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L O'Neal

Publications and source records attributed to L O'Neal.

8 recordsLinked to original sources
PubMed1998

Care tracker: a new approach to nursing care in ambulatory settings.

The shift from inpatient to ambulatory settings and the increasingly large and diverse numbers of ambulatory clients require reengineering and cost-effective approaches to managing ambulatory care. With data on 921 encounters in 12 ambulatory clinics, we developed CARE TRACKER, an instrument to describe nursing encounters by type, intervention, staff, time, and cost. Distinguishing nursing from medical interventions is an appreciable improvement over the traditional practice of bundling nursing as part of overhead costs. If managers can track the care delivered, they can better calculate staffing requirements, staff mix, inservice needs, and the costs of their existing and projected services.

Ambulatory Care↗
PubMed1994

Endotoxin and GM-CSF-mediated down-regulation of macrophage apo E secretion is inhibited by a TNF-specific monoclonal antibody.

Macrophage activation is associated with increased secretion of monokines, proteases, arachidonic acid metabolites, reactive oxygen, and nitrogen intermediates and yet decreased secretion of apolipoprotein E (apo E). Although the kinetics of apo E down-regulation have been investigated, the mechanism(s) involved remains unknown. In the present study, the question of whether macrophage-activating factors such as lipopolysaccharide (LPS) and granulocyte-macrophage colony-stimulating factor (GM-CSF) directly result in apo E down-regulation or indirectly by inducing the secretion of other inflammatory mediators has been investigated. LPS-stimulated macrophages demonstrated a dose-dependent reduction in apo E secretion with a 70% decrease occurring following a 48-h incubation with 20 ng/ml LPS. Coculture of these cells with a neutralizing concentration of a hamster monoclonal antibody against murine tumor necrosis factor (TNF) inhibited the LPS-mediated reduction in apo E secretion. This inhibitory effect resulting from TNF neutralization was not observed using pooled hamster immunoglobulin G, or hamster monoclonals against murine interleukin-1 alpha (IL-1 alpha), IL-1 beta, or interferon-gamma. Similar results were observed when GM-CSF was used to induce apo E down-regulation. The inhibitory effects of TNF neutralization on endotoxin-induced apo E down-regulation were dependent on LPS concentration and were no longer apparent at concentrations greater than 200 ng/ml. These results suggest that an autocrine, TNF-dependent mechanism may play a role in the down-regulation of apo E secretion during macrophage activation.

Animals↗
PubMed1993

Exogenous glucocorticoids increase macrophage secretion of apo E by cholesterol-independent pathways.

Macrophage apo E synthesis and secretion has been previously demonstrated to be regulated by intracellular free cholesterol levels and is decreased by cytokines and other inflammatory stimuli associated with macrophage activation. In a recent study, the opposing effects of TGF beta and GM-CSF were reported with the former increasing and the latter decreasing apo E secretion and apo E mRNA levels. In an attempt to further understand the mechanisms by which TGF beta increased apo E expression in mouse peritoneal macrophages, the present study was performed to determine whether pharmacological agents could up-regulate apo E secretion by a mechanism independent of intracellular free cholesterol levels. Agents which resulted in increased apo E secretion were subdivided based on their effects on cAMP elevation. In addition to TGF beta, dexamethasone resulted in significant increases in apo E secretion. The 2-4-fold enhancement in apo E secretion by both TGF beta and dexamethasone occurred without concomitant changes in intracellular cAMP or free cholesterol. Other agents which increased apo E secretion included cholera toxin and 8-bromo-cAMP. While these agents did not affect intracellular cholesterol levels, cholera toxin did increase macrophage cAMP. The changes in apo E secretion by dexamethasone and 8-bromo-cAMP were associated with elevations in apo E mRNA. Dexamethasone-treated macrophages had 6-fold increases in apo E mRNA by 48 h when compared with control macrophages. Macrophages stimulated with 8-bromo-cAMP for 48 h demonstrated a more modest but statistically significant (P < 0.001) 2.2-fold increase. Similar effects of dexamethasone, cholera toxin, TGF beta, and 8-bromo-cAMP on apo E secretion were also apparent in macrophage-derived foam cells. In addition to increasing apo E secretion in macrophages and foam cells, dexamethasone and 8-bromo-cAMP inhibited the down-regulation of apo E secretion mediated by LPS and GM-CSF. Finally, the increased apo E secretion by exogenous glucocorticoids or TGF beta was not species specific as similar effects were observed in rabbit peritoneal macrophages. Therefore, while macrophage activation results in decreased apo E synthesis, macrophages exposed to anti-inflammatory agents including dexamethasone, TGF beta, or following cAMP elevation demonstrate increased apo E secretion by a cholesterol-independent mechanism.

8-Bromo Cyclic Adenosine Monophosphate↗
PubMed1992

Cytokine regulation of macrophage apo E secretion: opposing effects of GM-CSF and TGF-beta.

Biosynthesis of apolipoprotein (apo) E has been previously demonstrated to be regulated in macrophages by intracellular free cholesterol levels as well as by macrophage activating factors. In this report, the regulation of apo E secretion by cytokines detected within atherosclerotic lesions has been investigated. Granulocyte macrophage-colony stimulating factor (GM-CSF) stimulated macrophages had a 3-5-fold reduction in apo E secretion, comparable to that observed for gamma interferon (IFN gamma), while tumor necrosis factor alpha (TNF alpha) and interleukin 1 beta (IL-1 beta) resulted in a 2-fold decrease. In contrast to the reduction in apo E secretion by these cytokines, transforming growth factor beta (TGF-beta) stimulated macrophages secreted 3-fold greater amounts of apo E than controls. The reduced secretion of apo E by GM-CSF was reversible, heat labile, dose dependent, maximal 48 h after cytokine exposure and was coincident with an increase in fibronectin secretion. The opposing effects of GM-CSF and TGF-beta on apo E secretion were consistent with similar changes detected in apo E mRNA levels. Cytokine effects on apo E secretion in cholesterol loaded macrophages were also investigated and found to be similar to the non-loaded cells with GM-CSF decreasing and TGF-beta increasing apo E secretion. The observed differences in apo E secretion did not correlate with any significant changes in either cellular cholesterol distribution in the non-cholesterol loaded macrophages or in basal ACAT activity. In addition to changes in apo E secretion, cytokine treated macrophages pulsed with [14C]oleate and acetylated LDL for 2-6 h had a 2-fold increase (GM-CSF) or decrease (TGF-beta) in cholesterol esterification. Therefore, GM-CSF and TGF-beta mediated changes in apo E secretion may occur through a mechanism independent of changes in cellular free cholesterol levels. These results suggest that cytokines expressed within an atheroma may play an important role in the modulation of macrophage mediated reverse cholesterol transport.

Animals↗