Search PubMed⌕ Search

Biomedical subjects

L King

Publications and source records attributed to L King.

At least 55 records · Page 3Linked to original sources
PubMed1998

Physician office-based diabetes care: comparison to guidelines for care.

Over the past decade, we have seen a significant increase in hospitalizations in South Carolina for the major complications of diabetes: myocardial infarcts (+68 percent), amputations (+61 percent), end stage renal disease (+85 percent), diseases of blood vessels (+100 percent), and eye complications (+52 percent). Many of these late stage complications can be prevented or their progression slowed down by early recognition and institution of intensive, well-defined preventive strategies. Independent surveys reviewed above indicate that such preventive practices are not being fully utilized in South Carolina. As one key example, less than 50 percent of people with diabetes receive self-management education. A number of simple and relatively inexpensive laboratory and physical examinations which would trigger preventive and remedial therapy are also performed at less than adequate frequency. The challenge is for all to use these examinations to guide therapy and to continue to monitor and intervene to prevent complications of diabetes. The DSC Board of South Carolina has developed a Ten Year Strategic Plan with nine major goals to improve diabetes care and outcomes in South Carolina. To improve office-based care of diabetes in South Carolina, all health professionals must assume responsibility for closely monitoring each person with diagnosed diabetes and assure that glycemic control is optimized. Early signs of complications must be recognized and interventions to limit their progression utilized. Screening of high-risk individuals to identify the estimated one-third of persons with diabetes who are undiagnosed, targeted education programs to the primary care professionals who deliver the majority of care to individuals with diabetes, implementation of the proven, cost-effective measures that can prevent (postpone) the complications of diabetes, monitoring of the health care delivery system and addressing the potential barriers to adequate care for all persons with diabetes are essential steps to decrease the burden of diabetes for South Carolinians (Table 1).

Diabetes Mellitus↗
PubMed1997

Contribution of caudal brainstem to d-fenfluramine anorexia.

Of the central 5-HT substrates that may mediate the anorexic actions of systemically administered d-fenfluramine (d-FEN), those in the forebrain have received the most attention. As a counterpoint to this forebrain focus, we evaluated the contribution of caudal brainstem substrates to the anorexic action of d-FEN. Two experimental protocols were employed. In one we compared the feeding response (intra-oral intake of 12.5% glucose) of intact and chronic supracollicular decerebrate (CD) rats to systemic administration of d-FEN. In the other, d-FEN was administered via fourth intracerebroventricular (ICV) injection to determine whether a dose-related suppression of intra-oral intake could be obtained. A dose-dependent suppression of intra-oral intake was obtained in the CD rat treated with d-FEN (0-8 mg/kg, delivered IP 20 min before testing). The threshold dose was two to three times higher in CD rats than in their intact controls, but the dynamic range of the dose-response curves of the two groups were overlapping with similar slopes of decline and with comparable maximal intake suppression. Fourth ICV administration of d-FEN in the intact rat yielded a dose-related suppression of intra-oral intake. Intake was also suppressed by fourth ICV d-FEN (30 mg) when rats drank 12.5% glucose solution from a spout. The reduced intra-oral intake following fourth ICV d-FEN treatment was partially attenuated by the systemic administration of the serotonin antagonist metergoline (0.4 mg/kg; IP). The CD results demonstrate the sufficiency of caudal brainstem receptors in mediating intake suppressive responses to systemic d-FEN. The fourth ICV results suggest further that 5-HT receptors in the caudal brainstem play a significant role in normal meal size control in the neurologically intact rat.

Animals↗
PubMed1997

Multiplying health gains: the critical role of capacity-building within health promotion programs.

