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1.  Cognitive memory screening and referral program in community pharmacies in the United States 
Introduction 12 chain community pharmacy sites located in two geographic areas with the United States implemented easy-to-administer memory screening assessments for patients with risk factors of cognitive memory decline and referred at-risk patients to their physicians. Aim of the study To evaluate the impact of a pharmacy-based cognitive memory screening and referral program, measure patient satisfaction with these advanced clinical services, and assess willingness to pay for cognitive memory screening services. Setting 12 chain pharmacy sites located in two geographic areas—ten Fred Meyer Pharmacies located in the Portland, Oregon area and two Kerr Drug Pharmacies located in North Carolina. Method Pharmacists were educated on Alzheimer’s disease, trained on how to provide cognitive memory screening exams, and equipped with screening and documentation tools. Following each screening, pharmacist provided education and counseling to the patients and referred at-risk patients to physicians for follow-up as appropriate. Main outcome measures Results of screenings; satisfaction of patients; willingness to pay. Results Pharmacists delivered cognitive memory assessments to 161 patients from June to November 2008. 44.1 % of patients experienced at least one cognitive deficiency that required referral to a physician based on the screening conducted. The cognitive memory screening and referral program was highly regarded by patients who completed the satisfaction survey, with 98.4 % of respondents indicating that they were either very satisfied or satisfied with the program. Conclusion Cognitive memory screening can be easily incorporated into clinical service offerings in community pharmacy practice and provides a valuable opportunity to identify patients at-risk and refer them to a physician for appropriate testing and diagnosis.
PMCID: PMC3984659  PMID: 24357467
Alzheimer’s disease; Ambulatory care; Clinical pharmacy services; Cognitive memory screening; Community pharmacy; Dementia; Physician referral
3.  Analysis of the enzymatic cleavage (beta elimination) of the capsular K5 polysaccharide of Escherichia coli by the K5-specific coliphage: reexamination. 
Journal of Bacteriology  1996;178(15):4747-4750.
The capsular K5 polysaccharide of Escherichia coli is the receptor of the capsule-specific coliphage K5, which harbors an enzyme that degrades the capsular K5 polysaccharide to a number of oligosaccharides. Analysis of the degradation products using gel permeation chromatography, the periodate-thiobarbituric acid and bicinchoninic acid reactions, and nuclear magnetic resonance spectroscopy showed that the major reaction products are hexa-, octa-, and decasaccharides with 4,5-unsaturated glucuronic acid (delta4,5GlcA) at their nonreducing end. Thus, the bacteriophage enzyme is a K5 polysaccharide lyase and not, as we had reported previously, an endo-N-acetylglucosaminidase.
PMCID: PMC178252  PMID: 8755913
4.  Neurobehavioural consequences of closed head injury in older adults. 
This study examined the neurobehavioural effects of closed head injury (CHI) in adults aged 50 years and older. Twenty two mild to moderate CHI patients who were within seven months of the injury were administered measures of language, memory, attention, and executive functioning. Compared with demographically similar normal controls, the patients exhibited significantly poorer functioning on the cognitive domains. Naming and word fluency under timed conditions, verbal and visual memory, and the ability to infer similarities were especially vulnerable. These initial findings indicate that CHI in older adults produces considerable cognitive deficits in the early stages of recovery. Future research should characterise long term outcome and the potential links between head injury and the development of progressive dementia.
PMCID: PMC1073082  PMID: 8057121
5.  Coexpression of colanic acid and serotype-specific capsular polysaccharides in Escherichia coli strains with group II K antigens. 
Journal of Bacteriology  1993;175(20):6725-6730.
