The physician's perception of medical error and its application to the development of an educational training tool.

It is becoming clear that if we are to impact the rate of medical errors it will have to be done at the practicing physician level. The purpose of this project was to survey the attitude of physicians in Alabama concerning their perception of medical error, and to obtain their thoughts and desires for medical education in the area of medical errors. The information will be used in the development of a physician education program.

Studies of the structure and function of a fibrinogen binding MSCRAMM(RTM) from Staphylococcus epidermidis

Coagulase-negative staphylococci (CNS) are recognized as important pathogens and are particularly associated with foreign body infections. S. epidermidis accounts for approximately 75% of the infections caused by CNS. Three genes, sdrF, sdrG, and sdrH, were identified by screening a S. epidermidis genomic library with a probe encompassing the serine-aspartate dipeptide repeat-encoding region (region R) of clfA from S. aureus. SdrG has significant amino acid identity to ClfA, ClfB and other surface proteins of S. aureus. SdrG is also similar to a protein (Fbe) recently described by Nilsson, et al. (Infection and Immunity, 1998, 66:2666–73) from S. epidermidis. The N-terminal domain (A region) of SdrG was expressed as a his-tag fusion protein in E. coli. In an ELISA, this protein, rSdrG(50-597) was shown to bind specifically to fibrinogen (Fg). Western ligand blot analysis showed that SdrG binds the Bβ chain of Fg. To further characterize the rSdrG(50-597)-Fg interaction, truncates of the Fg Bβ chain were made and expressed as recombinant proteins in E. coli. SdrG was shown to bind the full-length Bβ chain (1462), as well as the N-terminal three-quarters (1-341), the N-terminal one-half (1-220) and the N-terminal one-quarter (1-95) Bβ chain constructs. rSdrG(50-597) failed to bind to the recombinant truncates that lacked the N-terminal 25 amino acid residues of this polypeptide suggesting that SdrG recognizes a site within this region of the Bβ chain. Inhibition ELISAs have shown that peptide mimetics, including β1–25, and β6–20, encompassing this 25 residue region can inhibit binding of rSdrG(50-597) to Fg coated wells. Using fluorescence polarization we were able to determine an equilibrium constant (KD) for the interaction of rSdrG(50-597) with the Fg Bβ chain peptide β1–25. The labeled peptide was shown to bind to rSdrG(50-597) with a KD of 0.14 ± 0.01μM. Because rSdrG(50-597) recognizes a site in the Fg Bβ chain close to the thrombin cleavage site, we investigated the possibility of the rSdrG(50-597) site either overlapping or lying close to this cleavage site. An ELISA showed that rSdrG(50-597) binding to thrombin-treated Fg was significantly reduced. In a clot inhibition assay rSdrG(50-597) was able to inhibit fibrin clot formation in a concentration dependent manner. Furthermore, rSdrG(50-597) was able to inhibit clot formation by preventing the release of fibrinopeptide B as determined by HPLC. To further define the interaction between rSdrG(50-597) and peptide β6–20, we utilized an alanine amino acid replacement strategy. The residues in β6–20 that appear to be important in rSdrG(50-597) binding to Fg, were confirmed by the rSdrG(273-597)-β6–20 co-crystal structure that was recently solved by our collaborators at University of Alabama-Birmingham. Additionally, rSdrG(50-597) was not able to bind to Fg from different animal species, rather it bound specifically to human Fg in an ELISA. This suggests that the sequence variation between Fg Bβ chains of different species, specifically with in the N-terminal 25 residues, affects the ability of rSdrG(50-597) binding to Fg, and this may explain why S. epidermidis is primarily a human pathogen. ^

