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A B S T R A C T In the course of examining polymorphonuclear leukocyte (PMN) chemotaxis in patients w7ith systemic lupus erythematosus (SLE), we have found a previously undescribed serum inhibitor of complement (C5)-derived chemotactic activity. Serum from a 25-yr-old Black f'emale with untreated SLE, when activated with zymosan, failed completely to attract either her own or normal PMN. Incubation of normal PMN with the patient's serum did not aff'ect their subsequent random motility or chemotactic response toward normal zymosan-treated serum (ZTS). The patient's serum, however, did inhibit the chemotactic activity of normal ZTS and of column-purified C5-derived peptide(s), but had no effect on the chemotactic activity of either the synthetic peptide, N-formylmethionyl leucyl-phenylalanine or a filtrate prepared from a culture of Escherichia coli (bacterial chemotactic factor). The inhibitory activity in the patient's serum resisted heating at 56°C for 30 min and could be separated f'rom C5-derived chemotactic activity in the patient's ZTS (or normal ZTS that had been incubated with the patient's serum) by chromatography on Sephadex G-75. Despite its effect on C5-derived chemotactic activitv, the patient's serum did not influence two other C5-derived biologic activities: PMN lysosomal enzyme-releasing activity and PMN-aggregating activity. Chromatography of the patient's serum (65% ammonium sulfate pellet) on Sephadex G-200 yielded three distinct peaks of inhibitory activity. Two were This work was presented in part at the Eastern Section

The aim of this study was to understand home healthcare nurses' current experiences in obtaining outside clinical information at the point of care and the type of clinical information they most desire in their patients' health information exchange profile. A Web-based survey was deployed to home health workers in New York to learn about their experiences retrieving outside clinical data prior to having access to health information exchange, preferred data elements and sources in their patients' health information exchange profiles, and how availability of outside clinical data may affect emergency department referrals. Of the 2383 participants, 566 responded for a 23.8% overall response rate, and 469 of these respondents were RNs. Most RNs, 96.7%, agreed that easier and quicker access to outside information would benefit delivery of care, and 72.6% said the number of emergency department referrals would decrease. When asked about pre-health information exchange access to patient data, 96.3% said it was problematic. Inpatient discharge summaries were chosen most often by the RNs as a top five desired data element 81.5% of the time. Obtaining outside clinical information has been a challenge without health information exchange, but improved access to this information may lead to improved care. Further study is required to assess experiences with the use of health information exchange.

In the course of examining polymorphonuclear leukocyte (PMN) chemotaxis in patients with systemic lupus erythematosus (SLE), we have found a previously undescribed serum “inhibitor” of complement (C5)-derived chemotactic activity. Serum from a 25-year-old Black female with untreated SLE, when activated with zymosan, failed completely to attract either her own or normal PMN (measured by the “leading front” method of Zigmond and Hirsch). Incubation of normal PMN with the patient's serum (PS) did not affect random motility or chemotaxis towards normal zymosan-treated serum (ZTS). Whereas levels of C3 were modestly low in PS, no gross abnormalities involving alternative complement pathway activation could be detected. Furthermore, treatment of PS with zymosan resulted in the generation of normal amounts of C5-derived PMN lysosomal enzyme releasing activity (attributable to “C5a”). Incubation of normal ZTS or column (Sephadex G-75)-purified “C5a” with PS did not affect lysosomal enzyme releasing activity but did result in a significant dose-dependent diminution of chemotactic activity.