Six participants share insights on the Georgia Partnership for Health.
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Administrative Personnel↗
Biomedical subjects
J Parker
Publications and source records attributed to J Parker.
Development of the American Board of Nursing Specialties (1991-1993).
A peer review program for specialty nursing certification has been developed by 12 charter member groups. Its purpose is to serve as an advocate for consumer protection, to increase the public's awareness of the meaning and value of specialty nursing certification and to enhance prestige, self-actualization and professional advancement of certified nurses. The rationale for development of the organization and procedures for initiating membership are described.
Certification↗
Breast cancer screening in an urban public hospital. Five-year results.
BACKGROUND: This report describes the first 5 years of the Breast Cancer Screening Program (BCSP) at Cook County Hospital (CCH), a hospital that serves a predominantly African-American and low-income population. METHODS: A retrospective review of hospital cancer registry staging for breast cancers diagnosed between 1984 and 1988 was performed. RESULTS: Between 1984 and 1988, 499 new breast cancers were diagnosed at CCH, of which 33% were diagnosed after referral from the BCSP. The percentage of early breast cancers, defined as Stages 0 or 1, was 25% in women referred from the BCSP, compared with 6% for women referred from other clinical areas (P < 0.001). During this same period of time, the proportion of women at CCH with localized breast cancer increased from 30% in 1980-1983 to 40% from 1984-1988 (P < 0.05), an increase that can be attributed to the BCSP. Only 21% of the breast cancers detected by the BCSP were found by mammography alone. Of these, 91% were localized. CONCLUSIONS: The BCSP has had an impact on the proportion of early breast cancer diagnosed at CCH. Despite these efforts, the proportion of early breast cancer diagnosed at CCH (12%) is significantly less than that seen for all African-American women with breast cancer in Illinois (32%; P < 0.001).
Adult↗
Aggregation of human and canine platelets: modulation by purine nucleotides.
This study compared the responses of canine and human platelets to various aggregating agonists in the presence or absence of extracellular ATP and ATP analogues. Canine and human platelets were approximately equally reactive with ADP or collagen while the canine platelets were about 10 fold more sensitive to thrombin. Canine platelets were insensitive to the thromboxane mimetic U46619 but were synergistically aggregated by a mixture of ADP and U46619. Human platelets were very sensitive to U46619. Aggregations of human platelets with all of the above agonists were inhibited by extracellular ATP; beta, gamma methylene ATP (beta gamma ATP) and benzoyl ATP (BzATP) with a rank order suggestive of an interaction with P2x-like purinoceptors which support our previous findings. The comparable aggregations of canine platelets were likewise inhibited by ATP and its analogues but with a rank order suggestive of an interaction with P2y-like purinoceptors. ATP inhibited U46619- and ADP-induced aggregation of human platelets and ADP-induced aggregation of canine platelets, presumably, in part, due to competition for the ADP P2T receptor. However, when U46619 was added to either ATP or ATP analogue-inhibited ADP-treated canine platelets, the inhibition was nullified. Furthermore, we demonstrated, for the first time, that the canine thromboxane receptor becomes reactive to U46619 alone after incubation at room temperature for 3.5-5 hrs while human platelets become inactive under similar conditions. The implication of these studies is that there are significant differences in the canine and human platelet thromboxane and purine receptors. The future characterization of these differences and the mechanism by which they function should further our understanding of the impact of extracellular ATP on hemostasis and thrombosis.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
Occupancy of P2 purinoceptors with unique properties modulates the function of human platelets.