Statins and myasthenia gravis

Introduction. 3-hydroxy-3-methylglutaryl CoA reductase inhibitor ("statin") have been widely used for hypercholesteroremia and Statin induced myopathy is well known. Whether Statins contribute to exacerbation of Myasthenia Gravis (MG) requiring hospitalization is not well known. ^ Objectives. To determine the frequency of statin use in patients with MG seen at the neuromuscular division at University of Alabama in Birmingham (UAB) and to evaluate any association between use of statins and MG exacerbations requiring hospitalization in patients with an established diagnosis of Myasthenia Gravis. ^ Methods. We reviewed records of all current MG patients at the UAB neuromuscular department to obtain details on use of statins and any hospitalizations due to exacerbation of MG over the period from January 1, 2003 to December 31, 2006. ^ Results. Of the 113 MG patients on whom information was available for this period, 40 were on statins during at least one clinic visit. Statin users were more likely to be older (mean age 60.2 vs 53.8, p = 0.029), male (70.0% vs 43.8%, p = 0.008), and had a later onset of myasthenia gravis (mean age in years at onset 49.8 versus 42.9, p = 0.051). The total number of hospitalizations or the proportion of subjects who had at least one hospitalization during the study period did not differ in the statin versus no-statin group. However, when hospitalizations which occurred from a suspected precipitant were excluded ("event"), the proportion of subjects who had at least one such event during the study period was higher in the group using statins. In the final Cox proportional hazard model for cumulative time to event, statin use (OR = 6.44, p <0.01) and baseline immunosuppression (OR = 3.03, p = 0.07) were found to increase the odds of event. ^ Conclusions. Statin use may increase the rate of hospitalizations due to MG exacerbation, when excluding exacerbations precipitated by other suspected factors.^

The association of peer victimization and/or bullying perpetration and body dissatisfaction in elementary students from the healthy passages baseline study

This is the first U.S. study to investigate the association between peer victimization and/or bullying perpetration and body image dissatisfaction in American elementary school students. The study used data collected from the Healthy Passages baseline cohort of 5152 ethnically diverse fifth grade students from Alabama, Texas, and California. The overall prevalence of body dissatisfaction in our fifth grade sample was 50%. Students who were dissatisfied with their bodies were 23% more likely to be involved in peer victimization than students who were satisfied with their bodies (OR = 1.23; 95% CI = 1.02, 1.48). No significant associations were found between bullying status or bully-victim status and body dissatisfaction. Other factors that contributed significantly to a student's body image status were BMI, level of self-worth, level of household income, gender, pubertal timing and support received from adults (other than parents). It is noteworthy that those who were dissatisfied were heavier, came from lower income homes and were more likely to be male. Additional longitudinal studies are needed to confirm these associations, especially among large ethnically and socio-economically diverse samples. ^

Birth prevalence of isolated congenital limb reduction defects in Texas 1999--2001

Objective. Congenital limb defects are common birth defects occurring in approximately 2-7/10,000 live births. Because congenital limb defects are pervasive throughout all populations, and the conditions profoundly affect quality of life, they represent a significant public health concern. Currently there is a paucity of etiologic information in the literature regarding congenital limb reduction defects which represents a major limitation in developing treatment strategies as well as identifying high risk pregnancies. ^ Additionally, despite the fact that the majority of congenital limb reduction defects are isolated, most previous studies have not separated them from those occurring as part of a known syndrome or with multiple additional congenital anomalies of unknown etiology. It stands to reason that factors responsible for multiple congenital anomalies that happen to include congenital limb reduction defects may be quite different from those factors leading to an isolated congenital limb reduction defect. ^ As a first step toward gaining etiologic understanding, this cross-sectional study was undertaken to determine the birth prevalence and obtain demographic information about non-syndromic (isolated) congenital limb reduction defects that occurred in Texas from 1999-2001. ^ Methods. The study population included all infants/fetuses with isolated congenital limb reduction defects born in Texas during 1999-2001; the comparison population was all infants who were born to mothers who were residents of Texas during the same period of time. The overall birth prevalence of limb reduction defects was determined and adjusted for ethnicity, gender, site of defect (upper limb versus lower limb), county of residence, maternal age and maternal education. ^ Results. In Texas, the overall birth prevalence of isolated CLRDs was 2.1/10,000 live births (1.5 and 0.6/10,000 live births for upper limb and lower limb, respectively). ^ The risk of isolated lower limb CLRDs in Texas was significantly lower in females when gender was examined individually (crude prevalence odds ratio of 0.57, 95% CI of 0.36-0.91) as well as in relation to all other variables used in the analysis (adjusted prevalence odds ratio of 0.58, 95% CI of 0.36-0.93). ^ Harris County (which includes the Houston metropolitan area) had significantly lower risks of all (upper limb and lower limb combined) isolated CLRDs when examined in relation to other counties in Texas, with a crude prevalence odds ratio of 0.4 (95% CI: 0.29-0.72) and an adjusted prevalence odds ratio of 0.50 (95% CI: 0.31-0.80). The risk of isolated upper limb CLRDs was significantly lower in Harris County (crude prevalence odds ratio of 0.45, CI of 0.26-0.76 and adjusted prevalence odds ratio of 0.49, CI of 0.28-0.84). This trend toward decreased risk in Harris County was not observed for isolated lower limb reduction defects (adjusted prevalence odds ratio of 0.50, 95% confidence interval: 0.22-1.12). ^ Conclusions. The birth prevalence of isolated congenital limb reduction defects in Texas is in the lower limits of the range of rates that have been reported by other authors for other states (Alabama, Arkansas, California, Georgia, Hawaii, Iowa, Maryland, Massachusetts, North Carolina, Oklahoma, Utah, Washington) and other countries (Argentina, Australia, Austria, Bolivia, Brazil, Canada, Chile, China, Colombia, Costa Rica, Croatia, Denmark, Ecuador, England, Finland, France, Germany, Hungary, Ireland, Israel, Italy, Lithuania, Mexico, Norway, Paraguay, Peru, Spain, Scotland, Sweden, Switzerland, Uruguay, and Venezuela). In Texas, the birth prevalence of isolated congenital lower limb reduction defects was greater for males than females, while the birth prevalence of isolated congenital upper limb reduction defects was not significantly different between males and females. The reduced rates of limb reduction defects in Harris County warrant further investigation. This study has provided an important first step toward gaining etiologic understanding in the study of isolated congenital limb reduction defects. ^

