Biomedical subjects

L Palmer

Publications and source records attributed to L Palmer.

At least 19 recordsLinked to original sources

PubMed2000

Use of archival tissue in epidemiologic studies: collection procedures and assessment of potential sources of bias.

Collection and analyses of archival tumor tissue as a means to increase our understanding of disease pathways is becoming an important avenue of epidemiologic research. In this paper, we present methods of collection and processing of archival tissue and assess the population characteristics of those for whom we were able to and unable to obtain tumor DNA. Cases of colon cancer diagnosed between September, 1991 and October, 1994 living in Utah, Northern California, or the Twin Cities Metropolitan area of Minnesota were targeted for this study. Of the 2477 people for whom we had permission to obtain tumor blocks, we were able to collect blocks and extract DNA for 2117 (85.5%). There were no differences in age, tumor site, or diet and lifestyle characteristics between those with and without DNA extracted. However, we were less likely to be able to extract DNA if the case was diagnosed at a more advanced disease stage or at the earliest disease. Potential bias from exclusion of those with the most advanced disease stage is discussed.

Adult↗

PubMed2000

Major histocompatibility class I gene transcription in thyrocytes: a series of interacting regulatory DNA sequence elements mediate thyrotropin/cyclic adenosine 3',5'-monophosphate repression.

In response to TSH, thyroid cells decrease major histocompatibility (MHC) class I expression and transcription, providing an excellent model for studying the dynamic modulation of transcription of MHC class I genes. Here we show that protein kinase A (PKA), a downstream effector of the TSH/cAMP pathway, reproduces the effects of TSH in repressing class I transcription. PKA/cAMP-mediated repression of transcription involves multiple interacting upstream response elements in the class I promoter: an element extending from -127 to -90 bp containing a CRE-like core, and at least two elements within an upstream 30-bp segment (-160 to -130 bp), which overlaps with the interferon regulatory element. ICER (inducible cAMP early response), a transcriptional repressor induced by TSH/cAMP can decrease class I promoter activity when introduced into FRTL-5 thyroid cells in the absence of TSH/cAMP. ICER binds to both the CRE-like element and the upstream 30-bp segment, generating a novel TSH-induced ternary complex. The present studies led to the proposal that TSH-mediated repression of class I transcription is the result of integrating signals from transcription factors through the higher order interactions of multiple regulatory elements.

Animals↗

PubMed1999

Incidence of breast carcinoma in women with thyroid carcinoma.

BACKGROUND: Breast carcinoma and differentiated thyroid carcinoma(the most common endocrine malignancy) occur predominantly in women. An association between the two tumors has been suggested by some investigators, but the potential impact of treatment of one of these diseases on the development of the other remains unclear. The authors examined the relation between the occurrence of these two tumors. METHODS: There were 41,686 patients with breast carcinoma and 3662 with thyroid carcinoma who registered at The University of Texas M. D. Anderson Cancer Center between March 1944 and April 1997. Women who received both diagnoses since 1976 were identified and incidence rates and relative risks of secondary tumor development were calculated. Surveillance, Epidemiology and End Results (SEER) program data on the age-adjusted incidences of these diseases during the same time period were used for the expected incidences in the same population. RESULTS: Among 18,931 women with a diagnosis of breast carcinoma since 1976, 11 developed differentiated thyroid carcinoma > or = 2 years after the diagnosis of breast carcinoma. These breast carcinoma patients contributed 129,336 person-years of follow-up; the observed incidence of thyroid carcinoma in this group was not different from that in a similar age group of women in the SEER database. Among 1013 women with a diagnosis of thyroid carcinoma since 1976, 24 developed breast carcinoma > or = 2 years after the diagnosis of thyroid carcinoma. These thyroid carcinoma patients contributed 8380 person-years of follow-up; the observed incidence of breast carcinoma in women ages 40-49 years was significantly higher than the expected incidence for women in the same age group in the SEER database. CONCLUSIONS: Breast carcinoma developing after thyroid carcinoma was diagnosed more frequently than expected in young adult women seen at the study institution since 1976. This potential association and plausible mechanisms of breast carcinoma development after thyroid carcinoma should be evaluated in larger cohorts of patients.

