The Fetal Allograft Revisited: Does the Study of an Ancient Invertebrate Species Shed Light on the Role of Natural Killer Cells at the Maternal-Fetal Interface?

Human pregnancy poses a fundamental immunological problem because the placenta and fetus are genetically different from the host mother. Classical transplantation theory has not provided a plausible solution to this problem. Study of naturally occurring allogeneic chimeras in the colonial marine invertebrate, Botryllus schlosseri, has yielded fresh insight into the primitive development of allorecognition, especially regarding the role of natural killer (NK) cells. Uterine NK cells have a unique phenotype that appears to parallel aspects of the NK-like cells in the allorecognition system of B. schlosseri. Most notably, both cell types recognize and reject "missing self" and both are involved in the generation of a common vascular system between two individuals. Chimeric combination in B. schlosseri results in vascular fusion between two individual colonies; uterine NK cells appear essential to the establishment of adequate maternal-fetal circulation. Since human uterine NK cells appear to de-emphasize primary immunological function, it is proposed that they may share the same evolutionary roots as the B. schlosseri allorecognition system rather than a primary origin in immunity

Linguistics

Contains research objectives and reports on three research projects.National Science Foundation (Grant GP-2495)National Institutes of Health (Grant MH-04737-04)National Aeronautics and Space Administration (Grant NsG-496)U. S. Air Force (Electronic Systems Division) under Contract AF19(628)-248

Linguistics

Contains reports on six research projects.National Institutes of Health (Grant MH-04737-03)National Science Foundation (Grant G-16526)National Aeronautics and Space Administration (Grant NsG-496)United States Air Force, Electronic Systems Division (Contract AF19(628)-2487

Risk factors for 90-day readmission and return to the operating room following abdominal operations for Crohn's disease.

This study aimed to determine timing and risk factors for 30- and 90-day unplanned hospital readmissions and return to the operating room. Retrospective case series, including consecutive adult patients with Crohn's disease, undergoing a major abdominal surgical procedure during a 3.5-year inclusion period was performed. The primary outcomes were 0- to 30-day and 30- to 90-day readmission and return to the operating room rates. Univariate and multivariable risk factors for both outcomes at 30 and 90 days were assessed through Cox regression analysis. Of 680 included patients with Crohn's disease, 89 (13.1%) were readmitted within 30 days, 55 (8.1%) within 30-90 days, and 11 (1.6%) in both follow-up periods for a combined 90-day readmission rate of 24.4% (n = 166). Multivariable risk factors for 30-day readmissions were type of procedure performed, corticosteroid use (hazard ratio [HR] 1.71, P = .01), younger age (HR 0.98 per year, P = .01), and prolonged disease duration (HR 1.03 per year, P = .03). No significant risk factors identified for 30- to 90-day readmissions. By 90 days, 76 patients (11.2%) had a return to the operating room (of which 8.8% was within 30 days). Risk factors for 30-day return to the operating room included tobacco use (HR 1.86, P = .04), diabetes (HR 3.30, P = .01), corticosteroid use (HR 3.51, P <.001), and preoperative immunomodulator therapy (HR 2.70, P < .001). Type of surgery, corticosteroid use, younger age, and prolonged disease duration were associated with 30-day hospital readmission, and tobacco use, diabetes, corticosteroid use, and preoperative immunomodulator therapy were risk factors for 30-day return to the operating room. Postoperative biologic therapy did not increase hospital readmission or return to operating room rates within 90 days of surgery

Safer Systems, Safer Care: Bringing the Tools and Strategies to Clinical Service Areas Through Applied Patient Safety Programs

AbstractAlong with creating and supporting a trained network of Patient Safety Managers across the U.S. Veterans Health Administration, the National Center for Patient Safety brings an increased, shared awareness of patient safety goals and strategies to disciplines of healthcare, beginning with the biomedical engineers at VHA facilities. This presentation outlines a ‘roadmap’ for the journey to high reliability healthcare and shares the training approach and results to date. This roadmap is modelled after that used at NASA and contains four development phases beginning with an awareness of human limitations and ending with proactive analysis to anticipate causes of safety episodes. The goal of the roadmap is to systematically ensure the care given to patients is done as safely as possible by incorporating best practices from mature industries

Safeguards and Security Integration With Safety Analysis

The objective of this paper is to share the Savannah River Site lessons learned on Safeguards and Security (S&S) program integration with K-Area Complex (KAC) safety basis. The KAC Documented Safety Analysis (DSA), is managed by the Washington Savannah River Company (WSRC), and the S&S program, managed by Wackenhut Services, Incorporated--Savannah River Site (WSI-SRS). WSRC and WSI-SRS developed a contractual arrangement to recognize WSI-SRS requirements in the KAC safety analysis. Design Basis Threat 2003 (DBT03) security upgrades required physical modifications and operational changes which included the availability of weapons which could potentially impact the facility safety analysis. The KAC DSA did not previously require explicit linkage to the S&S program to satisfy the safety analysis. WSI-SRS have contractual requirements with the Department of Energy (DOE) which are separate from WSRC contract requirements. The lessons learned will include a discussion on planning, analysis, approval of the controls and implementation issues

Economic Assessment of 4 Approaches to the Diagnosis and Initial Treatment of Sleep Apnea

BACKGROUND: A dilemma faced by health-care administrators is that need greatly outstrips capacity for diagnosing and treating sleep apnea, with such decisions carrying significant economic consequences. Our objective was to develop an economic model to estimate the relative costs of 4 approaches for diagnosis and initial treatment of sleep apnea. METHODS: The analysis consisted of developing a mathematical model depicting possible diagnostic and treatment approaches to the care of patients with sleep apnea; developing 4 clinical scenarios to describe distinct approaches to the management of sleep apnea patients (in-laboratory, unattended, direct-to-autotitrating PAP [auto-PAP], and mixed); and identifying costs associated with each scenario. We created a hypothetical cohort of 1,000 patients with 85% prevalence of sleep apnea to generate cost estimates. RESULTS: The driver of per-patient costs was the total number of sleep studies, which varied widely across scenarios: from 425 for the direct-to-auto-PAP approach to 1,441 in the unattended approach. The scenarios also differed in per-patient costs: Per-patient costs excluding facility startup costs were $456 for direct-to-auto-PAP,$913 for in-laboratory, $991 for mixed, and$1,090 for unattended. CONCLUSIONS: Approaches to diagnosing and treating sleep apnea that emphasized early application of auto-PAP had lower per-patient costs