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Biomedical subjects

A Wilson

Publications and source records attributed to A Wilson.

At least 361 records · Page 20Linked to original sources
PubMed1989

Levels of adaptation and narcissistic psychopathology.

Why, one might reasonably query, do some narcissistic characters serve time as seemingly successful presidents of corporations while others serve time as seemingly impaired inpatients on psychiatric units? I will offer some observations on this unusual clinical phenomenon and suggest that it is useful to distinguish between two clinical presentations of narcissistic character psychopathology, which I will call, for the sake of expedience, Level 1 and Level 2. I will then examine 1) how an understanding of the dimensions of empathic abilities, paranoia, levels of depression, grandiosity, and defensive uses of denial and disavowal can lend a broad explanatory range to the understanding of these levels, and 2) how we can assess both successful and unsuccessful adaptation to the outer world and the inner world in narcissistic disorders. Moreover, it is important to distinguish between being well adapted and being emotionally healthy, which are quite different in meaning and intent. I use the term Level 1 to refer to the more poorly adapted presentation, and the term Level 2 to refer to the more successfully adapted narcissistic presentation. Characteristics of Level 1 narcissistic pathology dispose a patient to an adaptation that is similar to the description of the narcissistic patient who is often described as borderline; characteristics of Level 2 narcissistic pathology dispose a patient to a high-flying and superficially successful adaptation in which the patient can competently navigate the occupational and social demands of an external world despite the presence of severe object relational impairments. While a difference in adaptation is highlighted, emotional well-being is not within the exclusive province of either's characteristic adaptive skills.

Adaptation, Psychological↗
PubMed1989

The acquisition of CD4 and CD8 during the differentiation of early thymocytes in short-term culture.

Subpopulations of thymocytes known to represent early stages of T cell development were isolated from the adult mouse thymus, and their ability to differentiate during short periods of culture was assessed by their acquisition of surface CD4 and CD8. Virtually all cells of the most mature of the CD4-CD8- thymocyte subpopulations (other surface markers CD3- HSA++ IL-2R-Pgp-1-) and of the immature CD4-CD8+ thymocyte subpopulation (other surface markers also CD3- HSA++ IL-2R- Pgp-1-) became CD4+CD8+ in less than 1 day of culture without added stimuli or growth factors. This suggested they had already received signals initiating CD4 and CD8 acquisition. However, stimulation of these precursor cells with phorbyl ester and ionomycin prevented this acquisition of CD4 and CD8. No distinct CD4-CD8+ intermediate was detected as the CD4-CD8- cells became CD4+CD8+ in the non-stimulated cultures, thus questioning the assumption that these three groups of cells are sequential steps in one lineage. In contrast to this pre-programmed acquisition of CD4 and CD8, the less mature CD4-CD8- IL-2R+ subpopulation did not progress to the CD4+CD8+ stage in culture, although it is able to develop further on intrathymic transfer. It is likely that this subpopulation represents a control point requiring specific differentiation signals for further development.

Animals↗
PubMed1989

A randomised trial of empirical antibiotic therapy in febrile neutropenic patients with hematological disorders: ceftazidime versus azlocillin plus amikacin.

One hundred and two patients with neutropenia (less than 1 x 10(9)/L) secondary to primary hematological disorders or chemotherapy for hematological malignancies were prospectively randomised, upon the development of fever or other signs of infection, to receive empirical antibiotic treatment with either ceftazidime (+/- flucloxacillin) (n = 52) or azlocillin plus amikacin (+/- flucloxacillin) (A&A, n = 50). The two groups were equivalent with respect to clinical and laboratory parameters prior to antibiotic therapy and flucloxacillin was added to approximately 25% of the patients in each group on the clinical suspicion of Gram positive infection. When assessed at 96 hours, the complete response rates were 59.6% for the ceftazidime treated patients and 44% for A&A treated patients. Partial response rates were 17% and 20% respectively. This difference was not statistically significant. Eight patients died whilst on the trial, three of those initially randomised to ceftazidime and five initially randomised to A&A. Moderate to severe hypokalemia was encountered significantly less often in the ceftazidime treated group (p less than 0.01), whilst other parameters of toxicity were equivalent. No primary or acquired resistance to ceftazidime was encountered. Separate analysis of those patients who did not receive flucloxacillin yielded identical results. We conclude that ceftazidime (+/- flucloxacillin) is as efficacious as azlocillin plus amikacin (+/- flucloxacillin) in the empirical antibiotic management of such patients and is associated with a lower incidence of moderate to severe hypokalemia.