In Escherichia coli K-12, the rcsA and rcsB gene products are positive regulators in expression of the slime polysaccharide colanic acid. We have previously demonstrated the presence of rcsA sequences in E. coli K1 and K5, strains with group II capsular K antigens, and shown that introduction of multicopy rcsA into these strains results in the expression of colanic acid. We report here the presence of rcsB sequences in E. coli K1 and K5 and demonstrate that RcsB also plays a role in the biosynthesis of colanic acid in strains with group II K antigens. In E. coli K1 and K5 grown at 37 degrees C, multicopy rcsB and the resulting induction of colanic acid synthesis had no significant effect on synthesis of the group II K antigens. K-antigen-specific sugar transferase activities were not significantly different in the presence or absence of multicopy rcsB, and introduction of a cps mutation to eliminate colanic acid biosynthesis in a K1-derivative strain did not influence the activity of the polysialyltransferase enzyme responsible for synthesis of the K1 polymer. Furthermore, immunoelectron microscopy showed no detectable difference in the size or distribution of the group II K-antigen capsular layer in cells which produced colanic acid. Colanic acid expression therefore does not appear to significantly affect synthesis of the group II K-antigen capsule and, unlike for group I K antigens, expression of group II K antigens is not positively regulated by the rcs system.
PMCID: PMC206787  PMID: 8407850
6.  Expression of the capsular K5 polysaccharide of Escherichia coli: biochemical and electron microscopic analyses of mutants with defects in region 1 of the K5 gene cluster. 
Journal of Bacteriology  1993;175(18):5984-5992.
The gene cluster of the capsular K5 polysaccharide, a representative of group II capsular antigens of Escherichia coli, has been cloned previously, and three regions responsible for polymerization and surface expression have been defined (I.S. Roberts, R. Mountford, R. Hodge, K. B. Jann, and G. J. Boulnois, J. Bacteriol. 170:1305-1330, 1988). Region 1 has now been sequenced, and five open reading frames (kpsEDUCS) have been defined (C. Pazzani, C. Rosenow, G. J. Boulnois, D. Bronner, K. Jann, and I. S. Roberts, J. Bacteriol. 175:5978-5983, 1993). In this study, we characterized region 1 mutants by immunoelectron microscopy, membrane-associated polymerization activity, cytoplasmic CMP-2-keto-3-deoxyoctonate (KDO) synthetase activity, and chemical analysis of their K5 polysaccharides. Certain mutations within region 1 not only effected polysaccharide transport (lack of region 1 gene products) but also impaired the polymerization capacity of the respective membranes, reflected in reduced amounts of polysaccharide but not in its chain length. KDO and phosphatidic acid (phosphatidyl-KDO) substitution was found with extracellular and periplasmic polysaccharide and not with cytoplasmic polysaccharide. This and the fact that the K5 polysaccharide is formed in a kpsU mutant (defective in capsule-specific K-CMP-KDO synthetase) showed that CMP-KDO is engaged not in initiation of polymerization but in translocation of the polysaccharide.
PMCID: PMC206680  PMID: 8397188
7.  Structures of the O1B and O1C lipopolysaccharide antigens of Escherichia coli. 
Journal of Bacteriology  1992;174(24):7963-7970.
The O-specific moieties of the O1B antigen (lipopolysaccharide) from Escherichia coli O1B:K1 and the O1C antigen from E. coli O1C:K- both consist of L-rhamnose, D-galactose, N-acetyl-D-glucosamine, and N-acetyl-D-mannosamine in a molar ratio of 2:1:1:1. By using fragmentation procedures, methylation analysis, and one- and two-dimensional nuclear magnetic resonance spectroscopy, the structures of these polysaccharides were found to be [formula: see text] In the O1B polysaccharide X is 2, and in the O1C polysaccharide X is 3. With the recently published structure of the O1A polysaccharides (B. Jann, A. S. Shashkov, D. S. Gupta, S. M. Panasenko, and K. Jann, Carbohydr. Polym. 18:51-57 1992), three related O1 antigens are now known. Their common (O1-specific) epitope is suggested to be the side-chain N-acetyl-D-mannosamine residue.
