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Biomedical subjects

J E Prescott

Publications and source records attributed to J E Prescott.

At least 19 recordsLinked to original sources
PubMed2001

A novel c-Myc-responsive gene, JPO1, participates in neoplastic transformation.

We have identified a novel c-Myc-responsive gene, named JPO1, by representational difference analysis. JPO1 responds to two inducible c-Myc systems and behaves as a direct c-Myc target gene. JPO1 mRNA expression is readily detectable in the thymus, small intestine, and colon, whereas expression is relatively low in spleen, bone marrow, and peripheral leukocytes. We cloned a full-length JPO1 cDNA that encodes a 47-kDa nuclear protein. To determine the role of JPO1 in Myc-mediated cellular phenotypes, stable Rat1a fibroblasts overexpressing JPO1 were tested and compared with transformed Rat1a-Myc cells. Although JPO1 has a diminished transforming activity as compared with c-Myc, JPO1 complements a transformation-defective Myc Box II mutant in the Rat1a transformation assay. This complementation provides evidence for a genetic link between c-Myc and JPO1. Similar to c-Myc, JPO1 overexpression enhances the clonogenicity of CB33 human lymphoblastoid cells in methylcellulose assays. These observations suggest that JPO1 participates in c-Myc-mediated transformation, supporting an emerging concept that c-Myc target genes constitute nodal points in a network of pathways that lead from c-Myc to various Myc-related phenotypes and ultimately to tumorigenesis.

Amino Acid Sequence↗
PubMed2001

Emergency medical care in rural America.

The delivery of high-quality emergency care in a rural setting requires a conceptual framework quite different from that required in urban and suburban environments, given that available resources are limited in the rural setting. The intermittent and episodic nature of seriously ill and injured patients who present to rural emergency departments makes it difficult to plan, staff, and equip in order to provide emergency medical care at the same level seen at higher volume urban or suburban institutions. The objective of this article is to describe the distinctive nature and widely unrecognized features of emergency medicine in rural and remote areas, with a focus on clinical, workforce, and economic issues. We present recommendations for a shift in thinking and a call to action on behalf of all emergency medicine professionals that are based on a realistic assessment of the current status of emergency medicine and that are needed to develop and sustain high-quality emergency medical care in rural America.

Emergency Medical Services↗
PubMed2000

Tumor induction by the c-Myc target genes rcl and lactate dehydrogenase A.

The characterization of c-Myc target genes, such as rcl and lactate dehydrogenase A (LDH-A), is critical for understanding the mechanisms of c-Myc-induced cell transformation and tumorigenesis. We have previously demonstrated that Rcl induces anchorage-independent growth in Ratla fibroblasts and that LDH-A is required for cell transformation by c-Myc. In this study, we report that Rcl and LDH-A act synergistically to induce anchorage-independent growth. Cells expressing both Rcl and LDH-A form tumors after s.c. injection into nude mice, although neither Rcl or LDH-A overexpression alone induces tumorigenesis. The inability of Rcl and LDH-A to fully recapitulate c-Myc activity, however, indicates that other c-Myc target genes participate in tumorigenesis. In addition, cells that coexpress Rcl and vascular endothelial growth factor are more comparable with c-Myc overexpressing cells in their ability to form tumors in nude mice. These findings confirm Rcl and LDH-A as critical components of the cell transformation program induced by c-Myc and suggest that Rcl is tumorigenic in cells that are provided with a permissive metabolic milieu.

Animals↗
PubMed1999

Function of the c-Myc oncogenic transcription factor.

The c-myc gene and the expression of the c-Myc protein are frequently altered in human cancers. The c-myc gene encodes the transcription factor c-Myc, which heterodimerizes with a partner protein, termed Max, to regulate gene expression. Max also heterodimerizes with the Mad family of proteins to repress transcription, antagonize c-Myc, and promote cellular differentiation. The constitutive activation of c-myc expression is key to the genesis of many cancers, and hence the understanding of c-Myc function depends on our understanding of its target genes. In this review, we attempt to place the putative target genes of c-Myc in the context of c-Myc-mediated phenotypes. From this perspective, c-Myc emerges as an oncogenic transcription factor that integrates the cell cycle machinery with cell adhesion, cellular metabolism, and the apoptotic pathways.

Basic Helix-Loop-Helix Leucine Zipper Transcriptio↗
PubMed1999

Emergency center categorization standards.