Adolescent↗
PubMed1989

Medical practitioners and health promotion: results from a community survey in Sydney's western suburbs.

A health survey of 484 persons aged 14 to 89 years was conducted in Sydney's western suburbs in May 1987. Its aims included a description of preventive activities undertaken by medical practitioners and an assessment of the community's perception of the doctor's role in health promotion. Ninety-three per cent reported visiting a doctor in the previous year and 31 per cent of respondents reported having contact with a general practitioner the fortnight before the survey, either for their own health or that of another. Eighty per cent of respondents reported having had their blood pressure measured in the previous year and 63 per cent of female respondents aged 18 years and over who had not had a hysterectomy reported having had a Pap smear in the last five years. However, few respondents reported receiving any lifestyle-related advice at their most recent doctor visit and 77 per cent said that the food they ate was rarely or never discussed with their doctor. Despite this low level of advice, doctors and nurses were perceived to be the most important source of health information by nearly half the respondents. Strategies for increasing the involvement of doctors in health promotion are discussed.

Adolescent↗
PubMed1989

Metformin treatment of lean and obese Zucker rats modulates the ability of glucagon and insulin to regulate hepatocyte adenylate cyclase activity.

Glucagon stimulated adenylate cyclase activity some 21-fold in liver membranes from lean (Fa/Fa) and some 20-fold in membranes from obese (fa/fa) Zucker rats, with constants yielding half-maximal activation (Ka values) of 12.6 and 120.1 nmol/l respectively. Treatment of animals with the biguanide drug metformin (N',N'-dimethylbiguanide) decreased the ability of glucagon to stimulate this enzyme to some 16-fold for both the lean and obese animals and reduced the Ka values for activation of this enzyme by glucagon to 6.3 and 60.9 nmol/l respectively. Insulin inhibited glucagon-stimulated adenylate cyclase activity by some 24% in liver membranes from lean animals and some 17% in liver membranes from obese animals, with constants yielding half-maximal inhibition (Ki values) of 110 and 160 nmol/l respectively. The ability of insulin to inhibit the adenylate cyclase activity, from obese but not lean animals, was attenuated when insulin concentrations over 5 nmol/l were employed. Treatment of animals with metformin profoundly altered the sensitivity of adenylate cyclase to inhibition by insulin, with inhibition being increased to some 32% using liver membranes from either lean or obese animals. Values of Ki for this inhibitory action of insulin were 520 and 500 nmol/l using membranes from the lean and obese animals respectively, and no reduction in the ability of insulin, at concentrations over 5 nmol/l, to inhibit adenylate cyclase activity was observed using membranes from obese animals. Metformin also changed the kinetics of inhibition of adenylate cyclase by insulin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenylyl Cyclase Inhibitors↗
PubMed1989

Extending appointment length--the effect in one practice.

The effects of extending appointment length from 7.5 to 10.0 minutes in the evening surgeries of two general practitioners in one general practice were examined. The mean consultation length increased from 7.4 to 8.4 minutes. Most of this change appeared to be due to a small increase in the length of shorter consultations and was true for all age groups. The time that patients had to wait did not decrease and for one doctor actually increased. However, the results suggest that with longer appointments there is more discussion of lifestyle factors and more screening activity.

Adult↗
PubMed1989

Survey of practice annual reports.

A questionnaire was sent to those practices known by the Royal College of General Practitioners to have produced annual reports. Practices were asked what data they included, to whom the report was circulated, what problems and benefits they encountered, and their opinion of the government's proposal to encourage such reports. The data most frequently included in reports related to practice workload, and the main benefit which respondents mentioned was facilitation of planning within the practice. Few practices used data derived from outside the practice and several commented on the difficulty of obtaining good quality data from the practice. Although annual reports are useful as internal documents, standardization of definitions and format, with support from family practitioner committees and health authorities is essential if more practices are to be encouraged to produce such documents and if the information obtained from them is to have a broader role in planning for primary health care.