PMCID: PMC207532  PMID: 1281148
8.  Biosynthesis of the Escherichia coli K5 polysaccharide, a representative of group II capsular polysaccharides: polymerization in vitro and characterization of the product. 
Journal of Bacteriology  1991;173(13):4088-4094.
Biosynthesis of the capsular K5 polysaccharide of Escherichia coli, which has the structure 4)-beta GlcA-1,4-alpha GlcNAc-(1, was studied with membrane preparations from an E. coli K5 wild-type strain and from a recombinant K-12 strain expressing the K5 capsule. Polymerization occurs at the inner face of the cytoplasmic membrane without the participation of lipid-linked oligosaccharides. The serological K5 specificity of the in vitro product was determined with a K5-specific monoclonal antibody in an antigen-binding assay. The K5 polysaccharide, as obtained from the membranes after an in vitro incubation, has 2-keto-3-deoxyoctulosonic acid as the reducing sugar, which indicates that the polysaccharide grows by chain elongation at the nonreducing end.
PMCID: PMC208057  PMID: 1829455
9.  Electron microscopic study of coexpression of adhesive protein capsules and polysaccharide capsules in Escherichia coli. 
Infection and Immunity  1990;58(8):2710-2714.
Escherichia coli 21535 (O21:K4:H4 with nonfimbrial adhesin NFA-6) and 21511 (O7:K98:H6 with nonfimbrial adhesin NFA-4) were analyzed by immunoelectron microscopy with a K98-specific antiserum and K4- and NFA-4-specific and NFA-6-reactive monoclonal antibodies. The bacteria were analyzed in ultrathin sections after stabilization of the capsules with specific antibodies by embedding in Epon 812 as well as in Lowicryl K4M. With the Lowicryl-embedded samples, the polysaccharide K antigens were labeled by the immunogold technique. It was found that with both strains all bacteria expressed the polysaccharide capsule, while in each case about 20% expressed the protein capsule in addition. Thus, in both invasive E. coli strains, bacteria are present which express composite capsules with the adhesin (recognition protein) at the cell-distal outer region and the K antigen (acidic polysaccharide) at the cell-proximal inner region. These findings are discussed with respect to the participation of the capsular compartments in unspecific host defense.
PMCID: PMC258881  PMID: 1973415
10.  Expression of the Escherichia coli K5 capsular antigen: immunoelectron microscopic and biochemical studies with recombinant E. coli. 
Journal of Bacteriology  1990;172(2):1085-1091.
The capsular K5 polysaccharide, a representative of group II capsular antigens of Escherichia coli, has been cloned previously, and three gene regions responsible for polymerization and surface expression have been defined (I. S. Roberts, R. Mountford, R. Hodge, K. B. Jann, and G. J. Boulnois, J. Bacteriol. 170:1305-1310, 1988). In this report, we describe the immunoelectron microscopic analysis of recombinant bacteria expressing the K5 antigen and of mutants defective in either region 1 or region 3 gene functions, as well as the biochemical analysis of the K5 capsular polysaccharide. Whereas the K5 clone expressed the K5 polysaccharide as a well-developed capsule in about 25% of its population, no capsule was observed in whole mount preparations and ultrathin sections of the expression mutants. Immunogold labeling of sections from the region 3 mutant revealed the capsular K5 polysaccharide in the cytoplasm. With the region 1 mutant, the capsular polysaccharide appeared associated with the cell membrane, and, unlike the region 3 mutant polysaccharide, the capsular polysaccharide could be detected in the periplasm after plasmolysis of the bacteria. Polysaccharides were isolated from the homogenized mutants with cetyltrimethylammonium bromide. The polysaccharide from the region 1 mutant had the same size as that isolated from the capsule of the original K5 clone, and both polysaccharides were substituted with phosphatidic acid. The polysaccharide from the region 3 mutant was smaller and was not substituted with phosphatidic acid. These results prompt us to postulate that gene region 3 products are involved in the translocation of the capsular polysaccharide across the cytoplasmic membrane and that region 1 directs the transport of the lipid-substituted capsular polysaccharide through the periplasm and across the outer membrane.
