Cell surface biotinylation of GLUT4.
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Adipocytes↗
Biomedical subjects
A Jones
Publications and source records attributed to A Jones.
A 'bonding between strangers': a palliative model of clinical supervision.
This paper examines the role of clinical supervision in relation to the work of palliative care nurses. Through a single 'paradigm' case study illustration the author explores a phenomenologically guided palliative method of supervision. It is suggested that such means of supervised clinical practice forge a bond between patients, families, nurse and colleagues. The discussion explores ethical issues related to supervisory relationships including language, power and gender. The paper concludes with the central recommendation that, aside from methodological considerations, constructing a safe working environment for clinical supervision is important.
Anger↗
Death, poetry, psychotherapy and clinical supervision (the contribution of psychodynamic psychotherapy to palliative care nursing).
This paper explores one facet of a therapeutic relationship with a woman suffering from inoperable cervical cancer. The psychotherapy sessions were conducted in both hospital and the family home and continued on a weekly basis until final termination immediately prior to the woman's death. Through a "suspense structure' case study narrative, the writer, a nurse psychotherapist, describes the way in which the humanities, art and poetry can provide a means through which to understand seemingly incomprehensible feelings related to reviewing past events as a preparation for death. While no explicit critique is made of the twin psychoanalytical concepts of transference and countertransference, the occurrence is woven into the text. The essential nature of clinical supervision is illustrated in context. The author proposes that engagement in a therapeutic relationship with a dying person presents the worker with parallel struggles manifesting in elementary feelings which require discernment. The central recommendation of this paper is that the rich symbolic language and metaphors, redolent in art and poetry, be harnessed as a potent therapeutic tool. Throughout the discussion, the terms counselling and psychotherapy are used interchangeably.
Death↗
Antioxidant deficiency following clam enterocystoplasty.
OBJECTIVE: To assess whether there is a reduction in serum antioxidant activity in patients who have undergone a clam enterocystoplasty procedure. PATIENTS AND METHODS: Serum glutathione peroxidase (GPase) activity was measured in 20 patients who had undergone clam enterocystoplasty. Serum selenium concentration was also measured in 62 similar patients and compared with 56 healthy controls and 44 patients with a neuropathic bladder, mainly patients with spinal cord injuries who had not undergone surgery. RESULTS: GPase activity correlated well with serum selenium measurement. There was a significant reduction (P < 0.001) in serum selenium level in young (< 50 years old) non-neuropathic bladder patients following clam enterocystoplasty. This reduction in serum selenium was similar to that found in both unoperated patients with a neuropathic bladder (who are known to have an increased risk of developing bladder cancer) and those patients with a neuropathic bladder who had undergone augmentation. This reduction was not related to urinary tract infection nor the time since surgery. CONCLUSION: A reduction in serum selenium has been shown to increase susceptibility to bladder cancer following carcinogenic exposure to compounds such as nitrosamines. This study suggests that patients with idiopathic and congenital instability may be at an equally high risk as a result of undergoing this procedure.
Adolescent↗
Isolation and genomic analysis of the rat polymeric immunoglobulin receptor gene terminal domain and transcriptional control region.
The polymeric immunoglobulin receptor (pIgR) transports IgA and IgM across secretory epithelial cells and is essential in external immunity maintenance. We report here the structural characterization of the single-copy rat gene distributed over 30 kb of chromosomal DNA and analysis of its transcriptional control region. RNA sequencing and genomic analysis show a 5' terminal region originates at a major (+1) and a minor site producing an unusual 124-bp nontranslated exon I separated from a small 96-bp initiator ATG coding exon II by a 7.5-kb intron. The pIgR 5' region comprises a structured promoter with abundant helix-loop-helix (bHLH) cis elements positioned within an equivalent internal -70, -290, -528, and three centered at -745. The three latter bHLH elements each occur within 30-bp repeats at -690 to -780. Transient expression assays show a 1.3-kb 5' region is sufficient to drive expression in rat primary hepatocyte monolayer cultures, transformed human hepatic (HepG2) cells, and a mammary epithelial tumor cell line MCF-7, but is inactive in the rodent fibroblast 3T3 cell line. A minimal transcriptional promoter domain was deduced from sequentially deleted vectors revealing a +40 to -922 sequence to be sufficient for full activity. Further deletions within this region yield incremental losses in cis activity, indicating that multiple subregions comprise an extended transcriptional control region.
Animals↗
Inadvertent intra-articular injection of the wrong substance.
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Adult↗
Helping students learn to think like experts when solving clinical problems.