Health outcomes in populations are the product of three factors: (1) the size of effect of the intervention; (2) the reach or penetration of an intervention into a population and (3) the sustainability of the effect. The last factor is crucial. In recent years, many health promotion workers have moved the focus of their efforts away from the immediate population group or environment of interest towards making other health workers and other organisations responsible for, and more capable of, conducting health promotion programs, maintaining those programs and initiating others. 'Capacity-building' by health promotion workers to enhance the capacity of the system to prolong and multiply health effects thus represents a 'value added' dimension to the health outcomes offered by any particular health promotion program. The value of this activity will become apparent in the long term, with methods to detect multiple types of health outcomes. But in the short term its value will be difficult to assess unless we devise specific measures to detect it. At present the term 'capacity-building' is conceptualised and assessed in different ways in the health promotion literature. Development of reliable indicators of capacity-building which could be used both in program planning and in program evaluation will need to take this into account. Such work will provide health-decision makers with information about program potential at the conclusion of the funding period, which could be factored into resource allocation decisions, in addition to the usual information about a program's impact on health outcomes. By program potential, we mean ability to reap greater and wider health gains.

Australia↗
PubMed1997

Intuition: a critical review of the research and rhetoric.

This paper will explore the concept of intuition in nursing from an acute care and community nursing perspective. It will consider definitions of intuition and examine the research which can inform our understanding of this important component of decision making. In the current health service climate, which demands measurable research-based evidence, the involvement of intuition as an element of judgement is often denigrated. The result is that many nurses are being forced to be covert in their use of this crucial aspect of judgement and focus solely on the conscious elements of decision-making. However, research evidence would suggest that intuition occurs in response to knowledge, is a trigger for action and/or reflection and thus has a direct bearing on analytical processes in patient/client care. The authors therefore argue that the essential nature of intuition cannot be ignored in the practice, management, education and research of nursing.

Clinical Competence↗
PubMed1997

Expression of bcl-2 in lichen planus, acute graft-versus-host disease, and erythema multiforme.

The bcl-2 gene family plays a significant role in the propagation of cell survival and tissue modeling. Bcl-2 was originally described in follicular lymphomas and is associated with the suppresion of cellular apoptosis. Evaluation for this protein has been performed for a variety of benign and malignant cutaneous tumors but not to any significant extent on inflammatory disorders. Therefore, we stained biopsy specimens from diseases with interface inflammation (lichen planus, acute graft-versus-host disease, and erythema multiforme) for Bcl-2. Epidermal expression of this protein was minimal for all three diseases; however, lymphocytes stained prominently in lichen planus. The data suggest that Bcl-2 is not prominently involved in the epidermal changes in these diseases. The role of other members of this oncogene family in interface dermatitis still needs to be elucidated.

Erythema Multiforme↗
PubMed1997

Constructivism: a naturalistic methodology for nursing inquiry.

This article will explore the philosophical underpinnings of the constructivist research paradigm. Despite its increasing popularity in evaluative health research studies there is limited recognition of constructivism in popular research texts. Lincoln and Guba's original approach to constructivist methodology is outlined and a detailed framework for nursing research is offered. Fundamental issues and concerns surrounding this methodology are debated and differences between method and methodology are highlighted.

Data Interpretation, Statistical↗
PubMed1997

A major human immunodeficiency virus type 1-initiated killing pathway distinct from apoptosis.

We have investigated the relative contribution of apoptosis or programmed cell death (PCD) to cell killing during acute infection with T-cell-tropic, cytopathic human immunodeficiency virus type 1 (HIV-1), by employing diverse strategies to inhibit PCD or to detect its common end-stage sequelae. When Bcl-2-transfected cell lines were infected with HIV-1, their viability was only slightly higher than that of control infections. Although the adenovirus E1B 19-kDa protein has been reported to be a stronger competitor of apoptosis than Bcl-2, it did not inhibit HIV-mediated cell death better than Bcl-2 protein. Competition for Fas ligand or inactivation of the Fas pathway secondary to intracellular mutation (MOLT-4 T cells) also had modest effects on overall cell death during acute HIV infection. In contrast to these observations with HIV infection or with HIV envelope-initiated cell death, Tat-expressing cell lines were much more susceptible (200% enhancement) to Fas-induced apoptosis than controls and Bcl-2 overexpression strongly (75%) inhibited this apoptotic T-cell death. PCD associated with FasR ligation resulted in the cleavage of common interleukin-1beta-converting enzyme (ICE)-protease targets, poly(ADP-ribose) polymerase (PARP) and pro-ICE, whereas cleaved products were not readily detected during HIV infection of peripheral blood mononuclear cells or T-cell lines even during periods of extensive cell death. These results indicate that one important form of HIV-mediated cell killing proceeds by a pathway that lacks the characteristics of T-cell apoptosis. Our observations support the conclusion that at least two HIV genes (env and tat) can kill T cells by distinct pathways and that an envelope-initiated process of T-cell death can be discriminated from apoptosis by many of the properties most closely associated with apoptotic cell death.

