Serum cholesterol levels in a multiracial sample of 7,439 preschool children from Arizona.

BACKGROUND. The distribution and correlates of serum levels of total cholesterol were studied in cross-sectional analyses of 7,439 1 to 4 year olds examined through the Arizona Department of Health Services. RESULTS. Mean cholesterol levels increased with age, and levels among 2 year olds approached those seen in adolescents. Racial and ethnic differences in cholesterol levels were observed: mean (age-adjusted) levels were 147 mg/dl among American Indians (n = 622), 153 mg/dl among Hispanics (n = 3165), 154 mg/dl among non-Hispanic whites (n = 3448), and 163 mg/dl among blacks (n = 204). Cholesterol levels were not associated either with obesity, as assessed by relative weight or the Quetelet index, or with breast-feeding during infancy. Very overweight (greater than or equal to 20 kg/m2) 3 and 4 year olds, however, tended to have higher mean levels of cholesterol than did other children. The proportion of children with borderline (170 to 199 mg/dl) or high (greater than or equal to 200 mg/dl) levels of cholesterol varied by race/ethnicity: borderline (high) levels were seen among 14% (3%) of American Indians and 29% (11%) of blacks. The proportions of white and Hispanic children having cholesterol levels between 170 and 199 mg/dl or greater than or equal to 200 mg/dl were midway between those seen among American Indians and blacks. CONCLUSION. Additional information on the interrelationships of lipids and lipoproteins may aid in the identification of children who will be at increased risk for cardiovascular disease in adulthood.     

Temporomandibular joint: morphology and signal intensity characteristics of the disk at MR imaging

Magnetic resonance (MR) imaging has been used in the temporomandibular joint (TMJ) primarily to define the disk position. This report examines altered morphology and signal intensity characteristics of the TMJ disk as they relate to the severity of internal derangement. Two hundred sixteen joints in 133 patients with a history of such derangement. were imaged with MR. Disk position, signal intensity, morphology, and the presence of osteoarthritis were determined for each joint. The normal disk was not anteriorly displaced and had a normal "bow-tie" shape. A grade 1 disk was anteriorly displaced and had a normal shape; a grade 2 disk was anteriorly displaced and had an abnormal shape. Forty (19%) joints were considered normal; none of these exhibited osteoarthritis. One hundred thirty-nine (64%) joints were grade 1; osteoarthritis was found in 17%. Thirty-seven (17%) were grade 2; osteoarthritis was found in 95%. All forty normal joints had high or intermediate signal intensity in the disk. Osteoarthritic joints had a higher percentage of disks with diminished intensity (P less than .0001). Severe or untreated osteoarthritis is known to be a complication of TMJ internal derangements; hence this grading system seems to correlate with the severity of internal derangement.     

The costs and effects of a nutritional education program following work-site cholesterol screening.

OBJECTIVES. The purpose of this study was to assess the costs and impact of a nutrition education program following a cholesterol screening. METHODS. Forty work-sites were randomly assigned to one of two educational interventions: a "usual" intervention of 5 minutes of counseling, or a "special" intervention of 2 hours of behaviorally based education on dietary changes to lower serum cholesterol. Costs were monitored, and cholesterol levels were retested 6 and 12 months later. RESULTS. The total per-person cost for screening and the educational intervention was about $50. Cholesterol levels differed little between the two intervention groups 6 months after screening, but after 12 months those in the special intervention worksites showed a 6.5% drop in cholesterol, whereas those at the usual intervention worksites showed a drop of only 3.0%. Hence a 3.5% cholesterol reduction was attributable to the special intervention. CONCLUSIONS. A behaviorally based nutrition education program following cholesterol screening can have a meaningful impact on long-term cholesterol levels at a low cost. Nutrition education in work-sites may therefore be a useful way to lower the risk of heart disease in communities.     

