Core concepts in occupational therapy have often developed over time with contributions from multiple clinicians and scholars. This makes it difficult to determine exactly from where, or from whom, ...ideas originated. Without original sources, we cannot chart the historical development of ideas and honor those whose scholarship made it possible. This article documents the process undertaken to properly cite one such common concept in occupational therapy, the just-right challenge; illustrates the value of doing so; and advocates for the importance of thorough historical scholarship.
Five patients with end-stage renal disease received bone marrow and kidney transplants from HLA-mismatched living related donors. Transient hematopoietic chimerism developed in all five. In one ...patient, irreversible humoral rejection occurred. In the other four recipients, immunosuppressive therapy was discontinued after 9 to 14 months and renal function has subsequently remained stable.
Five patients with end-stage renal disease received bone marrow and kidney transplants from HLA-mismatched living related donors. In four recipients, immunosuppressive therapy was discontinued after 9 to 14 months and renal function has subsequently remained stable.
Long-term results of organ transplantation remain unsatisfactory, mainly because of chronic rejection and complications associated with immunosuppressive medications.
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Immune tolerance, which has been achieved in animal models, might provide a means for avoiding both of these problems. However, the results of attempts to extend such studies from laboratory animals to humans have been disappointing.
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Tolerance of allografts has been induced in mice
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and larger animals
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by first transplanting hematopoietic stem cells from the prospective donor into the recipient, thereby creating a lymphohematopoietic chimera in which donor and recipient hematopoiesis coexist (“mixed chimera”). Using a nonmyeloablative perioperative regimen, we . . .
OBJECTIVE: Bipolar spectrum disorders, which include bipolar I, bipolar II, and bipolar disorder not otherwise specified, frequently go unrecognized, undiagnosed, and untreated. This report describes ...the validation of a new brief self-report screening instrument for bipolar spectrum disorders called the Mood Disorder Questionnaire. METHOD: A total of 198 patients attending five outpatient clinics that primarily treat patients with mood disorders completed the Mood Disorder Questionnaire. A research professional, blind to the Mood Disorder Questionnaire results, conducted a telephone research diagnostic interview by means of the bipolar module of the Structured Clinical Interview for DSM-IV. RESULTS: A Mood Disorder Questionnaire screening score of 7 or more items yielded good sensitivity (0.73) and very good specificity (0.90). CONCLUSIONS: The Mood Disorder Questionnaire is a useful screening instrument for bipolar spectrum disorder in a psychiatric outpatient population.
Background
Anaplasma phagocytophilum is a tick‐borne bacterium and the cause of human granulocytic anaplasmosis (HGA). Here, we report a case of transfusion‐transmitted (TT)‐HGA involving a ...leukoreduced (LR) red blood cell (RBC) unit.
Case Report
A 64‐year‐old woman with gastric adenocarcinoma and multiple myeloma who received weekly blood transfusions developed persistent fevers, hypotension, and shortness of breath 1 week after receiving an RBC transfusion. Persistent fevers, new thrombocytopenia, and transaminitis suggested a tick‐borne infection.
Results
The absence of blood parasites on thick and thin blood smears suggested that malaria and Babesia infection were not present, and the recipient tested negative for antibodies to Borrelia burgdorferi. Blood testing by polymerase chain reaction (PCR) for Ehrlichia and Anaplasma species identified A. phagocytophilum. Treatment with doxycycline resolved the infection; however, the recipient expired due to complications of her known malignancies. The recipient lived in a nursing home and did not have pets or spend time outdoors. The donor was a female in her 70s from Maine who was diagnosed with HGA 3 weeks after donating blood and whose LR‐RBCs from the donation were transfused to the recipient 9 days following collection.
Conclusion
This is a confirmed case of TT‐HGA. Although rare, TT‐HGA has been reported with LR‐RBCs and platelets. In endemic areas, testing for tick‐borne associated infections should be considered when investigating post‐transfusion complications.
Images of the Present Time presents nearly three years of Alain Badiou's seminars, held from 2001 to 2004, which consider the relationship between philosophy and notions of "the present.".
We have previously reported operational tolerance in patients receiving human leukocyte antigen-mismatched combined kidney and bone marrow transplantation (CKBMT). We now report on transient ...multilineage hematopoietic chimerism and lymphocyte recovery in five patients receiving a modified CKBMT protocol and evidence for early donor-specific unresponsiveness in one of these patients.
Five patients with end-stage renal disease received CKBMT from human leukocyte antigen-mismatched, haploidentical living-related donors after modified nonmyeloablative conditioning. Polychromatic flow cytometry was used to assess multilineage chimerism and lymphocyte recovery posttransplant. Limiting dilution analysis was used to assess helper T-lymphocyte reactivity to donor antigens.
Transient multilineage mixed chimerism was observed in all patients, but chimerism became undetectable by 2 weeks post-CKBMT. A marked decrease in T- and B-lymphocyte counts immediately after transplant was followed by gradual recovery. Initially, recovering T cells were depleted of CD45RA+/CD45RO(-) "naïve-like" cells, which have shown strong recovery in two patients, and CD4:CD8 ratios increased immediately after transplant but then declined markedly. Natural killer cells were enriched in the peripheral blood of all patients after transplant.For subject 2, a pretransplant limiting dilution assay revealed T helper cells recognizing both donor and third-party peripheral blood mononuclear cells. However, the antidonor response was undetectable by day 24, whereas third-party reactivity persisted.