Adenovirus E1B Proteins↗
PubMed1997

Case study: physical therapy management of hip osteoarthritis prior to total hip arthroplasty.

It is important that we have information on the role of physical therapists in the treatment of patients with osteoarthritis of the hip prior to total hip arthroplasty. This article describes the management of a patient with limited range of motion of the right hip due to osteoarthritis. The patient made a significant improvement with decreased pain, increased range of motion of the right hip, increased periarticular muscle strength, improved gait, and improved mobility. One year later, the patient had a right total hip arthroplasty. The rationale of the management of patients with osteoarthritis of the hip is discussed. In addition, the role of physical therapists in the management and treatment of patients with osteoarthritis prior to total hip arthroplasty is discussed.

Female↗
PubMed1996

Signal-detection, threshold, and dual-process models of recognition memory: ROCs and conscious recollection.

Threshold- and signal-detection-based models have dominated theorizing about recognition memory. Building upon these theoretical frameworks, we have argued for a dual-process model in which conscious recollection (a threshold process) and familiarity (a signal-detection process) contribute to memory performance. In the current paper we assessed several memory models by examining the effects of levels of processing and the number of presentations on recognition memory receiver operating characteristics (ROCs). In general, when the ROCs were plotted in probability space they exhibited an inverted U shape; however, when they were plotted in z space they exhibited a U shape. An examination of the ROCs showed that the dual-process model could account for the observed ROCs, but that models based solely on either threshold or signal-detection processes failed to provide a sufficient account of the data. Furthermore, an examination of subjects' introspective reports using the remember/know procedure showed that subjects were aware of recollection and familiarity and were able to consistently report on their occurrence. The remember/know data were used to accurately predict the shapes of the ROCs, and estimates of recollection and familiarity derived from the ROC data mirrored the subjective reports of these processes.

Adult↗
PubMed1996

beta-Amyloid induces increased release of interleukin-1 beta from lipopolysaccharide-activated human monocytes.

Previous reports have demonstrated that IL-1 is elevated in the Alzheimer's disease brain. We propose that beta-amyloid (A beta) in senile plaques triggers microglial interleukin-1(IL-1) release. Since microglia and monocytes have similar lineage and functions, the human monocyte cell line, THP-1, was used to determine whether A beta peptides can stimulate release of IL-1 beta. THP-1 cells were grown in culture with LPS and incubated with various A beta peptides (0.5-10 microM). IL-1 released into the medium was measured using either an IL-1 beta ELISA or an IL-1 bioassay. Treatment of activated THP-1 cells with A beta 25-35, fibrillar A beta 1-40, or A beta 1-42 significantly elevated IL-1 beta release. A beta 25-35 with a scrambled sequence or non-fibrillar A beta 1-40 did not significantly change IL-1 beta release from activated THP-1 cells. The A beta 25-35- and fibrillar A beta 1-40 induced IL-1 beta release was dose-dependent. IL-1 released following treatment with A beta 25-35 and measured using an IL-1 bioassay gave similar results. The present report provides evidence that A beta is capable of elevating release of functional IL-1 beta, a potent pro-inflammatory cytokine, from macrophages/microglia and provides support that a chronic local inflammatory response is an ongoing phenomenon within and surrounding senile plaques.

