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Biomedical subjects

L J Cook

Publications and source records attributed to L J Cook.

At least 19 recordsLinked to original sources
PubMed1997

A regionalized perinatal continuing education programme: successful adaptation to a foreign health care system and language.

Much of the decline in perinatal mortality over the past two decades in the United States has been attributed to regionalization of perinatal care. Outreach education from regional medical centres to community hospitals is an essential component of regionalization. The Perinatal Continuing Education Program (PCEP) has been successfully used for outreach education in more than 30 states since 1979. This project tested the efficacy of implementing the PCEP strategy in Poland. PCEP was adapted to Polish conditions, translated, and implemented in four phases. The scheme allowed gradual transfer of ownership to Polish leaders and use of the existing regional structure to disseminate information from regional centres to community hospitals. Evaluation included measures of programme use (participation and completion rates) and acceptance (participant evaluation forms), cognitive knowledge (pre- vs. post-tests), and patient care (chart reviews). Of 2093 doctors, nurses and midwives who began, 1615 (77%) completed the programme, with higher completion by regional centre than community hospital staff. All participant groups responded favourably to the materials and expressed moderate confidence in their mastery of the information and skills. Test scores improved significantly for all phases and for all disciplines, with baseline and final scores consistent with degrees of previous professional education. Large baseline and inter-hospital variations in chart review data restricted analysis of care practices. A comprehensive perinatal education programme can be successfully transferred to a foreign health care system. We believe the following to be particularly important: multidisciplinary instructors and students; a self-instructional format; content aimed at practice rather than theory; and an organized implementation strategy co-ordinated by local personnel.

Community Health Services↗
PubMed1997

Molecular cloning, over-expression, developmental regulation and immunolocalization of fragminP, a gelsolin-related actin-binding protein from Physarum polycephalum plasmodia.

FragminP is a Ca2+-dependent actin-binding and microfilament regulatory protein of the gelsolin family. We screened a Physarum polycephalum cDNA library with polyclonal fragminP antibodies and isolated a cDNA clone of 1,104 bp encoding 368 amino acids of fragminP, revealing two consensus phosphatidylinositol 4,5 bisphosphate-binding motifs in the central part of the protein. The first methionine is modified by an acetyl group, and three amino acids were missing from the protein coded for by the cDNA clone. Full-length recombinant fragminP was generated by PCR, purified after over-expression from Escherichia coli and displayed identical properties to native Physarum fragminP. Northern blot analysis against RNA, isolated from cultures at various stages of development, indicated that fragminP is absent from amoebae and that expression is initiated at an early stage during apogamic development, in a similar way to that observed for the profilin genes. In situ immunolocalization of fragminP in Physarum microplasmodia revealed that the protein is localized predominantly at the plasma membrane, suggesting a role in the regulation of the subcortical actin meshwork. Our data indicate that we have isolated the plasmodium-specific fragminP cDNA (frgP) and suggest that, in each of its two vegetative cell types, P. polycephalum uses a different fragmin isoform that performs different functions.

Actins↗
PubMed1996

Familial juvenile systemic granulomatosis (Blau's syndrome).

Blau's syndrome refers to the rare familial presentation of a sarcoid-like granulomatous disease classically involving the skin, uveal tract and joints, in the absence of pulmonary manifestations. The onset is in childhood, and the mode of inheritance is thought to be autosomal dominant. We report a 15-year-old female and her 22-month-old daughter who presented with clinical features similar to those of Blau's syndrome. In addition to the skin, eye and joint disease, the mother also developed neurological involvement. In both patients long-term systemic corticosteroids were required to control the disease.

Adolescent↗
PubMed1996

Intracellular transport of pancreatic enzymes.

Most pancreatic secretory proteins are packaged within the trans-Golgi network into zymogen granules, which are secreted in a regulated manner by exocytosis. But others enter alternative, constitutive-like pathways directed towards both apical and basolateral membranes. Our in-vivo studies suggest that secretion via the latter type of pathway, which may be responsible for the appearance of pancreatic enzymes in the circulation, can be increased by stimulation, especially supramaximal stimulation. This may partly explain the increased concentration of pancreatic enzymes in the circulation in the early stages of pancreatitis. The mechanisms by which secretory proteins are sorted into zymogen granules remain vague. However, dissipation of the normally acidic gradient across the trans-Golgi network in vitro (e.g. with NH4Cl) inhibits the process by which newly synthesized proteins reach zymogen granules. However, secretion via the constitutive-like pathways is apparently not increased under these conditions. Thus, although the acidic milieu of the trans-Golgi network plays a role in pancreatic protein sorting, it may not be the mechanism by which constitutive-like secretion of pancreatic enzymes is increased.

