National Park, and the Snake River Plain. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/jb082i033p05349] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Brown LD, Fischer SJ, Friedman JE, Hay WW. 323 AMINO ACID REGULATION OF SIGNAL TRANSDUCTION IN THE LATE GESTATION OVINE FETUS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Brown LD, Gnecco G. Chile: reaping the rewards of investments in quality. QA Brief 2002; 3:28-31. [PMID: 12319098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Abstract
Adult skeletal muscle fibers can be isolated and cultured but tend to dedifferentiate and sprout with time in culture. We examined isolated adult mouse flexor digitorum brevis muscle fibers under various culture conditions by monitoring maintenance of the same fibers at 2-d intervals using survival analysis. Fibers plated on laminin and cultured in serum-free media did not show sprouting and exhibited significantly (P < 0.0001) longer survival (median survival time, T(50) = 10.2 d) than fibers in serum-containing media (T(50) = 3.3 d). Cell proliferation was markedly suppressed in serum-free cultures. Multiple or delayed Ca(2+) transients in response to brief field stimulation were often observed in dedifferentiated fibers after several d in serum-containing media but were not observed in fibers in serum-free media. The addition of cytosine arabinoside to serum-containing cultures did not prolong fiber survival (P = 0.39) and did not eliminate sprouting but did greatly suppress proliferation of nonmuscle cells. Fibers cultured in agarose gel with serum exhibited small, bud-like extensions but no sprouts and did not survive as long (T(50) = 6.2 d) as fibers plated on laminin and cultured in serum-free media (T(50) = 10.2 d) did. These results demonstrate that both morphological and physiological properties of fibers become modified in serum-containing media but can be retained by culturing without serum.
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Affiliation(s)
- L D Brown
- Department of Biochemistry, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA
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Brown LD, Datta S, Kouba JK, Smith LK, Wreford SS. Interconversion of cis-trans isomers in MX(CO)2(unsymmetric, bidentate phosphine)2. Inorg Chem 2002. [DOI: 10.1021/ic50181a046] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Albright JO, Brown LD, Datta S, Kouba JK, Wreford SS, Foxman BM. Molecular structure and dynamics of (.eta.4-naphthalene)chlorotantalum bis[1,2-bis(dimethylphosphino)ethane]. J Am Chem Soc 2002. [DOI: 10.1021/ja00458a066] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hall JH, Dixon DA, Kleier DA, Halgren TA, Brown LD, Lipscomb WN. Localized molecular orbitals for polyatomic molecules. II. Structural relations and charge distributions for open boron hydrides and ions. J Am Chem Soc 2002. [DOI: 10.1021/ja00848a010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brown LD, Cantino ME. Nonuniform distribution of myosin light chains within the thick filaments of lobster slow muscle: Immunocytochemical study. J Exp Zool 2001; 290:6-17. [PMID: 11429759 DOI: 10.1002/jez.1031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The in situ distribution of the alpha and beta myosin light chains was investigated at the subsarcomeric and subfilament levels in individual fibers of the superficial flexor muscle (SFM) of the lobster, Homarus americanus. Polyclonal antibodies were produced against the two classes of myosin light chains and used for subsequent immunolocalization on thin sections of sarcomeres and on isolated filaments from both the medial and lateral fiber bundles of the SFM. The beta myosin light chains were uniformly distributed within the crossbridge region of sarcomeres of both medial and lateral bundles. The alpha myosin light chains were uniformly distributed within the crossbridge region of sarcomeres from the medial bundle, but were nonuniformly distributed over the crossbridge region of lateral bundle sarcomeres. In the latter, the number of alpha myosin light chains was highest toward the center of the thick filaments, diminishing towards the ends. Similar distributions of alpha light chains were found in isolated myosin filaments. These data demonstrate that heterogeneity in protein composition extends to the level of the myosin filament and suggest that the myosin filament substructure in lobster may be different than that found in vertebrate skeletal muscle.
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Affiliation(s)
- L D Brown
- Department of Physiology and Neurobiology, The University of Connecticut, Storrs, Connecticut 06268, USA.
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Abstract
Despite extensive knowledge of many muscle A-band proteins (myosin molecules, titin, C-protein (MyBP-C)), details of the organization of these molecules to form myosin filaments remain unclear. Recently the myosin head (crossbridge) configuration in a relaxed vertebrate muscle was determined from low-angle X-ray diffraction (Hudson et al. (1997), J Mol Biol 273: 440-455). This showed that, even without C-protein, the myosin head array displays a characteristic polar pattern with every third 143 A-spaced crossbridge level particularly prominent. However, X-ray diffraction cannot determine the polarity of the crossbridge array relative to the neighbouring actin filaments; information crucial to a proper understanding of the contractile event. Here, electron micrographs of negatively-stained goldfish A-segments and of fast-frozen, freeze-fractured plaice A-bands have been used to determine the resting myosin head polarity relative to the M-band. In agreement with the X-ray data, the prominent 429 A-spaced striations are seen outside the C-zone, where no non-myosin proteins apart from titin are thought to be located. The head orientation is with the concave side of the curved myosin heads (containing the entrance to the ATP-binding site) facing towards the M-band and the convex surface (containing the actin-binding region at one end) facing away from the M-band.
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Affiliation(s)
- M E Cantino
- Department of Physiology and Neurobiology, University of Connecticut, Storrs 06269-2131, USA.