Alzheimer Disease↗
PubMed1996

Subjective assessment of fever by parents: comparison with measurement by noncontact tympanic thermometer and calibrated rectal glass mercury thermometer.

STUDY OBJECTIVE: To assess the ability of parents to subjectively evaluate their children for fever and to compare their assessments with temperature measurements made with the use of a noncontact tympanic (NCT) or rectal glass mercury thermometer. A secondary goal was to assess how well a recently developed definition of fever for NCT thermometers, when used in the ear-equivalent mode (temperature of 37.7 degrees C or more), performed in a clinical situation. METHODS: This 6-month prospective observational study employed a convenience sample of 180 children, aged birth to 4 years, who presented to the emergency department of a tertiary care children's hospital. Parents were asked to subjectively assess whether their child had a fever. The child's temperature was then measured with an NCT thermometer (three times in the rectal-equivalent mode and three times in the actual-ear mode). Both the subjective assessment and the NCT temperatures were compared with the rectal temperature measured by a rectal glass mercury thermometer. RESULTS: The mean age of participants was 14.6 +/- 11.8 months (range, 2 days to 48 months); 56% were boys. The sensitivity of parental detection of fever by subjective means was 81.8% and the specificity 76.5%. The parent and the rectal glass thermometer agreed 79% of the time (95% confidence interval [CI], 73% to 85%). The sensitivity of the first temperature reading obtained with the NCT thermometer in rectal-equivalent mode was 74.7%, and the specificity was 96.3%. The NCT thermometer and the rectal glass thermometer agreed 84% of the time (95% CI, 78% to 89%). Use of the proposed definition of fever for NCT thermometers, when used in the ear-equivalent mode, caused sensitivity of a single measurement for fever to drop to 53.5%. CONCLUSION: Parental subjective assessment of fever agreed with the presence of fever as measured by rectal glass thermometer in 79% of cases. Specificity was improved with the use of the NCT thermometer. The recently proposed definition for fever for NCT thermometers, when they are used in the ear-equivalent mode, does not appear to be validated by the current data.

Child, Preschool↗
PubMed1996

HIV envelope-directed signaling aberrancies and cell death of CD4+ T cells in the absence of TCR co-stimulation.

HIV-1 infection in CD4(+) T cells initiates a viral cytopathic effect (CPE) that is dependent on the activation of intracellular protein tyrosine kinases (PTK). PTK in T cells are also activated during the course of TCR or CD4 receptor engagement and the manner of receptor engagement may generate signals leading either to cell proliferation, tolerance induction (anergy) or programmed cell death (PCD). We have identified PTK triggered during the interaction of cells stably expressing surface HIV envelope (gp 120/gp41; HIVenv) and CD4(+)T cells, which leads to extensive and rapid individual cell death. We have found that killing is accompanied by tyrosine phosphorylation and activation of the CD4-associated p56(ICK) kinase, and by activation of a second member of the scr family of PTK, p59(fyn) kinase, normally associated with T cell stimulation through the TCR. Interestingly, in contrast with normal T cell signaling, the zeta subunit of the TCR fails to become tyrosine-phosphorylated during signaling accompanying HIV-directed cell killing. Downstream activation of the ZAP-70 PTK also does not occur. Unlike T cell apoptosis triggered by soluble HIVenv glycoproteins, which requires co-stimulation of CD4 and the antigen-specific TCR, T cell killing by membrane-associated HIVenv does not require TCR co-stimulation, because aberrant signaling and cell death are triggered by CD4(+) but TCR- cell lines. These results are the first report where dual activation of the Lck and Fyn PTK does not result in normal downstream signaling through the ZAP PTK, We suggest by analogy to SCID resulting from ZAP-70 mutations, that the dissociation of upstream PTK activation from ZAP-70 signaling contributes to T cell depletion by HIV and to the development of AIDS.

Apoptosis↗