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Biomedical subjects

J E Davis

Publications and source records attributed to J E Davis.

At least 55 records · Page 3Linked to original sources

Induction of apoptosis by anti-CD3 epsilon F(ab')2 in antigen receptor transgenic murine T cells activated by specific peptide.

Peripheral T cell tolerance can be achieved through deletion of mature CD4+ cells activated by high dose Ag. We tested whether apoptosis of peripheral CD4+ cells could be induced by a stimulatory dose of Ag plus a soluble ligand to the nonpolymorphic epsilon-chain of the TCR-associated CD3 complex. CD4+ T cells from the DO10 mouse express a transgenic TCR-alphabeta specific for OVA peptide 323-339 presented by I-A(d). OVA alone induced clonal activation and expansion of peripheral CD4+/TCR transgene+ cells. Simultaneous exposure to specific Ag plus soluble anti-CD3 Fos, a nonmitogenic anti-CD3epsilon genetically engineered F(ab')2-like Ab, blocked expansion and induced death of CD4+/TCR transgene+ cells, but not CD4+/TCR transgene- T cells. In contrast, a mitogenic anti-CD3epsilon Ab induced polyclonal activation and nonselective T cell death. Sequential stimulation by Ag followed by anti-CD3 Fos also induced death of TCR transgene+ cells, whereas stimulation by anti-CD3 Fos followed by Ag did not affect cell viability or function. Anti-CD3 Fos-induced death was associated with DNA fragmentation characteristic of apoptosis, was facilitated by IL-2, and was initiated by stimulation during the S-G2 phases of the cell cycle. Anti-CD3 Fos could induce deletion of Ag-activated T cells by apoptosis in vivo. Thus, a soluble, non-Fc-binding anti-CD3 Ab can induce programmed cell death of Ag-activated peripheral CD4+ T cells by CD3epsilon cross-linking during S or G2. Peripheral T cell deletion by activation-driven apoptosis is under cell cycle control and can be exploited to achieve selective immunosuppression by nonmitogenic anti-CD3epsilon Abs.

Amino Acid Sequence↗

Dental and life science students: a comparison of approaches to study and course perceptions.

Approaches to study and course perceptions were investigated and compared in both junior and senior students on a vocational course (dentistry) and on a non-vocational course (life sciences) using standard questionnaires. Junior dental students reported significantly greater tendencies towards both Deep and Surface Approaches than junior life science students. They also had significantly higher scores for Achieving Approach, but in senior students this trend was reversed. Final year dental students experienced greater workloads and less freedom in learning than life science students and they also reported less organized study methods. These course perceptions demonstrate similar trends to those reported by Ramsden (1991). The implications for the courses concerned and for curriculum development are considered.

Attitude↗

Children in accident and emergency: parental perceptions of the quality of care. Part I.

An exploratory descriptive survey of the perceptions of parents of children attending an Accident and Emergency department is described. The study examines parental perceptions of the quality of care received, and explores whether this sphere of patient care requires further attention. A retrospective postal questionnaire was administered to parents of children, under the age of 10, attending the department. Follow-up interviews were also conducted, allowing further exploration of the issues affecting the parents' perceptions of care. The study confirmed the usefulness of auditing parents' perceptions of care. Quality aspects of care were highlighted, with lack of information and communication patterns shown to affect the perceived standard of care.

Attitude to Health↗

Nursing resources in accident and emergency departments.

Accident and emergency (A&E) departments need to be able to respond quickly to any person seeking their services, 24 hours a day. The underlying philosophy of staffing A&E departments may be incongruent to today's nurse managers when attempting to provide a high quality, but cost-effective nursing service. Accident and emergency departments, by their very nature, have an unpredictable, demand-led workload, making the issue of effective staff utilization a complex one. A descriptive, comparative survey of issues affecting nurse staffing levels in A&E departments is presented. Personal, semi-structured interviews were conducted with A&E nurse managers, and with senior clinical nurses. The study examines a wide range of variables, and their effect on nursing resources in A&E. It also identifies the complexities surrounding the calculation of nursing establishments in A&E, and provides a snapshot picture of how departments were staffed at the time of the survey. The study successfully highlights the key factors to be contemplated when deciding upon nursing resources in A&E, and the uncertainty and disparity which currently exist on the subject.

Emergency Service, Hospital↗

Characteristics associated with the risk of unintended pregnancy among urban homeless women: use of the Shuler Nurse Practitioner Practice Model in research.

