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COVID-19 outbreak was declared a pandemic by the World Health Organization on March 11, 2020. To minimize casualties and the impact on the economy, various mitigation measures have being employed with the purpose to slow the spread of the infection, such as complete lockdown, social distancing, and random testing. The key contribution of this article is twofold. First, we present a novel extended spatially informed epidemic model, SIRTEM, Spatially Informed Rapid Testing for Epidemic Modeling and Response to COVID-19 , that integrates a multi-modal testing strategy considering test accuracies. Our second contribution is an optimization model to provide a cost-effective testing strategy when multiple test types are available. The developed optimization model incorporates realistic spatially based constraints, such as testing capacity and hospital bed limitation as well.

There is a remarkable phenomenon occurring among health professionals: the development of ongoing, routine collaboration, both in educating the next generation of providers and in delivering care. These new approaches, commonly referred to as interprofessional education and interprofessional collaborative practice, have been introduced into academic health settings and delivery systems throughout the U.S. and the rest of the world; however, the full integration of dentistry in health care teams remains unrealized. In academic settings, dentistry has found ways to collaborate with the other health professions, but most practicing dentists still find themselves on the margins of new models of care delivery. This article provides a perspective on the history and context of the evolution of collaborative approaches to health care and proposes ways in which dentistry can participate more fully in the future.

Drugs do not act solely by canonical ligand-receptor binding interactions. Amphiphilic drugs partition into membranes, thereby perturbing bulk lipid bilayer properties and possibly altering the function of membrane proteins. Distinguishing membrane perturbation from more direct protein-ligand interactions is an ongoing challenge in chemical biology. Herein, we present one strategy for doing so, using dimeric 6-bromo-2-mercaptotryptamine (BrMT) and synthetic analogues. BrMT is a chemically unstable marine snail toxin that has unique effects on voltage-gated K+ channel proteins, making it an attractive medicinal chemistry lead. BrMT is amphiphilic and perturbs lipid bilayers, raising the question of whether its action against K+ channels is merely a manifestation of membrane perturbation. To determine whether medicinal chemistry approaches to improve BrMT might be viable, we synthesized BrMT and 11 analogues and determined their activities in parallel assays measuring K+ channel activity and lipid bilayer properties. Structure-activity relationships were determined for modulation of the Kv1.4 channel, bilayer partitioning, and bilayer perturbation. Neither membrane partitioning nor bilayer perturbation correlates with K+ channel modulation. We conclude that BrMT's membrane interactions are not critical for its inhibition of Kv1.4 activation. Further, we found that alkyl or ether linkages can replace the chemically labile disulfide bond in the BrMT pharmacophore, and we identified additional regions of the scaffold that are amenable to chemical modification. Our work demonstrates a strategy for determining if drugs act by specific interactions or bilayer-dependent mechanisms, and chemically stable modulators of Kv1 channels are reported.

This Point/Counterpoint article discusses the transformation of dental practice from the traditional solo/small-group (partnership) model of the 1900s to large Dental Support Organizations (DSO) that support affiliated dental practices by providing nonclinical functions such as, but not limited to, accounting, human resources, marketing, and legal and practice management. Many feel that DSO-managed group practices (DMGPs) with employed providers will become the setting in which the majority of oral health care will be delivered in the future. Viewpoint 1 asserts that the traditional dental practice patterns of the past are shifting as many younger dentists gravitate toward employed positions in large group practices or the public sector. Although educational debt is relevant in predicting graduates' practice choices, other variables such as gender, race, and work-life balance play critical roles as well. Societal characteristics demonstrated by aging Gen Xers and those in the Millennial generation blend seamlessly with the opportunities DMGPs offer their employees. Viewpoint 2 contends the traditional model of dental care delivery-allowing entrepreneurial practitioners to make decisions in an autonomous setting-is changing but not to the degree nor as rapidly as Viewpoint 1 professes. Millennials entering the dental profession, with characteristics universally attributed to their generation, see value in the independence and flexibility that a traditional practice allows. Although DMGPs provide dentists one option for practice, several alternative delivery models offer current dentists and future dental school graduates many of the advantages of DMGPs while allowing them to maintain the independence and freedom a traditional practice provides.