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Brown LD. Medicaid managed care: using research for policy. Health Serv Res 2001; 36:53-60. [PMID: 11324743 PMCID: PMC1089215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Affiliation(s)
- L D Brown
- Division of Health Policy at Columbia University in New York, USA
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Abstract
Throughout the 1990s states sought politically acceptable policies to reduce the ranks of the uninsured. Visions of comprehensive health reform and universal coverage yielded by mid-decade to more modest measures to repair private health insurance markets, and to these enactments were added several new public programs (state and federal) to expand coverage for lower-income children and, in some cases, adults. Because governments remain ill equipped to counter the power of business, insurers, and providers in conflicts fought on private turf, reform agendas have been more readily set, moved, and cleared in public-sector arenas. Although the number of uninsured rose steadily until 1999, "catalytic federalism"--the accelerating interplay between state and federal reform forces and funds--may be putting the programmatic foundations for broader coverage incrementally into place.
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Affiliation(s)
- L D Brown
- Mailman School of Public Health, Columbia University, USA
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Brown LD, de Negri B, Hernandez O, Dominguez L, Sanchack JH, Roter D. An evaluation of the impact of training Honduran health care providers in interpersonal communication. Int J Qual Health Care 2000; 12:495-501. [PMID: 11202603 DOI: 10.1093/intqhc/12.6.495] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the impact of interpersonal communication (IPC) training on practice and patient satisfaction and to determine the acceptability of this training to providers in a developing country. DESIGN The study used a pre-post design with treatment and control groups. Data collection methods included interaction analysis of audio-taped clinical encounters, patient exit interviews, and a self-administered questionnaire for health providers. STUDY PARTICIPANTS Interaction analysis was based on an experimental group of 24 doctors and a control group of eight with multiple observations for each provider). Exit interviews were carried out with 220 pre-test patients and 218 post-test patients. All 87 health providers who received training responded to the self-administered questionnaire. INTERVENTION A brief in-service training programme on interpersonal communications was presented in three half-day sessions; these focused on overall socio-emotional communication, problem solving skills and counselling. MAIN OUTCOME MEASURES AND RESULTS The IPC intervention was associated with more communication by trained providers (mean scores of 136.6 versus 94.4; P = 0.001), more positive talk (15.93 versus 7.99; P = 0.001), less negative talk (0.11 versus 0.59; P = 0.018), more emotional talk (15.7 versus 5.5; P = 0.021), and more medical counselling (17.3 versus 11.3; P = 0.026). Patients responded by communicating more (mean scores of 113.8 versus 79.6; P = 0.011) and disclosing more medical information (54.7 versus 41.7; P = 0.002). Patient satisfaction ratings were higher for providers who had received the training and providers reported training to be relevant and useful. CONCLUSIONS Further validation of IPC skills and simplification of assessment methods are needed if IPC is to be an area for routine monitoring and quality improvement.
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Affiliation(s)
- L D Brown
- University Research Corporation, Bethesda, MD 20816, USA.
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Abstract
Health care providers that have traditionally served the poor are forming their own managed care plans, often in alliance with local safety-net peers. These alliances make it easier to raise needed capital, increase the pool of likely enrollees, and enable plans to benefit from efficiencies of scale. At the same time, however, the alliances often are undermined by conflicts of interest among the different sponsors and between the sponsors and the plan. This paper suggests that these plans are most likely to do well when the state makes special efforts to help and when plans have the leadership and financial reserves to take advantage of their supportive state policies.
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Affiliation(s)
- M S Sparer
- Division of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York, USA
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Sparer M, Brown LD, Kovner AR. Implementing Medicaid managed care: the New York City story. J Health Care Finance 1999; 26:1-17. [PMID: 10497747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Across the nation, public officials are encouraging or requiring Medicaid beneficiaries to enroll in managed care. In this article, we report on a study of the implementation of Medicaid managed care in New York City. Several findings are clear. First, government officials need to treat health plans as partners rather than adversaries; in New York, the relationship between the state and the plans is far too adversarial. Second, effective managed care requires good management information systems; New York officials are collecting an enormous amount of data but not much useful information. Third, effective implementation of Medicaid managed care is slow going; New York's effort to dramatically accelerate the enrollment process did not work.