PMCID: PMC208540  PMID: 2404935
11.  Novel change in the carbohydrate portion of Myxococcus xanthus lipopolysaccharide during development. 
Journal of Bacteriology  1989;171(4):1835-1840.
We have examined the alterations in lipopolysaccharide during aggregation and early development in Myxococcus xanthus. The lipopolysaccharide was isolated and characterized from cells developing on agar during glycerol induction and vegetative growth. A methylated amino sugar was identified as 6-O-methylgalactosamine by gas-liquid chromatography-mass spectrometry. This novel sugar was enriched in cells developing on agar.
PMCID: PMC209829  PMID: 2495265
12.  Nonfimbrial, mannose-resistant adhesins from uropathogenic Escherichia coli O83:K1:H4 and O14:K?:H11. 
Infection and Immunity  1987;55(8):1837-1842.
Nonfimbrial, mannose-resistant hemagglutinins (nonfimbrial adhesions [NFA] NFA-1 and NFA-2) were extracted from two agar-grown urinary isolates of Escherichia coli strains 827 (O83:K1:H4) and 54 (O14:K?:H11). The proteins were purified to homogeneity by ammonium sulfate precipitation and column chromatography. Nonfimbrial adhesins are soluble proteins, which tend to form aggregates of molecular weight above 10(6). NFA-1 and NFA-2 consist of subunits of 21,000 and 19,000 molecular weight, respectively. Both hemagglutinins caused hemagglutination of human erythrocytes and bound to human kidney cell monolayers. The binding of bacteria and hemagglutinins was assessed by using suitable antisera as detectors in an enzyme-linked immunosorbent assay. NFA-1 and NFA-2 inhibited the adherence of their respective strains to human kidney cells in a linear dose response. NFA-2 also inhibited heterologous strain adherence, but NFA-1 did not. Hemabsorption of bacterial suspension with erythrocytes at 4 degrees C, followed by differential centrifugation, enabled us to obtain a bacterial suspension lacking nonfimbrial adhesins in the supernatant and an adhesin-enriched bacterial suspension that was eluted from erythrocytes at 40 degrees C. Bacteria eluted from erythrocytes exhibited a higher adherence capacity than unfractionated cells. Bacteria of the fraction lacking adhesins did not adhere to human kidney cells. Electron microscope examinations showed the presence of an extracellular capsule-like layer in adhering E. coli 827, but not in nonadhering bacteria. E. coli 54 did not express the adhesin as a capsule. We conclude that E. coli 827 and 54 produce extracellular adhesins consisting of soluble proteins which are differently expressed and antigenically distinct. The adhesins seem to share a common receptor and mediate the adherence of two uropathogenic E. coli strains to epithelial cells.
PMCID: PMC260610  PMID: 2886432
13.  Lipopolysaccharides of Pseudomonas spp. that stimulate plant growth: composition and use for strain identification. 
Journal of Bacteriology  1987;169(4):1441-1446.
The outer membrane proteins of a series of fluorescent, root-colonizing, plant-growth-stimulating Pseudomonas spp. having been characterized (L. A. de Weger et al., J. Bacteriol. 165:585-594, 1986), the lipopolysaccharides (LPSs) of these strains were examined. The chemical composition of the LPSs of the three best-studied plant-growth-stimulating Pseudomonas strains WCS358, WCS361, and WCS374 and of P. aeruginosa PAO1 as a reference strain was determined and appeared to differ from strain to strain. The 2,6-dideoxy-2-aminosugar quinovasamine was the most abundant compound in the LPS of strain WCS358. Analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of purified LPS and of proteinase K-treated cell envelopes revealed ladderlike patterns for most of these strains. These patterns were not substantially influenced by differences in culture conditions. Analysis of proteinase K-treated cell envelopes of 24 root-colonizing Pseudomonas spp. revealed a unique band pattern for each strain, suggesting a great variety in the LPS structures present in these root colonizers. Therefore, electrophoretic analysis of LPS can be used for characterization and identification of the fluorescent root-colonizing Pseudomonas strains.