This article describes a quality improvement (QI) initiative that is in process at the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School and the website that grew out of this effort. The process of screening and assignment of patients was selected for improvement in 2006. QI methods were used to develop a website that improves access to care for patients and assists in the matching of patients and students. The website (www.dentalscreening.com) has received more than 15,000 screening applications in the period from May 2007 to January 2010 and has provided unprecedented insight into the needs of our patients. This article outlines the process by which the website was created, the rationale for the design, and the benefits of establishing a screening website for any dental school. The program was developed entirely at UTHSCSA, but it addresses a problem that may affect many dental schools.

The purpose of this study was to evaluate the effect of a fluoridated etching gel on the shear bond strength of a composite resin to enamel. A total of 75 extracted human permanent molars were used. A flat enamel surface was obtained with 600-grit silicon carbide paper and cleaned with a rubber cup and a water slurry of fine flour of pumice. The teeth were randomly distributed into 5 groups of 15 teeth each and etched as follows: group 1: 37% non-fluoridated phosphoric acid gel (Coe) for 60 seconds (control); group 2: 60% phosphoric acid gel with 0.5% NaF (Orthoprep) for 5 seconds; group 3: Orthoprep for 15 seconds; group 4: Orthoprep for 30 seconds; group 5: Orthoprep for 60 seconds. After etching, rinsing and drying, an unfilled resin (Coe Bond) was thinly applied with a brush and cured for 30 seconds. A nylon ring was placed over the area and filled with a light-cured composite resin (Occlusin). The teeth were thermocyled (100x), mounted in plastic cups and plaster, and sheared with a knife-edged blade in an Instron machine running at a crosshead speed of 1 mm/min. The results in MPa were as follows: group 1: 14.49 +/- 4.43; group 2: 10.81 +/- 3.70; group 3: 13.51 +/- 3.21; group 4: 14.79 +/- 3.76; group 5: 15.47 +/- 4.07. An analysis of variance showed that the results in groups 1, 4 and 5 were not significantly different but that the bond strengths in groups 2 and 3 were significantly lower. Fracture within the enamel occurred in 8 specimens in group 1, 5 in group 2, 6 in group 3, 8 in group 4, and 13 in group 5. In the fluoridated etchant groups the number of specimens showing enamel fracture increased as the application time of the etchant increased.

This Point/Counterpoint article discusses the transformation of dental practice from the traditional solo/small-group (partnership) model of the 1900s to large Dental Support Organizations (DSO) that support affiliated dental practices by providing nonclinical functions such as, but not limited to, accounting, human resources, marketing, and legal and practice management. Many feel that DSO-managed group practices (DMGPs) with employed providers will become the setting in which the majority of oral health care will be delivered in the future. Viewpoint 1 asserts that the traditional dental practice patterns of the past are shifting as many younger dentists gravitate toward employed positions in large group practices or the public sector. Although educational debt is relevant in predicting graduates' practice choices, other variables such as gender, race, and work-life balance play critical roles as well. Societal characteristics demonstrated by aging Gen Xers and those in the Millennial generation blend seamlessly with the opportunities DMGPs offer their employees. Viewpoint 2 contends the traditional model of dental care delivery-allowing entrepreneurial practitioners to make decisions in an autonomous setting-is changing but not to the degree nor as rapidly as Viewpoint 1 professes. Millennials entering the dental profession, with characteristics universally attributed to their generation, see value in the independence and flexibility that a traditional practice allows. Although DMGPs provide dentists one option for practice, several alternative delivery models offer current dentists and future dental school graduates many of the advantages of DMGPs while allowing them to maintain the independence and freedom a traditional practice provides.

Dental school clinics, originally envisioned as closely similar to private practice, evolved instead as teaching clinics. In the former, graduate and licensed dentists perform the treatment while undergraduate dental students are assigned treatment within their capabilities. In the latter, dental students provide the treatment under faculty supervision. It is generally recognized that the care provided by the teaching clinics is inefficient. However, in the last quarter of the twentieth century, dental school clinics began to pay much more attention to how treatment is rendered. The comprehensive care movement and quality assurance systems are leading towards more efficient patient-centered care. Case studies at the University of Maryland, Columbia University, and University of Louisville describe activities to make their clinic programs more efficient and patient-friendly. This article explores whether the potential exists for faculty to take a direct patient care delivery role in dental clinics in order for those clinics to become efficient patient care delivery systems as originally envisioned in the early part of the twentieth century.

