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Biomedical subjects

J C Beck

Publications and source records attributed to J C Beck.

At least 109 records · Page 6Linked to original sources
PubMed1989

Geriatric medicine in the United States. The current activities of former trainees.

To improve the health care received by frail older persons, an effort has been made in the United States to increase the number of physicians trained in geriatric medicine and geropsychiatry. The goal of training has been to create leaders in education, research, and patient care. To assess the progress of this effort, we surveyed physicians (284 in geriatric medicine and 91 in geropsychiatry) who graduated from U.S. geriatrics fellowship programs. Responses were obtained from 224 medicine (79% response) and 59 psychiatry fellows (65% response). Sixty-five percent of former geriatric medicine fellows report spending 10% or less time on teaching; 44% report doing no research, and 44% report spending more than half their time in patient care. Compared to other primary care specialties, the geriatricians reported caring for larger proportions of older patients and spending more time per patient visit. However, their role in teaching, research, and long-term care is minimal.

Data Collection↗
PubMed1988

Betamethasone effects on steroid and prostaglandin concentrations in pregnant rhesus monkeys.

Glucocorticoids delay parturition in rhesus monkeys, but the mechanism is unknown. This study was designed to determine the relationship between administration of glucocorticoids and prostaglandin levels in late pregnancy. Pregnant rhesus monkeys received intramuscular betamethasone (2 mg/day) from day 120 to day 133 of pregnancy. 13,14-Dihydro-15-keto-prostaglandin F2 alpha, progesterone, estradiol, estrone, and cortisol in amniotic fluid were measured by radioimmunoassay, and progesterone and estradiol were measured in the maternal serum. Among control animals, between 133 days and 160 days there were significant increases in adrenal size (p less than 0.05) and in amniotic fluid 13,14-Dihydro-15-keto-prostaglandin F2a metabolite, (p less than 0.005), estrone, and progesterone concentrations (p less than 0.05). The increase in adrenal size and the rise in amniotic fluid 13,14-Dihydro-15-keto-prostaglandin F2a metabolite, did not occur in betamethasone-treated monkeys. Maternal serum estradiol levels were suppressed immediately after treatment with betamethasone but recovered to control levels by day 160. Other changes in maternal serum and amniotic fluid sex steroid levels were sought but not observed. These data are consistent with the hypothesis that glucocorticoids delay primate parturition by altering intrauterine prostaglandin F2 alpha metabolism.

Amniotic Fluid↗
PubMed1988

Growth of mouse mammary epithelium in response to serum-free media conditioned by mammary adipose tissue.

Normal mouse mammary epithelial cells, isolated from female Balb/c mice, were cultured as multicellular organoids either on or within collagen gel matrices. Cultures were maintained in either serum-free control medium or the same medium conditioned by mammary adipose tissue. A significant proliferative response above that observed in control cultures (2.5-3.5 fold increase) was induced by conditioned medium derived from either mammary fat-pad explants or isolated adipocytes. In addition, scanning electron microscopy revealed epithelial morphology to be preserved in a more in vivo-like state in the conditioned medium. We conclude that diffusible factors derived from the mouse mammary fat pad influence the proliferative activity and morphology of mammary epithelial cells in culture.

Adipose Tissue↗
PubMed1988

Do physicians spend less time with older patients?

In view of the additional time that older persons require for giving and receiving information, as well as for the examination process, it is important for manpower and reimbursement planning to better understand the nature of the physician-patient encounter with the elderly. We examined a series of national surveys of physicians' professional activities and found that physicians tend to spend less time with their older patients and also that encounter time by physicians in different specialties varies widely. Internists and cardiologists spend substantially more time with patients compared with general and family practitioners. For 65-74-year-old ambulatory patients, the average visit lengths are 18.3 minutes for internists, 18.0 for cardiologists, 11.2 for general practitioners, and 12.1 for family practitioners. Compared with ambulatory visit lengths for patients aged 45 to 64 years, average encounter times for 75-year-olds with family physicians were 0.8 minutes shorter, with general practitioners 1.2 minutes shorter, with internists 2.3 minutes shorter, and with cardiologists 3.0 minutes shorter. However, when all characteristics of the visit were considered, the effect of patient age remained significant only for general practitioners. A multivariate analysis of factors related to physician time for ambulatory care showed that more time is associated with multiple problems, problem severity, and the use of diagnostic testing. For general and family practice, the greater the number of previous visits for a problem, the shorter the encounter time is. Additional characteristics associated with shorter physician-patient encounter times include the volume of patients per week and the use of physician assistants within the practice. These findings have implications for medical education and manpower projections.

Age Factors↗
PubMed1988

Are physicians sensitive to the special problems of older patients?

The sensitivity of primary care physicians to the health care needs of older patients was explored by means of an analysis of the use of diagnostic tests and therapeutic procedures during ambulatory visits. Survey data on a total of 28,265 visits to internists, family and general practitioners were examined to determine possible age-related differences in care. The study found that diagnostic testing falls off significantly for patients 75 years of age or older and that internists use substantially more tests for each age group than do family and general practitioners. The pattern of use of diagnostic tests in this secondary analysis does not address the issue of "appropriateness" but does suggest a pattern that makes little sense based on the known distribution of disease and functional disability in aging populations.