PMCID: PMC211965  PMID: 3558319
14.  A reexamination of the O1 lipopolysaccharide antigen group of Escherichia coli. 
Infection and Immunity  1986;53(2):257-263.
A total of 64 Escherichia coli strains of the O1 serogroup were tested for the migration pattern of their lipopolysaccharides (LPS) on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. O1:K1 and O1:K51 strains of the OMP5 outer membrane protein pattern possessed LPS with a doublet pattern (O1A1) or the lowermost band of the O1A1 doublet (O1A2). O1:K1 strains of the OMP9 pattern possessed LPS referred to as O1A, which corresponded to the uppermost band of the O1A1 doublet pattern. A few O1:K? strains possessed LPS of different migration patterns (O1B and O1C). O1A and O1A1 LPS were indistinguishable by chemical techniques, and both reacted with each of 10 different monoclonal antibodies tested. However, O1A1 had an additional epitope within the additional band in each doublet, as demonstrated by adsorption experiments with hyperimmune rabbit sera followed by Western blotting. Furthermore, purified polysaccharide from O1A bacteria was incapable of inhibition in enzyme-linked immunosorbent assays performed with O1A1 LPS as antigen and adsorbed, specific anti-O1A1 antibodies, whereas O1A1 polysaccharide inhibited this reaction. O1B and O1C LPS differed in all respects tested, including chemical composition, from O1A and O1A1 LPS.
PMCID: PMC260867  PMID: 2426197
15.  Monoclonal antibodies against the nonhemagglutinating fimbrial antigen 1C (pseudotype 1) of Escherichia coli. 
Infection and Immunity  1986;51(1):54-59.
Hybridoma-derived monoclonal antibodies were produced with fimbrial preparations from Escherichia coli 20025 (04:K12:H-) with fimbrial (F) antigens 1C, 13, one related to 12, and one preliminarily termed y and from E. coli 2980 (018ac:K5:H-) with F antigens 1C and 8. Two clones of subclonal hybrid cells were studied which produced monoclonal antibodies (mc-20025-F2b, immunoglobulin G2b [IgG2b]; mc-2980-F2, IgG1) that were reactive with E. coli 20025, 2980, and a number of additional strains which exhibited the F1C antigen. Results of enzyme-linked immunosorbent assay and Western blot analysis indicated that the antibodies had F1C specificity, and competitive enzyme-linked immunosorbent assay with 125I-labeled antibodies showed that they recognized different epitopes on the fimbrial subunit. Neither of the antibodies agglutinated F1C-fimbriated E. coli but bound to the bacteria. There was no binding to E. coli without F1C fimbriae.
PMCID: PMC261065  PMID: 2416691
16.  Monoclonal antibodies to enterobacterial common antigen and to Escherichia coli lipopolysaccharide outer core: demonstration of an antigenic determinant shared by enterobacterial common antigen and E. coli K5 capsular polysaccharide. 
Infection and Immunity  1985;50(2):459-466.
We established hybridoma cell lines producing monoclonal antibodies against enterobacterial common antigen (ECA) and a substructure of the outer core of different Escherichia coli lipopolysaccharides (LPSs). Anti-ECA antibodies 865 and 898 reacted with ECA in extracts of heated E. coli and with ECA-bound R1 and R4 core-containing LPS preparations, as well as with a purified sample of ECA from Salmonella montevideo. Antibody 865, but not antibody 898, cross-reacted with K5 capsular polysaccharide, suggesting that 4-linked alpha-N-acetylglucosamine is part of an antigenic determinant shared by both K5 polysaccharide and ECA. Anti-LPS antibody 786 recognized an outer core structure common to E. coli K-12, B, R2, and R4 core type LPS, but not to R1 and R3 core type LPS. Its most probable target is the trisaccharide sequence Hexp(1----2)-alpha-D -Glcp(1----3) alpha-D-Glcp----(Hepp) (where Hex is hexose, p is phosphate, Glc is glucose, and Hep is heptose), the first glucose being the immunodominant moiety. These monoclonal antibodies may be used not only for the detection of ECA, K5, and LPS core structures but also for analysis of the molecular forms resolved on polyacrylamide gels (banding patterns) of both ECA and LPS, independently of one another.
