PRACTITIONER APPLICATION: Association of ACO Shared Savings Success and Serious Illness Spending

Thrombotic thrombocytopenic purpura (TTP) is a rare but serious illness of unknown etiology. Treatment by plasmapheresis has been reported to be effective but the mechanism for benefit is unknown. We have investigated the effect of plasmapheresis in 2 patients with TTP by quantitating platelet associated IgG (PAIgG) levels prior to and following plasmapheresis. Both patients had very high levels of PAIgG at presentation (90 and A8 fg IgG/platelet respectively, normal 0-5). in both, the PAIgG levels progressively fell to within the normal range and the platelet count rose following plasmapheresis. One patient remained in remission with normal platelet counts and PAIgG levels. The other relapsed after plasmapheresis and the PAIgG level rose prior to the fall in platelet count. Plasmapheresis was repeated and resulted in normalization of both the platelet count and PAIgG level. It is suggested that plasmapheresis removes antiplatelet antibody or immune complexes which may be of etiological importance in this illness.

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A simple test can help point to serious illness in children

10.3310/signal-000148 ◽

2015 ◽

Author(s):

Keyword(s):

Simple Test ◽

Serious Illness

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The Foundation of St Andrews Cathedral Priory, 1140.

The Scottish Historical Review ◽

10.3366/shr.2005.84.1.1 ◽

2005 ◽

Vol 84 (1) ◽

pp. 1-37 ◽

Cited By ~ 4

Author(s):

A. A. M. Duncan

Keyword(s):

Final Section ◽

Serious Illness ◽

Marian Devotion

The hitherto accepted date of the priory's foundation, 1144, was copied on the bishop's diploma from the bull of Lucius II, and is impossible; Bower's 1140 is to be preferred. The foundation narrative (FN) probably by Robert, the first prior, ascribes to a Pictish king the grant to St Andrew of the Boar's Raik, but that was ignored by Wyntoun and Bower and is probably wrong. It seems that Alexander I made this gift, renegued on it, and restored it towards the end of his life. Though intended to found an Augustinian priory, the Raik was kept by the bishop until in 1138-9 David I obtained from Nostell a prior, Robert; Robert was unable to advance the foundation through his reluctance to recruit canons from elsewhere, perhaps resisting Scone and/or Holyrood. He and clerics of his resided in a ‘parsonage’, the vacant house of one of the seven ‘parsons’ who represented the earliest clerics of St Andrews, and are uniquely described in FN; they developed the hospital. In 1140 David I and Earl Henry at St Andrews compelled the bishop to disgorge the Raik and thereby establish the priory. The date was probably St Andrew's day, 1140, a month after the foundation of the abbey of St Mary at Newbattle. Both foundations should be seen as thanksgiving for Henry's recovery from serious illness. A narrower dating is suggested for some St Andrews charters, the endowments showing a closer relationship with those of Holyrood abbey than with those of Scone priory. Prior Robert probably wished from the beginning to recruit the céli Dé (Culdees) as canons and to obtain their endowments, succeeding at Lochleven but, despite papal and royal approval, failing at St Andrews. A final section asks why David I was so generous to the regular orders, suggesting that he was much influenced by the development of Marian devotion in his lifetime, when the Virgin had become head and most powerful of the hierarchy of saints.

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