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Biomedical subjects

N A Davis

Publications and source records attributed to N A Davis.

17 recordsLinked to original sources
PubMed1999

TATA box DNA deformation with and without the TATA box-binding protein.

DNA ring closure methods have been applied to TATA box DNA and its complex with the TATA box-binding protein (TBP). The J factors for cyclization (effective concentrations of one DNA end about the other) have been measured using cyclization kinetics, with and without bound TBP, for 18 DNA constructs containing the adenovirus major late promoter TATA box (TATAAAAG) separated by a variable helical phasing adapter from sequence-induced A-tract DNA bends. Six phasing lengths were used at three overall DNA lengths each. Cyclization kinetics were also measured in the absence of protein for the same set of molecules bearing a mutant TATA box (TACAAAAG). The results suggest that the TATA box DNA itself is strongly bent and anisotropically flexible, in a direction opposite to the bend induced by TBP, and that the mutant TACA box is much less bent/flexible. The bending and flexibility of the free DNA may govern the energetics of recognition of different DNA sequences by TBP, and the intrinsic bend may act to repress transcription complex assembly in the absence of TBP. The cyclization kinetics of TBP-DNA complexes in solution predict a geometry generally consistent with crystal structures, which show dramatic bending and unwinding. The novel observation of TBP-induced topoisomers suggests that this minicircle approach is able to distinguish TBP-induced unwinding from writhe (these cancel out in larger DNA), and this in turn suggests that changes in supercoiling in small topological domains can control TBP binding.

Adenoviridae↗
PubMed1998

Patients' trust in their physicians: effects of choice, continuity, and payment method.

OBJECTIVE: To evaluate the extent to which physician choice, length of patient-physician relationship, and perceived physician payment method predict patients' trust in their physician. DESIGN: Survey of patients of physicians in Atlanta, Georgia. PATIENTS: Subjects were 292 patients aged 18 years and older. MEASUREMENTS AND MAIN RESULTS: Scale of patients' trust in their physician was the main outcome measure. Most patients completely trusted their physicians "to put their needs above all other considerations" (69%). Patients who reported having enough choice of physician (p < .05), a longer relationship with the physician (p < .001), and who trusted their managed care organization (p < .001) were more likely to trust their physician. Approximately two thirds of all respondents did not know the method by which their physician was paid. The majority of patients believed paying a physician each time a test is done rather than a fixed monthly amount would not affect their care (72.4%). However, 40.5% of all respondents believed paying a physician more for ordering fewer than the average number of tests would make their care worse. Of these patients, 53.3% would accept higher copayments to obtain necessary medical tests. CONCLUSIONS: Patients' trust in their physician is related to having a choice of physicians, having a longer relationship with their physician, and trusting their managed care organization. Most patients are unaware of their physician's payment method, but many are concerned about payment methods that might discourage medical use.

Adolescent↗
PubMed1998

Prolonged weakness after cisatracurium infusion: a case report.

OBJECTIVE: To present the first documented case report of myopathy persisting for >48 hrs in a patient treated with cisatracurium and concomitant high-dose corticosteroids. DESIGN: Anecdotal observations in one patient. SETTING: Medical-respiratory intensive care unit (ICU) at a tertiary care, university teaching hospital. PATIENT: A 45-yr-old female admitted status for post-bilateral total knee replacement complicated by aspiration pneumonitis and acute respiratory distress syndrome (ARDS). INTERVENTIONS: The patient required pressure control ventilation and sedation with midazolam and fentanyl infusions. On ICU day 2, the patient was placed on inverse ratio ventilation and paralyzed with cisatracurium. On ICU day 6, methylprednisolone 125 mg i.v. every 6 hrs was initiated for fibroproliferative ARDS. On ICU day 11, methylprednisolone was reduced to 60 mg i.v. every 6 hrs and tapered over several weeks. Cisatracurium infusion rates ranged from 6.3 to 10.5 microg/kg/min, with an average of 8.0 microg/kg/min. MEASUREMENTS AND MAIN RESULTS: Train-of-Four was assessed before initiation of therapy and every 4 hrs, thereafter. Train-of-Four values were maintained from 1 to 4 throughout therapy and a value of 4 was recorded when therapy was discontinued. On day 13, neuromuscular blocking agent therapy was discontinued, but severe proximal and distal muscle weakness was observed bilaterally. Creatinine kinase concentrations on 3 and 13 days after discontinuation of the paralytic agent were 181 and 96 units/L, respectively. On day 24, the patient moved her fingertips. On ICU day 30, the patient was weaned from the mechanical ventilator. The patient was transferred to the ward on day 33. Extensive rehabilitation with physical and occupational therapy was required for several months. CONCLUSION: Clinicians should remember that irrespective of chemical structural, neuromuscular blocking agents might produce prolonged paralysis in predisposed patients.

