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PubMed1993

Computerized management of respiratory care.

Respiratory care as an organized discipline is only about 45 years old, and the management of this dynamic allied health profession has usually been characterized by a demand-for-service mentality. As pressure continues to control costs, those departments that maximize quality patient care cost-effectively with thoroughly documented outcomes are in a better position to compete for future resources. The practice of respiratory care is changing as is the practice of medical care in general. Accountability for resource consumption and the quality of the product delivered are essential elements in the delivery of respiratory modalities. We have developed and implemented a comprehensive patient-data-based approach to the management of respiratory care. The essential elements of this approach are (1) relative-value-unit procedure base; (2) individual, shift, and department productivity that is attached to the annual performance review process; (3) management reporting on a 24-hour basis, with biweekly review at the management level; (4) development and implementation of a comprehensive patient-data-documentation system that permits automatic patient billing and 100% data review for quality-assurance documentation; (5) the development of a medical alerting system that alerts the Medical Director and Respiratory Care staff to potentially harmful events that, if untreated, may result in increased morbidity or mortality; and (6) the development of concurrent and retrospective tools for patient-outcomes research. These functions are supported by an active Medical Informatics Department that is nationally recognized in medical computing and logic application.

Cost-Benefit Analysis↗

PubMed1998

Influencing physicians: the three critical elements of a successful strategy.

UNLABELLED: This activity is designed for leaders and managers of healthcare organizations, particularly those involved in the development of physician incentive and physician management programs. GOAL: To describe the challenges inherent in influencing physicians and review the essential elements of any successful strategy for achieving physician support and participation. OBJECTIVES: 1. Describe the reasons why healthcare organizations and medical groups need to influence physicians to be successful. 2. Cite the reasons why it is difficult to influence physicians. 3. Review the current strategies healthcare organizations and medical groups use to influence physicians. 4. Outline the three essential elements of any program designed to influence physicians.

Behavior↗

PubMed1999

Molecular interactions between single-stranded DNA-binding proteins associated with an essential MCAT element in the mouse smooth muscle alpha-actin promoter.

Transcriptional activity of the mouse vascular smooth muscle alpha-actin gene in fibroblasts is regulated, in part, by a 30-base pair asymmetric polypurine-polypyrimidine tract containing an essential MCAT enhancer motif. The double-stranded form of this sequence serves as a binding site for a transcription enhancer factor 1-related protein while the separated single strands interact with two distinct DNA binding activities termed VACssBF1 and 2 (Cogan, J. G., Sun, S., Stoflet, E. S., Schmidt, L. J., Getz, M. J., and Strauch, A. R. (1995) J. Biol. Chem. 270, 11310-11321; Sun, S., Stoflet, E. S., Cogan, J. G., Strauch, A. R., and Getz, M. J. (1995) Mol. Cell. Biol. 15, 2429-2936). VACssBF2 has been recently cloned and shown to consist of two closely related proteins, Puralpha and Purbeta (Kelm, R. J., Elder, P. K., Strauch, A. R., and Getz, M. J. (1997) J. Biol. Chem. 272, 26727-26733). In this study, we demonstrate that Puralpha and Purbeta interact with each other via highly specific protein-protein interactions and bind to the purine-rich strand of the MCAT enhancer in the form of both homo- and heteromeric complexes. Moreover, both Pur proteins interact with MSY1, a VACssBF1-like protein cloned by virtue of its affinity for the pyrimidine-rich strand of the enhancer. Interactions between Puralpha, Purbeta, and MSY1 do not require the participation of DNA. Combinatorial interactions between these three single-stranded DNA-binding proteins may be important in regulating activity of the smooth muscle alpha-actin MCAT enhancer in fibroblasts.

Actins↗

PubMed1996

[Particle Induced X-ray Emission (PIXE) for analysis of trace elements in biological materials].

Outline of Particle Induced X-ray Emission (PIXE) and its application to biomedical samples are described. Charged particles from cyclotron or van de Graaff generator bombards analytical samples and semiconductor detector measures energy and intensity of induced characteristic x-ray. Simultaneous determination for 22Na to 92U is possible by PIXE. 100 nA of 3 MeV protons bombards biomedical samples and detection limits for almost all trace essential elements are sub microgram/g. Only 1 mg of biomedical sample is necessary for determination of trace elements and no chemical procedure is necessary for preparation of analytical sample. PIXE is powerful tool for determination of essential elements and applied for diagnosis for several diseases.