A series of six 2,5-disubstituted adjacent bis(tetrahydrofuran) stereoisomers with trans/erythro/cis, trans/threo/trans, or cis/threo/cis relative stereochemistry have been synthesized from known dihydroxycyclooctenes via ring opening/cross metathesis and Pd(0)-mediated asymmetric double cycloetherification. The stereochemistry of four of these isomers has been found in the biologically active annonaceous acetogenin natural products. [reaction: see text].

Tris-(μ-(3-methyl-5-trifluoromethylpyrazolato)-κN:κN′)triangulo-trigold(I), (3,5-tfmpz)3 Au3, has been synthesized and exhibits a planar nine-member ring containing a central gold triangle with an average intramolecular Au–Au distance of 3.3455(8) A. The complex crystallizes in the monoclinic space group Cc with a = 12.998(2) A, b = 22.910 (3) A, c = 7.217(1) A, and β = 104.781(1)∘. The solid-state structure consists of sheets of (3,5-tfmpz)3Au3 units stacked in an “offset” fashion along the c axis such that one gold atom in each Au3 unit (Au1) lies approximately over the midpoint of the Au1–Au3 edge of the triangle in the layer below it. The intermolecular Au–Au distances are between 3.880(1) and 4.023(1) A, which are too long for there to be significant intertrimer bonding interaction suggesting that any supramolecular organization may be due to hydrogen-fluorine and fluorine-fluorine interactions between the molecules. The complex exhibits excitation-dependent emission at room temperature in the solid state. The structured higher energy emission (λem = 468, 517, and 556(sh) nm) is believed to be a ligand-centered π → π* transition with a lower energy unstructured emission (λem = 658 nm) assigned to the classical Au–Au excited state transition.

Cornstarch powder on latex examination gloves acts as an airborne carrier of natural latex allergens resulting in cutaneous, conjunctival, and/or respiratory responses to latex, a particular concern in a dental school environment where concentrated use of latex examination gloves occurs. This study measured airborne powder levels associated with a trial substitution of powder-free latex examination gloves for powdered latex examination gloves in a dental school clinic. Secondary aims of the study were to assess user acceptance of powder-free gloves during the trial and to assess the financial impact of converting the entire dental school to a powder-free environment. Air was sampled from two areas (dispensary and treatment room) of a student clinic fifteen to thirty minutes before the beginning of normal clinic sessions and again about 1.5 hours into the clinic session. The samples were microscopically analyzed for particulate counts of cornstarch powder. A written survey instrument assessed user acceptance of the two types of gloves. Historical financial data were used to estimate the cost of converting the entire dental school to a powder-free environment. Both the dispensary and the treatment room showed significant reductions in airborne powder counts during use of powder-free latex gloves and a return to high powder counts with resumption of powdered glove use. During the weeks of powdered glove use, the powder counts were also significantly lower before the beginning of the clinic session and higher during the clinic session. User acceptance of the powder-free latex gloves was high. The increased cost per year to convert the entire dental school to a powder-free environment was estimated to be $13,943.

The concept of an implicit contract between the public and a profession is used as a foundation for the responsibility for professions to develop continued competency assessment and enforcement mechanisms that ensure that the public can expect safe and competent care. The literature in medicine, other health professions, and from other countries is reviewed. There is concern that the fact of continued practice alone does not ensure continued competency in a changing profession and that mandatory continuing education attendance is insufficient. Public-interest groups that have looked at the issue report greater concern among the public than in the professions that effective continued competency mechanism be established and that action be taken where practitioners who are not competent are identified. There has been substantial develop of a variety of approaches in medicine, especially through the specialty boards which account for the majority of medical practitioners, in other health fields, and in several countries.

This study determined the effect of a clinical program driven by patient needs upon students' productivity, attitudes, and academic performance. A group of eight senior students, whose academic and clinical performance profile replicated that of the rest of the class, were chosen to participate in a year-long non-requirement clinic. The students were expected to attend all clinic sessions, and treat their assigned patients. Their performance was compared to that of classmates in the regular requirement-driven curriculum. The non-requirement group had significantly higher academic achievement and significantly outproduced their classmates. Non-requirement students had no state board failures, versus 17 percent in the regular curriculum, and reported significantly lower stress. This study suggests that predoctoral clinical programs can maintain quality and productivity in the absence of unit requirements.