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Affiliation(s)
- M Sparer
- Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
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20
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O'Neill BP, Wang CH, O'Fallon JR, Colgan JP, Earle JD, Krigel RL, Brown LD, McGinnis WJ. The consequences of treatment and disease in patients with primary CNS non-Hodgkin's lymphoma: cognitive function and performance status. North Central Cancer Treatment Group. Neuro Oncol 1999; 1:196-203. [PMID: 11554388 PMCID: PMC1920741 DOI: 10.1093/neuonc/1.3.196] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Per protocol, patients with primary CNS non-Hodgkin's lymphoma in an intergroup phase II trial conducted by the North Central Cancer Treatment Group and the Eastern Cooperative Oncology Group had their cognitive functions measured using the Folstein and Folstein Mini-Mental Status Examination (MMSE) and their physical functions measured using the Eastern Cooperative Oncology Group Performance Score (PS) at study entry, at each treatment evaluation, and at quarterly intervals thereafter until disease progression or death. Of the 53 eligible participants who began therapy, 46 (87%) had baseline MMSE scores recorded, 36 (68%) had at least one follow-up MMSE, and 32 (60%) had both, while 52 (98%) had baseline PS, 49 (92%) had at least one follow-up PS, and 48 (91%) had both. Patterns of MMSE and PS values over time were studied in each individual, in the group as a whole, in the 20 patients who completed the study regimen, in the 23 who survived more than a year, and in patients who were classified as nonprogressors at each key evaluation. For each patient, all recorded values were plotted versus time, with dates of disease progression and death included, to look for signs of decline in cognitive or physical function preceding adverse events. Long-term declines in scores of both cognitive and physical function were observed in many treated patients with primary CNS non-Hodgkin's lymphoma. Nearly all patients who were alive more than 52 weeks after study entry had a demonstrable decline in cognitive and physical functionality. Such declines may occur before disease progression is documented; they may also occur in some patients who have long-term follow-up without evidence of disease progression. Declining MMSE and PS was a poor predictor of disease progression. There was no association of PS and toxicity. The data from this study demonstrated the considerable difficulties we encountered conducting an ancillary study such as this within a multicenter clinical trial. Firstly, the test instruments written into the protocol were unable to tell if the declines seen were due to disease, treatment, co-morbidity, or other factors. Secondly, the missing data created difficulties in interpreting outcome.
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Affiliation(s)
- B P O'Neill
- Department of Neurology, Mayo Clinic and Foundation, 200 SW First St., Rochester, MN 55905, USA
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Brown LD. Management by objection? Public policies to protect choice in health plans. Med Care Res Rev 1999; 56 Suppl 1:145-65; discussion 166-76. [PMID: 10354682 DOI: 10.1177/1077558799056001s09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Consumer choice is a watchword of the market reforms now sweeping the U.S. health care system. Policy makers, however, must grapple with an important ambiguity; is the objective to expand choice or protect choosers, and what should be done if the two goals conflict? Concerns about health care market malfunctions trigger a politics of consumer protection that may emphasize regulatory standards over market flexibility. To complicate matters further, hopes that deluging consumers with information can ensure that choices are at once ample and prudent are likely to be disappointed.
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Affiliation(s)
- L D Brown
- Joseph L. Mailman School of Public Health of Columbia University, USA
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Abstract
Nearly every state is encouraging or requiring Medicaid beneficiaries to enroll in managed care delivery systems. In New York City, Medicaid officials began with an incremental, but not insignificant, managed care initiative. Buoyed by its success, New York policy makers tried, and failed, to accelerate the transition to managed care. The legacy of that failure still plagues them. A comparison of such initiatives in other states indicates that most state officials have remembered what New York's leaders temporarily forgot, namely, that Medicaid managed care is a complex exercise that demands consultation and consensus building.
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Affiliation(s)
- M S Sparer
- Columbia University School of Public Health, NY 10032, USA
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Abstract
In 1993 Germany joined the small but swelling ranks of societies determined to explore managed competition as a means of slowing the growth of health spending by giving stakeholders new incentives for efficiency. Realizing the benefits of competition, however, demands changes in institutional norms and regulatory practices that now largely handcuff those who would follow competitive logic into "managed care." In time Germany's system of "manacled competition" may evolve into a happy higher synthesis of managed care and managed competition. Or policymakers may conclude that the political price of installing workable market forces in health care is too high and reconcile themselves to more traditional applications of political pressure.
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O'Neill BP, Wang CH, O'Fallon JR, Colgan JD, Earle JD, Krigel RL, Brown LD, McGinnis WL. Primary central nervous system non-Hodgkin's lymphoma (PCNSL): survival advantages with combined initial therapy? A final report of the North Central Cancer Treatment Group (NCCTG) Study 86-72-52. Int J Radiat Oncol Biol Phys 1999; 43:559-63. [PMID: 10078637 DOI: 10.1016/s0360-3016(98)00450-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We herein report updated survival and toxicity data on the entire cohort of 53 eligible patients treated on North Central Cancer Treatment Group (NCCTG) protocol 86-72-52, which is now closed. METHODS AND MATERIALS An initial report was published in this journal in 1995. No substantive changes in the conclusions of that report were identified in this analysis. Median survival was 9.6 months for the entire cohort; median survival for the 20 patients who completed the prescribed protocol treatment was 20.7 months. The hematologic and non-hematologic toxicity distributions are virtually the same as those reported in the original paper. RESULTS Results are given for the entire group and for subsets defined by age < or = 60 versus > 60 years, and < 70 versus > or = 70 years of age. CONCLUSIONS No significant differences were observed in any of the outcome variables by age group. There was, however, a nonsignificant suggestion of poorer outcome in those who were > 60 years of age.
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Affiliation(s)
- B P O'Neill
- Department of Neurology, Mayo Clinic/Foundation, Rochester, MN 55905, USA.
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Alsdorf D, Makovsky Y, Zhao W, Brown LD, Nelson KD, Klemperer S, Hauck M, Ross A, Cogan M, Clark M, Che J, Kuo J. INDEPTH (International Deep Profiling of Tibet and the Himalaya) multichannel seismic reflection data: Description and availability. ACTA ACUST UNITED AC 1998. [DOI: 10.1029/98jb01078] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Examining health policy and its recent reform misadventures
in the United States from a moral viewpoint is painful.
