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Biomedical subjects

L Ray

Publications and source records attributed to L Ray.

14 recordsLinked to original sources
PubMed1995

Prospective identification and triage of nonemergency patients out of an emergency department: a 5-year study.

STUDY OBJECTIVE: To determine whether nonemergency patients can be prospectively identified by triage nurses and safely triaged out of the emergency department without treatment. METHODS: All adult patients (16 years or older) who presented to a university ED were provided an evaluation by a triage nurse. For a patient's case to be defined as nonemergency, four criteria were required: vital signs within a specific range, presence of 1 of 50 potentially nonemergent chief complaints, absence of key indicators found on screening examination, and absence of chest pain, abdominal pain, any severe pain, and inability to walk. Between July 1988 and July 1993, patients who satisfied these criteria were defined as nonemergency, refused care in the ED, and triaged out of the ED. Patients were referred to off-site clinics. The clinics had agreed to see patients in advance of the study, and the referral lists were frequently updated. Outcome data were obtained by telephone surveys to both triaged individuals and other health care providers. RESULTS: In this 5-year study, 176,074 adults presented to the ambulatory triage area in the ED, and 31,165 (18%) were defined as nonemergency, were not treated, and were referred elsewhere. Letters and telephone calls to all referral clinics, eight local EDs, and the coroner's office identified no instances of gross mistriage and only a small number of insignificant adverse outcomes. Telephone follow-up to individuals triaged away was successful in 34% of calls and showed that 39% of persons received care elsewhere on the same day, 35% received care within 3 days, and 26% decided not to seek medical care. A group of 1.0% sought care at other hospital EDs for minor complaints. CONCLUSION: A subset of patients with nonemergency problems can be prospectively identified and triaged out of the ED without significant adverse outcomes provided there is community support for follow-up care.

Adult↗
PubMed1990

Potential role of dendritic cells in bronchiolitis obliterans in heart-lung transplantation.

Dendritic cells are essential for the activation of the type IV immunological reactions that are intrinsic to rejection of transplanted organs. We evaluated the number of dendritic cells in the recipient and donor portions of the trachea and donor bronchi of 6 heart-lung transplant recipients, 3 of whom had evidence of bronchiolitis obliterans, a presumed manifestation of chronic rejection of the lung. As compared with recipients without bronchiolitis obliterans, patients with it showed a significant increase in the number of S100-protein-positive dendritic cells in the tracheal and bronchial epithelium and submucosa of the donor organs. This finding of increased accessory cells in the transplanted mucosa provides support for the belief that bronchiolitis obliterans is an immunologically mediated form of chronic rejection.

Bronchi↗
PubMed1990

Role of the promoter in activation of transcription by nitrogen regulator I phosphate in Escherichia coli.

The protein nitrogen regulator I (NRI)-phosphate is known to activate the initiation of transcription of the Escherichia coli glnA gene. This activation is facilitated by the binding of the protein to NRI-specific sites located upstream of the sigma 54-dependent glnA promoter. To determine whether binding of NRI-phosphate to upstream sites is sufficient for activation, we placed several promoters not normally activated by NRI-phosphate downstream of NRI binding sites and measured activation in intact cells and in an in vitro transcription system. We found that the sigma 70-dependent lac promoter was not activated, that the sigma 54-dependent Klebsiella pneumoniae nifH promoter was weakly activated, and that a nifH promoter altered in the RNA polymerase binding site was almost as well activated as the glnA promoter. We conclude that the sensitivity of the susceptible promoter depends on the presence of NRI binding sites, but that the presence of bound NRI-phosphate upstream of a promoter is not sufficient for activation of transcription by RNA polymerase. This activation is determined by the structure of the RNA polymerase binding site. We suggest that sigma 54-but not sigma 70-dependent promoters are susceptible to activation by NRI-phosphate and that the nucleotide sequence of the sigma 54-RNA polymerase binding site is an important determinant of the efficiency of activation.

Bacterial Proteins↗
PubMed1987

Combined chemoseparation and immunoseparation of clonogenic T lymphoma cells from human bone marrow using 2'-deoxycoformycin, deoxyadenosine, 3A1 monoclonal antibody, and complement.

Chemoseparation and immunoseparation techniques have been combined to eliminate malignant clonogenic T lymphoma cells from human bone marrow. Incubation with 5 microM 2'-deoxycoformycin and 500 microM deoxyadenosine has eliminated 2 logs of HSB-2 T lymphoma cells from a 20-fold excess of irradiated human bone marrow. Multiple incubations with 3A1 antibody and rabbit complement eliminated approximately 2 logs of HSB-2 cells from similar mixtures. Used in combination, the 2 techniques eliminated up to 4 logs of T lymphoma cells. Incubation of normal human bone marrow under similar conditions failed to affect growth of granulocyte-macrophage colony-forming cell units, burst-forming erythroid units, or multipotential erythroid-granulocyte-megakaryocyte-macrophage colony-forming hematopoietic progenitor cells units.

