Gain Expertise Research Articles

Use of phage display technology to investigate allergen-antibody interactions

Phage display is an advanced technology that can be used to characterize the interactions of antibody with antigen at the molecular level. It provides valuable data when applied to the investigation of IgE interaction with allergens. The aim of this rostrum article is to provide an explanation of the potential of phage display for increasing the understanding of allergen-IgE interaction, the discovery of diagnostic reagents, and the development of novel therapeutics for the treatment of allergic disease. The significance of initial studies that have applied phage display technology in allergy research will be highlighted. Phage display has been used to clone human IgE to timothy grass pollen allergen Phl p 5, to characterize the epitopes for murine and human antibodies to a birch pollen allergen Bet v 1, and to elucidate the epitopes of a murine mAb to the house dust mite allergen Der p 1. The technology has identified peptides that functionally mimic sites of human IgE constant domains and that were used to raise antiserum for blocking binding of IgE to the FcϵRI on basophils and subsequent release of histamine. Phage display has also been used to characterize novel peanut and fungal allergens. The method has been used to increase our understanding of the molecular basis of allergen-IgE interactions and to develop clinically relevant reagents with the pharmacologic potential to block the effector phase of allergic reactions. Many advances from these early studies are likely as phage display technology evolves and allergists gain expertise in its research applications. (J Allergy Clin Immunol 2000;105:1085-92.)

Incorporating Existential Themes into the Supervision of Social Work Practitioners

The social work profession has traditionally espoused a concern with the holistic person, including biological, psychological, and social influences on human behavior. Recently this perspective has expanded to include existential concerns, or the human search for, and adherence to, meanings, purposes, and commitments. An increasing number of social workers are interested in exploring existential themes in their work with some clients. Clinical supervisors can help practitioners gain expertise in this practice not by conceptualizing existentialism as a separate theory, but by integrating it with existing theoretical perspectives. In this paper the author discusses the concept of existentialism and demonstrates its fit with ego and cognitive theory. Two case examples are used as illustrations.

PERI-OPERATIVE ECHOCARDIOGRAPHY IN THE AMBULATORY ANESTHESIA SETTING

S9 INTRODUCTION: It is predicted that by the year 2000 75% of all elective surgery will be performed on an outpatient basis. Concurrently, an increasing number of these patients with be elderly and have co-existing medical diseases. Anesthesiologists will more frequently be faced with day-of-surgery dilemmas regarding the adequacy of preoperative testing, or whether a patient's postoperative condition is adequate for safe discharge home. In these three reports, we describe the value of perioperative transthoracic echocardiography (ECHO) in the decision-making process. METHODS: Case #1 A 67 year old woman presented for right knee arthroscopy. Despite insignificant past medical history (PMH) of cardiovascular disease, auscultation of the heart revealed a loud, harsh systolic munnur. Repolarization abnormalities and left ventricular hypertrophy (LVH) were evident on her EKG. Rather than postpone surgery for additional testing, ECHO was performed, revealing only senile aortic calcification, good left ventricular function and absence of significant aortic stenosis by Doppler (Figure 1), it was decided to proceed with the operation under spinal anesthesia. Her perioperative course was uneventful.Figure 1Case#2 A 65 year old smoker with arterial hypertension was scheduled for transurethral bladder tumor resection (TURBT). The patient reported poor exercise tolerance, but had no PMH of lung or heart disease, and no signs of congestive heart failure. His EKG was consistent with LVH. An ECHO performed in the holding area demonstrated mild LVH with an ejection fraction of 65% and absence of regional wall motion abnormalities (WMA). The surgery proceeded uneventfully under spinal anesthesia, and the patient was discharged home following his recovery in the postoperative care unit (PACU). Case#3 A 75 year old man with arterial hypertension, well controlled with hydrochlorothiazide 25 mg (Hctz), presented for TURBT. His preoperative blood pressure was 175/95 mmHg and the EKG showed LVH. The introduction of spinal anesthesia (75 mg of hyperbaric lidocaine in the sitting position) resulted in hypotension requiring multiple boluses of ephedrine and phenylephrine. Although the operation ended uneventfully, he remained dependent on intermittent doses of vasopressors in the PACU. ECHO was performed at this time revealing severe concentric LVH, and absence of WMA (Figure 2). Subsequently, administration of 750 ml of isotonic saline promptly corrected his episodic hypotension. His internist was notified of the findings, the Hctz was discontinued, and the patient was discharged home.Figure 2DISCUSSION Despite attempts to carefully prescreen and optimize patients scheduled for ambulatory surgery, many patients with significant PMH "slip through the cracks". Often surgeons fail to recognize existing medical problems, or internists have inadequate understanding of the interaction of medical disease with the stresses of anesthesia and surgery. Occasionally patients do not comply with the recommended preoperative screening. The rapidly changing health care environment and the shift toward outpatient surgery demands modification in the practice of anesthesiology. In addition to providing anesthesia, anesthesiologists are now often called upon to assume new responsibilities and act as perioperative physicians for patients with coexisting diseases presenting for same-day surgery. As more anesthesiologists gain expertise in the use of echocardiography, this expertise can become a valuable adjunct in the perioperative management and clinical decision making process in the same-day surgery setting.

