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Biomedical subjects

C E Lewis

Publications and source records attributed to C E Lewis.

At least 145 records · Page 8Linked to original sources
PubMed1990

The limitations of generic AIDS educational programs for the health professions.

Three major trends are driving the widespread need for continuing education in AIDS. First, with the spread of AIDS, increasing numbers of health care professionals are becoming involved in the care and treatment of AIDS, ARC and HIV positive individuals. Second, as the disease spreads beyond current AIDS epicenters, more persons with minimal information are required to have a baseline working knowledge of AIDS. Finally, the reluctance of many health care professionals to care for HIV-positive individuals, along with already existing staff shortages, limits access to care and makes the provision of responsive educational programs even more important. Generic programs to educate health professionals frequently lack sufficient specificity and sensitivity to address the needs of health professionals with varying levels of knowledge and role responsibility. This paper briefly summarizes the literature on the similarities and differences in knowledge and attitudes across and within professional groups. In addition, it presents specific research designed to provide initial direction for considering the circumstances under which health professionals, particularly nurses and physicians, may or may not profit from generic programs aimed at mixed levels and types of health care provider.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The stresses of hospitalization among AIDS patients on integrated and special care units.

This study examined the stresses of hospitalization in AIDS patients and assessed the extent to which two different inpatient delivery systems differed with respect to perceived stresses in these patients. Patients from four AIDS dedicated special care units (SCU's) and five AIDS integrated units (IU's) in eight acute care hospitals were surveyed using a modified version of the Volicer Hospital Stress Rating Scale. Stresses related to loss of independence, separation from loved ones and problems with medications were experienced equally by both groups of patients. However, SCU patients had lower total hospital stress scores than IU patients in terms of the number of stresses experienced (p = 0.008) and how bothersome these stresses were perceived to be (p = 0.02). Additionally, patients on IU's more frequently experienced and were bothered by factors associated with ambiguity about their care and condition and feelings of abandonment and impersonal or discriminatory treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Effects of ethanol on human monocyte/macrophage lysozyme storage and release. Implications for the pathobiology of alcoholic liver disease.

The effect of ethanol on the release and/or intracellular accumulation of lysozyme (LZM) by human monocytes and monocyte-derived macrophages (mø) was investigated in vitro. A reverse haemolytic plaque assay, to detect and quantify LZM release by individual cells was combined with quantitative immunocytochemistry using LZM and the pan-macrophage monoclonal EBM/11 as markers. Ethanol had no effect on monocytes; however it reduced secretion of LZM by a mø subpopulation. Ethanol also reduced both the total number of mø immunoreactive for LZM, (but not EBM/11), and the proportion of LZM-secreting mø containing detectable LZM. The latter was correlated with an increase in the proportion of LZM-secreting mø that were not immunoreactive for this enzyme. These data suggest functional heterogeneity amongst human macrophages with a mø subpopulation which responds to ethanol exposure with a drop in both content and release of LZM. This might have implications for macrophage function in alcoholic liver disease.

Cell Separation↗
PubMed1990

The AIDS-related experiences and practices of primary care physicians in Los Angeles: 1984-89.

Telephone interviews of random samples of Los Angeles primary care physicians in 1984, 1986, and 1989 obtained information about their AIDS-related practice experiences, and sexual history taking. Data from mid-1989 reveal almost 74 percent have worked up at least one patient for AIDS or HIV infection in the past six months and 39.5 percent are caring for at least one patient with AIDS or AIDS-related complex. Self-reported use of appropriate sexual history questions has improved substantially over this five-year period.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Differential effects of LPS, IFN-gamma and TNF alpha on the secretion of lysozyme by individual human mononuclear phagocytes: relationship to cell maturity.

Human mononuclear phagocytes can be activated to perform a variety of complex functions by exposure to the immunomodulators, lipopolysaccharide (LPS), interferon-gamma (IFN-gamma) and tumour necrosis factor alpha (TNF alpha). Although such activation often involves the release of various cytokines by monocytes and macrophages, little is known of the effects of such signals on their secretion of lysozyme (LZM). In this study, a reverse haemolytic plaque assay for LZM secretion is coupled with immunocytochemistry for the pan macrophage (CD68) marker, EBM/11. This enabled the direct effects of LPS, IFN-gamma and TNF alpha on the secretion of LZM by individual, immunoidentified human mononuclear phagocytes to be investigated. The overall secretion of this peptide by populations of freshly isolated or 3-day cultured monocytes was augmented by exposure for 6 hr to bacterial LPS, recombinant human IFN-gamma or recombinant human TNF alpha. Extension of the culture period for monocytes from 3 to 7 days prior to use in the assay resulted in higher levels of LZM secretion, which could be further increased by TNF alpha but not by LPS or IFN-gamma. Individual peritoneal macrophages activated by inflammation in vivo were uniform in their augmented LZM responses to TNF alpha, but a small subpopulation of human peritoneal macrophages, which may represent younger 'inflammatory' exudate macrophages, was seen to be preferentially responsive to the LZM-stimulating effects of LPS and IFN-gamma. These studies suggest that (i) secretion of LZM by human mononuclear phagocytes can be regulated by LPS and IFN-gamma, although the effects of these agents may be dependent upon the state of maturation and/or differentiation of the cells, and (ii) TNF alpha is a potent stimulant of LZM secretion by monocytes and macrophages irrespective of cell maturity.