This article describes a quality improvement (QI) initiative that is in process at the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School and the website that grew out of this effort. The process of screening and assignment of patients was selected for improvement in 2006. QI methods were used to develop a website that improves access to care for patients and assists in the matching of patients and students. The website (www.dentalscreening.com) has received more than 15,000 screening applications in the period from May 2007 to January 2010 and has provided unprecedented insight into the needs of our patients. This article outlines the process by which the website was created, the rationale for the design, and the benefits of establishing a screening website for any dental school. The program was developed entirely at UTHSCSA, but it addresses a problem that may affect many dental schools.

Measurement of the magnetic susceptibility of more than 6000 samples of granitic rock from the Mariposa 1° by 2° quadrangle, which crosses the central part of the Sierra Nevada batholith between 37° and 38°N latitude, shows that magnetic susceptibility values are above 10−2 SI units in the east and central parts of the batholith and drop abruptly to less than 10−3 SI units in the western foothills. In a narrow transitional zone, intermediate values (10−3 to 10−2) prevail. Magnetic susceptibility appears to decrease slightly westward within the zones of both high and low values. Magnetic susceptibility in plutonic rocks is chiefly a function of the abundance of magnetite, which depends, in turn, on the total iron content of the rocks and their oxidation ratio. Lower magnetic susceptibilities of felsic members of Sierran intrusive suites and of some felsic rock units relative to adjacent mafic rock units commonly reflect differences in total iron content, but the differences of magnetic susceptibility that define the regional pattern generally are much larger and are determined chiefly by the oxidation ratios of the rocks. The relatively unaltered condition of the samples and restriction of δ18O to the range of +7 to +10.3‰ indicate that neither hydrothermal fluids nor subsolidus alteration were important in modifying oxidation ratios. Correlations of magnetic susceptibility with initial 87Sr/86Sr suggest that oxidation ratios have been inherited from the source regions for the magmas from which the rocks crystallized. Reduction of Fe3+ to Fe2+ by organic carbon or other reducing substances may also have affected magnetic susceptibility.

The proportion of claims filed for specific dental procedures (ADA codes # 05110, 05120, 03320, 03330, 04260, 02150) between January 1, 2000 and June 30, 2004 by Texas general practitioners participating in a preferred provider network was compared to the proportion of these procedures performed by students graduating from the three Texas dental schools during the same period. Analysis of the data revealed that Texas dental students provide class two amalgam restorations in permanent teeth (02150) at approximately the same frequency as Texas general practitioners. Both groups provide periodontal osseous surgery (04260) at an extremely low frequency (0.02% of total procedures). Bicuspid endodontic procedures (03320) were performed at a slightly higher frequency by students (0.43% of all procedures) than by general practitioners (0.36% of all procedures), and molar endodontic procedures (03330) were performed at a slightly higher frequency by general practitioners (0.65%) than by students (0.36%). Significant discrepancies between the groups were noted for the two complete denture procedures (05110, 05120). Students provided these procedures at frequencies fifteen times (05110) and twenty-five times (05120) greater than general practitioners. Dental schools should use data provided by scope of practice analyses to help determine an appropriate breadth and depth for their educational programs.

The Radiology Research Laboratory at the Henry Ford Hospital has been involved in modeling x-ray units in order to predict image quality. A critical part of that modeling process is the accurate choice of interaction coefficients. This paper serves as a review and comparison of existing interaction models. Our objective was to obtain accurate and easily calculated interaction coefficients, at diagnostically relevant energies. We obtained data from: McMaster, Lawrence Berkeley Lab data (LBL), XCOM and FFAST Data from NIST, and the EPDL-97 database via LLNL. Our studies involve low energy photons; therefore, comparisons were limited to Coherent (Rayleigh), Incoherent (Compton) and Photoelectric effects, which were summed to determine a total interaction cross section. Without measured data, it becomes difficult to definitively choose the most accurate method. However, known limitations in the McMaster data and smoothing of photo-edge transitions can be used as a guide to establish more valid approaches. Each method was compared to one another graphically and at individual points. We found that agreement between all methods was excellent when away from photo-edges. Near photo-edges and at low energies, most methods were less accurate. Only the Chanter (FFAST) data seems to have consistently and accurately predicted the placement of edges (through M-shell), while minimizing smoothing errors. The EPDL-97 data by LLNL was the best over method in predicting coherent and incoherent cross sections.