Animals↗
PubMed1995

Novel mutations in keratin 16 gene underly focal non-epidermolytic palmoplantar keratoderma (NEPPK) in two families.

Keratins K6 and K16 are expressed in suprabasal interfollicular epidermis in wound healing and other pathological conditions associated with hyperproliferation, such as psoriasis and are induced when keratinocytes are cultured in vitro. However, these keratins are also constitutively expressed in normal suprabasal mucosal and palmoplantar keratinocytes. Mutations in keratins have been reported in the basal keratin pair K5 and K14 in epidermolysis bullosa simplex and in suprabasal epidermal keratins K1, K2 and K10 in epidermolytic ichthyoses. Two families with autosomal dominant disorder of focal non epidermolytic palmoplantar keratoderma, have oral mucosal and follicular lesions in addition to the palmoplantar hyperkeratosis. Previous studies have shown linkage in these families to the type I keratin gene cluster at 17q12-q21 and this report shows that the cDNA of affected members of both families have novel heterozygous mutations in the expressed keratin 16 gene. These mutations (R10C and N8S) lie in the helix initiation motif of the 1A domain. These mutations do not appear to cause epidermolysis on light or electron microscopy, which may reflect differences in function, assembly or interaction of the 'hyperproliferative' or 'mucoregenerative' keratins from other major types of keratins. The mutations reported here are the first to describe the molecular pathology of focal non epidermolytic palmoplantar keratoderma.

Base Sequence↗
PubMed1994

Continuous fluorometric measurement of intracellular pH and Ca2+ in perfused salivary gland and pancreas.

Intracellular pH (pHi) has been measured in intact, perfused rat mandibular salivary glands loaded with the fluorescent pH indicator BCECF [2',7'-bis(2-carboxyethyl)-5(6)- carboxyfluorescein]. Glands mounted in the cuvette of a conventional bench-top spectro-fluorometer were perfused for 5 min with the acetoxymethyl ester of BCECF and fluorescence was measured ratiometrically at 6-s intervals. The mean value of pHi in glands perfused with a HCO3(-)-free, N-2-hydroxyethylpiperazine-N'-2- ethanesulphonic acid (HEPES)-buffered solution at 37 degrees C was 7.36 +/- 0.01 (n = 52) which is comparable with values obtained by 31P nuclear magnetic resonance (NMR) spectroscopy. NMR data confirmed that the BCECF loading period was accompanied by a transient acidification of the cells, but there was no significant change in the content of the major phosphorus metabolites. Changes in pHi in response to NH4Cl pulses and acetylcholine stimulation were comparable with results reported previously for isolated acini. Additional, preliminary experiments show that the method can also be used to monitor intracellular Ca2+ (using fura-2) in perfused salivary glands, and can be adapted for studies of the isolated, perfused pancreas.

Acetylcholine↗
PubMed1984

Effect of dietary cholesterol protected against ruminal hydrogenation on the plasma cholesterol and liver of sheep.

Dietary supplements containing cholesterol or sunflower oil were prepared to protect them against degradation in the rumen. On feeding daily supplements containing 1-2 g protected cholesterol and/or 100 g protected sunflower oil to sheep, along with a basal ration of crushed oat grain and lucerne chaff, a rise in the plasma cholesterol was observed when compared with control animals. Livers from sheep fed protected cholesterol were enlarged, friable and cirrhotic in appearance and contained large deposits of esterified and free cholesterol, while livers from animals fed protected sunflower oil alone contained much less cholesterol. Octadecenoates constituted the major fatty acids in cholesteryl esters, which, in animals fed protected sunflower oil, were mainly polyunsaturated. The factors involved in the deposition of liver lipid at very low dietary cholesterol concentrations (0.11-.22%) in sheep compared with monogastric animals are discussed.

Animals↗
PubMed1984

Perinatal outreach education. A continuation strategy for a basic program.