These results characterize the transient multilineage mixed hematopoietic chimerism and recovery of lymphocyte subsets in patients receiving a modified CKBMT protocol. The observations are relevant to the mechanisms of donor-specific tolerance in this patient group.
Two patients with end-stage renal disease secondary to multiple myelomas were treated with combined kidney and bone marrow transplantation in an effort to achieve donor-specific allotolerance through ...the induction of mixed lymphohematopoietic chimerism.
Two female patients (55 and 50 years of age) with end-stage renal disease secondary to kappa light-chain multiple myelomas received a nonmyeloablative conditioning regimen that consisted of 60 mg/kg cyclophosphamide intravenously (IV) on days -5 and -4; 15 mg/kg equine anti-thymocyte globulin (ATGAM) IV on days -1, +1, and +3; and thymic irradiation (700 cGy) on day -1. On day 0, the recipients underwent kidney transplantation, followed by IV infusion of donor bone marrow (2.7x10(8) and 3.8x10(8) /kg nucleated cells, respectively) obtained from a human leukocyte antigen (HLA)-matched sibling. Cyclosporine A was administered IV at a dose of 5 mg/kg on day -1, then continued orally at 8 to 12 mg/kg per day until days +73 and +77, respectively, after which no further immunosuppression was given. Donor leukocyte infusions (1x10(7) /kg CD3+ T cells) were administered in an attempt to enhance the graft-versus-myeloma effect (days +66 and +112 in the first patient and day +78 in the second patient). Hematopoietic chimerism was monitored weekly by microsatellite assays.
Multilineage lymphohematopoietic chimerism (5%-80% donor CD3+ or CD3- cells, or both) was first detected during the second posttransplant week and was maintained for approximately 12 weeks, after which there was a gradual decline to undetectable levels (<1% donor cells) after day 105 in the first patient and after day 123 in the second patient. In both recipients, the blood urea nitrogen and creatinine levels returned to normal within 3 days. No rejection episodes have occurred. Quantification of urinary kappa light chains revealed a decline from 28 mg/dL to undetectable levels (<2.5 mg/dL) within 29 days in the first case and from 99.8 mg/dL to <10 mg/dL within 50 days in the second case. Both patients continue with normal kidney function and sustained anti-tumor responses, while receiving no immunosuppression for nearly 4 years and 2 years, respectively.
This nonmyeloablative regimen followed by combined HLA-matched donor bone marrow and renal allotransplantation is the first example of an intentional and clinically applicable approach to inducing renal allograft tolerance and achieving potent and sustained antitumor effects in patients with multiple myeloma.
Lacan Badiou, Alain; Reinhard, Kenneth; Spitzer, Susan L ...
2018, 20181016, 2019, 2018-10-16
eBook
The transcript of Alain Badiou's year-long seminar on the psychoanalytic theory of Jacques Lacan, this book offers a forceful reading of an enigmatic yet foundational thinker and sheds light on the ...crucial role that Lacan plays in Badiou's own thought. It is the first volume of Badiou's seminars to be published in English.
Play in children with autism spectrum disorder (ASD) is often atypical, yet consensus regarding effective occupational therapy strategies for improving play is not established. To examine the ...efficacy of strategies used in occupational therapy to improve play in ASD, authors completed a systematic review of papers from January 1980 through January 2019. Search terms included autism, Asperger’s, ASD, autistic in combination with play, playfulness, pretend, imagination, praxis, creativity, and generativity. Twenty papers met inclusion criteria and were reviewed. Reviewed interventions included parent education, modified play materials or environments, imitation of the child, and modeling by an adult, a peer, or video. Moderate to strong support exists for the specific strategies of imitation of the child and modeling for the child, with lesser or mixed support for other strategies. Certain strategies commonly used in occupational therapy may be effective in improving the occupation of play in ASD.
Disasters-natural ones, such as hurricanes, floods, or earthquakes, and unnatural ones such as terrorist attacks-are part of the American experience in the twenty-first century. The challenges of ...preparing for these events, withstanding their impact, and rebuilding communities afterward require strategic responses from different levels of government in partnership with the private sector and in accordance with the public will.
Disasters have a disproportionate effect on urban places. Dense by definition, cities and their environs suffer great damage to their complex, interdependent social, environmental, and economic systems. Social and medical services collapse. Long-standing problems in educational access and quality become especially acute. Local economies cease to function. Cultural resources disappear. The plight of New Orleans and several smaller Gulf Coast cities exemplifies this phenomenon.
This volume examines the rebuilding of cities and their environs after a disaster and focuses on four major issues: making cities less vulnerable to disaster, reestablishing economic viability, responding to the permanent needs of the displaced, and recreating a sense of place. Success in these areas requires that priorities be set cooperatively, and this goal poses significant challenges for rebuilding efforts in a democratic, market-based society. Who sets priorities and how? Can participatory decision-making be organized under conditions requiring focused, strategic choices? How do issues of race and class intersect with these priorities? Should the purpose of rebuilding be restoration or reformation? Contributors address these and other questions related to environmental conditions, economic imperatives, social welfare concerns, and issues of planning and design in light of the lessons to be drawn from Hurricane Katrina.
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