Mobilization of early hematopoietic progenitor cells with BB-10010: a genetically engineered variant of human macrophage inflammatory protein- 1 alpha

BB-10010 is a genetically engineered variant of human macrophage inflammatory protein-1 alpha with improved solution properties. We show here that it mobilizes stem cells into the peripheral blood. We investigated the mobilizing effects of BB-10010 on the numbers of circulating 8-day spleen colony-forming units (CFU-S8), CFU-S12, and progenitors with marrow repopulating ability (MRA). A single subcutaneous dose of BB-10010 caused a twofold increase in circulating numbers of CFU-S8, CFU-S12, and MRA 30 minutes after dosing. We also investigated the effects of granulocyte colony-stimulating factor (G- CSF) and the combination of G-CSF with BB-10010 on progenitor mobilization. Two days of G-CSF treatment increased circulating CFU-S8, CFU-S12, and MRA progenitors by 25.7-, 19.8-, and 27.7-fold. A single administration of BB-10010 after 2 days of G-CSF treatment increased circulating CFU-S8, CFU-S12, and MRA even further to 38-, 33-, and 100- fold. Splenectomy resulted in increased circulating progenitor numbers but did not change the pattern of mobilization. Two days of treatment with G-CSF then increased circulating CFU-S8, CFU-S12, and MRA by 64-, 69-, and 32-fold. A single BB-10010 administration after G-CSF treatment further increased them to 85-, 117-, and 140-fold, respectively, compared with control. We conclude that BB-10010 causes a rapid increase in the number of circulating hematopoietic progenitors and further enhances the numbers induced by pretreatment with G-CSF. BB- 10010 preferentially mobilized the more primitive progenitors with marrow repopulating activity, releasing four times the number achieved with G-CSF alone. Translated into a clinical setting, this improvement in progenitor cell mobilization may enhance the efficiency of harvest and the quality of grafts for peripheral blood stem cell transplantation.     

Impact of a Regional Pharmacy Call Center on Telephone Access Metrics Within the Veterans Health Administration

Purpose:

To establish a cost-effective centralized pharmacy call center to serve the patients of Veterans Integrated Service Network (VISN) 11 that would meet established performance metrics.

Methods:

A pilot project began in August 2011 with the Indianapolis VA Medical Center (VAMC) and the Health Resource Center (HRC) in Topeka, Kansas. The Indianapolis VAMC used a first-call resolution business model consisting of pharmacy technicians receiving tier 1 phone calls that could be escalated to a tier 2 line that consisted of lead technicians and pharmacists, while the HRC utilized general telephone agents that would transfer unresolved calls to the primary facility. Pre- and post-VISN 11 Pharmacy Call Center performance metrics were compared for each of the 7 facilities in the network with the goals being monthly average abandoned call rate less than 5% and average speed to answer less than 30 seconds. Cost per call was also compared.

Results:

The average abandoned call rate for the network during the year prior to VISN 11 Pharmacy Call Center implementation (August 2010-July 2011) was 15.66% and decreased to 3% in July 2014. The average abandoned call rate decreased for each individual facility. In fiscal year 2014, the VISN 11 Pharmacy Call Center was operating at a cost of $4.35 per call while providing more services than the HRC, resulting in less workload being transferred back to the individual facilities.

Conclusion:

A centralized VISN pharmacy call center is a reasonable alternative to individual facility call centers or the HRC.     

K-ras mutation detection in colorectal cancer using the Pyrosequencing technique

The identification of gene mutations is a critical goal for the assessment of diagnosis and prognosis in cancer disease, particularly by direct sequencing. Pyrosequencing is a straightforward, non-electrophoretic DNA sequencing method using the luciferase-luciferin light release as a signal for nucleotide incorporation into a PCR template DNA. In this study, we aimed to investigate mutations in the K-ras gene using Pyrosequencing technology, because its reliable chemistry and robust detection mechanism allow for rapid, real-time detection of sequencing events. For the simultaneous detection of the predominant K-ras codons 12 and 13 mutations, we established a sequencing protocol based on the design of a single PCR primer pair and a single sequencing primer. The assay has been validated with DNA from 65 colorectal carcinomas. Furthermore, analysis of the rare K-ras codon 61 mutation was included. In 29% (19/65) of the patients, the K-ras gene was found to be mutated, whereas codons 12 and 13 were most frequently affected (18/65, 27.7%). Mutations with the highest frequency were G-->A transitions (12/19, 63%), followed by G-->T transversions (5/19, 26%). Overall survival was significantly shorter in patients with a tumor containing K-ras codon 12 mutations than in those without K-ras codon 12 mutations (p=0.024). In conclusion, we found Pyrosequencing to be a suitable technology for fast detection of hot-spot mutations in the K-ras oncogene. We demonstrated an important relationship between K-ras codon 12 mutations and overall survival in colorectal cancer patients.