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Biomedical subjects

R D Horner

Publications and source records attributed to R D Horner.

90 records · Page 5Linked to original sources

Millisecond kinetics of ATP synthesis driven by externally imposed electrochemical potentials in chloroplasts.

We have used rapid mixing and quenching techniques to measure the initial ATP synthesis rates and the duration of the ATP synthetic capacity derived from artificially imposed proton gradients and valinomycin-mediated K+ diffusion potentials in chloroplasts. The initial rate of ATP synthesis driven by a K+ diffusion potential was 10-fold slower than that driven by an acid-base transition of equivalent electrochemical potential. Total yields of ATP resulting from a K+ concentration shift were only slightly affected by the absence of Cl-, indicating that Cl- permeability does not significantly reduce the K+ diffusion potential. The ATP synthetic capacity decayed with a half-life of 0.2 s in the case of a K+ diffusion potential and a half-life of 1.0 s in the case of an acid-base shift. In both cases, ATP, added at the time of the pH or [KCl] shift, slowed the decay of the ATP synthesis rates, indicating that the coupling factor controls a channel for proton efflux, as proposed earlier (Portis, A.R., and McCarty, R.E. (1974) J. Biol. Chem. 249, 6250-6254). Because the proton gradient has a longer half-life than the K+ diffusion potential, when combinations of the two are employed to drive ATP synthesis, the proton gradient will make a larger contribution to the initial rate and total yield than that predicted from a strictly linear proportionality of the initial magnitudes of the two gradients.

Acid-Base Equilibrium↗

The effect of permeant buffers on initial ATP synthesis by chloroplasts using rapid mix-quench techniques.

The chemiosmotic hypothesis predicts that buffers which permeate chloroplast membranes should delay the formation of the proton gradient at the onset of illumination. If valinomycin and KCl are present to collapse the electrical potential as well, this delay should result in a lag in initial ATP synthesis. Using rapid-mix, acid-quench techniques, we have found that in light-driven ATP synthesis the permeant buffer imidazole does not increase the initial lag caused by the valinomycin-KCl pair. Similar results are obtained under methyl viologen or phenazine methosulfate/ascorbate-mediated photophosphorylation and are independent of the internal volume of the chloroplasts. Furthermore, we have observed that chloroplasts can synthesize significant amounts of ATP in darkness following an illumination period as short as 100 ms. This capacity for ATP synthesis in darkness after short pre-illumination periods is decreased in the presence of imidazole, and this may account for the apparent lags reported in earlier studies which have used rapid flash photophosphorylation in the presence of permeant buffers. The results of the present study argue that in chloroplasts, initial ATP synthesis and post-illumination ATP synthesis are driven by distinct components of the proton motive potential.

Adenosine Triphosphate↗

Initial products of photophosphorylation with AMP and [32P]Pi.

The role of AMP in photophosphorylation was studied using rapid mixing acid quench techniques. Fragmented spinach chloroplast membranes or subchloroplast particles were illuminated and rapidly mixed with [32P]orthophosphate and AMP at pH 7 for 10 ms to 60 s after which time perchloric acid was added to quench the reaction. ATP was found to be the primary and predominant nucleotide labeled. It was found that after illumination, an adenylate kinase-like activity carried out an AMP-dependent conversion of labeled ATP to labeled ADP which was inhibited by the presence of ADP. This reaction was characterized as being similar to chloroplast adenylate kinase in Mg2+ dependency and in sensitivity to phlorizin and tentoxin and distinct from chloroplast coupling factor 1. The small amounts of adenylate kinase activity present in fragmented well washed chloroplast membranes were found to be sufficient to carry out this rapid reaction. These results necessitated a reinterpretation of the earlier findings of Tiefert and Moudrianakis (Tiefert, M.A., and Moudrianakis, E.N. (1979) J. Biol. Chem. 254, 9500-9508) and no longer support the role of ADP as a phosphorylated intermediate in ATP synthesis.

Adenosine Diphosphate↗

The effects of an environmental "enrichment" program on the behavior of institutionalized profoundly retarded children.