The Perinatal Continuing Education Program consists of a nine-month intervention with community hospital nurses, physicians, and support personnel. Components include a hospital self-inventory of resources, coordination by community hospital staff, a skills workshop, and self-instructional books. This article outlines a follow-up strategy to the basic program and describes changes in community hospital knowledge and care practices that occur between programs. The follow-up program presented includes a modified coordinators' workshop, identification of updated self-instructional materials for careful study by past participants, and a self-survey of "recommended routines" intended to facilitate change in hospital policies. Otherwise, except for the deletion of the resources inventory, the follow-up program is similar to the basic program. Testing of participants and detailed review of 1435 hospital charts at sequential time periods revealed a decline in mean knowledge scores between programs, higher scores by new participants before follow-up when compared to pre-basic program, a plateau of patient care quality between programs, and a further improvement in patient care quality after the follow-up program. We conclude that a follow-up program is best accepted after three years but that timing is not critical. Evaluation measures suggest that new knowledge and care practices become institutionalized as a result of this program and that altered care practices are not simply a result of improved performance by individuals.

Education, Medical, Continuing↗
PubMed1983

Assessment of transportability of a perinatal education program.

We evaluated a perinatal outreach education program to determine its "transportability" (usefulness to other regional centers). Three kinds of data were available from seven regional centers: (1) participation in the program by health care providers, (2) changes in cognitive knowledge, and (3) changes in neonatal care practices. Data were obtained from 2,735 program participants and from retrospective chart review of 2,781 at-risk babies born in participating hospitals. Analysis showed that results were comparable when the program was used by six regional centers from two states and when it was used by the regional center that originally developed the program. We therefore concluded that the Perinatal Continuing Education Program is transportable.

Education, Continuing↗
PubMed1983

Lack of effect of cimetidine in chronic-idiopathic urticaria.

The effect of an H1 and an H2 receptor blocker singly and in combination was studied in 20 patients with chronic idiopathic urticaria. Both H1 receptor blockade alone and in combination with H2 receptor blockade produced a significant reduction in wealing and itch; there was no significant difference between these treatments. H2 blockade alone produced no significant reduction in wealing; there was a slight increase in itch, though not statistically significant.

Adolescent↗
PubMed1982

Iatrogenic hyperadrenocorticism during topical steroid therapy: assessment of systemic effects by metabolic criteria.

Systemic absorption of topically applied glucocorticoids in quantities sufficient to replace endogenous production is not uncommon. However, iatrogenic Cushing's syndrome resulting from the use of topical corticosteroids is very rare. Thus the possibility that systemic absorption may cause hyperglucocorticism has been deemphasized and examined only sporadically. We have studied changes in carbohydrate metabolism induced by topical glucocorticoids in a psoriatic patient who had developed Cushing's syndrome from topical desoximetasone (Topicort). The results indicated that (1) fasting hyperglycemia and increased insulin-glucose ratios could be induced within 24 hours of administration of topical glucocorticoids, (2) insulin resistance accompanied abnormal carbohydrate tolerance, and (3) fluctuations in circulating leukocytes paralleled the changes in carbohydrate metabolism. The findings suggest that metabolic indexes of glucocorticoid action action may provide useful parameters for assessing systemic absorption of topical glucocorticoids. glucose relationship as one such index to assess the risk of treatment of extensive chronic skin disease with potent topical glucocorticoids.

Administration, Topical↗
PubMed1980

Effect of feeding protected lipids on fatty acid synthesis in ovine tissues.

The effects of including protected lipid supplements in the sheep diet have been studied by measuring the incorporation of [1-14C]acetate into tissue fatty acids in vivo and in vitro. Supplementing the diet with protected lipid significantly (P > 0.05) depressed lipogenesis in adipose tissue both in vovo and in vitro. However, when protected lipids of different fatty acid composition were given to lambs, the protected safflower oil supplement containing high levels of linoleic acid was the only treatment to cause a significant (P > 0.05) depression in fatty acid synthesis in adipose tissue, the major site of lipogenesis in the sheep. Larger adipose cells in the lipid-supplemented sheep indicate that these sheep were fatter than those receiving the basal diet. Therefore, supplemented wethers deposited more fat than sheep receiving the basal diet and this fat was derived from the supplement rather than from de novo synthesis.

Acetates↗
PubMed1979

Lesions induced by trauma in pemphigoid.

Three patients are described with pemphigoid (two with typical adult type and one with juvenile pemphigoid) in whom bullous lesions had clearly been induced by the trauma of scratching. In two patients this phenomenon occurred during the first few weeks of systemic corticosteroid treatment at a time when other lesions were resolving or had completely healed. Although lesions induced by trauma are not usually of great clinical importance, epidermolysis bullosa acquisita may represent a variant of pemphigoid in which trauma-induced lesions predominate. Induction of pemphigoid lesions by trauma may prove a useful method of studying early immunopathological events.

Aged↗