Animals↗

PubMed1999

An intronic NF-kappaB element is essential for induction of the human manganese superoxide dismutase gene by tumor necrosis factor-alpha and interleukin-1beta.

Tumor necrosis factor-alpha (TNF) and interleukin-1beta (IL-1) are cytokines that induce expression of various genes through activation of the redox-sensitive transcription factor nuclear factor-kappaB (NF-kappaB). We have previously cloned the entire human MnSOD (SOD2) gene and found several NF-kappaB-binding sites in the 5' and 3' flanking and intronic regions. To test whether these putative NF-kappaB-binding sites are able to respond to TNF and IL-1, we performed induction analysis using various deletion constructs ligated to a luciferase reporter gene. We found that the 5' and 3' flanking regions containing several NF-kappaB-binding sites do not mediate MnSOD induction by TNF or IL-1. When a 342-bp intron 2 fragment containing NF-kappaB, C/EBP, and NF-1 binding sites was linked to the basal promoter of the SOD2 gene, transcriptional activities were significantly increased in response to TNF and IL-1 in an orientation- and position-independent manner. To accurately identify the element that is most critical for the enhancer activity, deletions and specific mutations of each individual site were studied. The results indicated that the NF-kappaB binding site is essential but not sufficient for TNF- or IL-1-mediated induction. Furthermore, NF-kappaB elements in the 5' and 3' flanking regions could be made to function in TNF or IL-1 induction when they were transposed to the intronic fragment. Taken together, these results suggest that an NF-kappaB element and its location in the SOD2 gene is critical for TNF/IL-1-mediated induction. However, a complex interaction between NF-kappaB and other transcription elements is needed for a high-level induction.

Base Sequence↗

PubMed1998

The proximal interferon-stimulated response elements are essential for interferon responsiveness: a promoter analysis of the antiviral MxA gene.

Interferon (IFN)-inducible human MxA protein mediates resistance against influenza and several other RNA viruses. The MxA gene is under the control of type I IFN and, in certain cell types, is also directly activated by viruses. Here we show that in human macrophages, MxA mRNA levels are upregulated by very low doses of IFN-alpha in a dose-dependent manner. A similar, albeit much weaker, dose-dependent induction was seen with IFN-gamma. The induction was rapid and independent of protein synthesis. Interleukin-6 (IL-6) or tumor necrosis factor-alpha (TNF-alpha) did not influence MxA mRNA levels alone or in combination with IFNs, in spite of the presence of putative response elements of these cytokines in the MxA promoter. We show that the promoter of the MxA gene contains two functional IFN-stimulated response elements (ISRE) near the transcription start site and one homologous ISRE-like element, which is apparently nonfunctional, further upstream. The two proximal ISRE sites are essential for IFN-alpha-induced transcription and appear to be binding sites for IFN-stimulated gene factor 3 complex. In addition, EMSA and DNAse I footprinting analysis demonstrated that Spl binds with high affinity to a region encompassing nucleotides -25 and -50 and, thus, may provide means of interaction with the basal transcriptional machinery.

Antiviral Agents↗

PubMed2000

Osteoporosis.

Osteoporosis is a disorder of decreased bone mass, microarchitectural deterioration, and fragility fractures. Osteoporosis is widespread and can affect people of all ethnic backgrounds and many older women and men. An essential element in preventing osteoporosis is the achievement of normal peak bone mass. Adequate nutrition, appropriate calcium and vitamin D intake, regular menstrual cycles and a well balanced exercise program of exercise are essential elements in achieving peak bone mass. At menopause women undergo accelerated bone loss. Thereafter, women and men gradually lose bone mass. A loss of one standard deviation give rise to an enhanced twofold risk of spine fractures or a 2.5 risk of hip fracture. Bone mass is determined by dual energy x-ray absorptiometry, quantitative computed tomography scan, and a peripheral ultrasound. Dual energy x-ray absorptiometry has outstanding precision (within 1% to 2%), and has the ability to show the efficacy of drug intervention. Peripheral measurements may identify osteoporosis but only have a 70% correlation with hip and spine bone mass. Dual energy x-ray absorptiometry determines bone mass in a patient but the bone collagen breakdown products (N-telopeptide crosslinks) establish the current rate of bone loss. Major risk factors leading to fragility fracture include low body weight, history of fracture, family history of osteoporosis, and smoking. All individuals should ingest adequate calcium and vitamin D, exercise, and prevent falls. Women with low bone mass, high urinary bone collagen breakdown products, and/or major risk factors should consider hormone replacement therapy or a selective estrogen receptor modulator (Evista), calcitonin and bisphosphonates (alendronate). These agents successfully increase bone mass and limit fracture risk. Men at risk for fragility fractures respond similarly as women to alendronate and calcitonin. Although vertebral compression fractures can occur spontaneously, hip fractures are attributable to low bone mass coupled with a fall. Hence, fall prevention programs in addition to medical treatment are critical in the prevention of fragility fractures.