This report demonstrates that platelets possess P2 purinoceptors with unique properties that distinguish them from the ADP (P2T) receptor. Extracellular ATP, and its poorly hydrolyzable analogues, inhibit collagen- and U46619 (a thromboxane mimetic)-induced platelet aggregations. Adenosine deaminase was without effect on ATP action while reversing the inhibitory effect of adenosine. A unique aspect of the P2 receptor is the sensitivity to UTP and CTP and insensitivity to GTP. The rank order of inhibition by beta gamma-methylene ATP, alpha beta-methylene ATP > ATP indicates that a P2x-like receptor is present on the platelet membrane. This conclusion is further supported by the nearly complete desensitization to ATP by pre-exposure of platelets to alpha beta-methylene-ATP. However, unlike previously described P2x purinoceptors, the inhibition of platelet aggregation by extracellular ATP appears to result, at least in part, from the ATP-induced increase of intracellular cyclic AMP levels apparently coupled through a Gs protein. The combined addition of iloprost (0.14 to 1.39 nM) and ATP (18 microM) or ATP (20-40 microM) and the phosphodiesterase inhibitor theophylline (0.5 to 1 mM) synergistically inhibited platelet aggregation implying a common interactive site with adenylate cyclase. This is further substantiated by the ability of the adenylate cyclase inhibitor, 2',5'-dideoxyadenosine, to abrogate the inhibitory effects of ATP. The protein kinase A (PKA) inhibitor H1004 blocks ATP inhibition of platelet aggregation while the protein kinase C inhibitor H7 did not. This implies that the generation of cyclic AMP, with the subsequent activation of PKA and phosphorylation of selected proteins is required, in part, for the action of ATP.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
Organic dust exposures from compost handling: case presentation and respiratory exposure assessment.
Inhalation of dust from contaminated organic materials may result in acute respiratory tract illness. Possible mechanisms include toxic and cellular reactions to microbial and other organic products or immunologic responses after prior sensitization to an antigen. A case is presented of a 52 year old male who developed fever, myalgia, and marked dyspnea 12 hr after shoveling composted wood chips and leaves. Inspiratory crackles, hypoxemia, and bilateral patchy pulmonary infiltrates were seen. Precipitating antibody tests for the usual antigens were inconclusive. He improved over 3 days. In order to assess the environmental conditions the patient had experienced, we returned to the site to reproduce and measure respiratory exposures during hand loading of the compost. Visible clouds of fine particulate were easily generated during handling activities. Microscopic examination of these dusts indicated a predominance of spores. Endotoxin concentrations from inspirable and respirable dust samples ranged from 636 to 16,300 endotoxin units/m3. Levels of contaminants found were consistent with those associated with respiratory illness in other agricultural settings. Two respiratory disorders, hypersensitivity pneumonitis (HP) and organic dust toxic syndrome (ODTS), may occur after exposure to organic dusts containing fungal spores and endotoxins. Despite extensive clinical and environmental investigations, we were unable to differentiate these two disorders, and suggest they may represent parts of a spectrum of responses to complex organic dusts, rather than completely distinct clinical entities.
Agriculture↗
Spine and femur BMD by DXA in patients with varying severity spinal osteoporosis.
Bone mineral density (BMD) at the lumbar spine, femoral neck, trochanteric region, and Ward's triangle was measured using dual-energy X-ray absorptiometry (DXA) in 118 women with osteoporotic vertebral collapse (average age 65 years), divided into four groups according to numbers and SD of vertebral deformation below norms: group 1: -3SD deformations only; group 2: one -4SD deformation; group 3: two-four -4SD deformations; and group 4: 5 or more -4SD deformations. There were no significant differences between the groups. Results were compared with those from 80 premenopausal (average age 32 years, range 20-40 years) and 109 postmenopausal normal women (average age 64, range 60-70 years). Mean BMD in osteoporotic group 1 was lower than premenopausal normal women by 32% at the lumbar spine, 31% femoral neck, 30% trochanteric region, and 44% at Ward's triangle, and postmenopausal controls by 17% lumbar spine, 16% femoral neck, 17% trochanter, and 14% Ward's triangle. There was a clear trend to reduction in mean BMD between osteoporotic groups 1 and 4 at all four measured sites with significant differences at the spine of 0.102 g/cm2 (P < 0.01) and Ward's triangle 0.059 g/cm2 (P < 0.01). When compared with premenopausal controls, there was a reduction in mean BMD between osteoporotic groups 1 and 4 of 10% at the lumbar spine, 7% femoral neck, 8% trochanteric region, and 13% Ward's triangle. Receiver operating characteristic analysis showed no significant differences in diagnostic sensitivities among the four measured sites for vertebral fractures. We conclude from this cross-sectional data that the majority of bone loss in spinal osteoporosis occurs before the onset of fractures.
Absorptiometry, Photon↗
Role of arteriography for blunt or penetrating injuries in proximity to major vascular structures: an evolution in management.