That the nation devotes 14% of its Gross Domestic Product
to health services—sometimes of doubtful clinical
efficacy and value for money—and yet lets more than
40 million citizens go without health coverage strikes
critics, both foreign and domestic, as a disgrace explicable
only by ethical deficiencies distinctive to the American
value system. There is certainly merit in this critique,
which understandably incites fire and brimstone about the
urgent moral imperative of getting the nation on the path
of righteousness at last.
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Affiliation(s)
- L D Brown
- Division of Health Policy and Management, Columbia School of Public Health, New York City, USA
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Affiliation(s)
- L D Brown
- Division of Health Policy and Management, School of Public Health, Columbia University, New York, NY 10032, USA
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Abstract
American health care reformers, who often look to other nations for models of desirable health systems, are often surprised nowadays by cross-national infatuation with health policy innovations minted in the United States. American innovations appeal to policy makers abroad as they struggle with cost pressures, distinguish knowledge about how health systems work, and deal with changing images of what constitutes good public policy. These strategems are adapted, not adopted; however, the premises and practices with which other nations follow American directions differ deeply from those in the United States. Ironically, even cross-national experiments may end up offering instructive policy "rules" to the exceptionalist United States.
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Abstract
Using a retrospective comparative design, the investigators evaluated the effects of training 10% of a nursing staff in the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) on preterm infant outcomes. A convenience sample of 25 preterm infants (< 1500 grams) cared for during the NIDCAP implementation and training period were matched by birth weight and gestational age to infants born before NIDCAP implementation. Outcome measures collected through chart review showed NIDCAP infants had significantly fewer and less severe intraventricular hemorrhages, fewer days of ventilatory support, shorter hospitalizations, and greater rate of weight gain. Findings suggest that benefits of developmental care are achievable with only a portion of the staff being NIDCAP trained.
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Affiliation(s)
- L D Brown
- Association of Iowa Hospitals and Health Systems, Altoona 50009, USA
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Marino MT, Urquhart MR, Sperry ML, Bredow JV, Brown LD, Lin E, Brewer TG. Pharmacokinetics and kinetic-dynamic modelling of aminophenones as methaemoglobin formers. J Pharm Pharmacol 1997; 49:282-7. [PMID: 9231346 DOI: 10.1111/j.2042-7158.1997.tb06796.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Methaemoglobin, the oxidized form of haemoglobin, can be formed by a variety of agents, most of which act to oxidize haemoglobin directly or indirectly. Cyanide has a higher affinity for methaemoglobin than for mitochondrial cytochromes, making methaemoglobin formation a basis for the treatment of cyanide poisoning. We used the beagle dog model to investigate the relationship between drug concentration and methaemoglobin levels for two candidate anti-cyanide compounds. The compounds studied were the aminophenones p-aminopropiophenone (PAPP) and p-aminoheptylphenone (PAHP). Both PAPP and PAHP were given as intravenous boluses and as two different oral formulations. The kinetics of both compounds appeared to follow a three-compartment open model for intravenous bolus administration and a two-compartment open model for oral administration. The first distribution phase seen with the intravenous administration was obscured by the absorption phase during oral administration. Bioavailability for all formulations varied between 20 and 47%. For both compounds there was a delay between the appearance of drug in the plasma and the appearance of methaemoglobin (counter-clockwise hysteresis) which is suggestive of an active metabolite causing methaemoglobin formation. The pharmacodynamics were fit with an effect-compartment kinetic-dynamic model linked to a sigmoid Emax pharmacodynamic model. Maximum amounts of methaemoglobin occurred between 2 and 4 h for PAHP and between 1 and 3 h for PAPP. When administered intravenously estimates of EC50 were lower than the estimates of EC50 from oral administration for both compounds. This might be because of oral first-pass inactivation or a 'first-pass' activation through the lungs contributing to the formation of an active metabolite. The phenones as a class appear to have the drug cleared and methaemoglobin return to near baseline within 12 h. Both compounds seem to produce sufficient methaemoglobin to treat acute cyanide poisoning and to serve as prophylactic agents against acute cyanide poisoning in a military setting.
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Affiliation(s)
- M T Marino
- Department of Pharmacology, Walter Reed Army Institute of Research, Washington, D.C. 20307-5100, USA
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31
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Brown LD. The metamorphosis: conversion in historical context. Bull N Y Acad Med 1997; 74:238-47. [PMID: 9439861 PMCID: PMC2359354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L D Brown
- Division of Health Policy and Management, School of Public Health, Columbia University, New York, NY 10032, USA
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Makovsky Y, Klemperer SL, Ratschbacher L, Brown LD, Li M, Zhao W, Meng F. INDEPTH Wide-Angle Reflection Observation of P-Wave-to-S-Wave Conversion from Crustal Bright Spots in Tibet. Science 1996; 274:1690-1. [PMID: 8939853 DOI: 10.1126/science.274.5293.1690] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Three-component wide-angle seismic data acquired in southern Tibet during Project INDEPTH show strong P-to-S converted reflections from reflectors that are aligned at a depth of approximately 15 kilometers beneath the northern Yadong-Gulu rift. These converted reflections are locally higher in amplitude than the corresponding P-wave reflections. Modeling of reflection mode conversion as a function of incidence angle indicates that this condition obtains for a reflector that is a solid over fluid interface; it is not typical of a solid-solid interface. The likely candidates for a fluid trapped within the crystalline crust of southern Tibet are granitic magma and water (brine).