Annual Reports as Topic↗
PubMed1989

Activation mechanisms of the Xenopus beta globin gene.

Comparative protein binding studies have been performed on the Xenopus beta globin gene promoter. Erythroblast nuclear extracts 'footprint' over the erythroid-specific consensus sequence, AGGATAAG, which is located immediately upstream of the CCAAT footprint. Nonerythroid cell extracts do not give rise to an AGGATAAG footprint but rather to an extended CCAAT footprint reminiscent of the CCAAT displacement protein (CDP). Erythroblast extracts also protect a sequence similar to the chicken stage selector element (SSE) immediately downstream of the CCAAT box footprint. In contrast to these discrete footprints observed using erythroblast extracts, Xenopus erythrocyte nuclear extracts give rise to more extensive promoter protection. We have previously reported that this promoter is active in transfected HeLa cells when linked to the SV40 enhancer and that transcriptional activation is accompanied by the formation in the chromatin of a nuclease hypersensitive site (HS) in this region. As a first step towards defining the roles of the various promoter-binding proteins in transcriptional activation and HS formation, we transfected deletion mutants of the promoter into HeLa cells. Deletion of the sequences upstream of -116 had no effect on transcription or HS formation. Indeed the upstream boundary of the HS remained unchanged (at around-170) even though plasmid sequences had replaced Xenopus sequences. If the HS boundary reflects resumption of nucleosomal structure, then sequences downstream of -116 must be able to position a nucleosome from at least 50 bp away. beta globin gene activation in a number of transfected cell lines is absolutely dependent on DNA replication. The replication requirement is not a consequence of template copy number or methylation, nor is it dependent on the direction in which the replication fork passes through the gene. We conclude that replication facilitates active transcription complex formation by disrupting a stable association of the template with negative factors, which could include histones. About 200 bp upstream of the Xenopus beta globin gene promoter is a tract of alternating A and T residues which adopts cruciform geometry at low levels of supercoiling. Because of this sensitivity to torsional stress, we have probed the structure of the (AT)n sequence in microinjected Xenopus oocytes, where the Xenopus beta globin gene is transcribed very efficiently. We find that S1 nuclease cleaves specifically in the middle of the (AT)n tract, suggesting that the gene is under torsional stress.

Animals↗
PubMed1989

A review of the prevalence and causes of myopia.

In this study, we reviewed the prevalence of myopia by country. Different types of myopia are elaborated and the causes of myopia are presented. It appears that the origin of myopia is due to both environmental and genetic factors.

Animals↗
PubMed1989

A hierarchical model of opiate addiction. Failures of self-regulation as a central aspect of substance abuse.

In this paper, we first examine and recast the research literature on opiate addiction in the light of a hierarchical model of self-organization. The hierarchical model consists of five modes of psychological and psychobiological functioning defined epigenetically. Research and theories of opiate addiction are classified as to their primary modal emphases. We then describe failures of self-regulation as particular vulnerabilities along the first three modes of the hierarchy. A measure of this construct, the Scale for Failures in Self-Regulation (SFSR), a projective measure that utilizes Thematic Apperception Test responses, is introduced for the study of opiate addicts. The SFSR was administered to normal and opiate-addicted subjects in order to examine the predictive and explanatory power of the hierarchial model. A multivariate analysis of variance showed the addicts to have greater difficulties in self-regulatory functioning than normal subjects. In terms of the hierarchical model, the implications of these findings for the questions of severity of illness, psychotherapy technique, and future research are discussed.

Adult↗
PubMed1989

The state of South Dakota's child: 1988.

South Dakota's five year (1982-86) mean neonatal mortality rate (6.2) has achieved the Surgeon General's 1990 goal of 6.5 and is lower than the 7.1 national mean rate. The rate of post neonatal mortality continues to be an area of concern, especially for the non-white population whose five year mean rate is twice that of the nation. Inadequate utilization of prenatal care in South Dakota is significantly related to higher neonatal and post neonatal mortality, higher admission rates to neonatal intensive care and higher costs for neonatal intensive care. Improving access and utilization of prenatal care is advocated as a cost effective and humane investment of public resources.

