Pathogenic, Molecular, and Immunological Properties of a Virus Associated with Sea Turtle Fibropapillomatosis. Phase II : Viral Pathogenesis and Development of Diagnostic Assays

Research conducted under this RWO from July 1, 1997 through June 30, 2000 has provided important new information about the pathogenesis, virology, and immunology of marine turtle fibropapillomatosis. In particular, we have provided strong evidence for the association of a herpesvirus with fibropapillomatosis of the green turtle,Chelonia mydas, and the loggerhead turtle, Caretta caretta, in Florida. In addition we have provided new evidence for the absence of papillomaviruses from sea turtle fibropapillomas. Although unsuccessful, important new attempts were made to cultivate the FP-associated herpesvirus in vitro in collaboration with the National Wildlife Health Center. During this period of time, we completed publication of the first comprehensive description of the comparative pathology and pathogenesis of experimentally induced and spontaneous fibropapillomas of green turtles (Chelonia mydas). We initiated innovative studies on the persistence of a Chelonian herpesviruses in the marine environment demonstrating for the first time that the environmental survivability of Chelonian herpesviruses makes them real threats to marine turtle health. Finally, we explored development of a serological assay for FP using synthetic herpesvirus peptides and developed methodologies for detection of antibodies to LETV [Iung-eye-trachea virus] a disease-associated herpesvirus of the green turtle, Chelonia mydas.. This last initiative is ongoing and will further our efforts to develop specific immunological assays for the FP-associated herpesvirus and FP. (17 page document

Association between frequency of telephonic contact and clinical testing for a large, geographically diverse diabetes disease management population

Diabetes disease management (DM) programs strive to promote healthy behaviors, including obtaining hemoglobin A1c (A1c) and low-density lipoprotein (LDL) tests as part of standards of care. The purpose of this study was to examine the relationship between frequency of telephonic contact and A1c and LDL testing rates. A total of 245,668 members continuously enrolled in diabetes DM programs were evaluated for performance of an A1c or LDL test during their first 12 months in the programs. The association between the number of calls a member received and clinical testing rates was examined. Members who received four calls demonstrated a 24.1% and 21.5% relative increase in A1c and LDL testing rates, respectively, compared to members who received DM mailings alone. Response to the telephonic intervention as part of the diabetes DM programs was influenced by member characteristics including gender, age, and disease burden. For example, females who received four calls achieved a 27.7% and 23.6% increase in A1c and LDL testing, respectively, compared to females who received mailings alone; by comparison, males who were called achieved 21.2% and 19.9% relative increase in A1c and LDL testing, respectively, compared to those who received mailings alone. This study demonstrates a positive association between frequency of telephonic contact and increased performance of an A1c or LDL test in a large, diverse diabetes population participating in DM programs. The impact of member characteristics on the responsiveness to these programs provides DM program designers with knowledge for developing strategies to promote healthy behaviors and improve diabetes outcomes

A focused telephonic nursing intervention delivers improved adherence to A1c testing

Compliance with hemoglobin A1c (A1c) testing is suboptimal despite the clear national recommendations and guidelines established for care of patients with diabetes. Recent studies have demonstrated a relationship between participation in a diabetes disease management (DM) program and improved adherence to A1c testing. A focused intervention study was initiated to investigate the ability of a DM program to drive improvement in A1c testing. A cohort of 36,327 members experienced a statistically significant increase (29%) in A1c testing while participating in the 6-month focused intervention. This finding demonstrated that a focused DM intervention is able to deliver improvement in a clinical process metric critical for managing patients with diabetes, thereby reducing their risk of disease exacerbation