Over a 14-month period at Boston City Hospital, 93 consecutive patients who had received a blunt or penetrating extremity injury in proximity to a major vascular structure were evaluated. All patients were totally asymptomatic and underwent arteriography for proximity as a sole indication. Twenty-seven patients (27%) were found to have abnormal arteriograms. Muscular branches of the profunda femoris artery were the most frequently injured arteries (28%). Arterial spasm (41%) was the most common radiographic finding. All patients were managed nonoperatively and followed closely by serial pulse examinations. Follow-up arteriography or duplex scanning was used in isolated cases. No patients in this study required operative intervention based on arteriographic findings. No patients have subsequently required operative intervention for delayed arterial abnormalities. Based on these findings we believe the use of arteriography for asymptomatic injuries in proximity to major vascular structures is unwarranted.
Adolescent↗
Increasing catheter ablation lesion size by simultaneous application of radiofrequency current to two adjacent sites.
Treatment of ventricular tachycardia by radiofrequency current application can be difficult, partly because of the larger size of the reentry circuit in relation to the lesion generated. Larger lesions than those currently achieved with single radiofrequency applications are desirable. This study evaluated simultaneous radiofrequency application to two adjacent electrodes to determine the effects of inter-electrode distance and configuration (bipolar serial vs parallel) on lesion size and tissue temperature. Two 6F electrodes were placed, with the tips facing each other, on bovine myocardium in a saline bath at 37 degrees C. Radiofrequency current was applied to a single electrode, or simultaneously to two electrodes connected either in series or in parallel. Tissue temperature, power, and lesion size were measured. Lesions produced by simultaneous radiofrequency delivery to both electrodes were more than twice the size of those produced by a single electrode alone (> 100 mm3 vs 33.2 mm3, p < 0.01). Temperatures between electrodes were greater than those temperatures at the same distances from a single electrode (p < 0.001). The size of the lesions increased as inter-electrode distance decreased below 3.5 mm (p < 0.030) because of the increasing depth of the lesion between the electrodes. Two electrodes placed in a bipolar as opposed to a parallel configuration were most efficient, as this configuration produced greater lesion sizes for a given level of power delivery (p < 0.0001). The bipolar lesion size decreased by > 50% if one electrode was not in contact with the tissue (p < 0.0004).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Supportive nurse-midwife care is associated with a reduced incidence of cesarean section.
OBJECTIVE: Our purpose was to examine whether care by a certified nurse-midwife, including personal labor support, was associated with a reduced risk of cesarean delivery. STUDY DESIGN: A retrospective cohort study comparing 3551 physician-managed patients with 1056 certified nurse-midwife-managed patients in a university hospital with a mixed socioeconomic and ethnic population was performed. Regression analysis was used to estimate the risk of labor abnormalities, diagnosis of fetal distress, and cesarean delivery in patients delivered by a certified nurse-midwife vs a physician and to control for maternal age, race, parity, fetal size, and delivery year. Subjects included were women having at least five prenatal visits who were delivered of term, singleton, liveborn infants without congenital anomalies with occiput presentation. RESULTS: Odds ratio for cesarean section for women delivered by certified nurse-midwives versus those delivered by physicians was 0.71 (95% confidence interval 0.55, 0.91). Midwifery care was associated with a lower risk of abnormal labor (adjusted odds ratio 0.70, 95% confidence interval 0.60, 0.83) and diagnosis of fetal distress (adjusted odds ratio 0.50, 95% confidence interval 0.32, 0.77). CONCLUSION: This work demonstrates that labor abnormalities and diagnosis of fetal distress are less frequent in patients cared for by nurse-midwives, and there is an association with a lower incidence of cesarean section.
Adult↗
The adult respiratory distress syndrome: a review.
The adult respiratory distress syndrome, characterized by hypoxemia, reduced pulmonary expansion, and noncardiogenic pulmonary edema, is a clinical entity with a high mortality rate that has been recognized only relatively recently. We present the newest aspects of the subject.
Humans↗
Effects of the somatostatin analogue octreotide on rectal afferent nerves in humans.