Birth Rate↗
PubMed1989

The current status of surgery for bullous emphysema.

The great majority of cases of emphysema are generalized with diffuse involvement of all portions of the lung: Clearly, surgery has little to offer in such cases. In contrast, there is an uncommon variant involving primarily the upper lobes and the superior portions of the lingula and lower lobes, which spares the relatively normally functioning lower lobes. A number of diagnostic tests are available to identify compression of uninvolved lower lobe tissue, the most reliable of which identify pulmonary vasculature that is crowded together. We suggest that whole lung tomograms or pulmonary angiograms provide the most convincing evidence of compression of normal tissue. In properly selected patients with compression or displacement of normal lung, thoracotomy with simple excision of the bullae is tolerated by even the most ill patients if care is taken to carefully support the patient postoperatively with assisted ventilation and prolonged chest tube suction. There were no deaths in 19 patients and the results were rewarding, often spectacular, and surprisingly enduring. It is likely that some patients with operable bullous emphysema are not being studied or offered operation because of a lack of knowledge about the benefits possible with bullectomy.

Adult↗
PubMed1988

The Western Sydney Health Study: results of the shopping-centre survey.

The Western Sydney Health Study is a two-phase descriptive study that is designed to provide data on the health-related knowledge, attitudes and behaviour of persons in the Western Metropolitan health region, which has higher-than-average death rates of many disorders that are associated with life-style. In the first phase of the study, 2164 respondents were interviewed in six shopping centres in the region. The prevalence rates of self-reported cardiovascular disease and diabetes were about twice those that were found in the Australia-wide National Heart Foundation Risk Factor Prevalence Study in 1983. The prevalence rates of smoking and self-reported raised blood lipid levels were also high. Doctors and nurses were the main sources of health information, and the media was less important as a source of health information than was found in the Better Health Commission's national survey in 1985. Over 80% of respondents believed that a lowering of the dietary fat intake and an increase in exercise were health-enhancing behaviours. Given this high level of health knowledge, the major aims for health promotion in the region should be a social change to facilitate choices towards healthy behaviour and the provision of skills to enable individual behavioural changes.

Adolescent↗
PubMed1988

T cell antigen receptor expression by subsets of Ly-2-L3T4- (CD8-CD4-) thymocytes.

The V beta 8-specific mAb F23.1 and KJ16 were used as fluorescent stains to test for TCR expression on the surface of subpopulations of early, CD4-CD8- (L3T4-Ly-2-) thymocytes from adult CBA mice. A surprisingly high proportion (27%) of Ly-2-L3T4- thymocytes were strongly F23.1 and KJ16 positive. No positive cells were detected among Ly-2-L3T4- thymocytes from V beta 8-negative SJL mice. In contrast to the adult thymus, Ly-2-L3T4- cells from embryonic CBA thymus lacked F23.1-positive cells. Subsets of adult CBA Ly-2-L3T4- thymocytes were separated to determine which expressed V beta 8. The major subset, Ly-1 low B2A2-M1/69+Thy-1+Pgp-1-, representing a phenotype similar to embryonic Ly-2-L3T4- thymocytes and the phenotype commonly isolated from adult thymocytes as Ly-1 "dull," lacked cells strongly positive for F23.1. In contrast, a series of subsets of adult CBA Ly-2-L3T4- thymocytes which were B2A2-M1/69- and Pgp-1+ all included strongly F23.1-positive cells. A minor subset, negative for most markers except Pgp-1 and presumed on the basis of this phenotype and some reconstitution studies to include the earliest intrathymic precursors, contained 28% F23.1-positive cells. However, no F.23.1-positive cells were detected in equivalent "prethymic" populations from bone marrow or from athymic mouse spleen. The subsets of Ly-2-L3T4- thymocytes which were Ly-1 high, B2A2-M1/69-, and Pgp-1+ all contained about 70% F23.1-positive cells, indicating a V beta 8 usage much higher than the mature T cell average. These results indicate that a series of distinct developmental events have occurred within these CD4-CD8- thymocytes previously considered as a single group of early precursor cells, and that some aspects of repertoire selection may be occurring amongst thymocytes which lack CD4 or CD8.