The SAEM EC Categorization Task Force was developed in response to the 1994 Macy Foundation's recommendation that emergency medicine (EM) organizations "should revise the classification of emergency departments ... to reflect the level of care available in emergency departments, and indicate whether or not facilities are adequate and whether appropriately qualified and credentialed emergency physicians are available 24 hours a day." By holding Level 1 emergency centers (ECs) to objective standards based on the quality of care delivered as well as administrative, research, and educational efforts, SAEM hopes to improve patient care. The SAEM EC Categorization Task Force is now beginning the process of reviewing ECs that provide comprehensive emergency care and serve as regional resources for education, research, and administration in EM. This standards document describes relative and critical criteria to be met in order to receive designation as a Level 1 emergency center. Such centers must meet all critical criteria, and be in sufficient compliance with most or all relative criteria, in order to achieve this designation. This process is entirely voluntary. Any EC is eligible for review. Any institution can initiate the review process by applying. Application materials and further information, including the policies and procedures of the SAEM EC Categorization Task Force, are available from SAEM.

Education, Continuing↗
PubMed1998

Physicians in rural West Virginia emergency departments: residency training and board certification status.

OBJECTIVE: To describe the training and certification of physicians who staff small EDs in rural West Virginia. METHODS: A survey of rural hospital-based EDs was performed. The authors chose to study all hospitals in counties with populations of <30,000 and in which the hospital was the only one in the county. Interviews were conducted with the medical director of the ED or the hospital administrator, depending on who was available at the time of interview. Data collected describing the emergency physicians (EPs) employed at each facility included: medical school and residency training, specialty board certification, and certification in a variety of life support courses. General information about each ED, such as census and hospital resources, was also obtained. Interview data were collected on a survey form and subsequently entered into a database. Descriptive analyses were performed. RESULTS: 20 hospitals met rural criteria for inclusion in the study and all were included. The median number of full-time physicians per ED was 2 (IQR 2-4). 98 part-time doctors were identified; 28 (29%) of these were residents in training. 13/40 (33%) of full-time and 37/98 (38%) of part-time physicians were foreign medical graduates. Only 3/40 (7.5%) of full-time EPs completed residency training in emergency medicine (EM). Only 4/98 (4%) of part-time EPs were residency-trained in EM. 50% of full-time EPs were board-certified in a primary care specialty. Only 5/42 (12%) of full-time EPs were board-certified in EM. One third of full-time and the majority of part-time EPs were not board-certified in any specialty whatsoever. The majority of EPs had been certified in Advanced Cardiac Life Support, but fewer had been certified in Advanced Trauma Life Support and/or Pediatric Advanced Life Support/Advanced Pediatric Life Support. CONCLUSIONS: The majority of physicians staffing small rural EDs in West Virginia are neither residency-trained nor board-certified in EM. Further studies are warranted to determine the most efficient and effective way to maximize the skills and availability of emergency care providers in rural settings.

Certification↗
PubMed1997

Injury recidivism in a rural ED.

STUDY OBJECTIVE: To determine the degree of injury recidivism in our ED population and to identify indicators of injury recidivism. METHODS: We conducted a retrospective review in a university-affiliated department of emergency medicine. The study participants were patients who presented for treatment of an injury. An injury recidivist was defined as a patient who presented for treatment of two or more unique injuries during the 1-year study period. The injured population was divided into three categories: (1) those with a single injury visit, (2) those with two to three injury visits, and (3) those with four or more injury visits. Demographics, mechanism of injury, and outcome data were collected and comparative analyses performed. RESULTS: Of the 37,360 ED patient visits, 12,075 were injury related. Of the injury visit load, 2,838 of the 12,075 (24%) were injury recidivists. Of injured patients, 1,239 of 10,476 (12%) were recidivists. The sex distribution was similar among the groups, but the mean age decreased as the degree of recidivism increased. The degree of recidivism was higher for patients with Medicaid and for those who were uninsured. Lower mean medical charges per visit were found with increasing degree of recidivism, but the average total charges per patient increased with increasing degree of recidivism. Increasing degree of recidivism was associated with decreasing incidence of transportation-related injury but increased incidence of overexertion or intentional injuries. CONCLUSION: A small group of patients account for a significant proportion of ED injury visits. In comparison with injury patients seen once during the year, recidivists represent a younger population of lower socioeconomic status, and they are at increased risk of intentional injury.

Adult↗
PubMed1997

Work-related injuries in a rural emergency department population.