PMCID: PMC261975  PMID: 2414223
17.  Escherichia coli O18ac antigen: structure of the O-specific polysaccharide moiety. 
Infection and Immunity  1984;45(1):203-209.
The O-specific polysaccharide moiety (O18ac polysaccharide) of the O18ac antigen (lipopolysaccharide) from Escherichia coli 2980 (O18ac:K5:Fim+:H-) was isolated in pure form by degradation of the lipopolysaccharide and chromatography on Sephadex G-50. The primary structure of the O18ac polysaccharide was elucidated by composition, fragmentation procedures, methylation analysis, and nuclear magnetic resonance spectroscopy. The polysaccharide consists of repeating units of the pentasaccharide: (formula; see text) which are joined in the polymer by alpha-1,2 linkages.
PMCID: PMC263301  PMID: 6203837
18.  Structure of the Escherichia coli K2 capsular antigen, a teichoic acid-like polymer. 
Journal of Bacteriology  1980;143(3):1108-1115.
The primary structure of the K2 antigen of Escherichia coli was elucidated by composition, alkaline fragmentation, dephosphorylation with hydrofluoric acid, periodate oxidation, and methylation analysis. The polymer contains galactose in the pyranosidic and furanosidic ring form. It consists of phosphogaolactopyranosyl glycerol and phosphagalactofuranosyl glycerol units in a molar ratio of 2:1. The sequence of these units is not known. The structure of the K2 antigen is reminiscent of that of certain teichoic acids of gram-positive bacteria. Using microprecipitation, it was shown that in the polymer galactoside is immunodominant.
PMCID: PMC294457  PMID: 6251025
19.  Characterization of pili associated with Escherichia coli O18ac. 
Infection and Immunity  1980;29(2):685-691.
A strain of Escherichia coli O18ac isolated from the stool sample of a patient with diarrhea was found to agglutinate human erythrocytes. From the results presented it is suggested that this hemagglutination is mediated by pili. Isolated pilus preparations agglutinated human erythrocytes, whereas pilus-negative mutants did not. The serological and chemical analyses indicate that the pili associated with E. coli O18ac are distinct from other types found with E. coli.
PMCID: PMC551181  PMID: 6111534
20.  Citrobacter O-antigens: structure of the O-antigenic polysaccharide from Citrobacter sp. 396. 
Journal of Bacteriology  1978;134(2):462-469.
The structure of the O-specific polysaccharide moiety of the lipopolysaccharide from Citrobacter 396 was elucidated by composition, methylation, and periodate oxidation studies. The repeating unit consists of four 2-linked mannoses and one 3-linked N-acetylglucosamine. One of the mannose units is substituted at C3 with alpha-glucose, and one is substituted at C3 with alpha-(2-O-acetyl)-abequose. All the mannosyl linkages appear to have the beta-configuration; the N-acetylglucosaminyl linkage has the alpha-configuration. In bacterial agglutination and passive hemagglutination in some Salmonella antisera, Citrobacter 396 as well as its O-antigenic lipopolysaccharide expressed the serological factors 5 and 6. In corroboration of our structural studies, this showed the presence of alpha-(2-O-acetyl)-abequosyl-1,3-mannose (factor 5) and alpha-glucosyl-1,3-mannose (factor 6).
PMCID: PMC222274  PMID: 207667

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