Aging↗
PubMed1988

Subpopulations of early thymocytes. A cross-correlation flow cytometric analysis of adult mouse Ly-2-L3T4-(CD8-CD4-) thymocytes using eight different surface markers.

Putative early thymocytes, the Ly-2-L3T4-(CD8-CD4-) cells representing 3 to 4% of adult CBA mouse thymic lymphocytes, were isolated in high purity (99.5%). They were then stained by using mAb and analyzed by flow cytometry for the expression of six additional surface antigenic markers. Cross-correlation of the data obtained from a complete series of successive two-parameter analyses revealed the existence of about 11 discrete subsets, falling into four-main groups, within the Ly-2-L3T4- population. All subsets consisted of relatively large lymphoid cells. The most numerous group of Ly-2-L3T4- cells was Ly-1 low B2A2-M1/69 high Thy-1 high Pgp-1 low and by these markers resembled Ly-2+L3T4+ cortical blasts. Many of the cells in this group were positive for the IL-2R and/or for MEL-14. A second major group of Ly-2-L3T4- cells was Ly-1 high B2A2-M1/69 low Pgp-1 high, and resembled in some respects activated mature T cells. This group had previously been shown to be absent from the embryonic thymus. The group could be divided into Thy-1 high and Thy-1 low subsets. None of the cells in this group were positive for the IL-2R and very few expressed MEL-14. A third group, 13% of the Ly-2-L3T4- population, was Ly-1 low B2A2-M1/69 low Pgp-1 high, and could also be divided into Thy-1 high and Thy-1 low subsets. A final minor group, 9% of the Ly-2-L3T4- population, was Ly-1 high B2A2-M1/69 high Pgp-1 low Thy-1 high. The particular pattern of markers on these subsets, combined with subsequent information on their properties, makes it unlikely that they all represent sequential steps in one continuous developmental stream, and indicates that complex developmental steps have occurred, even at this supposedly early stage of T cell differentiation.

Aging↗
PubMed1988

Subpopulations of CD4- CD8- murine thymocytes: differences in proliferation rate in vivo and proliferative responses in vitro.

Cell sorting and cytotoxic depletion procedures were used to subdivide the population of CD4- CD8- ("double-negative") thymocytes from adult CBA mice on the basis of expression of Ly-1, HSA (the "heat-stable antigen" M1/69 or B2A2), Pgp-1 glycoprotein, Thy-1, MEL-14 and the PC61 antigenic determinant on the IL2 receptor (IL2R). The level of dividing cells within these subsets was assessed by brief in vivo administration of [3H]-thymidine, followed by radioautography, or by flow cytometric cell cycle analysis after DNA staining. The capacity of the subsets to proliferate in culture, in response to stimulation with concanavalin A (Con A), or with phorbol myristate acetate (PMA) and the calcium ionophore ionomycin, was assessed in high cloning efficiency single-cell culture systems. In general, the proliferative response in culture was inversely related to the rate of cell division in vivo. Response of the double-negative subsets to Con A correlated with expression of the T cell antigen receptor complex; although a high cloning efficiency was obtained from the receptor-positive fractions, very few of the clones were cytotoxic. In particular, a major Ly-1+ HSA- Pgp-1+ double-negative subset, as well as minor Ly-1- HSA- Pgp-1+ subsets, contained very few cells in cycle in vivo, but showed a high cloning efficiency in both culture systems. Conversely, the other major double-negative subset, Ly-1- HSA+ Pgp-1-, included most of the cells in cycle, but showed a reduced cloning efficiency in response to PMA and ionomycin and failed to respond to Con A. The dividing cells within the Ly-1- HSA+ Pgp-1- group were strongly enriched in the IL2R- rather than in the IL2R+ subset, suggesting IL2 was not the growth factor maintaining their proliferation in vivo.

Animals↗