Adenocarcinoma, Follicular↗

PubMed1999

Reducing inappropriate restraint use in Colorado's long-term care facilities.

BACKGROUND: Many physical and psychosocial complications arise from the use of physical restraints. Restraints in nursing homes have been estimated to cause approximately 1 in every 1,000 nursing home deaths. When restraints are removed, quality of life and functional status improve; there does not appear to be an increase in serious falls, and serious injuries may even decline. METHODS: To assess the current status in Colorado nursing homes, in 1997 the Colorado Foundation for Medical Care mailed a questionnaire to 214 nursing homes to identify remaining barriers to restraint reduction. Results were used to plan interventions to further reduce inappropriate use that met most providers' needs. Given providers' need for greater family and public awareness of the risks associated with restraints, the project team developed educational tools for distribution to families and a media campaign for the public. In addition, an assessment tool and educational materials were created to facilitate appropriate use of devices and implementation of least-restrictive interventions. Data were collected before and after the intervention phase on remaining barriers, frequency of assessment, and perceived level of success of restraint reduction. RESULTS: Most of the 175 (82%) of Colorado's 214 long-term care providers who received educational materials found them very useful and recommended expansion to other states. Facilities indicated a higher perceived level of success in reducing restraints, an increase in the frequency of assessments, and a decrease in barriers to restraint reduction. The public awareness campaign, performed in tandem with the state health department, reached more than a half-million people in Colorado, using the slogan, "Restraints Have Risks!"

Aged↗

PubMed1999

Stabilized plasmid-lipid particles: construction and characterization.

A detergent dialysis procedure is described which allows encapsulation of plasmid DNA within a lipid envelope, where the resulting particle is stabilized in aqueous media by the presence of a poly(ethyleneglycol) (PEG) coating. These 'stabilized plasmid-lipid particles' (SPLP) exhibit an average size of 70 nm in diameter, contain one plasmid per particle and fully protect the encapsulated plasmid from digestion by serum nucleases and E. coli DNase I. Encapsulation is a sensitive function of cationic lipid content, with maximum entrapment observed at dioleoyldimethylammonium chloride (DODAC) contents of 5 to 10 mol%. The formulation process results in plasmid-trapping efficiencies of up to 70% and permits inclusion of 'fusigenic' lipids such as dioleoylphosphatidylethanolamine (DOPE). The in vitro transfection capabilities of SPLP are demonstrated to be strongly dependent on the length of the acyl chain contained in the ceramide group used to anchor the PEG polymer to the surface of the SPLP. Shorter acyl chain lengths result in a PEG coating which can dissociate from the SPLP surface, transforming the SPLP from a stable particle to a transfection-competent entity. It is suggested that SPLP may have utility as systemic gene delivery systems for gene therapy protocols.

Animals↗

PubMed1999

An introductory hospice experience for third-year medical students.

BACKGROUND: An organized and distinct curriculum in hospice and palliative care education is lacking in most United States medical school programs. Because of this knowledge deficit, physicians are often not able to meet the needs of their terminally ill patients and their families. METHODS: A five-day combined didactic and clinical rotation in hospice and palliative care for third-year medical students was developed and is presented. The program is run through a home-based hospice in conjunction with the state's medical school. RESULTS: The pilot program has been well accepted by the participating students as a valuable learning experience. Although brief, it has also been successful in changing some of their attitudes about death and the care of the dying. CONCLUSIONS: This one-week program is an effective means to provide an intense course in hospice education. It should be easily transportable to other health care curricula.

Attitude to Death↗

PubMed1999

How telehomecare affects patients.

The emergence of telemedicine as an acceptable mode of health care delivery creates opportunities and challenges for home care providers. As part of strategic planning and deployment of a telemedicine project, agencies must ask questions, such as, is this technology suitable for elderly clients? Can patients with multiple, chronic conditions benefit? Are caregivers willing to take on the responsibility of additional equipment in the home? Agencies must consider these and other issues when planning and evaluating a telemedicine project.

Community Health Nursing↗

PubMed1998

Planning and implementing an anesthesia crisis resource management course for student nurse anesthetists.