OBJECTIVE: To describe the spectrum of work-related injury evaluated in a rural ED population. METHODS: An ED-based injury surveillance system (EDBISS) was used to collect injury data for all ED patients seen over a 1-year period. A patient was classified as injured if his or her record contained an ED log injury code, an ICD-9 N-code between 800 and 995 in any diagnostic field, an E-code, or an entry in the trauma registry. An injury was considered work-related if the patient reported that the injury had occurred while at work. RESULTS: Work-related injuries accounted for 1,539/12,321 (12.5%) of all injuries. The mean age of patients injured on the job was 33.8 years (range, 16-77 years), compared with a mean age of 27.7 years for all the injured patients. Males accounted for 1,026/1,537 (67%) of the work-related injury visits, compared with 57% of all the injury visits. The most common mechanisms of work-related injuries were: overexertion (313; 20%); cut or pierced by sharp implements (248; 16%); falls (250; 16%); struck by object (202; 13%); and transportation-related injuries (71; 5%). Sprains and strains were the most common type of injury sustained (415; 27%), followed by wounds to upper limbs (283; 18%), contusions (182; 12%), and fractures (151; 10%). Of the 1,539 patients presenting with occupational injuries, 178 (12%) presented to the ED via ambulance. Most (1,401; 91%) were treated and released from the ED, with the remainder (136; 9%) hospitalized. The mechanisms of injury that most commonly resulted in hospitalization included struck by an object (28; 21%), transportation (26; 19%), falls (27; 20%), crushing mechanism (13; 10%), and machinery (20; 15%). Of those requiring hospitalization, 132/136 (97)% were male, and the average length of stay was 4.4 days. Four of the hospitalized persons died of their work-related injuries. Known medical charges incurred by patients injured at work were as high as $62,622. The average charge for those treated and released was $273; the average charge for those who required hospitalization was $10,910. CONCLUSIONS: Occupational injuries contribute significantly to the overall incidence of injuries seen in this ED and are responsible for significant medical charges each year.

Accidents, Occupational↗
PubMed1996

Development of an emergency department-based injury surveillance system.

STUDY OBJECTIVE: To describe the development of an emergency department-based injury surveillance system, to describe the problems encountered, and to briefly describe the data output and potential applications. METHODS: Within our university-based hospital system and Level I trauma center register, injury data currently exist on all ED patients. Over a 1-year period, these data sets were linked with our ED log using the hospital identification number and date of service as the key merge variables. Elements in our data set included demographic information, ED-related variables, and codes for nature of injury and circumstances of injury. Data files for 1 month were inspected manually to validate the success of the merger. Problems encountered in developing the system were summarized. RESULTS: A manual review of 1 month of data files from our hospital system, trauma register, and ED log revealed that the records of more than 97% (2,802) of 2,878 injury patients seen in our ED had additional data attached after the merger. No errors of commission were found, but errors of omission occurred. The barriers that were encountered during the development of this injury surveillance system are described. CONCLUSION: Hospital data can be linked to the ED log to create an injury surveillance system that captures valuable information on patients admitted and discharged from the ED.

Bias↗
PubMed1996

Transformation by the Bmi-1 oncoprotein correlates with its subnuclear localization but not its transcriptional suppression activity.

The bmi-1 oncogene cooperates with c-myc in transgenic mice, resulting in accelerated lymphoma development. Altering the expression of Bmi-1 affects normal embryogenesis. The protein product of bmi-1 is homologous to certain Drosophila Polycomb group proteins that regulate homeotic gene expression through alteration of chromatin structure. Chimeric LexA-Bmi-1 protein has previously been shown to repress transcription. How Bmi-1 functions in embryogenesis and whether this relates to the ability of Bmi-1 to mediate cellular transformation is unknown. We demonstrate here that Bmi-1 is able to transform rodent fibroblasts in vitro, providing a system that has allowed us to correlate its molecular properties with its ability to transform cells. We map functional domains of Bmi-1 involved in transcriptional suppression by using the GAL4 chimeric transcriptional regulator system. Deletion analysis shows that the centrally located helix-turn-helix-turn-helix-turn (HTHTHT) motif is necessary for transcriptional suppression whereas the N-terminal RING finger domain is not required. We demonstrate that nuclear localization requires KRMK (residues 230 to 233) and that the absence of nuclear entry ablates transformation. In addition, we find that the subnuclear localization of wild-type Bmi-1 to the rim of the nucleus requires the RING finger domain and correlates with its ability to transform. Our studies with Bmi-1 deletion mutants suggest that the ability of Bmi-1 to mediate cellular transformation correlates with its unique subnuclear localization but not its transcriptional suppression activity.

Animals↗
PubMed1995

The emergency department log as a simple injury-surveillance tool.