The UTHSCSA Dental School, just short of 30 years in existence, has made great strides to be a leader in dental education. Although increased use of computers has the greatest potential for revolutionizing dental education, there are other components that must constantly be evaluated and improved. A major curriculum review is in progress. The process is a grass roots effort to allow input from faculty, students, alumni and outside consultants. The school's competencies are being reevaluated to assure they are contemporary and the methods to assess them are valid and reliable. The way we evaluate applicants is an ongoing evolution. Our appropriate role in the community (local, national, and international) continues to be a challenge. Success will be measured by how well we continuously evaluate our mission and goals, identify problems and find and implement solutions.

Samples of four composites (Herculite, Visio-Dispers, Silux, and Prisma-Fil) were finished with aluminum-oxide discs either wet or dry so that the effects of these two finishing procedures could be compared. The samples were evaluated for surface smoothness, color stability, and surface hardness. Surface smoothness was determined immediately after a sample was finished with a profilometer. Knoop hardness values were determined for each sample immediately after being finished and once a week for five weeks. Color stability was evaluated with a tristimulus colorimeter by the color of each sample being finished and once a week for five weeks. When surface smoothness was compared between the wet- and dry-finished samples, there was no significant difference between Prisma-Fil, Silux, or Herculite; however, the wet-finished Visio-Dispers was significantly rougher than the dry-finished. When surface hardness was compared, there was no significant difference in hardness values between the wet and dry samples when compared over time. When changes in color were evaluated, only Visio-Dispers had no significant change in color for both the wet- and dry-finished samples over the five-week evaluation period. Dry finishing of only one composite (Silux) produced a significant change in color. Dry finishing of composites was superior or equal to wet finishing in all tests except for the color change in Silux.

Cornstarch powder on latex examination gloves acts as an airborne carrier of natural latex allergens resulting in cutaneous, conjunctival, and/or respiratory responses to latex, a particular concern in a dental school environment where concentrated use of latex examination gloves occurs. This study measured airborne powder levels associated with a trial substitution of powder-free latex examination gloves for powdered latex examination gloves in a dental school clinic. Secondary aims of the study were to assess user acceptance of powder-free gloves during the trial and to assess the financial impact of converting the entire dental school to a powder-free environment. Air was sampled from two areas (dispensary and treatment room) of a student clinic fifteen to thirty minutes before the beginning of normal clinic sessions and again about 1.5 hours into the clinic session. The samples were microscopically analyzed for particulate counts of cornstarch powder. A written survey instrument assessed user acceptance of the two types of gloves. Historical financial data were used to estimate the cost of converting the entire dental school to a powder-free environment. Both the dispensary and the treatment room showed significant reductions in airborne powder counts during use of powder-free latex gloves and a return to high powder counts with resumption of powdered glove use. During the weeks of powdered glove use, the powder counts were also significantly lower before the beginning of the clinic session and higher during the clinic session. User acceptance of the powder-free latex gloves was high. The increased cost per year to convert the entire dental school to a powder-free environment was estimated to be $13,943.

Bryodin 1 (BD1) is a type I ribosome-inactivating protein (RIP) with low inherent animal toxicity. It has been cloned recently and the recombinant protein (rBD1) has been produced and crystallized. To gain insight into the relationship of rBD1 structure and function, we investigated the role of sequences in a region (residues 128-156) that exhibits homology with membrane interactive sequences and is not part of the enzymatically defined active site. Progressive deletions representing alpha-helical tums within these residues were generated; mutant rBD1 proteins were expressed in Escherichia coli and demonstrated increasing losses of enzymatic activity. Point mutations were also generated within this region to replace Y140, Y141, and Y142 with either alanine or lysine. Mutants at position 140 or 142 retained full enzymatic activity, whereas A141 and K141 mutants were >19-fold less potent. In cytotoxicity assays, the rBD1 point mutants at Y141 were >80-fold less potent than either rBD1 or mutants at residues 140 or 142. However, when introduced into the anti-CD40 single-chain immunotoxin rBD1-G28-5 sFv, the A140 and A141 point mutations led to decreased cytotoxicity toward CD40 positive cell lines. These data indicate that Y141 plays an important role in the enzymatic activity of BD1 and that Y140, although not essential for catalytic activity, is required for full BD1 function. Because residues 140 and 141 are distinct from residues implicit in the active site, they may be involved in ribosomal and/or membrane interactions or in intracellular trafficking of the toxin and immunotoxin.