In this pilot study, family planning practices and risk for unintended pregnancy among 50 homeless women residing in the downtown area of Los Angeles were investigated through the retrospective analysis of data collected through a wholistic clinic intake questionnaire. Those women who were least likely to use a birth control method in this study were Black, used cocaine daily, had multiple sources of emotional support, were satisfied with their sex lives, and reported access problems to family planning services (p < or = .05). Furthermore, over half of the total sample was at risk for unintended pregnancy. These at risk women were more likely to be separated from their children (p < or = .05), report current (p < or = .05) and past (p < or = .01) drug problems, have multiple sex partners (p < or = .001), engage in prostitution (p < or = .01), have a past history of sexually transmitted diseases (p < or = .05), and were least likely to be satisfied with their sex lives (p < or = .05). The findings suggest that homeless women are in great need of family planning health services, and that such services should be combined with vocational, social service, and drug treatment programs.

Adult↗

Intensive conditioning regimen for bone marrow transplantation in children with high-risk haematological malignancies.

Between September 1987 and May 1991, 21 children aged 10 months to 15 years (median 9 years) underwent bone marrow transplantation (BMT) for advanced haematological malignancies using a conditioning regimen consisting of total body irradiation (TBI), etoposide 1.8 g/m2 by continuous infusion, and cyclophosphamide 2 g/m2 on 3 consecutive days. The patients included 14 with acute lymphoblastic leukaemia (ALL), 1 with chronic myeloid leukaemia (CML), 1 with juvenile CML, 4 with non-Hodgkin's lymphoma and 1 with acute nonlymphocytic leukaemia. Eleven had an allogeneic BMT from an HLA-matched sibling, and 1 from an unrelated donor. Nine patients received 4-hydroperoxycyclophosphamide purged autologous marrow. Median time to myeloid engraftment (ANC > 500/microliters) was 19 days in allogeneic BMT patients and 28 days in autologous BMT patients (P < .01). Mucositis was the major regimen-related toxicity (RRT). GI toxicity in the form of diarrhoea affected ten patients and five had veno-occlusive disease of the liver. Two patients had mild bladder toxicity and one died of renal toxicity. There was no CNS or cardiac toxicity. There was no significant difference in the incidence of toxicity according to the type of BMT (autologous or allogeneic), total dose, or sequence of TBI. With a median follow-up of 44 months, ten patients are alive (6/12 allogeneic BMT patients and 4/9 autologous BMT patients). Of the 11 deaths, four were related to toxicity (2 aspergillus, 1 haemorrhage following liver biopsy, and 1 from haemolytic-uraemic syndrome), and 4/12 allogeneic and 4/9 autologous BMT patients died from relapsed disease. This conditioning regimen is well tolerated in children, demonstrating mild and reversible RRT.

Adolescent↗

Frequency and determinants of screening for breast cancer in primary care group practice.

BACKGROUND: Many studies reporting the frequency of breast cancer screening have been based only on physician and patient surveys or on data from quality assurance studies and do not assess the reliability of information obtained from these various sources. METHODS: To obtain more complete data we studied mammography performed in a 3-year period, 1988 through 1991, in 24 nonacademic primary care group practices by both auditing the medical records and obtaining questionnaire responses from 1819 women aged 53 to 62 years and from their 98 physicians in the nonmetropolitan Midwest. RESULTS: Medical record data indicated that mammography was performed in all 3 years in 16.7%, in at least two of 3 years in 49.8%, and in at least one of 3 years in 81.7% of women. While patient reports of a family history of breast cancer, health insurance coverage for mammography, and greater annual household income were each significant predictors, a patient report that a clinic staff member had discussed mammography was the strongest predictor of greater frequency of mammography. CONCLUSIONS: In this study of self-selected physicians and their patients, record-documented mammographic examinations were considerably more frequent than has been reported in some studies, but occurred at rates consistent with quality assurance data for the region. These data suggest that clinic staff initiatives with screening mammography have a large impact.

Breast Neoplasms↗

Ambulatory surgery ... how far can we go?

Since its revival in the United States in the 1970s, ambulatory surgery, that intermediate level of care between inpatient and outpatient surgery (with immediate discharge of the patient), has grown phenomenally. During the past decade, the growth has been the result of new surgical techniques, improved anesthetic agents and practices that make such procedures safer, improved and better managed ambulatory surgical facilities, and regulations by government and third-party payers. Consequently, increased utilization of expanded ambulatory surgery appears almost unlimited in the foreseeable future.

Ambulatory Surgical Procedures↗

Male sterilization.

This review of recent information and advances in the area of male sterilization deals with recent epidemiologic studies that discuss potential ill effects hypothesized to be a result of vasectomy, including carcinoma of the prostate and carcinoma of the testicle. Rebuttals to these hypotheses are presented. Recent advances in techniques of vasectomy including the "no-scalpel" vasectomy technique and open-ended vasectomy are presented, including the rationale for their use. A good deal of attention is given to postvasectomy follow-up, particularly the use of the technique of measuring numbers of ejaculations following vasectomy rather than the period of time afterward to determine when a man is sterile. The final two sections deal with complications of vasectomy and the most recent percentages on reversing vasectomy with particular reference to return of sperm to the ejaculate and pregnancy rates.

Aftercare↗