Faculty Bibliography

Columbia-Presbyterian and Westchester Medical Center were the only hospitals in the state that had risk-adjusted death rates that were significantly higher than the statewide rate. The rate for Westchester Medical Center, in Valhalla, was 3.27

Whether cats can transmit the virus strain, A(H5N1), to humans is not known. The World Health Organization of the United Nations has received no reports that cats played a role in afflicting the 35 people who have developed A(H5N1) infection, all in Thailand and Vietnam, said Dick Thompson, a spokesman for the agency in Geneva. Those cases were traced chiefly to direct contact with sick birds. Many influenza experts and health officials fear a worst-case occurrence in which a person becomes infected with both an avian influenza virus and a human one. Under such a circumstance, the viruses might swap genes, creating a new virus that could cause an epidemic all over the planet. The laboratory that reported the new findings, which is in Rotterdam, has done research on A(H5N1) since 1997, when its scientists detected the strain in a child who had died of the disease in Hong Kong. A month later, scientists identified the A(H5N1) virus in three dead cats, and in a white tiger that recovered after becoming ill in the same zoo where the leopard died. The cats belonged to a Thai woman who had 15 in all, 14 of which apparently died of avian flu, although the remains of only those three could be found for testing. The woman did not develop bird flu

In the Dutch study, some cats with the infection died of it, while others survived. A few did not even show any symptoms that they were carrying the disease. Whether cats can transmit the virus strain, A(H5N1), to humans is not known. The World Health Organization of the United Nations has received no reports that cats played a role in afflicting the 35 people who have developed A(H5N1) infection, all in Thailand and Vietnam, said Dick Thompson, a spokesman for the agency in Geneva. Those cases were traced chiefly to direct contact with sick birds. Many influenza experts and health officials fear a worst-case occurrence in which a person becomes infected with both an avian influenza virus and a human one. Under such a circumstance, the viruses might swap genes, creating a new virus that could cause an epidemic all over the planet much like that of the influenza epidemic of 1918-19, which killed more than 20 million around the world, including 675,000 in the United States

In a coronary bypass operation, cardiac surgeons open the chest. Though procedures vary according to different factors, surgeons in many cases then isolate one or two internal mammary arteries from beneath the breastbone and connect the cut end to a point beyond the blockage in a coronary artery. In addition, the surgeons may take a vein or artery from elsewhere in the body, connect one end to the aorta, the main artery emerging from the heart, then connect the other end at a point beyond the blocked coronary artery. There, doctors advised him to undergo bypass surgery after he underwent a procedure known as a coronary angiogram. In it, doctors insert a thin tube into an artery near the groin and thread it up to the coronary arteries. Then doctors inject a dye to determine the contour of the coronary arteries and the location of any blockages. ''I think it's unlikely the diet would have had any major impact on his developing the coronary artery disease,'' said Dr. Robert Robbins, director of the Stanford Cardiovascular Institute in Palo Alto, Calif. ''Obviously, it's been developing over a period of many years and is related to his genetic predisposition for coronary artery disease and environmental factors such as his heavy weight and his proclivity for McDonald's and junk food.''

Whether cats can transmit the virus strain, A(H5N1), to humans is not known. The World Health Organization has received no reports that cats played a role in afflicting the 35 people who have developed A(H5N1) infection, all in Thailand and Vietnam, said Dick Thompson, a spokesman for the agency in Geneva. Those cases were traced chiefly to direct contact with sick birds. A month later, scientists identified the A(H5N1) virus in three dead cats, and in a white tiger that recovered after becoming ill in the same zoo where the leopard died. The cats belonged to a Thai woman who had 15 in all, 14 of which apparently died of avian flu, although the remains of only those 3 could be found for testing. The woman did not develop bird flu. First, Dr. [Thijs Kuiken]'s team introduced the Vietnamese virus into the airways of three European shorthair cats, the breed generally used in animal experiments. All three became sick beginning the next day, and one died on the sixth day of illness. In comparison, none of three cats infected with the most common type of human influenza virus became ill

Fifty million new infections with Mycobacterium tuberculosis occur annually, claiming 2-3 million lives from tuberculosis worldwide. Despite the apparent lack of significant genetic heterogeneity between strains of M. tuberculosis, there is mounting evidence that considerable heterogeneity exists in molecules important in disease pathogenesis. These differences may manifest in the ability of some isolates to modify the host cellular immune response, thereby contributing to the observed diversity of clinical outcomes. Here we describe the identification and functional relevance of a highly biologically active lipid species-a polyketide synthase-derived phenolic glycolipid (PGL) produced by a subset of M. tuberculosis isolates belonging to the W-Beijing family that show 'hyperlethality' in murine disease models. Disruption of PGL synthesis results in loss of this hypervirulent phenotype without significantly affecting bacterial load during disease. Loss of PGL was found to correlate with an increase in the release of the pro-inflammatory cytokines tumour-necrosis factor-alpha and interleukins 6 and 12 in vitro. Furthermore, the overproduction of PGL by M. tuberculosis or the addition of purified PGL to monocyte-derived macrophages was found to inhibit the release of these pro-inflammatory mediators in a dose-dependent manner

Mycobacterium tuberculosis Beijing genotype strains are highly prevalent in Asian countries and in the territory of the former Soviet Union. They are increasingly reported in other areas of the world and are frequently associated with tuberculosis outbreaks and drug resistance. Beijing genotype strains, including W strains, have been characterized by their highly similar multicopy IS6110 restriction fragment length polymorphism (RFLP) patterns, deletion of spacers 1 to 34 in the direct repeat region (Beijing spoligotype), and insertion of IS6110 in the genomic dnaA-dnaN locus. In this study the suitability and comparability of these three genetic markers to identify members of the Beijing lineage were evaluated. In a well-characterized collection of 1,020 M. tuberculosis isolates representative of the IS6110 RFLP genotypes found in The Netherlands, strains of two clades had spoligotypes characteristic of the Beijing lineage. A set of 19 Beijing reference RFLP patterns was selected to retrieve all Beijing strains from the Dutch database. These reference patterns gave a sensitivity of 98.1% and a specificity of 99.7% for identifying Beijing strains (defined by spoligotyping) in an international database of 1,084 strains. The usefulness of the reference patterns was also assessed with large DNA fingerprint databases in two other European countries and for identification strains from the W lineage found in the United States. A standardized definition for the identification of M. tuberculosis strains belonging to the Beijing/W lineage, as described in this work, will facilitate further studies on the spread and characterization of this widespread genotype family of M. tuberculosis strains

We examined the relationship between cross-cultural provider-patient interactions and health outcomes through a literature review. Results were presented in the form of guiding principles to an expert panel of health care administrators, medical practitioners, and medical care providers. This expert panel met at the workshop "Changing Patient Behavior" during a conference convened by the office of Minority Health, US Department of Health and Human Services, February 17-18, 2000. The panel reviewed the themes and formulated suggestions for program and policy change. Six principles were identified: (1) Physicians should acknowledge that patients may be actively involved in health maintenance long before they seek medical care. (2) Patients should be empowered to be active participants in their medical care. (3) Providers should critically evaluate their own assumptions and underlying values about what constitutes a "good" patient and consider how these assumptions and values affect their communication strategies. (4) The patient's behavior change in the medical interaction should result from a process of negotiation between provider and patient. (5) The medical system should focus on community empowerment in addition to individual empowerment. (6) Accessible and understandable health outcome data will empower the community to participate in the elimination of health disparities.