Two Obstetrical Heresies

Dr. Silas F. Starley deplores what he considered errors generally taught and accepted in the late 19th century in Two Obstetrical Heresies . “The first is the part that membranes containing the amniotic fluid and the foetus play in effecting dilation of the os uteri in the first stage of labor.The second is the supposed necessity for waiting for their rupture and the escape of the waters before applying the forceps, in every case, without exception.” Silas F. Starley (1823-1887) was born in Alabama and moved to Texas with his family in 1837. He graduated from the University of Louisville School of Medicine in 1854 and spent his professional career in Texas, ending his career in Corsicana. He was President of the State Medical Association of Texas (Texas Medical Association) in 1883 and wrote articles in Texas medical journals on various topics including obstetrics, vascular tumor, and pneumonia. Texas State Historical Association, http://www.tshaonline.org/handbook/online/articles/sat05 , accessed 10/16/2012. Texas Physicians Historical Biographical Database, http://www4.utsouthwestern.edu/library/doctors/doctors.cfm?DoctorID=16809 , accessed 10/16/12.

Discarge compilation from The Global River Discharge (RivDIS) Project

The Global River Discharge (RivDIS) data set contains monthly discharge measurements for 1018 stations located throughout the world. The period of record varies widely from station to station, with a mean of 21.5 years. These data were digitized from published UNESCO archives by Charles Voromarty, Balaze Fekete, and B.A. Tucker of the Complex Systems Research Center (CSRC) at the University of New Hampshire. River discharge is typically measured through the use of a rating curve that relates local water level height to discharge. This rating curve is used to estimate discharge from the observed water level. The rating curves are periodically rechecked and recalibrated through on-site measurement of discharge and river stage.

Technology of bare tether current collection

The outstanding problem for useful applications of electrodynamic tethers is obtaining sufficient electron current from the ionospheric plasma. Bare tether collectors, in which the conducting tether itself, left uninsulated over kilometers of its length, acts as the collecting anode, promise to attain currents of 10 A or more from reasonably sized systems. Current collection by a bare tether is also relatively insensitive to drops in electron density, which are regularly encountered on each revolution of an orbit. This makes nighttime operation feasible. We show how the bare tether's high efficiency of current collection and ability to adjust to density variations follow from the orbital motion limited collection law of thin cylinders. We consider both upwardly deployed (power generation mode) and downwardly deployed (reboost mode) tethers, and present results that indicate how bare tether systems would perform as their magnetic and plasma environment varies in low earth orbit.