This study determined the effects of procedures designed to "enrich" the physical and social environment of an institutional ward on the "adaptive" and "maladaptive" child, adult, self, and object-directed behaviors of five profoundly retarded ambulatory females. Behavior observed in two treatment conditions, an environment "enriched" with toys and objects and an "enriched" environment coupled with differential reinforcement of adaptive behavior, was compared to behavior occurring in corresponding baseline or "austere" conditions and during a period of noncontingent reinforcement. The results generally revealed: (1) little change in adaptive and maladaptive child and adult-directed behavior across conditions, (2) an overall higher incidence of adaptive object-directed behavior and reduced self-directed maladaptive behavior in each treatment condition from that observed in corresponding control conditions, and (3) the use of an "enriched" environment and differential reinforcement of adaptive behavior resulted in maladaptive self-directed behavior being reduced and adaptive object-directed behavior being icreased beyond that observed in the "enriched" environment alone. These behavioral gains were largely maintained during a follow-up condition by continuing the "enriched" environment and transferring the responsibility for differential reinforcement to direct-care staff.

Adolescent↗

Multiple-probe technique: a variation on the multiple baseline.

Multiple-baseline and probe procedures are combined into a "multiple-probe" technique. The technique is designed to provide a thorough analysis of the relationship between an independent variable and the acquisition of a successive-approximation or chain sequence. It provides answers to the following questions: (1) What is the initial level of performance on each step in the training sequence? (2) What happens if sequential opportunities to perform each next step in the sequence are provided before training on that step? (3) What happens when training is applied? (4) What happens to the performance of remaining steps in the sequence as criterion is reached in the course of training each prior step? The technique features: (1) one initial probe of each step in the training sequence, (2) an additional probe of every step after criterion is reached on any training step, and (3) a series of "true" baseline sessions conducted just before the introduction of the independent variable to each training step. Intermittent probes also provide an alternative to continuous baseline measurement, when such measurement during extended multiple baselines (1) may prove reactive, (2) is impractical, and/or (3) a strong a priori assumption of stability can be made.

Journal Article↗

Training mentally retarded adolescents to brush their teeth.

The need for self-care by retarded individuals in behaviors such as brushing teeth led to the development and evaluation of a comprehensive toothbrushing program that included a task analysis and training procedure specific to each component of the task analysis. Eight mentally retarded adolescents, in two groups, individually received acquisition training that included scheduled opportunities for independent performances, verbal instruction, modelling, demonstration, and physical assistance. The first group of four subjects received token plus social reinforcement; the second received only social reinforcement. All eight subjects showed improved toothbrushing behaviors when compared to baseline. Six of the eight subjects correctly performed all toothbrushing steps in two of three consecutive sessions. The study emphasizes the need for systematic program development and evaluation.

Adolescent↗

Increasing mentally retarded adolescents' verbalizations about current events.

The effects of antecedent and consequent events on the verbal behavior of three institutionalized mentally retarded adolescents were examined. Verbal statements, related to current national and international events, were recorded after exposures to television news programs. The study examined the accuracy of verbalizations as a function of: (1) exposures to television news presentations in massed (i.e., viewing the entire news program before an opportunity to describe it) versus distributed from (i.e., viewing each news item separately with each followed by an opportunity to describe it), and (2) contingent tokens and social praise for correct verbal responses (i.e., statements corresponding to news items presented). Both the temporal distribution of news presentations and the reinforcement procedures improved the accuracy of verbal statements emitted by the subjects.

Journal Article↗

Establishing use of crutches by a mentally retarded spina bifida child.

A 5-yr-old mentally retarded spina bifida child was taught to walk with the aid of crutches. This behavior was developed through fading of physical prompting within a 10-step successive approximation sequence. Preliminary training to establish gait consisted of developing use of parallel bars through fading of physically modelled responses within a six-step successive approximation sequence. Use of parallel bars ceased during an extinction period and completely recovered upon being primed with one "free" reinforcement. Systematic use of natural reinforcers was employed as an aid in maintaining use of crutches.

Journal Article↗

Lack of weight gain associated with short-term astemizole treatment.

The effect of treatment with astemizole for three weeks on weight was assessed in 44 patients with seasonal allergic rhinitis who participated in a randomized, double-blind, placebo-controlled clinical trial. Astemizole 10-mg tablets and identical placebo tablets were used. Compared with baseline, weight increased significantly in astemizole-treated patients (1.07 +/- 1.39 kg; p = 0.0004); however, the mean change in weight in astemizole-treated patients was not statistically significantly different than that seen in placebo-treated patients (0.85 +/- 1.68 kg). No relationship was found between changes in weight and age, sex, initial weight, percentage of obesity, and plasma astemizole concentrations.

Adult↗

Patterns of care for HIV-related Pneumocystis carinii pneumonia in a university medical program: a case study.