Development of Anesthesia Crisis Resource Management (ACRM) skills is a highly desirable outcome of a nurse anesthesia educational program. Access to an ACRM course is limited by a variety of factors including cost, availability of a center, time constraints, and the lack of adequately prepared CRNA faculty. The authors describe a Nurse Anesthesia Program's planning and implementation of an ACRM course by using a high fidelity human simulator. Key supportive and logistical elements necessary to implement an ACRM course are described. The authors address administrative concerns, faculty preparation needs, and explain the process of course design. Strengths of the course and problems encountered during the implementation of the experience are described. Feedback from participating students, faculty perceptions, and lessons learned from the experience are shared.

Clinical Competence↗

PubMed1997

Mutation screening of interferon-gamma (IFNgamma) as a candidate gene for asthma.

BACKGROUND: Reduced levels of interferon gamma (IFNgamma) mRNA and protein have been detected in the bronchoalveolar lavage fluid of atopic asthmatics. IFNgamma is secreted by TH1 cells while IL-4 and IL-5 are secreted by TH2 cells and an imbalance in the TH1/TH2 response may be responsible for atopic asthma. The gene for IFNgamma is located on chromosome 12; a region of the genome which has been shown in linkage studies to be associated with asthma. OBJECTIVE: To determine if there are any mutations present in the coding exons and 5' flanking region of the IFNgamma gene in atopic asthmatic subjects compared with controls to explain the lower levels of this cytokine as an inherited, rather than acquired, factor in the asthmatic subjects. METHODS: The four exons and 5' flanking region of the IFNgamma gene were amplified by polymerase chain reaction (PCR) from genomic DNA of 265 individuals from a Western Australian and a Venezuelan population. The PCR products were examined by single strand conformational polymorphism and heteroduplex analyses to see if there were any changes in the DNA migration patterns which would suggest the presence of a sequence variation. RESULTS: The four exons and the 5' flanking region of the IFNgamma gene were amplified from 265 individuals from two populations. Single strand conformational polymorphism and heteroduplex analyses did not reveal any mutations in the regions examined. CONCLUSION: The gene for IFNgamma appears to be highly conserved as no sequence variations were detected in 265 individuals. These results suggest that mutations of the IFNgamma gene are unlikely to be a significant cause of an inherited asthma diathesis.

Adolescent↗

PubMed1997

A computerized adaptive testing system for speech discrimination measurement: the Speech Sound Pattern Discrimination Test.

A computerized, adaptive test-delivery system for the measurement of speech discrimination, the Speech Sound Pattern Discrimination Test, is described and evaluated. Using a modified discrimination task, the testing system draws on a pool of 130 items spanning a broad range of difficulty to estimate an examinee's location along an underlying continuum of speech processing ability, yet does not require the examinee to possess a high level of English language proficiency. The system is driven by a mathematical measurement model which selects only test items which are appropriate in difficulty level for a given examinee, thereby individualizing the testing experience. Test items were administered to a sample of young deaf adults, and the adaptive testing system evaluated in terms of respondents' sensory and perceptual capabilities, acoustic and phonetic dimensions of speech, and theories of speech perception. Data obtained in this study support the validity, reliability, and efficiency of this test as a measure of speech processing ability.

Adolescent↗

PubMed1997

Who prescribe better: doctors or dispensers?

Doctors in Sierra Leone were more rational than dispensers in that they prescribed antibiotics in a smaller percentage of encounters with patients and averaged fewer drugs per prescription. They were less rational than dispensers, however, in that they prescribed generics less often and made less use of the country's essential drugs list.

Adolescent↗

PubMed1996

The impact of child sexual abuse on the children of survivors. Implications for forensic nursing.

1. Assuming that dysfunctional familial patterns arise from child sexual abuse experiences and that they are learned by the victims' children, there is a potential risk conferred to the children of becoming victims of child sexual abuse. 2. Certain physical manifestations, psychosocial behaviors, and relational patterns typify the personae of adults who experienced sexual abuse as children. 3. Roles of the nurse that might be used to meet the needs of this risk group are varied and target the victims, their children, and the community at large.

Adolescent↗

PubMed1996