Female↗

PubMed1984

Effect of metal chelators on excretion and tissue levels of essential trace elements.

The influence of one, three, and six doses of ethylenediaminetetraacetic acid (EDTA), diethylenetriaminepentaacetic acid (DTPA), and triethylenetetramine (TETA) on the urinary excretion of Ca, Cu, Fe, and Zn, and on their levels in liver, kidneys, heart, and serum in rats, was investigated to ascertain their suitability in amelioration of metal intoxication. While excretion of all the essential trace metals examined was enhanced significantly, the tissue and serum levels of some of them either increased or decreased after administration of the chelators. The results suggest depletion of some of the endogenous trace metals from the body and their intertissue redistribution following treatment with these chelating agents.

Animals↗

PubMed1998

In vitro mineral availability from digested tea: a rich dietary source of managanese.

Tea is potentially a rich source of some dietary metals and approximately 70 l are drunk per capita per year in the UK. In particular, tea may be an important source of Mn, since leaf tea contains 350-900 micrograms g-1 of this essential element. However, the leaching and bioavailability of Mn from tea have been little studied, so a recently developed in vitro assay was applied to compare the bioavailability of Mn from tea infusions with that of other major and trace essential elements. Analysis of tea infusions before digestion showed that 1.0 l contained 115% of the average daily dietary intake of Mn but < 6% of all other minerals. Samples of these infusions were incubated with human gastric juice (37 degrees C, 1 h) and some were then adjusted to pH 6.5 to simulate intestinal pH. All were centrifuged through ultrafilters with molecular mass cut-offs of 3, 10 and 30 kDa. The percentages of ultrafilterable (< 3 kDa) elements following simulated gastrointestinal digestion were (n = 3; mean +/- s) Ca 47.7 +/- 10.7, Cu 45.3 (n = 1), Fe < 5, Mg 66.4 +/- 1.6, Mn 39.8 +/- 11.4, K 40.3 +/- 2.2, Na 100.0 +/- 5.3 and Zn 33.7 +/- 1.1. Hence the ultrafilterability of elements showed the general trend M+ > M2+ > M3+, which is probably the inverse of the order of their strengths of binding to tea polyphenols. However, Mn was the only element found in significant dietary amounts in tea, and under simulated intestinal conditions was still 40% bioavailable.

Biological Availability↗

PubMed1995

A developmentally regulated chromosomal origin of replication uses essential transcription elements.

Only one of the two chromosomes in the asymmetric Caulobacter predivisional cell initiates replication in the progeny cells. Transcription from a strong promoter within the origin occurs uniquely from the replication-competent chromosome at the stalked pole of the predivisional cell. This regulated promoter has an unusual sequence organization, and transcription from this promoter is essential for regulated (cell type-specific) replication. Our analysis defines a new class of bacterial origins and suggests a coupling between transcription and replication that is consistent with the phylogenetic relationship of Caulobacter to the ancestral mitochondrion.

Base Sequence↗

PubMed2005

The American Board of Radiology Maintenance of Certification (MOC) Program in Radiologic Physics.