BACKGROUND/OBJECTIVE: Previous studies have identified large variations in patterns of in-hospital acquired immunodeficiency syndrome (AIDS) care among groups of hospitals and physicians. We evaluated the patterns of care for patients with AIDS-related Pneumocystis carinii pneumonia (PCP) care at a single university program with patients treated at an adjacent county and Veterans' Administration (VA) hospital. All medical care was provided by physicians in a single residency program, but attending physician staffs were separate. SETTING AND PATIENTS: A randomized sample of patients with human immunodeficiency virus (HIV)-related PCP from the two hospitals who received care between 1987 and 1990. RESULTS: During the study years, the VA hospital provided care for approximately one fourth as many AIDS patients as the county hospital. Patients at the VA hospital had a higher bronchoscopy rate (39.7% versus 27.7%, P = .05), higher intensive-care unit (ICU) rate (11.8% versus 2.9%, P = .008), longer hospitalizations (mean length of stay of 18.9 versus 13.9 days, P = .004), but delayed initiation of anti-PCP therapy (median of day 2 versus day 1, P < .05). The odds of death were significantly different between the VA and county hospitals, even after adjusting for differences in important patient characteristics. CONCLUSION: Patterns of in-hospital PCP care differed between the two hospitals of this medical school. Possible explanations include organizational differences related to level of attending physician HIV experience, hospital case loads of AIDS patients, or specific hospital considerations such as concerns over tuberculosis exposure.

Acquired Immunodeficiency Syndrome↗

The structure and structural effects of VA rehabilitation bedservice care for stroke.

The purpose of this study was to: 1) examine the variation in organizational structure within rehabilitation bed-service units (RBU) in the Veterans Health Administration (VHA), and 2) evaluate the effects of RBU and parent hospital structure on stroke rehabilitation outcomes. Two VHA-wide surveys of acute and rehabilitation services for stroke were linked with 2 y of VHA rehabilitation outcomes for stroke patients. A random effects mixed model was used to adjust for patient level covariates, control for unique site effects, and test for facility level structural effects. After adjusting for patient covariates, four structural variables were associated with length of stay or patient functional gain. These results indicate that rehabilitation structure is important to rehabilitation outcome. The individual variables identified in this study, namely, diverse multidisciplinary staff, expert physician leadership, staff participation in team care, and richer rehabilitation equipment resources, may represent the distinct aspects of a successful, comprehensive rehabilitation unit.

Adult↗

The effect of faculty private practice experience on appropriate charging for professional services.

Private practice experience is widely considered invaluable for academic family physicians, especially for clinical efficiency and for charging appropriately for professional services. This study tested the hypothesis that faculty members with private practice experience charged more appropriately for professional services. Patient-physician encounters were rated in terms of propriety of charges by consensus of two faculty physicians and compared to the actual level of service marked on the encounter form. Private practice experience for faculty resulted in less undercharging (21% of encounters undercharged versus 31% for faculty without that experience, P = .03). Physicians with private practice experience undercharged on average $.36 per encounter, versus $1.94 for providers without that experience (Kruskal-Wallis test, P = .27). Physicians with private practice experience also tended to perform more procedures but not to bill for more. Academic family physicians with private practice experience demonstrated more appropriate billing practices for professional services, but ideally preference for this type of academic physician should be based on other attributes, such as breadth of experience and efficiency in patient care.

Faculty, Medical↗

Patient perceptions of the need for chaperones during pelvic exams.

This report describes the attitudes of women patients about the presence and role of a chaperone during pelvic exams and factors associated with these perceptions. A questionnaire was mailed to a systematic sample of all adult women patients of an academic-affiliated family practice (n = 939) in a rural southeastern United States community. Approximately 64% of the sample responded, and 440 (91%) of the returned questionnaires could be used in the analysis. Over half of the patients had no gender preference for the examining physician; when a preference was indicated, it was for a woman physician. Patients expressing a preference were more likely to be younger, never married, nulliparous, and black. Gender of the examining physician was a major factor in the desire for a chaperone during pelvic exams. A chaperone was desired most often when the examining physician was male, and this was especially so when a female physician was preferred. The results indicate most women desired a chaperone when the physician was male, but preferred no chaperone or had no preference when a woman physician was involved.

Adolescent↗

Process and outcome of critical care provided by community and academic primary care physicians.