Analysis of problem-solving strategies reveals that although there is no universal, generic problem-solving process, there is a clinical reasoning process that is specific and highly tailored to the complexity of each clinical problem. Research reveals that successful problem solvers must possess comprehensive knowledge, but that the way they organize and understand their knowledge is even more critical. Moreover, using "schemes" for both learning and problem solving provides the advantage of combining the creation of a knowledge structure and a search-and-retrieval strategy into a single operation. (A "scheme" in this context is a mental categorization of knowledge that includes a particular organized way of understanding and responding to a complex situation.) The implication for medical education is that a comprehensive knowledge domain must be appropriately organized for knowledge mastery, which in turn is essential for clinical problem solving. Problem-solving strategies must be specific for each problem and not based on the assumption of a universal generic process. Consequently, a new taxonomy of medical problems is recommended, along with an altered problem-based learning (PBL) format. The "hypothetico-deductive" strategy traditionally used in PBL should be replaced by scheme-driven search strategies so that students develop a more organized and logical approach to problem solving.
Clinical Competence↗
Muscle weakness in osteoarthritis.
Muscle has an integral role in the structure and function of joints. Evidence for muscle weakness in osteoarthritis of the knee exists and is not fully explained by the effects of aging. Weakness is associated with pain and disability. The temporal relationship requires further study, but preliminary evidence for a causative role is emerging. Muscle weakness can be assessed in various ways. Voluntary measures of strength are affected by degree of effort. In osteoarthritic patients, as in other patient groups, effort may be influenced by pain and psychologic outlook. Techniques to estimate muscle activation are available but have yet to be fully explored in osteoarthritis. Quadriceps exercises increases strength and may have beneficial effects on pain and function. The long-term benefits of exercise for therapy and possible prevention of osteoarthritis are not yet known. This is an exciting area of research, and it is anticipated that more findings will emerge in the near future.
Aging↗
Broad-range and binary-range acyl-acyl-carrier protein thioesterases suggest an alternative mechanism for medium-chain production in seeds.
In the current model of medium-chain (C8-14) fatty acid biosynthesis in seeds, specialized FatB acyl-acyl-carrier-protein (ACP) thioesterases are responsible for the production of medium chains. We have isolated and characterized FatB cDNAs from the maturing seeds of elm (Ulmus americana) and nutmeg (Myristica fragrans), which accumulate predominantly caprate (10:0)- and myristate (14:0)-containing oils, respectively. In neither species were we able to find cDNAs encoding enzymes specialized for these chain lengths. Nutmeg FatB hydrolyses C14-18 substrates in vitro and expression in Brassica napus seeds leads to an oil enriched in C14-18 saturates. Elm FatB1 displays a binary specificity: one activity is centered on 10:0-ACP, and a second is centered on palmitate (16:0)-ACP. After expression in B. napus seeds the oil is enriched in C10-18 saturates, predominantly 16:0, 14:0, and 10:0. The composition of free fatty acids produced by elm FatB1 in Escherichia coli shifts from C14-16 to mostly C8-10 by increasing the rate of chain termination by this enzyme. These results suggest the existence of an alternative mechanism used in the evolution of medium-chain production, a model of which is presented.
Amino Acid Sequence↗
Funeral for a friend (an existential view on hospital closure).
Views the closure of a hospital in an unusual manner. Questions the role of health workers as "care in the community" comes to the fore. Raises questions about psychiatric hospitals, people with mental health problems and mental health workers.
Emotions↗
The Lead Lecture as an adjunct to experiential learning (an appropriate modality for the introduction of issues related to death, loss and change).
Issues related to grief in response to loss and developmental changes are of significance to palliative care cancer nurses. This paper is essentially an educational debate although the issues effect all who concerned with palliative cancer care nursing. It reviews selected literature related to the lecture method of teaching. The author makes a case for using the Lead Lecture approach with experiential learning. It is considered an appropriate means through which to introduce palliative nurses to sensitive issues intimately connected to grief. The author explores experiential and student centred methods of learning, concluding that we should approach them with a certain amount of caution; we can expose the learner to too much too soon. The central recommendation of the paper is for an integrated approach, harnessing the potential of group led tutorials and clinical supervision. An outline seminar plan provides a conceptual route map.
Adaptation, Psychological↗
An assessment of the peripheral antinociceptive potential of remoxipride, clonidine and fentanyl in sheep using the forelimb tourniquet.