Maintenance of Certification (MOC) recognizes that in addition to medical knowledge, several essential elements involved in delivering quality care must be developed and maintained throughout one's career. The MOC process is designed to facilitate and document the professional development of each diplomate of The American Board of Radiology (ABR) through its focus on the essential elements of quality care in Diagnostic Radiology and its subspecialties, and in the specialties of Radiation Oncology and Radiologic Physics. The initial elements of the ABR-MOC have been developed in accord with guidelines of The American Board of Medical Specialties. All diplomates with a ten-year, time-limited primary certificate in Diagnostic Radiologic Physics, Therapeutic Radiologic Physics, or Medical Nuclear Physics who wish to maintain certification must successfully complete the requirements of the appropriate ABR-MOC program for their specialty. Holders of multiple certificates must meet ABR-MOC requirements specific to the certificates held. Diplomates with lifelong certificates are not required to participate in the MOC, but are strongly encouraged to do so. MOC is based on documentation of individual participation in the four components of MOC: (1) professional standing, (2) lifelong learning and self-assessment, (3) cognitive expertise, and (4) performance in practice. Within these components, MOC addresses six competencies: medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.

Certification↗

PubMed1995

Therapeutic communities for addictions: a theoretical framework.

Adaptation of therapeutic communities (TCs) for new clients and in different settings has resulted in a diversity of programs with unique treatment protocols and different planned duration of stays. The extent to which the various adaptations retain the essential elements of the TC model is not known, and moreover, casts questions about the general effectiveness of the therapeutic community modality. This paper outlines a theoretical framework of the addiction TC to advance research and guide training, practice, and program development. The essential elements of the TC are organized into four areas: its perspective, treatment approach, program model, and the treatment process. Some implications of a TC theory, model, and method are discussed in terms of research, treatment, and policy issues.

Goals↗

PubMed1996

[Overview--suppression effect of essential trace elements on arteriosclerotic development and it's mechanism].

It is known that the peroxidation of LDL is a trigger for developing arteriosclerosis. The oxidized LDL is produced by either oxidative stress or a few oxidant. Selenium decreased in serum and some organs of stroke-prone spontaneously hypertensive rats (SHRSP), which is a cofactor of glutamine peroxidase. Serum magnesium decreased in patients with diabetes mellitus, with ischemic heart disease, with essential hypertension and with cerebral vascular lesions. Calcium to magnesium ratio was higher in some organs of SHRSP as compared to Wistar Kyoto rats (WKY). These changes accelerated vascular lesions in SHRSP.

Animals↗

PubMed1998

Choice, isolation, and preparation of cells for bioartificial vascular grafts.

Preparation of cells and tissues for bioartificial vascular grafts is discussed from the viewpoint of tissue engineering. In general, a neointima is not formed on vascular prostheses except at the anastomotic sites. Graft surfaces do not heal and are covered with fresh thrombi for a long period of time after implantation. The delayed healing is, so to speak, an intractable ulcer of the vascular wall. To overcome this problem, we have developed a tissue fragment transplantation method. We consider that neointima formation of vascular prostheses after implantation is a product of tissue engineering in vivo. Therefore, 3 essential elements for tissue engineering, i.e., cells, extracellular matrices, and cytokines, are required for neointima formation. Synthetic vascular prostheses lack one or more of these elements. In this study we demonstrated a standard healing process of fabric vascular prostheses and an antithrombogenic polymer graft using animal models. Then we showed the tissue fragment transplantation method using venous tissues, adipose tissues, and bone marrow. This method provided the 3 essential elements to the prostheses. To allow these elements to be actively engaged in neointima formation, we treated cells and tissues as clumps without enzymatic digestion. We also took advantage of the in vivo environment. With the results we demonstrate our way of thinking in relation to bioartificial vascular grafts.

Adipose Tissue↗

PubMedDate not supplied

Major and trace elements in spruce needles by NAA.

Concentrations of 23 elements in needles of Norway spruce (P. abies) have been determined at 47 sites. It is shown that a thorough removal of the aerosols sitting on the needles surface is necessary in order to get the inherent needle concentrations. Neutron activation was used to determine concentrations from 10(-9) to 10(-2) g/g. Irradiation and counting conditions are given. The essential elements, Ca, Cl, Cu, Fe, K, Mg, Mn, P, Zn, and the nonessential elements, Al, As, Ba, Br, Co, Cs, Hg, La, Na, Rb, Sb, Sc, Sr, and V, could be determined. The concentrations of most elements are about a factor of 6 smaller than the mean concentrations in land plants. Analytical reproducibility was much better than the variation among individual trees, and the variation within sites is smaller than among sites. In general, essential elements have smaller variations than nonessential elements. For some elements, variations between sites are owing to differences in the soil pH or the emission situation.