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Affiliation(s)
- Y Makovsky
- Y. Makovsky, S. L. Klemperer, L. Ratschbacher, Department of Geophysics, Stanford University, CA 94305-2215, USA. L. D. Brown, Department of Geological Sciences, Cornell University, Ithaca, NY 14853, USA. Ming Li, Wenjin Zhao, and Fanle Meng, Chinese Academy of Geological Sciences, Baiwanzhuang Road 26, Beijing 100037, China
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Brown LD, Zhao W, Nelson KD, Hauck M, Alsdorf D, Ross A, Cogan M, Clark M, Liu X, Che J. Bright Spots, Structure, and Magmatism in Southern Tibet from INDEPTH Seismic Reflection Profiling. Science 1996; 274:1688-90. [PMID: 8939852 DOI: 10.1126/science.274.5293.1688] [Citation(s) in RCA: 272] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INDEPTH seismic reflection profiling shows that the decollement beneath which Indian lithosphere underthrusts the Himalaya extends at least 225 kilometers north of the Himalayan deformation front to a depth of approximately 50 kilometers. Prominent reflections appear at depths of 15 to 18 kilometers near where the decollement reflector apparently terminates. These reflections extend north of the Zangbo suture to the Damxung graben of the Tibet Plateau. Some of these reflections have locally anomalous amplitudes (bright spots) and coincident negative polarities implying that they are produced by fluids in the crust. The presence of geothermal activity and high heat flow in the regions of these reflections and the tectonic setting suggest that the bright spots mark granitic magmas derived by partial melting of the tectonically thickened crust.
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Affiliation(s)
- LD Brown
- L. D. Brown, M. Hauck, D. Alsdorf, A. Ross, M. Clark, Institute for the Study of the Continents, Cornell University, Ithaca, NY 14853, USA. Wenjin Zhao and Xianwen Liu, Chinese Academy of Geological Sciences, Beijing 100037, China. K. D. Nelson and M. Cogan, Department of Earth Sciences, Syracuse University, Syracuse, NY 13244, USA. Jinkai Che, Bejing Computing Center, Ministry of Geology and Mineral Resources, Beijing, 100083, China
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Nelson KD, Zhao W, Brown LD, Kuo J, Che J, Liu X, Klemperer SL, Makovsky Y, Meissner R, Mechie J, Kind R, Wenzel F, Ni J, Nabelek J, Leshou C, Tan H, Wei W, Jones AG, Booker J, Unsworth M, Kidd WSF, Hauck M, Alsdorf D, Ross A, Cogan M, Wu C, Sandvol E, Edwards M. Partially Molten Middle Crust Beneath Southern Tibet: Synthesis of Project INDEPTH Results. Science 1996; 274:1684-8. [PMID: 8939851 DOI: 10.1126/science.274.5293.1684] [Citation(s) in RCA: 921] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INDEPTH geophysical and geological observations imply that a partially molten midcrustal layer exists beneath southern Tibet. This partially molten layer has been produced by crustal thickening and behaves as a fluid on the time scale of Himalayan deformation. It is confined on the south by the structurally imbricated Indian crust underlying the Tethyan and High Himalaya and is underlain, apparently, by a stiff Indian mantle lid. The results suggest that during Neogene time the underthrusting Indian crust has acted as a plunger, displacing the molten middle crust to the north while at the same time contributing to this layer by melting and ductile flow. Viewed broadly, the Neogene evolution of the Himalaya is essentially a record of the southward extrusion of the partially molten middle crust underlying southern Tibet.
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Affiliation(s)
- KD Nelson
- K. D. Nelson, M. Cogan, C. Wu, Department of Earth Sciences, Syracuse University, Syracuse, NY 13244, USA. W. Zhao, J. Che, X. Liu, Chinese Academy of Geological Sciences, Beijing 100037, China. L. D. Brown, M. Hauck, D. Alsdorf, A. Ross, Institute for the Study of the Continents, Cornell University, Ithaca, NY 14853, USA. J. Kuo, Lamont Doherty Geological Observatory, Palisades, NY, 10964, USA. S. L. Klemperer and Y. Makovsky, Department of Geophysics, Stanford University, Stanford, CA 94305, USA. R. Meissner, Institut fur Geophysik, Christian-Albrechts-Universitaet zu Kiel, 24098 Kiel, Germany. J. Mechie and R. Kind, GeoForschungsZentrum Potsdam (GFZ), 14473 Potsdam, Germany. F. Wenzel, Geophysikalisches Institut, Universitaet Karlsruhe, 76187 Karlsruhe, Germany. J. Ni and E. Sandvol, Department of Physics, New Mexico State University, Las Cruces, NM 88003, USA. J. Nabelek, College of Oceanography, Oregon State University, Corvallis, OR 97331, USA. L. Chen, H. Tan, W. Wei, China University of Geosciences, Beijing, China. A. G. Jones, Geological Survey of Canada, 1 Observatory Crescent, Ottawa, Ontario, Canada. J. Booker and M. Unsworth, Geophysics Program, University of Washington, Seattle, WA 98195, USA. W. S. F. Kidd and M. Edwards, Department of Geosciences, SUNY-Albany, Albany, NY 12222, USA
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35