Age Factors↗
PubMed1988

Characterization of the fetal glucose transporter in rabbit kidney. Comparison with the adult brush border electrogenic Na+-glucose symporter.

Glucose transport was characterized in rabbit renal brush border membrane vesicles (BBMV) of the fetus late in gestation. Highly purified, osmotically reactive fetal BBMV contained a glucose transporter that was qualitatively indistinguishable from that in the adult: both are concentrative, Na+ dependent, electrogenic, stereospecific, and sensitive to phlorizin. Although the apparent Km for glucose is similar in the fetus and adult, the Vmax is significantly higher in the adult. When the membrane potential was clamped with a protonophore, this difference diminished; however, Vmax remained significantly higher in adult BBMV. This postnatal increase in Vmax was paralleled by a similar increase in the number of phlorizin binding sites. These findings indicate that the maturational increase in glucose transport is, in part, consequent to a more favorable electrical potential for Na+-dependent glucose transport and, in part, the result of the insertion of new transporters. The homogenate activity of several brush border enzymes also demonstrated significant maturational increases. The magnitude of these changes was variable and enzyme dependent. These combined observations suggest that mature expression of membrane proteins (transporters and enzymes) occurs at different stages of development of renal proximal tubule cells.

Aging↗
PubMed1988

Training in geriatric psychiatry: will the supply meet the demand?

The number of geriatric patients with major psychiatric disorders is expected to grow along with the rising proportion of people age 65 and older. Despite recognition of this growth and increases in the training of geropsychiatrists, the supply of specialists is unlikely to keep up with the demand. The authors argue for greater resource expenditure in fellowship programs and a focus on training academic leaders to serve as role models for general psychiatrists and other primary care givers.

Aged↗
PubMed1988

The therapist's legal duty when the patient may be violent.

This article reviews the legal basis for the psychiatrist's duty to protect third parties who are foreseeably endangered by their patients. Cases illustrating how courts decide whether the duty exists and whether it was violated are presented. Courts are impressed by, and clinicians should know about, threats to particular individuals, existence of a credible motive for violence, and a past history of violence. The importance of careful note taking and obtaining consultation about these cases is stressed.

Forensic Medicine↗
PubMed1988

Competency determinations.

Explore the source record for details and available documents.

Commitment of Persons with Psychiatric Disorders↗
PubMed1987

Reports of childhood incest and current behavior of chronically hospitalized psychotic women.

Of the female patients (N = 26) on a state hospital unit who remained chronically institutionalized and actively psychotic despite psychopharmacologic and psychosocial treatment, 12 (46%) reported histories of childhood incest. These 12 patients were more likely than the others to engage socially with ward staff. A higher proportion had sexual delusions, affective symptoms, substance abuse, suspected organicity, and major mental problems, and they spent more time in seclusion than other patients. The authors acknowledge the difficulty of assessing the accuracy of reports of incest. They discuss the implications of a possible relationship between incest and severe, intractable psychotic disorder.

Adolescent↗
PubMed1986

Slower processing, weaker beta 2-M association, and lower surface expression of H-2Ld are influenced by its amino terminus.

To determine why Ld antigens are expressed on the cell surface at levels three to four times lower than Dd or Kd antigens, pulse-chase experiments were used to compare their rates of biosynthesis and processing. Electrophoresis on sodium dodecyl sulfate gradient polyacrylamide gels resolved immunoprecipitates of each of these histocompatibility complex class I molecules into a slower and faster species. During the chase period, the faster migrating species appeared to be converted to the slower migrating species in a time-dependent manner. However, the conversion of Ld from the faster to the slower migrating species proceeded significantly more slowly than did the conversion of either Dd or Kd. Endoglycosidase H sensitivity and cell surface radiolabeling were used to determine the glycosylation state and cell location of each species of Ld and Dd. The results from these experiments, along with the pulse-chase studies and cytofluorometric analyses, suggest that Ld possesses a much slower rate of processing from a faster migrating, high mannose-bearing species to a slower migrating, complex oligosaccharide-bearing species found on the cell surface. Analysis of the beta 2-microglobulin (beta 2-m) association confirmed that Ld is associated with less beta 2-m than Dd. To localize the structures on class I molecules influencing their surface expression, rate of processing, and beta 2-m association, the Ddm1 molecule was analyzed. The Ddm1 molecule of the mutant B10.D2-H-2dm1 has previously been shown to be a chimeric Dd (amino-terminal)/Ld (carboxyl-terminal) polypeptide. The surface expression, processing and beta 2-m association of Ddm1 were found to be similar to Dd rather than Ld, suggesting that each of these phenomena are influenced by protein structure in the amino terminus.

Amino Acid Sequence↗
PubMed1986

The relationship between verdict, defendant characteristics, and type of crime in sex-related criminal cases.

In an earlier study, we unexpectedly found that defendants charged with sex crimes were four times less likely to be convicted than were all other defendants. We now report that failure to convict for rape was associated with failure to come to trial and that minor sex crimes were tried, but often continued without a finding, even when the judge found sufficient facts to make a guilty finding. Whether a minor crime involved a victim and whether the defendant has a criminal record both relate to verdict, but psychiatric history did not. The implications for understanding "acquittal of the guilty" are discussed.

Adolescent↗