A modification of the intravenous regional anaesthesia technique was used to assess the peripheral antinociceptive effect of remoxipride, clonidine and fentanyl. Drugs administered intravenously via peripheral catheters were restricted to the distal limb and nociceptive threshold test site by prior inflation of a tourniquet proximal to both the catheter and a threshold-testing device. Lignocaine (1 mg/kg) induced peripheral antinociception during tourniquet inflation. Clonidine (6 micrograms/kg) only induced significant elevations in thresholds after tourniquet deflation. A low dose of remoxipride (2 mg/kg), which had no systemic antinociceptive effect, produced antinociception after its restriction to the periphery. Peripheral administration of saline and tourniquet-induced restriction of blood flow to the distal limb did not alter threshold values. Peripheral administration of fentanyl was used to test a further modification of the injection protocol designed to reduce the incidence of leakage into the systemic circulation. Fentanyl administration (11.2 micrograms/kg) failed to elicit an increase in thresholds when it was restricted to the distal limb test site. The contribution of a peripheral mechanism to the antinociception induced by systemic administration of a higher remoxipride dose (7.5 mg/kg) was investigated using an inflated tourniquet to exclude remoxipride from the periphery. Exclusion of remoxipride from the periphery reduced its antinociceptive effect, i.e. threshold values were lower than if remoxipride was allowed free access to the limb prior to tourniquet inflation. The technique described here was effective in demonstrating that the increase in noninflammatory nociceptive thresholds seen with clonidine and fentanyl is not peripherally mediated whilst that seen with remoxipride has a peripheral component.
Adrenergic alpha-Agonists↗
Ganglioneuroma of the adrenal medulla.
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Adrenal Gland Neoplasms↗
Clear-cell transitional cell carcinoma.
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Adenocarcinoma, Clear Cell↗
Impact of litigation on senior clinicians: implications for risk management.
OBJECTIVES: To investigate the impact of litigation on consultants and senior registrars and to establish their views on methods of reducing adverse events and litigation. DESIGN: Postal survey. SETTING: Acute hospitals in the North Thames (West) Regional Health Authority. SUBJECTS: 1011 consultants and senior registrars in acute hospitals. MAIN MEASURES: Perceived causes and effects of adverse events; views on methods of reducing litigation and adverse events. RESULTS: 769 (76%) doctors responded. 288 (37%) had been involved in litigation at some point during their career; 213 surgeons (49%) and 75 (23%) doctors in the medical specialties. Anger, distress, and feeling personally attacked were common responses to litigation. Clinicians' views on reducing litigation emphasised the need for change at the clinical level. Supervision of junior staff, workload, and training in communication skills were to the fore. CONCLUSIONS: The high frequency of doctors who have experienced litigation and the emotional responses described indicate that clinicians require support at several levels. At a personal level, support can be offered to clinicians going through the litigation process or after an adverse event. Also, managerial support is needed by offering financial and practical help in correcting the factors that have been consistently identified as producing high risk situations to minimise the possibility of a reoccurrence. Accidents in medicine are, by their very nature, costly in human and financial terms and the root causes must be tackled. Recommendations are made for clinicians and risk management teams.
Attitude of Health Personnel↗
Construction of two near-kilobase resolution restriction maps of the 5' regulatory region of the human apolipoprotein B gene by quantitative DNA fiber mapping (QDFM).
Quantitative DNA fiber mapping (QDFM) is a high-resolution technique for physical mapping of DNA. The method is based on hybridization of fluorescently labeled DNA probes to individual DNA molecules stretched on a chemically modified glass surface. We now demonstrate and validate a rapid QDFM-based approach for the mapping of multiple restriction sites and precise localization of restriction fragments in large genomic clones. Restriction fragments of a 70-kb P1 clone (P1-70) containing the 5' region of the human apolipo-protein B gene (APOB) were subcloned and mapped along straightened P1-70 DNA molecules. Multicolor fluorescence in situ hybridization (FISH) and digital image analysis allowed us to rapidly position 29 restriction fragments, ranging in size from 0.5 kb to 8 kb, and to map 43 restriction sites. The restriction map obtained by QDFM was in excellent agreement with information obtained by RecA-assisted restriction endonuclease (RARE) cleavage, long-range PCR, and DNA sequence analyses of the P1-70 clone. These data demonstrate that QDFM is a rapid, reliable method for detailed restriction site-mapping of large DNA clones.
Apolipoproteins B↗
Truth and deception in AIDS information brochures.
This essay documents state governmental subversion of expansive constructions of HIV-disease. While it is clear that governments frequently practice deception and secrecy with the justification that the public would become dangerously emotional and irrational if fully informed, there is no evidence that the public would, in fact, behave that way. The essay concludes with a ranking of state AIDS brochures for accuracy and totality of information.
Acquired Immunodeficiency Syndrome↗