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Knapp JH, Steer DN, Brown LD, Berzin R, Suleimanov A, Stiller M, Lüschen E, Brown DL, Bulgakov R, Kashubin SN, Rybalka AV. Lithosphere-Scale Seismic Image of the Southern Urals from Explosion-Source Reflection Profiling. Science 1996. [DOI: 10.1126/science.274.5285.226] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- J. H. Knapp
- J. H. Knapp, D. N. Steer, L. D. Brown, Institute for the Study of the Continents, Cornell University, Ithaca, NY 14853, USA
| | - D. N. Steer
- J. H. Knapp, D. N. Steer, L. D. Brown, Institute for the Study of the Continents, Cornell University, Ithaca, NY 14853, USA
| | - L. D. Brown
- J. H. Knapp, D. N. Steer, L. D. Brown, Institute for the Study of the Continents, Cornell University, Ithaca, NY 14853, USA
| | - R. Berzin
- R. Berzin and A. Suleimanov, Spetsgeofisika, Moscow, 107140 Russia
| | - A. Suleimanov
- R. Berzin and A. Suleimanov, Spetsgeofisika, Moscow, 107140 Russia
| | - M. Stiller
- M. Stiller and E. Lüschen, GeoForschungsZentrum, D-14473 Potsdam, Germany
| | - E. Lüschen
- M. Stiller and E. Lüschen, GeoForschungsZentrum, D-14473 Potsdam, Germany
| | - D. L. Brown
- D. L. Brown, Instituto de Ciencias de la Tierra, Consejo Superior de Investigaciones Cientificas-Barcelona, 08028 Spain
| | - R. Bulgakov
- R. Bulgakov, Bashneftegeofizika, Ufa, 450000 Russia
| | - S. N. Kashubin
- S. N. Kashubin and A. V. Rybalka, Bazhenov Geophysical Expedition, Scheelite, 624051 Russia
| | - A. V. Rybalka
- S. N. Kashubin and A. V. Rybalka, Bazhenov Geophysical Expedition, Scheelite, 624051 Russia
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Valadez JJ, Brown LD, Vargas WV, Morley D. Using lot quality assurance sampling to assess measurements for growth monitoring in a developing country's primary health care system. Int J Epidemiol 1996; 25:381-7. [PMID: 9119564 DOI: 10.1093/ije/25.2.381] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Local supervisors used lot quality assurance sampling (LQAS) during routine household visits to assess the technical quality of Costa Rican community-based health workers (CHW): measuring and recording weights of children, interpreting their growth trend and providing nutrition education to mothers. METHOD Supervisors sampled 10 households in each of 12 Health Areas (4-8 hours per area). No more than two performance errors were allowed for each CHW. This LQAS decision rule resulted in judgments with a sensitivity and specificity of about 95 percent. RESULTS Three categories of results are reported: (1) CHW adequately weighed children, calculated ages, identified children requiring nutritional services, and used the growth chart. (2) They needed to improve referral, education, and documentation skills. (3) The lack of system support to regularly provide growth cards, supplementary feeding to identified malnourished children, and other essential materials may have discouraged some CHW resulting in them not applying their skills. CONCLUSIONS Supervisors regularly using LQAS should, by the sixth round of supervision, identify at least 90 percent of inadequately performing CHW. This paper demonstrates the strength of LQAS, namely, to be used easily by low level local health workers to identify poorly functioning components of growth monitoring and promotion.
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Affiliation(s)
- J J Valadez
- Department of International Health, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD, USA
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Brown LD. The politics of Medicare and health reform, then and now. Health Care Financ Rev 1996; 18:163-8. [PMID: 10167856 PMCID: PMC4193637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- L D Brown
- Columbia School/Public Health, New York 10032, USA
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Abstract
A sustainable quality assurance (QA) program depends on development of a QA structure, ongoing standard setting, routine monitoring, quality improvement activities and the development of a culture of quality. A review of QA implementation in five countries identifies some practical guidelines for successful institutionalization of QA. These experiences underscore the importance of organizational assessment and provide insight about the advantages and disadvantages of an initial QA assessment. Developing a methodology that is both standardized and flexible is stressed, as well as a training strategy that integrates classroom learning, coaching and application. Gradual development of QA structure, based closely on existing systems, is recommended. Issues relating to gaining and sustaining political support, dealing with personnel changes, using appropriate incentives and dissemination are also discussed. Finally, the definition and dimensions of quality are put forth as the foundation for a culture of quality, which develops as individuals and groups commit themselves to their quality ideal.