Developing and Implementing the Integrated Information System for Foster Care and Adoption

ABSTRACT Information Is normally collected to monitor a situation, communicate about it, and gain expertise over time. Yet, current information collection and handling practices in social service settings leads to problems in agencies” abilities to competently perform these functions. We propose a conceptual framework to improve this situation. Focus is on bringing expertise to the front line; meeting Information needs at all agency levels; and meeting reporting requirements to the state and federal goYemment As an example of the way the framework is used, we present the Integrated Information for Foster Care and Adoption (IIS-FCA) implemented in child welfare agencies in Michigan. The paper discusses costs and benefits associated with the IIS-FCA.

Training and User Services to Implement a Shared Local System

DALNET is a network with a local automated library system voluntarily shared by twelve libraries of different types that are close to each other geographically. To deliver the needed training and user services to its partner libraries, Wayne State University Library (WSUL), the host institution, expanded the staff in its Systems Office. The DALNET Office staff gain expertise with the shared local system by first implementing each module at WSUL. The training and user services needed to implement a shared automated library system can be grouped into three areas: (1) startup services, including developing an implementation schedule, designing local hardware and telecommunications systems, and creating effective communication channels; (2) database loading and management, including procurement and processing of bibliographic and authority records, MARC record loading, and shared file management; and (3) module implementation, including orientation, training, and testing/acceptance. This article describes DAL...

Precasting work sheet--an assessment tool. A clinical report.

Physical therapists often use casting as an adjunct to traditional management of patients with brain injury. Casts generally are used on these patients for one of two reasons: 1) to increase range of motion with the use of serial casting or 2) to augment functional treatment with the use of inhibitive casting. This clinical report describes serial and inhibitive casts and introduces a precasting work sheet that promotes the selection of appropriate casting patients and necessary planning. The work sheet guides the therapist through an assessment of patient data relevant to casting, including passive range of motion, postural tone and abnormal reflexes, and voluntary movement. The precasting work sheet helps therapists gain expertise in casting by familiarizing them with the factors to consider before casting, encouraging them to set goals for casting, and helping them to determine whether the goals were met.

Evaluating Manuscripts in Political Science

A developmental review is a request for advice from experts and potential adopters of the book. Basically, we ask the reviewer to help us evaluate and shape the manuscript by telling us honestly and directly what's good about it and what's not so good.We commission three kinds of reviews.We occasionally ask well known scholars to serve as expert advisors, providing bibliographies, abstracts of articles, and outlines. They read draft chapters and then reread them. The point of their efforts is to help a nonexpert author gain expertise. Remuneration is generous by publishing standards: about $500 per chapter. The expert advisor can expect to have his or her name associated with the book when it's published. This kind of reviewing is relatively rare in political science.In another kind of expert review, we ask specialists to prepare outlines and provide bibliographies and do one careful reading. The fee is usually $250 per chapter.