Antibodies, Monoclonal↗
PubMed1985

Problems of substance abuse: exploitation and control.

The notion of substance abuse is highly problematic. There is considerable disagreement amongst 'experts' as to the relative hazards and addictive properties of both legally and illegally available substances. There are also widely divergent sub-cultural attitudes to the harmfulness or benefit of drug use. One can assume no social consensus as to the nature of the contemporary 'drug problem', nor about the most appropriate means of dealing with it. There is, however, considerable evidence that criminalization of drug use, and harsh penalties against users and suppliers, are ineffective and counter-productive. Other models of control need to be considered, and in particular the merits and de-merits of the medicalization of drug abuse require examination. However, this is only one aspect of the problem. On the other side are the national and international corporations and syndicates, both legitimate and criminal, that earn vast profits from trade in toxic substances. Tobacco is legally available in every country in the world, and the industry is rarely subject to strict control. Thus the issue of substance abuse and control should be seen in a global context, in which account is taken of both legitimate and underworld operations. In attempts to control international trade in toxic substances, the limited success and the problems of already existing legal controls should be acknowledged. Local awareness and regulation of trade in substances is essential, but not sufficient. Amongst other avenues to be explored is the possibility of diverting presently illicitly grown narcotics into indigenous pharmaceutical industries in the Third World. Some problems with this strategy are noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Crime↗
PubMed1984

Going up in smoke: the case of British American tobacco in Kenya.

Faced in the developed world by increasing restrictions on cigarette advertising and sales, and with declining markets, the tobacco transnationals are opening up new markets in developing countries, where they face few controls and little health education. As cigarette sales increase in the Third World, so does the evidence of an increasing incidence of smoking-related diseases. This paper considers the case study of BAT (Kenya) Ltd, a subsidiary of the London-based transnational, which since 1974 has encouraged both local leaf production and increased cigarette sales in Kenya. We examine: the relationship between BAT (K) and the Kenya state, the recruitment of farmers into the leaf growing scheme, how BAT (K)'s directorships interlock with those of other leading Kenyan firms and the implications of these for the company's power and influence; BAT (K)'s marketing strategies, how successful they have been, and how they compare with codes of conduct agreed in developed countries; and we estimate the likely success of possible strategies to combat the smoking hazard in Kenya. We conclude that although BAT (K) might make minor concessions to the "health lobby' in Kenya, it is sufficiently powerful, and the leaf growing programme is given sufficient Government support, as to make fundamental changes unlikely in the near future.

Advertising↗
PubMed1983

The family health project: cardiovascular risk reduction education for children and parents.

The principles of family support and of social learning theories were applied to a feasibility study of working directly with family units in a health education program. Twenty-four Anglo, Black, and Mexican-American families of young elementary school children participated in a 3-month cardiovascular risk reduction education project which included eight weekly evening sessions designed to assist families to decrease the frequency of consumption of foods high in sodium and in saturated fats, and to increase the frequency of aerobic exercise. Statistically significant differences between randomly assigned treatment and control groups were noted for reported consumption of high sodium foods and of foods high in saturated fats. Experimental subjects gained more knowledge of factors influencing cardiovascular risk, even though the intervention was behaviorally, rather than cognitively, based. This method of health promotion is deserving of further study.

Adolescent↗
PubMed1981

The new morbidity: use of school and community health care resources for behavioral, educational, and social-family problems.

The extent of the use of services for the new morbidity, that is, children's behavioral, educational, and family-social problems, has not previously been the subject of a community-based prospective study. The demographic characteristics and utilization of school and community health care resources over a two-year period are compared for two groups selected from a random sample (n = 671) of elementary school children. Twenty-four percent (n = 164) were observed to have behavioral, educational, or social-family problems requiring attention or intervention by health or educational personnel. This group was compared to their schoolmates (n = 507) not so identified. Although no overall differences in sex, ethnic background, or family structure were identified, the children with new morbidity problems were more frequently in the lowest socioeconomic group, and had lower reading achievement scores and higher rates of absenteeism. The new morbidity group also has higher rates of utilization of services both at school and at community sites of health care, not only for new morbidity complaints, but for other problems as well. The data suggest that this portion of the school-aged population places a significant demand for health care resources on both community and school sites. The findings support the need for training of physicians in the care and prevention of such problems.

Child↗