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Affiliation(s)
- L D Brown
- The Quality Assurance Project, University Research Corporation/Center for Human Services, Bethesda, MD 20816, USA
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O'Neill BP, O'Fallon JR, Earle JD, Colgan JP, Brown LD, Krigel RL. Primary central nervous system non-Hodgkin's lymphoma: survival advantages with combined initial therapy? Int J Radiat Oncol Biol Phys 1995; 33:663-73. [PMID: 7558957 DOI: 10.1016/0360-3016(95)00207-f] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Results of multiple radiation, chemotherapy, and combined treatment trials have shown that the fate of primary central nervous system lymphoma (PCNSL) patients is very different from that of patients with similarly treated systemic IE non-Hodgkin's lymphoma. This study was designed to improve the survival of PCNSL patients by the use of combined initial therapy. METHODS AND MATERIALS Forty-six eligible primary PCNSL patients were treated with whole brain irradiation and adjuvant chemotherapy consisting of preirradiation cyclophosphamide-adriamycin-vincristine-prednisone (CHOP) and postirradiation high-dose cytosine arabinoside (HDAC) as part of an ongoing Phase II Mayo/North Central Cancer Treatment Group/Eastern Cooperative Oncology Group (M/NCCTG/ECOG) intergroup effort, which opened in April 1986. RESULTS This cohort consisted of 23 men and 23 women with median age 63.5 years (range 24 to 75 years). Only 5% were under age 40; 36% were age 40 to 59, 37% were age 60 to 69, and 22% were age 70 and over. Forty-six percent had good performance scores of ECOG 0-1 at time of study entry. Forty-six patients were evaluable for treatment outcome as of October 6, 1993. Of these, 10 were still alive. Estimated median survival and 21-month survival were 45.3 weeks and 29%, respectively. There were four early deaths ranging from Day 9 to Day 15 (three drug-related, one from other complications), and two CHOP responders died at 32 and 35 days, soon after Cycle 2 of CHOP (one probably drug-related, one from other complications). There was no significant difference in survival according to baseline performance status. However, survival was consistently worse for patients > 60 years old than for the younger patients (< or = 60 years). With deaths recorded for 21 of 21 older patients, but only 9 of the 14 younger patients, 21-month survival for older vs. younger was 14 vs. 50% based on the 35 patients who entered the study at least 21 months ago (p = 0.0365). Of the 46 patients evaluable for response, 63% had objective remissions on CHOP and another 20% remained stable. CONCLUSION Combined modality therapy in this study did not produce an overall survival advantage in treating PCNSL. The 50% 21-month survival of younger patients may be a reflection of age only.
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Affiliation(s)
- B P O'Neill
- Department of Neurology, Mayo Clinic/Foundation, Rochester, MN 55905, USA
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Buckner JC, Brown LD, Kugler JW, Cascino TL, Krook JE, Mailliard JA, Kardinal CG, Tschetter LK, O'Fallon JR, Scheithauer BW. Phase II evaluation of recombinant interferon alpha and BCNU in recurrent glioma. J Neurosurg 1995; 82:430-5. [PMID: 7861221 DOI: 10.3171/jns.1995.82.3.0430] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The goal of this study was to determine the antitumor activity and toxicity of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) plus recombinant interferon-alpha (IFN-alpha) in patients with recurrent glioma. As single agents, both BCNU and IFN-alpha can cause tumor regression in patients with recurrent glioma. In vitro studies suggest synergy between the two agents. Thirty-five patients in whom computerized tomography (CT) or magnetic resonance (MR) evidence was obtained of progressive astrocytoma, oligoastrocytoma, or oligodendroglioma received recombinant IFN-alpha 2a (12 x 10(6) U/m2 intramuscularly) on Days 1 through 3 and BCNU (150 mg/m2 intravenously) on Day 3 of each 6-week cycle. All patients had tumor progression despite radiation therapy and had received no prior chemotherapy. Response was assessed by CT or MR evidence and by neurological examination while the patients were on a regimen of stable or decreasing doses of corticosteroids. All patients could be evaluated for response and toxicity. Twenty-nine percent of the patients demonstrated objective tumor regression; 37% remained stable for more than 6 months and 25% were stable for less than 6 months. The median duration of response to IFN-alpha and BCNU was 9.9 months and the median survival for all patients was 13.3 months. Toxicity consisted primarily of moderate myelosuppression, venous irritation, vomiting, flulike symptoms, and transient reversible exacerbation of underlying neurological symptoms. The use of BCNU plus IFN-alpha is a safe, active regimen in the treatment of patients with recurrent glioma who have failed to respond to prior radiation therapy. The contribution of IFN to the antitumor activity observed in this study compared with that previously described with BCNU alone cannot be assessed from this trial.
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Affiliation(s)
- J C Buckner
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Brown LD. State initiatives in health policy. Bull N Y Acad Med 1995; 72:604-13. [PMID: 10101395 PMCID: PMC2359293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- L D Brown
- Division of Health Policy and Management, Columbia University School of Public Health, New York, NY 10032, USA
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Jackman W, Brown LD, Al-assaf AF, Reinke JM, Abubaker W, Winter L, Murphy G, Blumenfeld S. Quality assurance planning and structure. QA Brief 1995; 4:3-6. [PMID: 12295830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Hermida J, Brown LD, Winter L, Zaenger D. Methods for selection of quality problems. QA Brief 1995; 4:7-9. [PMID: 12295831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Brown LD, Dennehy ME, Rawlings DE. The F1 genes of the F1F0 ATP synthase from the acidophilic bacterium Thiobacillus ferrooxidans complement Escherichia coli F1 unc mutants. FEMS Microbiol Lett 1994; 122:19-25. [PMID: 7958772 DOI: 10.1111/j.1574-6968.1994.tb07137.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
An atp gene cluster from the extreme acidophile Thiobacillus ferrooxidans was able to complement Escherichia coli F1 unc mutants for growth on minimal medium plus succinate. Complementation with all four E. coli F1 mutants tested was observed and subunits for the F1 portion of the T. ferrooxidans ATP synthase formed a functional association with the F0 subunits of the E. coli enzyme. In addition, a hybrid F1 enzyme in which some units were derived from E. coli and some from T. ferrooxidans was partially functional. No clones capable of complementing E. coli F0 unc mutants were isolated. The nucleotide sequence of the gene cluster was determined and the genes for the F0 and the F1 ATP synthase subunits were found to be physically linked.