Cell Differentiation↗
PubMed1990

Consequences of empowering children to care for themselves.

The social climate of the past 3 decades has resulted in an increased interest in empowering children to participate in their own health care. Research conducted over the past 18 years by the authors suggests that children are quite competent to enter into programs that are child-centered and family-oriented, whose objectives are to teach children decision making, and to transfer increasing control over decision making related to health matters to the child. These studies indicate that children learn decision-making skills, and apply them quite competently, especially when the scope of decision making is clearly defined. Despite the evolution of programs that have been demonstrated by randomized control trials to effectively reduce the utilization of emergency rooms and hospitals by children with asthma, such programs have not diffused widely, not even into pre-paid health plans. Experience with two such programs indicates that the principle resistance to diffusion derives first from physicians, who are reluctant to share power with adult patients, let alone children, and even some of the parents themselves whose roles are threatened by such efforts.

Child↗
PubMed1989

Heterogeneity among human mononuclear phagocytes in their secretion of lysozyme, interleukin 1 and type-beta transforming growth factor: a quantitative analysis at the single-cell level.

Human mononuclear phagocytes have the remarkable capacity to secrete a wide range of products. The reverse hemolytic plaque assay was used to visualize and quantify the secretion of lysozyme, interleukin 1 or type-beta transforming growth factor by individual monocytes and macrophages. With this sensitive immunoassay, the release of these products by either freshly isolated monocytes, macrophages derived from monocytes in vitro, or activated peritoneal macrophages was detected in both the presence and absence of secretagogues. When coupled with immunocytochemistry for EBM/11, a monoclonal marker for human cells of the monocyte/macrophage cell lineage, functional heterogeneity was evident both in the amount of lysozyme, interleukin 1 or type-beta transforming growth factor released per cell, and in the number of EBM/11+ cells which secreted detectable levels of these products at any one time. In addition, there was a size-dependent heterogeneity among human monocytes and culture-derived macrophages in their ability to secrete interleukin 1 or lysozyme, respectively. We conclude that the secretory activity of individual mononuclear phagocytes is markedly heterogeneous.

Antibodies, Monoclonal↗
PubMed1989

Event-related brain potentials in depressed patients treated with electroconvulsive therapy.

1. As impairment of attention has long been recognized as a clinical feature of depression, we undertook to evaluate in depressed subjects and controls a feature of the event-related brain potentials (ERP) the N100 wave which has been linked to attentional processes. 2. This study involved collection of EEG data in an "auditory oddball" ERP paradigm in 9 depressed subjects prior to and following a course of 6 electroconvulsive therapy (ECT) treatments, as well as 11 controls. Concurrent Hamilton depression rating scales provided a measure of symptomatic severity. 3. Pretreatment N100 amplitude was significantly lower in the depressed group while N100 latency was greater than among controls, with treatment differences from control values disappeared. Further a robust correlation (r = 0.85 p less than or equal to .0038) emerged between N100 amplitude (increased amplitude being lower) and severity of depression. 4. Those results provide evidence for a physiological attentional disturbance in depression and suggest that certain features of this disturbance relate directly to symptom severity.

Adult↗
PubMed1989

Heterogeneity of responses to LH-releasing hormone and phorbol ester among rat gonadotrophs: a study using a reverse haemolytic plaque assay for LH.

Protein kinase C (PK-C) has been implicated in the action of LHRH because LHRH-induced release of LH is partially mimicked by phorbol esters which activate PK-C, and reduced in magnitude by inhibitors of PK-C. We have used a reverse haemolytic plaque assay for LH to visualize and compare the direct effects on individual rat gonadotrophs of (1) a 2-h exposure to a range of concentrations of LHRH and phorbol 12-myristate 13-acetate (PMA) and (2) a single maximally stimulatory dose (10 nM) of LHRH or PMA, or LHRH in the presence of inhibitors of PK-C (retinal and isoquinolone sulphonamide; H7) over six consecutive 30-min intervals. Quantitative analysis of the size and number of haemolytic plaques indicated that LHRH induced a dose- and time-dependent increase in the amount of LH release by individual gonadotrophs, with no evidence of the priming effect of LHRH. Stimulation by 10nM LHRH induced recruitment of actively secreting gonadotrophs which reached maximum levels by 90 min. There was a delay of 90-120 min before 10 nM PMA caused a significant release of LH, as assessed by both the size and number of plaques. During the first 30 min of exposure, the presence of 10 microM retinal or H7 augmented LHRH-induced secretion of LH, with the absence of any inhibition of the effects of LHRH until 90-120 min, when both the size and number of plaques were reduced compared with those formed in the presence of LHRH alone.(ABSTRACT TRUNCATED AT 250 WORDS)

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed1989

Educational outcomes and illness behaviors of participants in a child-initiated care system: a 12-year follow-up study.

