Biomedical subjects
H Heath
Publications and source records attributed to H Heath.
Update in endocrinology.
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Hyperparathyroidism-jaw tumor syndrome: the HRPT2 locus is within a 0.7-cM region on chromosome 1q.
Hyperparathyroidism-jaw tumor syndrome (HPT-JT) is an autosomal dominant disease characterized by the development of multiple parathyroid adenomas and multiple fibro-osseous tumors of the maxilla and mandible. Some families have had affected members with involvement of the kidneys, variously reported as Wilms tumors, nephroblastomas, and hamartomas. The HPT-JT gene (HRPT2) maps to chromosome 1q25-q31. We describe further investigation of two HPT-JT families (K3304 and K3349) identified through the literature. These two expanded families and two previously reported families were investigated jointly for linkage with 21 new, closely linked markers. Multipoint linkage analysis resulted in a maximum LOD score of 7.83 (at recombination fraction 0) for markers D1S2848-D1S191. Recombination events in these families reduced the HRPT2 region to approximately 14.7 cM. In addition, two of these four study families (i.e., K3304 and K11687) share a 2.2-cM length of their (expanded) affected haplotype, indicating a possible common origin. Combining the linkage data and shared-haplotype data, we propose a 0.7-cM candidate region for HRPT2.
Women's health. Growing old--staying healthy.
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Surmounting the barriers to care.
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Keeping a reflective practice diary: a practical guide.
Reflective practice aims to enhance client care via the professional development and growing expertise of practitioners. This paper offers practical guidelines for writing diaries that may form the basis for reflective practice, while acknowledging the skills that practitioners already use to examine their nursing actions and interactions. There is an emphasis on the outcomes of reflection as well as the reflections themselves, as this is seen as important if professional development is to be recognized and clients benefit. Time constraints that may make frequent formal reflection difficult are recognized by the format that allows deeper reflection where time permits and as skills develop. While ideas presented have been influenced by the literature on reflection, the paper owes as much to the continuing education students of the Homerton School of Health Studies who studied the reflective practice module during 1996. Without listening to their discussions, becoming aware of their difficulties and sharing their growing ability to reflect on practice, this article would not have been possible.
Reflection and patterns of knowing in nursing.
Over the last decade nursing has progressed from a reliance on empirical theory applied to practice to a recognition that experience develops knowledge that can guide the actions of practitioners. Reflection is a means of surfacing experiential knowledge, and students may begin to use reflection as their experience of nursing accumulates. As Carper was a key figure in widening that knowledge accepted as knowing in nursing beyond the empirical, it is both justified and recommended that her work should be incorporated into reflective practice. Johns has integrated Carper's work in his model of guided reflection and this paper briefly examines this combination. The main focus is on two further patterns of knowing: unknowing and sociopolitical knowing. These patterns are examined and the contribution they could make to reflective practice is discussed.
Paradigm dialogues and dogma: finding a place for research, nursing models and reflective practice.
Debates within nursing can take the form of useful discussion and critique or verbal conflict generated from inflexible paradigm positions intolerant of differing stances perceived to be of no value. It is suggested that the most profitable process is debate that generates understanding of the strengths and limitations of various tools and techniques and helps identify suitable usage rather than uncritical advocacy or outright rejection. Suggested uses will thus themselves become subject to further debate and practitioners will be encouraged to adopt a use that suits their practice setting and role. The quantitative-qualitative research debate, criticisms of the nursing process and nursing models and reflective practice are examined. Dogmatic positions are highlighted and uses that are potentially controversial are identified.
Comment on lack of effect of raloxifene on coronary artery atherosclerosis of postmenopausal monkeys.
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Interaction of chemokine receptor CCR5 with its ligands: multiple domains for HIV-1 gp120 binding and a single domain for chemokine binding.