Somatostatin (Som) administered intrathecally to humans has been shown to exert potent analgesic effects on somatic pain, and anecdotal evidence suggests that Som may also relieve visceral pain. In the current study, we used rectal balloon distension in seven healthy volunteers to evaluate the effect of the Som analogue octreotide (Oct; 1.25 microgram/kg sc) on four pathways mediated by different visceral afferents that originate in the rectum: conscious perception, receptive relaxation, reflex inhibition of internal anal sphincter, and a viscerosomatic reflex. Rectal mechanoreceptors were stimulated either by distending the rectum tonically (volume ramp at 20-40 and 400 ml/min) or phasically (intermittent pressure steps of 60 s duration). Pressure thresholds for nonnoxious and noxious sensations in response to slow tonic distension were increased in the presence of rectal lidocaine (20 ml of 2% solution), whereas those to phasic distension were unaffected. Oct significantly increased pressure and volume thresholds for nonnoxious and noxious sensations in response to slow tonic distension but did not further increase thresholds in the presence of intrarectal lidocaine. In contrast, no effect of Oct on rectal sensations was observed during rapid tonic or phasic distension. Oct had no effect on any of the monitored reflex responses. The effect of Oct on rectal sensation in the concentration used in this study was not associated with changes in the rectal wall pressure-volume relationship during any distension protocol. These findings indicate that the inhibitory effect of Oct on rectal sensation is likely to represent a direct effect on a subset of extrinsic primary afferent neurons, with receptive fields in the mucosa.
Administration, Topical↗
With new eyes: the animal rights movement and religion.
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Animal Experimentation↗
Patent term restoration in non-drug-developing nations.
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Economics, Pharmaceutical↗
Wernicke's encephalopathy complicating schizophrenia.
Wernicke's encephalopathy producing an altered mental state may occur in malnourished psychiatric patients even in the absence of alcohol abuse. A case is reported of a woman, aged 61 years, with schizophrenia who refused her medication for four months, had the delusion she was dying from a tumour, and withdrew to her bed with a neglect of her nutrition. She was committed to hospital in a mute unresponsive state and after taking some food and fluids for four days lapsed into coma. She responded within three hours to the administration of thiamine. Clinicians need to remain vigilant to the possibility that an altered mental state in malnourished patients may be due to thiamine deficiency rather than to the primary psychiatric disorder. If doubt exists as to the presence of Wernicke's encephalopathy, then parenteral thiamine should be administered.
Activities of Daily Living↗
Annotated bibliography: grant writing.
This is the first in series of annotated bibliographies on research topics that will appear in the ANNA Journal. The bibliographies have been prepared by members of ANNA's Research Special Interest Group. Each bibliography focuses on a particular topic and includes reviews of research books and articles published in nursing and allied health journals in recent years. The series is intended to assist nephrology nurse researchers in locating resources to plan and implement research studies and to communicate and implement research findings. The annotation for each item includes a full citation, a brief summary, and a categorization of the content level. The topic covered in this first bibliography is grant writing. Contributors to the grant writing bibliography were Nancy Hoffart, Janel Parker, and Nancy Seaby. The next installment will cover the research proposal, abstract writing, and the conceptual framework. Topics to be covered in future articles will include: (a) research proposal development and literature review; (b) poster preparation, abstract writing, and collaborative research; (c) instrument references, instrumentation, and reliability and validity; (d) research question, design and methods, and sampling; and (e) statistics and general nursing research texts. The following key was used in rating the content level for each citation: Basic/Introductory--For professionals who have no previous research background. Intermediate--For professionals who possess some knowledge of the research process and terminology, and have participated in some research projects. Advanced--For professionals who possess broad knowledge and experience with research projects.
Nursing Research↗
Misreading of the argI message in Escherichia coli.
It has previously been shown that either phenylalanine codon, UUU or UUC, could be misread as leucine during phenylalanine starvation, if the codons encoded residue 8 of the Escherichia coli argI gene product, ornithine transcarbamylase (OTC). However, no leucine misincorporation was detected when either of these same codons encoded residue 3. Here we report that leucine misincorporation can be directed by a UUU codon for residue 3 of OTC during phenylalanine starvation, if the argI gene has been mutated so that the codon preceding the UUU has been changed from the rarely used glycine codon GGG to the more commonly used GGC.
Amino Acid Sequence↗
Sequence and characterization of the gcpE gene of Escherichia coli.
In Escherichia coli, the gene gcpE encodes a protein of unknown function and lies immediately upstream of the hisS gene for histidyl-tRNA synthetase. The nucleic acid sequence of gcpE predicts an open reading frame for a protein of 40,681 Da. The probable transcription terminator of gcpE overlaps the hisS promoter. Haploid cells containing a disrupted gcpE could not be obtained, suggesting that the gcpE gene is essential.
Amino Acid Sequence↗