We have conducted a 9-year multicenter trial of autologous bone marrow transplantation (ABMT) for acute myeloid leukemia (AML). Remission BM was purged in vitro using monoclonal antibodies (MoAbs; PM-81, AML-2-23) and complement targeting myeloid differentiation antigens (CD15, CD14). In 1988, the preparative regimen changed from 60 mg/kg/d cyclophosphamide x 2 and fractionated total body irradiation (TBI) total dose, 1,200 cGy (Cy/fTBI), to 4 mg/kg/d busulfan x 4 and 60 mg/kg/d Cy x 2 (Bu/Cy2). Recent analysis (October 1, 1993) shows that the Bu/Cy2 regimen along with the same MoAb purging method yields an improved outcome. Seven first complete-remission (CR) (CR1), 45 second- or third-CR (CR2/3), and 11 first-relapse (R1) patients were treated with chemotherapy and TBI or chemotherapy alone followed by ABMT with MoAb-purged BM. Median age at ABMT for those patients in CR 2/3 and R1 patients was 36 years. Twenty-nine CR 2/3 and R1 patients were conditioned with Cy/fTBI, and 27 CR2/3 and R1 patients were conditioned with Bu/CY. Using the Kaplan-Meier method, the CY/fTBI, CR2/3, and R1 patients have a 3-year disease-free survival (DFS) of 21%. On the other hand, the Bu/Cy2, CR2/3, and R1 patients have a 3-year DFS of 48%. Nineteen CR2/3 and R1 patients relapsed post-ABMT. On analysis by conditioning regimen, those treated with Cy/fTBI have a 3-year relapse rate (RR) of 58%, whereas the patients conditioned with Bu/Cy2 have a 39% 3-year RR. Long-term DFS can be achieved in about 50% of patients with advanced remissions and relapsed AML using Bu/Cy2 with MoAb-purged BM.

This study determined the effect of a clinical program driven by patient needs upon students' productivity, attitudes, and academic performance. A group of eight senior students, whose academic and clinical performance profile replicated that of the rest of the class, were chosen to participate in a year-long non-requirement clinic. The students were expected to attend all clinic sessions, and treat their assigned patients. Their performance was compared to that of classmates in the regular requirement-driven curriculum. The non-requirement group had significantly higher academic achievement and significantly outproduced their classmates. Non-requirement students had no state board failures, versus 17 percent in the regular curriculum, and reported significantly lower stress. This study suggests that predoctoral clinical programs can maintain quality and productivity in the absence of unit requirements.

This study evaluated the effect of enamel bleaching with a commercial product on the sheer bond strength of a composite resin. A total of 45 human extracted permanent molars were used. A flat enamel surface was obtained with 600-grit SiC paper. The teeth were then randomly distributed into three groups of 15 teeth each: Group 1: Enamel etching with 37% phosphoric acid gel (Coe) for 60 seconds, placement of an unfilled resin (Coe) thinly applied with a brush and a composite resin (Occlusin); Group 2: Enamel bleaching (Rembrandt Lighten Bleaching Gel, Den-Mat) for one hour, etching for 60 seconds and placement of unfilled and composite resins. Group 3: Enamel bleaching for 24 hours, etching for 60 seconds, and placement of unfilled and composite resins. A nylon ring over the etched enamel retained the composite resin. The teeth were thermocycled (X100) and sheared with a knife-edged blade in an Instron machine running at a cross-head speed of 1 mm/min. The results in MPa were: Group 1: 12.86 +/- 4.83, Group 2: 12.33 +/- 2.95, and Group 3: 7.67 +/- 1.98. An ANOVA revealed that Groups 1 and 2 were significantly different from Group 3 (P0.001). Fracture within the enamel occurred in 53% in Group 1, 33% in Group 2, and 0% in Group 3. The study reveals that the shear bond strength of composite resins is significantly reduced after enamel bleaching for 24 hours.