STUDY OBJECTIVE: To describe the development of an injury-surveillance system based on the emergency department log. SETTING: An ED with 40,000 visits annually, tertiary care center. PARTICIPANTS: All patients to our ED during a 6-month period. ED logs are used to collect basic information such as demographics, chief complaint, mode of arrival, and disposition. Our log was modified for collection of injury-related information such as whether the ED visit was because of an injury and, if so, the mechanism of injury. A list of 16 mechanism-of-injury codes was developed on the basis of review of existing literature and on a 1-month review of injuries in our population. The ED log data were entered into a database, and descriptive analysis was performed. RESULTS: A list of mechanisms of injury was developed that, when implemented, was successful in coding 93% of injured patients in our ED population. The expansion of the ED log for collection of injury data required minimal training and cost. An example of the data obtained is presented to demonstrate the type of information available. Of the 18,742 patients, the ED log identified 5,067 patients (27%) as having been injured. Most were male (2,972 of 5,067 [59%]), and most were between 15 and 40 years of age (2,857 of 5,067 [61%]). Common mechanisms of injury included falls (907 of 5,067 [19%]), transportation (706 of 5,067 [15%]), cuts or punctures (332 of 5,067 [7%]), sports (323 of 5,067 [7%]), and assaults (245 of 5,067 [5%]). CONCLUSION: With minimal training and cost, the ED log can be adapted for collection of injury data on all patients seen in the ED.

Abstracting and Indexing↗
PubMed1994

Extracorporeal circulation in the management of severe tricyclic antidepressant overdose.

Extracorporeal circulation is a technique that provides precise control of circulation, oxygenation, temperature, and blood composition in patients suffering from cardiopulmonary failure. The investigators present the case of a near fatal tricyclic antidepressant overdose that failed to respond to standard therapy but was resuscitated using extracorporeal circulation.

Adult↗
PubMed1994

Injury in West Virginia: an introduction to injury control and prevention.

Each year, one of every four Americans sustains an injury severe enough to seek medical attention. Injuries account for 25% of all emergency department visits, 12% of all hospital admissions, and cost the nation over $180 billion annually. Despite being the leading cause of mortality for Americans under the age of 40, there is a lack of awareness of the epidemic of injuries and effective methods for their prevention. Many consider injuries to be the result of unavoidable accidents or unfortunate acts of God. In reality, injuries are diseases which have associated risk factors, demographic distributions, seasonal variations, epidemic episodes, and are predictable and preventable. This article describes injuries in West Virginia and discusses basic principles of injury control and prevention.

Accident Prevention↗
PubMed1993

Safety belt use and hospital charge differences among motor vehicle crash victims.

Trauma remains a leading cause of death and disability in America, and motor vehicle crashes (MVC) are the most common cause of serious injury in West Virginia. In this study, we examined the role of seat belt use or non-use in the death, disability, and hospital charges of 500 patients admitted after MVC to a rural Level 1 trauma center in 1990. Eighty percent of the patients who required hospitalization did not use seat belts. The unbelted patients had a 34% higher injury severity score, a 97% increase in the need for extended care after discharge from the hospital, and a 186% increase in hospital charges compared to belted patients. Our study concluded that seat belt use among motor vehicle crash victims reduced their hospital costs, and improved their outcome as compared to those patients not wearing seatbelts.

Accidents, Traffic↗
PubMed1992

A randomized, double-blind, comparative study of the efficacy of ketorolac tromethamine versus meperidine in the treatment of severe migraine.

STUDY OBJECTIVE: To evaluate the relative efficacy of ketorolac tromethamine and meperidine hydrochloride in the emergency department treatment of severe migraine. DESIGN: Prospective, randomized, double-blind trial. SETTING: University hospital ED. PARTICIPANTS: Patients presenting to the ED with an isolated diagnosis of common or classic migraine. INTERVENTIONS: Subjects were randomized to receive a single intramuscular injection of either 30 mg ketorolac or 75 mg meperidine. MEASUREMENTS AND MAIN RESULTS: Of the 31 patients completing the trial, 15 received ketorolac and 16 received meperidine. The demographic characteristics of both groups were comparable. At one hour, ketorolac was significantly less effective than meperidine in reducing headache pain (P = .02) and in improving clinical disability (P = .01). Ketorolac also was less effective at reducing nausea, photophobia, and the need for rescue medication (P less than .05). Sustained headache relief was experienced by 44% of the patients treated with meperidine at 12- to 24-hour follow-up, compared with 13% of the patients treated with ketorolac (P = NS). No significant side effects were observed for either group. CONCLUSION: IM ketorolac tromethamine is less effective than meperidine in the ED treatment of severe migraine.

Acute Disease↗
PubMed1985

Studies on the sero-epidemiology of endemic diseases in Libya. III. Schistosomiasis.

An ELISA system showed a positive rate for Schistosoma mansoni infections of 33.4% in Tauorga school-children; qualitative stool examination detected only 6.9%. Subsequent sampling of the school population indicated that a mollusciciding programme involving the major water body in the area had prevented any overall increase in prevalence and had apparently produced a decrease in prevalence in certain locations. New housing, piped water, sanitary disposal of wastes and health education were additional favourable factors.

Adolescent↗