Academic and community physicians traditionally have conducted their practices in separate settings. This study compared the process and outcome of critical care admissions of patients at one hospital by primary care physicians who were either in full-time academic positions or in community based practice. The comparison showed that community physicians treated an older patient population with a different diagnostic mix. Although the community physicians tended to serve older patients with Medicare coverage, the major difference between the two groups was that academic physicians requested 50% more consultations than community physicians (.86 and .56 consultations per admission, respectively). Analysis of outcome measures, such as survival time, readmission rate, and death rate, showed no differences. Survival analysis showed the risk of death to be significantly higher for patients of academic physicians (relative risk = 1.46, C1 = 1.07, 2.00). Other factors contributing significantly to the risk of death included severity of illness, patient age and race, and digestive diseases. The apparent differences in patient outcome between the two groups of physicians are more likely related to underlying differences in the patients than in the clinical approaches of their physicians.

Adult↗

Outpatient antimicrobial susceptibility: comparison with inpatient susceptibility patterns.

Because specific outpatient epidemiologic data on the susceptibility of organisms are not readily available to guide empiric antibiotic therapy in the ambulatory setting, we reviewed all positive culture reports of clinical specimens (n = 935) isolated exclusively from outpatients of the Eastern Carolina Family Practice Center over a 1-year period. Eighty percent were from urine cultures, 12 percent from wound cultures, and 5 percent from sputum cultures. An antibiogram was developed that showed a pattern of bacterial resistance similar to that reported elsewhere. More than 80 percent of urinary tract infections were caused by Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. More than 50 percent of skin and soft tissue infections were caused by Staphylococcus aureus and other Staphylococcus species. Susceptibilities of these organisms were compared with those reported by the local hospital, and antimicrobial resistance patterns were similar, which suggests that the choice of empiric antibiotic therapy can follow susceptibility patterns derived from either inpatient or outpatient laboratories in areas with similar resistance patterns. Further research into the epidemiology and susceptibility of organisms isolated from outpatients is needed. Whether the susceptibility of inpatient and outpatient antimicrobial resistance found in this investigation can be extrapolated to other geographic areas remains to be determined.

Ambulatory Care Facilities↗

Racial differences in care among hospitalized patients with Pneumocystis carinii pneumonia in Chicago, New York, Los Angeles, Miami, and Raleigh-Durham.

BACKGROUND: While strategies for medical care for human immunodeficiency virus-related Pneumocystis carinii pneumonia (PCP) are well established, racial variations in care have not been evaluated. OBJECTIVE: To determine whether sociodemographic characteristics influence patterns of care and patient outcomes, by analyzing the use of diagnostic tests and anti-PCP medications and in-hospital mortality rates for persons who were hospitalized with human immunodeficiency virus-related PCP. METHODS: Retrospective chart review of a cohort of 627 Veterans Administration (VA) patients and 1547 non-VA patients with empirically treated or cytologically confirmed PCP who were hospitalized from 1987 to 1990. Outcomes included representative aspects of the process of care for PCP and short-term mortality rates. RESULTS: Among VA patients, black and Hispanic patients were not significantly different from white patients with regard to in-hospital mortality rates, use and timing of a bronchoscopy, or receipt of timely anti-PCP medications. Among non-VA patients, black and Hispanic patients were more likely to die in the hospital and less likely to undergo a diagnostic bronchoscopy in the first 2 days of hospitalization. These racial and ethnic group differences in the use of a bronchoscopy and in-hospital mortality among non-VA patients were almost fully accounted for by differences in health insurance status and hospital characteristics. CONCLUSIONS: Racial factors do not appear to be an important determinant of the intensity of diagnostic or therapeutic care among patients who are hospitalized with PCP. Variations in care are largely attributable to differences in health insurance and admitting hospital characteristics.

AIDS-Related Opportunistic Infections↗

The high cost of stroke to society, the family, and the patient.

Stroke is the third leading cause of mortality in the United States, after heart disease and cancer, and is a major cause of adult disability. Stroke-related neurologic deficits affect language, cognition, and motor function. They are often persistent, exerting a negative effect on the patient's quality of life. Besides affecting the patient, stroke also places a heavy emotional burden on the caregivers of patients with stroke. In the United States, the medical and nonmedical costs of caring for patients with stroke during the first year after their stroke are $30 billion/year, or approximately $50,000/patient. Many strokes are preventable, however, through judicious medical or surgical therapies. In addition, emerging thrombolytic and neuroprotective drugs, administered early after stroke onset, may minimize or eliminate some of the residual deficits associated with stroke. A massive educational effort is needed to raise public and professional awareness about stroke and emerging stroke therapies.

Cerebrovascular Disorders↗