Atracurium↗
PubMed1996

HIV/AIDS resources on the Internet.

Both HIV/AIDS patients and their caregivers can find a wealth of information about HIV and AIDS on the Internet, if they know where to look for it. Below is a guide to get both professionals and lay people started on their search for HIV/AIDS information.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Benign osteoblastoma.

Benign osteoblastoma is a benign bone-forming lesion, seen most commonly in the first three decades of life and having a predilection for the vertebral column and the short limb bones. It is distinguishable from osteoid osteoma on the bases of size (being more than one centimetre in diameter) and the absence of surrounding sclerosis. The two lesions, however, are probably of the same origin and behave differently because of their different situations. Treatment is by operation, either excision in whole if practicable, or thorough piecemeal excision and curettage, with bone grafting of the defect if indicated.

Adolescent↗
PubMedDate not supplied

Maternity experiences in a managed care organization.

We conducted a telephone survey of female managed care enrollees who recently had a normal vaginal delivery to examine the relationship between hospital length-of-stay and maternal characteristics, pregnancy factors, length-of-stay preferences, and postdischarge experiences. Results indicated that length-of-stay varied by maternal characteristics and pregnancy factors. Length-of-stay and maternal or newborn readmissions were not statistically associated. Most respondents reported that they would be willing to go home within twenty-four hours after future deliveries if additional services were provided. Emphasis should be placed on which services can be provided to prepare and assist mothers through the perinatal period.

Adolescent↗
PubMedDate not supplied

HHS circulating regulations finalized on June 17.

On June 17, 1986, the US Department of Health and Human Services (HHS) published its final regulations in the Federal Register governing the hospital Conditions of Participation in Medicare and Medicaid programs. The final regulations state that "In accordance with applicable State laws and approved medical staff policies and procedures, ...surgical technologists may assist in circulatory duties under the supervision of a qualified registered nurse who is immediately available to respond to emergencies". Coming after a dozen years of exhaustive research and debate on the conditions, HHS deleted the work "direct" as it applies to the degree of supervision required for circulating surgical technologists because, HHS states, "it will give hospitals maximum flexibility to manage their internal procedures...and will recognize appropriately the special qualifications of surgical technologists". The following article will provide you with the historical background and development of this regulation, scheduled to take effect on September 15.

Facility Regulation and Control↗
PubMedDate not supplied

EDNA membership survey.

Explore the source record for details and available documents.

Education, Nursing, Continuing↗
PubMedDate not supplied

Evaluation of three methods for improving mammography rates in a managed care plan.

INTRODUCTION: Mammography has been shown to reduce breast cancer mortality among women 50 and older. Although mammography rates are increasing nationally, this effective screening tool remains underused. This study was conducted among 395 women who were members of a network model health maintenance organization (HMO) in Philadelphia in order to determine which of three methods was most effective in increasing mammography rates: (1) a birthday card reminder only (the standard method); (2) a personalized letter from the medical director and materials promoting mammography; and (3) a multicomponent phone call incorporating a reminder, counseling, and scheduling of appointments. An additional goal was to determine whether the interventions were more or less effective depending on a woman's readiness to get a mammogram, as measured by stage of change. METHODS: Eligible women were randomized into one of three treatment groups described earlier. Mammography rates were calculated on the basis of a claims review and follow-up phone interviews after a period of six months. RESULTS: Women who received the telephone intervention were most likely to obtain a mammogram (28%); followed by the group that received the birthday card only (15%), and those who received the mailed intervention (9%). CONCLUSIONS: These results indicate that a multicomponent phone intervention is significantly effective in promoting mammography in managed health care plan members. An analysis by women's stage of change found a difference in the effectiveness of the three interventions among contemplators only.

Aged↗