Young adults who participated as children in a study of child-initiated care from 1972 to 1974 and their parents were studied again in 1986. More than 80% of all parents were located and interviewed. Of the 260 young persons located, 71% responded to a questionnaire. Although there was no significant association between being a frequent user of health care in either 1972 to 1973 or 1973 to 1974 and use of care 12 years later, girls who or 1973 to 1974 and use of care 12 years later, girls who were consistently frequent care users in both school years had a similar pattern of use as young women in 1986. Frequent users as children and young adults had a greater prevalence of headaches and stomachaches, but at both ages boys were less likely to seek care when faced with complaints or perceived health problems. A significant association was found between consistently frequent care use as a child and subsequent academic problems as a young adult. The importance of identifying children with chronic complaints (unrelated to physical causes) and helping them to deal with the true sources of their distress are emphasized by the data.

Adult↗
PubMed1989

Developing population profiles from dental claims data for conceptualizing effectiveness of care.

The purpose of this study was to explore longitudinal observational analysis of insurance claims data with goal of graphically demonstrating that effective dental care leads to the diminished use of services in subsequent time intervals. Using the Rand HIE claims data, definitions of the best patients for whom claims data would be profiled and the best parameters to use in rate calculations for the time series graphs were empirically derived. Profiles using these definitions were found to be very similar to a conceptual model of such profiles.

Adult↗
PubMed1988

Calcitonin gene-related peptide and somatostatin inhibit insulin release from individual rat B cells.

Hormone secretion from single, rat pancreatic B cells was visualised by a reverse haemolytic plaque assay for C-peptide. Quantitative analysis of the size and number of haemolytic plaques indicated that exposure to 3, 5, 10 and 20 mM glucose resulted in a dose-dependent increase in both the magnitude of C-peptide, and thus, insulin release by individual B cells and the recruitment of activity secreting B cells. Somatostatin and calcitonin gene-related peptide, fragment 28-37 (CGRP28-37) were shown to inhibit glucose-stimulated insulin release as assessed by the size of individual plaques and the number of recruited B cells, and hence to reduce the total area of plaques formed. In the presence of 15 mM glucose, a dose-dependent effect of CGRP28-37 on the secretion of insulin was observed, with the size of plaques formed by individual B cells reduced at concentrations of CGRP28-37 between 10(-5) and 10(-11) M. Thus, both somatostatin and CGRP28-37 can act directly on individual B cells to inhibit their secretory response to increasing levels of glucose. We suggest that these peptides which can be immunolocalised in islet cells may have a role in the regulation of insulin secretion.

Animals↗
PubMed1987

Islet amyloid formed from diabetes-associated peptide may be pathogenic in type-2 diabetes.

Pancreatic islet amyloid deposits were found in 22 of 24 type-2 diabetic subjects (aged 48-68 years) and were not present in 10 age-matched controls. A novel peptide, 37 aminoacids long, termed diabetes-associated peptide (DAP), has been identified in amyloid-containing pancreatic extracts from 3 type-2 diabetic patients but not in extracts from 6 non-diabetic subjects. DAP has major homology with calcitonin-gene related peptide (CGRP) and the islet amyloid of all 22 diabetics showed CGRP immunoreactivity. The immunoreactivity was inhibited by preabsorption of three different CGRP antisera either with CGRP carboxyterminal peptide 28-37 or with extracted DAP. Both diabetic and non-diabetic subjects had CGRP/DAP immunoreactivity in islet B-cells. Electron microscopy of islets containing amyloid indicated fibrillar amyloid between the endocrine cells and capillaries, usually penetrating into deep invaginations of the plasma membrane of the B-cells. These results suggest that islet amyloid contains DAP, which may originate from B-cells. Accumulation of amyloid in islets is likely to impair islet function and may be a causal factor in the development of type-2 diabetes.

Aged↗
PubMed1987

Evaluation and implementation of self-management programs for children with asthma.

We have reviewed the needs and problems associated with the evaluation and implementation of programs designed to assist children with asthma and their parents to manage the illness. To date, there are several programs that have been evaluated and found to be effective in terms of the objectives and dimensions described. Implementation has presented a larger problem because there are few implementors and because of the major barriers to be overcome by those who would make these programs available to the significant numbers of children and families who would benefit. Unless ways can be found to overcome the medical and reimbursement barriers, asthma self-management programs will not thrive. The growing number of individuals enrolled in some form of health maintenance organization, however, suggests a greater market for asthma self-management programs, under circumstances in which the costs of emergency room use and hospital services must be borne by physicians and hospitals, rather than by their patients.

Asthma↗