Biomedical subjects

David Bregman

Publications and source records attributed to David Bregman.

4 recordsLinked to original sources

PubMed2004

The inhibitor of cyclin-dependent kinase 4a/alternative reading frame (INK4a/ARF) locus encoded proteins p16INK4a and p19ARF repress cyclin D1 transcription through distinct cis elements.

The Ink4a/Arf locus encodes two structurally unrelated tumor suppressor proteins, p16(INK4a) and p14(ARF) (murine p19(ARF)). Invariant inactivation of either the p16(INK4a)-cyclin D/CDK-pRb pathway and/or p53-p14(ARF) pathway occurs in most human tumors. Cyclin D1 is frequently overexpressed in breast cancer cells contributing an alternate mechanism inactivating the p16(INK4a)/pRb pathway. Targeted overexpression of cyclin D1 to the mammary gland is sufficient for tumorigenesis, and cyclin D1-/- mice are resistant to Ras-induced mammary tumors. Recent studies suggest cyclin D1 and p16(INK4a) expression are reciprocal in human breast cancers. Herein, reciprocal regulation of cyclin D1 and p16(INK4a) was observed in tissues of mice mutant for the Ink4a/Arf locus. p16(INK4a) and p19(ARF) inhibited DNA synthesis in MCF7 cells. p16(INK4a) repressed cyclin D1 expression and transcription. Repression of cyclin D1 by p16(INK4a) occurred independently of the p16(INK4a)-cdk4-binding function and required a cAMP-response element/activating transcription factor-2-binding site. p19(ARF) repressed cyclin D1 through a novel distal cis-element at -1137, which bound p53 in chromatin-immunoprecipitation assays. Transcriptional repression of the cyclin D1 gene through distinct DNA sequences may contribute to the tumor suppressor function of the Ink4a/Arf locus.

Animals↗

PubMed2003

Simulation and management games for training command and control in emergencies.

The aim of our project was to introduce and implement simulation techniques in a problematic field of increasing health care system preparedness for disasters. This field was chosen as knowledge is gained by few experienced staff members who need to disperse it to others during the busy routine work of the system personnel. Knowledge management techniques ranging from classifying the current data, centralized organizational knowledge storage and using it for decision making and dispersing it through the organization--were used in this project. In the first stage we analyzed the current system of building a preparedness protocol (set of orders). We identified the pitfalls of changing personnel and loosing knowledge gained through lessons from local and national experience. For this stage we developed a database of resources and objects (casualties) to be used in the simulation in different possibilities. One of those was the differentiation between drills with trainer and those in front of computers enable to set the needed solution. The model rules for different scenarios of multi-casualty incidents from conventional warfare trauma to combined chemical/toxicological as well as, levels of care pre and inside hospitals--were incorporated to the database management system (we used Microsoft Access' DBMS). The hardware for management game was comprised of serial computers with network and possibility of projection of scenes. For prehospital phase the possibility of portable PC's and connections to central server was used to assess bidirectional flow of information. Simulation software (ARENA) and graphical interfase (Visual Basic, GUI) as shown in the attached figure. We hereby conclude that our system provides solutions which are in use in different levels of healthcare system to assess and improve management command and control for different scenarios of multi-casualty incidents.

Computer Simulation↗

PubMed1980

The current status of cardiovascular surgery in the People's Republic of China.

Dr. David Bregman was invited to participate in a thirteen-physician American Teaching Delegation led by Dr. Tsung O. Cheng, Professor of Medicine at George Washington University Medical Center in Washington, D.C. The trip was sponsored by the American College of Physicians. Deputy Director of the delegation was Dr. Samuel Asper, Deputy Executive Vice President of the American College of Physicians and Professor of Medicine at Johns Hopkins University. The American Teaching Delegation was the first of its kind to be invited to lecture and impart new medical-surgical techniques throughout the People's Republic of China. The trip lasted approximately one month, from September to October, 1979, and included the September 30 to October 1 celebrations in Peking commemorating the 30th Anniversary of the founding of the People's Republic of China. Principal cities visited were Peking and Shanghai, as well as Chengtu, Chungking, and Wuhan. Dr. Bregman demonstrated, for the first time in the People's Republic of China, intraaortic balloon pumping, a new percutaneous intraaortic balloon, and other cardiac assist techniques.

Journal Article↗

PubMedDate not supplied

National strategy for mass casualty situations and its effects on the hospital.

A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized. The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each site's readiness level and the continuity of the flow of care are tested. In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs). A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent.

Disaster Planning↗