Neutron Activation Analysis↗

PubMed1999

Concentrations of essential trace elements in maternal serum and the effect on birth weight and newborn body mass index in sub-arctic and arctic populations of Norway and Russia.

BACKGROUND: This project is part of an assessment of the impact of environmental factors on human health in the Kola Peninsula of Russia and the neighboring arctic area of Norway. Pregnant women and their newborns were studied to explore a relationship between maternal status of essential metals and birth weight. METHODS: Life-style information and serum specimens were collected from at least 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities (N=151 and 167, respectively). Pregnancy outcomes were verified by consulting medical records. Copper, selenium and zinc in serum were determined by atomic absorption spectrometry and ferritin by an automated analyzer method. RESULTS: Mean birth weight and child's body mass index (BMIC) were significantly lower in the Russian group (p<0.001), with or without adjustment for gestational age. Copper, iron (as ferritin) and selenium serum concentrations were in the normal range, while zinc levels in both countries were mostly below the lower limit (10.8 micromol/L) of reported reference intervals. A positive correlation between zinc and birth weight or BMIC was only observed for concentrations exceeding 10.8 micromol/L. Analysis by quartiles showed that maternal urinary creatinine and birth weight were negatively correlated (p=0.001). The influence of the different elements on BMIC, grouped by quartiles, was significantly positive only for selenium (p=0.03) and ferritin (p=0.02), while there was no significant relationship for copper or zinc. Adjustment of birth weight and BMIC for gestational age did not alter substantially the various associations indicated. CONCLUSIONS: With the exception of zinc, the mineral status of delivering women in arctic and sub-arctic regions of Norway and western Russia appears to be adequate. The significantly lower BMIC for the Russian group suggests the likely occurrence of nutritional deficiencies during pregnancy in Russia. However, the significant contribution of a country factor in the predictive model implies that the maternal serum trace-element concentrations explored in this study are incomplete indicators of fetal undernourishment.

Adult↗

PubMed1995

A cluster of basic amino acids within an alpha-helix is essential for alpha-subunit recognition by the glycoprotein hormone N-acetylgalactosaminyltransferase.

The glycoprotein hormone N-acetylgalactosaminyltransferase is responsible for synthesis of Asn-linked oligosaccharides terminating with GalNAc-4-SO4 on lutropin, thyrotropin, and the uncombined glycoprotein hormone alpha subunit. We previously established that a recognition determinant for the N-acetylgalactosaminyltransferase is contained within a 22-amino acid glycopeptide fragment of the alpha subunit. We proposed that the tripeptide Pro-Leu-Arg is an essential element of the recognition determinant. Using site-directed mutagenesis we have examined the role of individual amino acids in recognition by the glycoprotein hormone N-acetylgalactosaminyltransferase. Within the sequence Pro40-Leu41-Arg42-Ser43-Lys44-Lys45, Lys44, and Lys45, as well as Arg42 of the tripeptide, are essential for recognition. Substitution of the Leu41 with other amino acids can either increase or decrease the rate of GalNAc transfer over an 8-fold range, suggesting that the middle amino acid of the tripeptide plays a modulatory role in recognition. The critical Leu41-Arg42 and Lys44-Lys45 residues are present on the same surface of an alpha-helix, which projects from the surface of the alpha subunit. Our results indicate that an essential element of the recognition determinant consists of a cluster of basic residues and that neutral but not negatively charged residues are tolerated within this cluster.

Acetylgalactosamine↗

PubMed1983

Quick-blot: selective mRNA or DNA immobilization from whole cells.

Quick-blot, a method for selectively immobilizing either mRNA or DNA on nitrocellulose, is described in detail. Essential elements of the procedure for immobilizing DNA include tissue lysis, proteinase K treatment, solubilization of nucleic acids in hot 12.2 molal NaI, passage through a nitrocellulose filter, and acetylation of residual protein with acetic anhydride. Advantages include speed, quantitative recovery, low background, and elimination of the usual baking step. Essential elements of the procedure for selectively immobilizing mRNA include dissolving cells in Brij-35 and desoxycholate, proteinase K treatment, solubilizing nucleic acids in room temperature 12.2 molal NaI, filtration through nitrocellulose, and acetylation of residual protein. Advantages include selective immobilization of mRNA but not tRNA, rRNA, or DNA, and the maintenance of biological activity of the immobilized mRNA. Control experiments to optimize the procedures and examples of their application are shown.

Cells↗