Estudio de la diversidad genética de Botrytis sp en orquídeas y la resistencia al ataque del hongo

En la actualidad la mayoría de plantas sufren pérdidas debido a las enfermedades que les provocan los hongos. Uno de estos grupos amenazado por el ataque de los hongos son las especies de la familia Orchidaceae, especies que se encuentran amenazadas y con numerosas especies en peligro de extinción. Uno de los problemas sanitarios más destacados es Botrytis cinerea, hongo patógeno cosmopolita, causante de enfermedades importantes en muchas plantas tales como frutas, verduras, accesiones de viveros, plantas ornamentales y huertos cultivos (Jarvis 1977; Elad et al., 2007). Este género es uno de los grupos de hongos más ampliamente conocido y distribuido. Contiene 22 especies (Hennebert 1973; Yohalem et al., 2003) y un híbrido (B. allii) (Yohalem & Alabama, 2003) vinculado a las etapas sexuales y un amplio número de huéspedes específicos (Beever y Weds, 2000); infecta más de 200 especies vegetales distintas (Williamson et al., 2007). Dada la importancia de este patógeno se realiza un estudio de caracterización morfológica y molecular del hongo, aislado de plantas de orquídeas cultivadas en condiciones de invernadero, de hortalizas y plantas frutales, con síntomas de necrosis, atizonamientos y pudriciones. El análisis de las características morfológicas (presencia de esclerocios, tamaño de conidios, presencia de estructuras sexuales in vitro) y fenotípicas (crecimiento micelial a diferentes temperaturas, germinación de esporas), nos permitió determinar características importantes del comportamiento del hongo y establecer cuáles son las mejores condiciones para su patogenicidad. Se afianzo este trabajo con estudios moleculares a través del análisis de la región ribosomal ITS1-ITS4. Entre los aislados estudiados se identificaron dos especies diferentes, Botrytis cinerea y B. fabiopsis, esta última conocida como especifica de Vicia faba, se lo aisló de una planta de Pelargonium sp. Se hizo un análisis filogenético para comparar estas dos especies, encontrándose que B. fabiopsis está estrechamente relacionada con B. cinerea y B. elliptica, pero lejanamente relacionado con B. fabae. Además, se analizó las poblaciones de los aislados de Botrytis, para ello se seleccionaron tres parejas de cebadores microsatelites con altos porcentajes de polimorfismo. Al analizar la similaridad entre los aislados se determinaron tres grupos de poblaciones de B. cinerea entre los cuales Botrytis fabiopsis comparte un grupo grande con B. cinerea. La diferenciación genética no fue significativa entre la población de aislados de orquídeas y hortalizas, la diferencia génica que fue muy baja, lo que sugiere que la especificidad de Botrytis no está dada por los hospederos, aunque la posibilidad de la especificidad con algún cultivo no puede descartarse. ABSTRACT Most plants suffer diseases caused by fungi. Orchidaceae is one of the threatened groups with many endangered species. Included into the most important problems in plant health is Botrytis cinerea, a cosmopolitan pathogen which causes major diseases in many plants of agronomic interest such as fruits, vegetables, planthouses accessions and ornamental plants (Jarvis, 1977; Elad et al, 2007). The genus Botrytis is one of the most widely and disseminated fungi. The genus contains 22 species (Hennebert 1973; Yohalem et al, 2003) and a hybrid (B. allii) (Yohalem & Alabama, 2003) linked to the sexual stages of a large number of specific hosts (Beever & Weds, 2000); infects over 200 different plant species (Williamson et al., 2007). Due to the importance of this pathogen, a study of morphological and molecular characterization of the fungus was carried out. Fungi samples were isolated from orchid plants grown in greenhouse conditions, vegetables and fruits with signs of necrosis, blight and rottening. To establish the best conditions for pathogenicity, behavioral characteristics of the fungus were studied through the analysis of morphological characteristics (presence of sclerotia, conidia size, sexual structures in vitro) and mycelial growth at different temperatures. To complete the characterization of the fungi, a molecular study was performed via the analysis of ribosomal ITS1-ITS4 region. Two different species were identified: Botrytis cinerea and Botrytis fabiopsis (known by specificity to Vicia faba). B. fabiopsis was isolated from a plant of the genus Pelargonium. A phylogenetic analysis was carried out to compare these two species leading to the conclusion that B. fabiopsis is closely related to B. cinerea and B. elliptica, but distantly related to B. fabae. The populations of Botrytis isolates were also analyzed. Three pairs of microsatellite primers with high percentages of polymorphism were selected. A similarity analysis showed three groups of populations of B. cinerea, including Botrytis fabiopsis. The genetic differentiation was not significant among the populations of isolates from orchids and vegetables; genetic differences were very low, suggesting that the specificity of Botrytis species is not given by the hosts.