The 1987 to 1991 direct medical costs and service utilization of Class IV Human Immunodeficiency Virus (HIV) patients cared for at a Group Health Cooperative of Puget Sound (GHC) are described and compared across four time periods: 1987-'88, 1989, 1990, and 1991. Cost and utilization information for an age- and sex-matched control group of GHC enrollees not having Class IV HIV conditions are also compared to those of the Class IV HIV group. Data are presented on pharmacy, inpatient care, outpatient visits by physician specialty, laboratory, radiology, home health/hospice and other costs. The costs of the Class IV HIV population are, on average, 20 times those of the control group. The percent distribution of the control group's costs did not experience much change from 1989 to 1991. Conversely, the Class IV HIV group experienced a shift in costs from the inpatient to outpatient setting from 1987-'88 to 1989. This shift was temporary, as the locus of care shifted back to the inpatient setting over the following 2 years. Anecdotal evidence suggests that antiretroviral treatment may have led to a period in which patients required less intensive settings to manage their illness. Inpatient costs may have increased as the initial benefit of zidovudine treatment began to wane. The Class IV HIV population had greater percent of total expenses in pharmacy, laboratory, radiology, and home health/hospice services, and lower percent of total expenses in outpatient primary and specialty care than the control group.

OBJECTIVE--To study the clinical characteristics of respiratory tract illness caused by Chlamydia pneumoniae.-Prospective clinical, bacteriologic, and serologic study. Secondarily, a matched comparison of patients with and without evidence of C pneumoniae infection (serologic titers greater than or equal to 1:64 and less than 1:16, respectively).--Four primary care (family practice) clinics in Madison, Wis, and nearby towns.--The study included 365 white males and females (mean age, 34.2 years).--Association of acute C pneumoniae infection with signs and symptoms of respiratory illness and the relationship of C pneumoniae antibody titer with wheezing at the time of enrollment in the study, and with the diagnosis of asthmatic bronchitis.--Nine (47%) of 19 patients with acute C pneumoniae infection had bronchospasm during respiratory illness, and there was a strong quantitative association of C pneumoniae titer with wheezing at the time of enrollment in the study (P = .01). In the matched study, C pneumoniae antibody was significantly associated with asthmatic bronchitis after, but not before, respiratory illness (odds ratio, 7.2; 95% confidence interval, 2.2 to 23.4). Four infected patients had newly diagnosed asthma after illness, and four others had exacerbation of previously diagnosed asthma. There was no serologic evidence of coexisting Mycoplasma pneumoniae, Chlamydia trachomatis, or respiratory viral infection in 96% of patients with asthmatic bronchitis and asthma.--Some C pneumoniae antibody titers, although not diagnostic of chlamydial infection by present criteria, probably represent acute reinfection or ongoing chronic infection. Repeated or prolonged exposure to C pneumoniae may have a causal association with wheezing, asthmatic bronchitis, and asthma.

Objective. —To study the clinical characteristics of respiratory tract illness caused by Chlamydia pneumoniae . Design. —Prospective clinical, bacteriologic, and serologic study. Secondarily, a matched comparison of patients with and without evidence of C pneumoniae infection (serologic titers ≥1:64 and Setting. —Four primary care (family practice) clinics in Madison, Wis, and nearby towns. Patients. —The study included 365 white males and females (mean age, 34.2 years). Main Outcome Measures. —Association of acute C pneumoniae infection with signs and symptoms of respiratory illness and the relationship of C pneumoniae antibody titer with wheezing at the time of enrollment in the study, and with the diagnosis of asthmatic bronchitis. Results. —Nine (47%) of 19 patients with acute C pneumoniae infection had bronchospasm during respiratory illness, and there was a strong quantitative association of C pneumoniae titer with wheezing at the time of enrollment in the study ( P =.01). In the matched study, C pneumoniae antibody was significantly associated with asthmatic bronchitis after, but not before, respiratory illness (odds ratio, 7.2; 95% confidence interval, 2.2 to 23.4). Four infected patients had newly diagnosed asthma after illness, and four others had exacerbation of previously diagnosed asthma. There was no serologic evidence of coexisting Mycoplasma pneumoniae, Chlamydia trachomatis , or respiratory viral infection in 96% of patients with asthmatic bronchitis and asthma. Conclusions. —Some Cpneumoniae antibody titers, although not diagnostic of chlamydial infection by present criteria, probably represent acute reinfection or ongoing chronic infection. Repeated or prolonged exposure to C pneumoniae may have a causal association with wheezing, asthmatic bronchitis, and asthma. ( JAMA . 1991;266:225-230)