CCR5 is a chemokine receptor expressed by T cells and macrophages, which also functions as the principal coreceptor for macrophage (M)-tropic strains of HIV-1. To understand the molecular basis of the binding of chemokines and HIV-1 to CCR5, we developed a number of mAbs that inhibit the various interactions of CCR5, and mapped the binding sites of these mAbs using a panel of CCR5/CCR2b chimeras. One mAb termed 2D7 completely blocked the binding and chemotaxis of the three natural chemokine ligands of CCR5, RANTES (regulated on activation normal T cell expressed and secreted), macrophage inflammatory protein (MIP)-1alpha, and MIP-1beta, to CCR5 transfectants. This mAb was a genuine antagonist of CCR5, since it failed to stimulate an increase in intracellular calcium concentration in the CCR5 transfectants, but blocked calcium responses elicited by RANTES, MIP-1alpha, or MIP-1beta. This mAb inhibited most of the RANTES and MIP-1alpha chemotactic responses of activated T cells, but not of monocytes, suggesting differential usage of chemokine receptors by these two cell types. The 2D7 binding site mapped to the second extracellular loop of CCR5, whereas a group of mAbs that failed to block chemokine binding all mapped to the NH2-terminal region of CCR5. Efficient inhibition of an M-tropic HIV-1-derived envelope glycoprotein gp120 binding to CCR5 could be achieved with mAbs recognizing either the second extracellular loop or the NH2-terminal region, although the former showed superior inhibition. Additionally, 2D7 efficiently blocked the infectivity of several M-tropic and dual-tropic HIV-1 strains in vitro. These results suggest a complicated pattern of HIV-1 gp120 binding to different regions of CCR5, but a relatively simple pattern for chemokine binding. We conclude that the second extracellular loop of CCR5 is an ideal target site for the development of inhibitors of either chemokine or HIV-1 binding to CCR5.
Chemokine receptor usage by human eosinophils. The importance of CCR3 demonstrated using an antagonistic monoclonal antibody.
Chemokines bind and signal through G-protein coupled seven transmembrane receptors. Various chemokine receptors are expressed on leukocytes, and these may impart selective homing of leukocyte subsets to sites of inflammation. Human eosinophils express the eotaxin receptor, CCR3, but respond to a variety of CC chemokines apart from eotaxin, including RANTES, monocyte chemotactic protein (MCP)-2, MCP-3, and MCP-4. Here we describe a mAb, 7B11, that is selective for CCR3 and has the properties of a true receptor antagonist. 7B11 blocked binding of various radiolabeled chemokines to either CCR3 transfectants, or eosinophils. Pretreatment of eosinophils with this mAb blocked chemotaxis and calcium flux induced by all CCR3 ligands. In all individuals examined, including allergic and eosinophilic donors, > 95% of the response of eosinophils to eotaxin, RANTES, MCP-2, MCP-3, and MCP-4 was shown to be mediated through CCR3. The IL-8 receptors, particularly CXCR2, were induced on IL-5 primed eosinophils, however these eosinophils responded to CC chemokines in the same manner as unprimed eosinophils. These results demonstrate the importance of CCR3 for eosinophil responses, and the feasibility of completely antagonizing this receptor.
Fractures after thyroidectomy in men: a population-based cohort study.
Bone mass is purportedly reduced by an endogenous or exogenous excess of thyroid hormone or, perhaps, by calcitonin deficiency. Patients who have undergone thyroidectomy could be subject to all of these effects, yet their practical implications in terms of fracture risk are poorly defined. Interpretation is further hampered by the focus on women, where results may be influenced by involutional osteoporosis. Consequently, we assessed the potential for fractures among the 136 Rochester, Minnesota men who underwent thyroidectomy between 1935 and 1979, relative to a group of age-matched control men from the community. With 2194 person-years of follow-up in each group, survival free of any fracture of vertebra, proximal humerus, distal forearm, pelvis, or proximal femur was similar in the two groups (p = 0.23), and the relative risk of any of these fractures for thyroidectomized patients versus their controls was increased only 1.5-fold (95% CI, 0.7-3.2). The difference was entirely accounted for by a statistically significant excess of proximal femur fractures in the men with thyroidectomy. Risk factors for fractures among men with thyroidectomy included greater age at surgery, greater extent of surgery, and the presence of risk factors for secondary osteoporosis. Thus, thyroidectomy, performed mainly for adenoma or goiter, seems to have little overall influence on the risk of age-related fractures in men. However, the association with hip fractures requires further evaluation.
Sensory function in older people.
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Developing outcome indicators in continuing care: part 2.
In their follow-up to last week's article which described the development of outcome indicators for nursing older people in continuing care settings, the authors describe in detail the process of indicator development. Referring to theoretical models, they provide a practical example of how a nurse could use one of his or her experiences from nursing to illustrate the distinct value of patient interventions provided by a registered practitioner.
Developing outcome indicators in continuing care: part 1.
In the first of two articles, the authors describe the development of outcome measures for nursing older people in a continuing care setting. They describe why such a process was initiated and the framework which guided the project, including current nursing and government policy and theories of knowledge and expert practice. The second article will appear next week.
Bone mineral density in non-insulin-dependent diabetes.
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