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Affiliation(s)
- L D Brown
- Department of Microbiology, University of Cape Town, Rondebosch, South Africa
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Denegri B, Hernandez O, Dominquez L, Roter D, Brown LD, Rosenbaum J. Quality consultations. Dialogue Diarrhoea 1994:7. [PMID: 12346323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Marino MT, Peggins JO, Brown LD, Urquhart MR, Brewer TG. Pharmacokinetics and kinetic-dynamic modeling of an 8-aminoquinoline candidate anticyanide and antimalarial drug (WR242511). Drug Metab Dispos 1994; 22:358-66. [PMID: 8070311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Malaria is a major cause of health problems in a large portion of the world. The 8-aminoquinoline compound, primaquine, is one of the only compounds useful for relapses of Plasmodium vivax and Plasmodium ovale malaria. Primaquine has several toxicities that include methemoglobinemia and hemolytic anemia. The induction of methemoglobinemia is a treatment for cyanide poisoning. We studied the pharmacokinetics and pharmacodynamics (percentage methemoglobin) for WR242511, an 8-aminoquinoline primaquine replacement and potential anticyanide compound. The drug's pharmacokinetics and pharmacodynamics are described for oral and intravenous dosing, and two kinetic-pharmacodynamic models are shown to describe the single dose data. A significant lag occurs between the onset of appearance of drug in the plasma and the onset of methemoglobinemia. Peak drug concentrations occurred within 4 hr for oral dosing, and peak effect (percentage methemoglobin) did not occur for 72-96 hrs for both the oral and intravenous routes. Elimination half-life for the drug was 30 +/- 14 hr. Two kinetic-dynamic models, one with an effect compartment relating drug concentration to effect and one with metabolite causing a first-order conversion of hemoglobin to methemoglobin, are compared as to their ability to predict multiple dose pharmacokinetics and pharmacodynamics. Both models were useful in predicting drug concentrations and methemoglobin levels for multiple-dose experiments.
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Affiliation(s)
- M T Marino
- Department of Pharmacology, Walter Reed Army Institute of Research, Washington, DC 20307-5100
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Loprinzi CL, Goldberg RM, O'Fallon JR, Quella SK, Miser AW, Mynderse LA, Brown LD, Tschetter LK, Wilwerding MB, Dose M. Transdermal clonidine for ameliorating post-orchiectomy hot flashes. J Urol 1994; 151:634-6. [PMID: 8308973 DOI: 10.1016/s0022-5347(17)35034-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To determine the efficacy of transdermal clonidine for alleviating post-orchiectomy hot flashes, a randomized, double-blind, crossover clinical trial was designed including 70 men with a history of prostate cancer who had undergone a medical or surgical orchiectomy and were suffering from hot flashes. The results of this study demonstrated that clonidine did not significantly decrease hot flash frequency or severity. Future research is necessary to find effective means of alleviating hot flashes in post-orchiectomy patients.
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Affiliation(s)
- C L Loprinzi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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Affiliation(s)
- L D Brown
- Division of Health Policy and Management, Columbia University School of Public Health, New York City
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Brown LD, Marmor TR. The Clinton reform plan's administrative structure: the reach and the grasp. J Health Polit Policy Law 1994; 19:193-199. [PMID: 8014409 DOI: 10.1215/03616878-19-1-193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Dinapoli RP, Brown LD, Arusell RM, Earle JD, O'Fallon JR, Buckner JC, Scheithauer BW, Krook JE, Tschetter LK, Maier JA. Phase III comparative evaluation of PCNU and carmustine combined with radiation therapy for high-grade glioma. J Clin Oncol 1993; 11:1316-21. [PMID: 8315428 DOI: 10.1200/jco.1993.11.7.1316] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE We performed a randomized trial to compare survival distributions and toxicity of radiation therapy (RT) and PCNU with those of RT and carmustine (BCNU) in patients with malignant glioma. PATIENTS AND METHODS A total of 346 patients with histologically verified supratentorial grade 3 and grade 4 astrocytoma were studied. After surgery, patients were randomly assigned to receive RT 60 Gy in 30 fractions and either PCNU 100 mg/m2 or BCNU 200 mg/m2 every 7 weeks for 1 year and every 10 weeks for the second year. RT and chemotherapy were started within 72 hours of randomization and usually on the same day. Of 334 assessable patients, 72% had partial or radical resection and 71% had grade 4 tumors. Median age was 59 years, and 85% had performance scores of 0 to 2 (Eastern Cooperative Oncology Group [ECOG]). The follow-up duration of 51 living patients ranged from 10.3 to 63.2 months, with a median of 36.2 months. RESULTS The median survival duration in each group was 47 weeks, and median time to progression was 28 weeks. PCNU produced significantly more leukopenia and thrombocytopenia, whereas BCNU produced significantly more nausea, vomiting, and irritation. CONCLUSION PCNU has no therapeutic advantage at this dose and schedule and does not warrant further study as a single agent for patients with high-grade glioma.
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Affiliation(s)
- R P Dinapoli
- North Central Cancer Treatment Group, Rochester, MN
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