Polyagglutination is a rare and underdiagnosed condition, characterized by agglutination of red blood cells(RBCs) with almost all ABO-compatible adult sera. Polyagglutination can occur when a ...cryptantigen is exposed on RBCs via microbial enzyme activity. Becausenearly all adults naturally produce antibodies against cryptantigens, transfusion of plasma can cause unexpected hemolysis and hematologic complications, such as thrombocytopenia and disseminated intravascular coagulation, in patients whose cryptantigens are exposed. We report a case of Glycine soja polyagglutination occurring in a 60-year-old African-American man with disseminated methicillin-resistant Staphylococcus aureus (MRSA) infection. Prior to transfusion, the patient developed severe anemia of unknown etiology. Following transfusion of 3 units of fresh frozen plasma (FFP), his RBC count could not be determined for 24 days because of RBC agglutination in his blood sample. In addition, the FFP transfusion correlated with the rapid development of severe, transfusionrefractory thrombocytopenia and anemia. The perplexed clinical team consulted the blood bank. A direct antiglobulin test demonstrated 1+ mixed-field reactivity with both monoclonal anti-IgG and anti-C3d. Lectin panel testing showed reactivity with only Glycine soja, confirming the condition. Subsequently, plasma components were avoided, and RBC and platelet (PLT) components were washed prior to transfusion. After a 44-day hospitalization involving the transfusion of 22 units of RBCs and 13 units of PLTs, the patient was discharged to a long-term care facility. The patient's confounding hematologic complications can best be explained by polyagglutination, which developed secondary to the severe MRSA infection. The FFP transfusion likely passively transferred antibodies that bound to the patient's RBC cryptantigens, leading to RBC agglutination and anemia. The development of severe thrombocytopenia may be related to cryptantigen exposure on the patient's PLTs. Although difficult to identify, polyagglutination needs to be recognized to appropriately manage hemotherapy. The purpose of this case study is to report hematologic complications following FFP transfusion in a patient with Glycine soja polyagglutination, a rarely described condition.
Background
Accelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities.
Objective
To determine whether a ...positive deviance approach would improve blood pressure (BP) control across diverse health systems.
Design
Quality improvement study using 1-year cross sections of electronic health record data over 5 years (2013–2017).
Participants
Adults ≥ 18 with hypertension with two visits in 2 years with at least one primary care visit in the last year (
N
= 114,950 at baseline) to a primary care practice in Better Health Partnership, a regional health improvement collaborative.
Interventions
Identification of a “positive deviant” and dissemination of this system’s best practices for control of hypertension (i.e., accurate/repeat BP measurement; timely follow-up; outreach; standard treatment algorithm; and communication curriculum) using 3 different intensities (
low
: Learning Collaborative events describing the best practices;
moderate
: Learning Collaborative events plus consultation when requested; and
high
: Learning Collaborative events plus practice coaching).
Main Measures
We used a weighted linear model to estimate the pre- to post-intervention average change in BP control (< 140/90 mmHg) for 35 continuously participating clinics.
Key Results
BP control post-intervention improved by 7.6% 95% confidence interval (CI) 6.0–9.1, from 67% in 2013 to 74% in 2017. Subgroups with the greatest absolute improvement in BP control included Medicaid (12.0%, CI 10.5–13.5), Hispanic (10.5%, 95% CI 8.4–12.5), and African American (9.0%, 95% CI 7.7–10.4). Implementation intensity was associated with improvement in BP control (high: 14.9%, 95% CI 0.2–19.5; moderate: 5.2%, 95% CI 0.8–9.5; low: 0.2%, 95% CI−3.9 to 4.3).
Conclusions
Employing a positive deviance approach can accelerate translation of real-world best practices into care across diverse health systems in the context of a regional health improvement collaborative (RHIC). Using this approach within RHICs nationwide could translate to meaningful improvements in cardiovascular morbidity and mortality.
The Ninth Circuit Court of Appeals decision in the case of A&M Records v. Napster (2001a) represented a resounding legal victory for the record companies over the largest of the Internet music ...exchange services. Napster's ultimate survival is uncertain at best, but the key for the record industry is not Napster's eventual life or death per se. Rather, final victory will be determined by whether the music industry can parlay its legal triumph over Napster into any real control of the music piracy that still thrives on the Internet, threatening to alter intellectual property exchange permanently. In this paper, the authors analyze the legal arguments related to Internet digital music transfer and the future of the music industry in light of the current legal and technological environment.
The explosion of database marketing combined with the advent of computer matching programs and cheap computing power has forever changed the face of data collection and distribution in America and ...the world. Never before have marketers had such inexpensive access to reliable information about consumers. This new marketing power has, however, come with a privacy price tag that many consumers find objectionable: Detailed personal data on virtually every American is readily available for discovery or download at little or no cost. This relatively new state of data availability operates against a backdrop of limited privacy regulation. Federal privacy statutes largely focus on government distribution of information, not private data exchanges. State laws vary widely, with some states heavily regulating the type of information that can be exchanged and others providing few restrictions on private information distribution. The result is a significant series of gaps in the privacy protections for consumers. In this paper, we examine federal and state laws that restrict data collection and distribution in the United States and their strengths and weaknesses in the face of rapid technological advancement. We also develop a framework for classifying the existing privacy mechanisms. We use this framework to explore the implications for a comprehensive overhaul of the statutory privacy policy as well as the consequences of maintaining the status quo in an era in which the existing statutes are effectively overwhelmed by the changing technology. PUBLICATION ABSTRACT
The author investigates the court cases raised to contest sections of the Communications Decency Act (1996) and thereby examines the issue of First Amendment rights and the Internet.
PDF
