Medicine and Health Sciences Commons^™

Elevated Expression Of Type Vii Collagen In The Skin Of Patients With Systemic Sclerosis. Regulation By Transforming Growth Factor-Beta., Lidia Rudnicka, John Varga, Angela M. Christiano, Renato V. Iozzo, Sergio A. Jimenez, Jouni Uitto

Department of Dermatology and Cutaneous Biology Faculty Papers

A hallmark of systemic sclerosis (SSc) is the development of tissue fibrosis. Excessive production of several connective tissue components normally present in the dermis, including type I, III, V, and VI collagens as well as fibronectin and proteoglycans, is a consistent finding in the skin of SSc patients. Type VII collagen is a major constituent of anchoring fibrils, present in the skin at the dermal-epidermal basement membrane zone. TGF-beta has been shown to upregulate the expression of the type VII collagen gene. In this study, we assessed the expression of type VII collagen and TGF-beta in the skin of patients …

Management Decisions Made By Caregiver Spouses Of Persons With Alzheimer's Disease., Mary A. Corcoran

Department of Occupational Therapy Faculty Papers

OBJECTIVES: As the incidence of Alzheimer's disease increases, so does the effect on families and friends who assume caregiving responsibilities. Despite the proliferation of caregiving studies reported in the literature, little is known of the day-to-day management styles and preferences of caregivers. To develop, implement, and test interventions designed to sustain caregivers in their role, more information is needed about the caregiving experience. Results of a descriptive study are presented as a first step in understanding the complex process of choosing, organizing, and implementing everyday caregiving tasks.

METHOD: Subjects of the study were 26 persons who provide care for a …

Ochrobactrum Anthropi Bacteremia In A Child., Joel D. Klein, Stephen C. Eppes

Department of Pediatrics Faculty Papers

Children undergoing chemotherapy for cancer are at increased risk of supervening infection, including bacteremia. This may be due to immunosuppression as well as the presence of intravascular devices such as central venous catheters. Bacteria responsible for these infections include those found in the child's endogenous flora as well as in environmental sources. We report the case of a child with acute lymphoblastic leukemia (ALL) who developed bacteremia secondary to Ochrobactrum anthropi. Details of this extremely rare infection are the focus of this report.

Sequencing Of Cdna From 50 Unrelated Patients Reveals That Mutations In The Triple-Helical Domain Of Type Iii Procollagen Are An Infrequent Cause Of Aortic Aneurysms., Gerard Tromp, Yuli Wu, Darwin J. Prockop, Swarna L. Madhatheri, Caren Kleinert, James J. Earley, Jiapiao Zhuang, Orjan Norrgård, R. Clement Darling, William M. Abbott, C. William Cole, Pekka Jaakkola, Markku Ryynanen, William H. Pearce, James S.T. Yao, Kari Majamaa, Stanton N. Smullens, Zoran Gatalica, Robert E. Ferrell, Sergio A. Jimenez, Charles E. Jackson, Virginia V. Michels, Michael Kaye, Helena Kuivaniemi

Department of Biochemistry and Molecular Biology Faculty Papers

Detailed DNA sequencing of the triple-helical domain of type III procollagen was carried out on cDNA prepared from 54 patients with aortic aneurysms. The 43 male and 11 female patients originated from 50 different families and five different nationalities. 43 patients had at least one additional blood relative who had aneurysms. Five overlapping asymmetric PCR products, covering all the coding sequences of the triple-helical domain of type III procollagen, were sequenced with 28 specific sequencing primers. Analysis of the sequencing gels revealed only two nucleotide changes that altered the structure of the protein. One was a substitution of threonine for …

Regulation Of Human Lung Fibroblast Alpha 1(I) Procollagen Gene Expression By Tumor Necrosis Factor Alpha, Interleukin-1 Beta, And Prostaglandin E2., Arturo Diaz, Elena Munoz, Rosemary Johnston, Joseph H. Korn, Sergio A. Jimenez

Department of Medicine Faculty Papers

We investigated the participation of prostaglandin (PG) E2 in the regulation of the alpha 1(I) procollagen gene expression by tumor necrosis factor alpha (TNF alpha), and interleukin-1 beta (IL-1 beta) in normal adult human lung fibroblasts. TNF alpha (100 units/ml) and IL-1 beta (100 units/ml) stimulated the production of PGE2 and caused a dose-dependent inhibition of up to 54 and 66%, respectively, of the production of type I procollagen. Preincubation of cultures with indomethacin partially reversed the inhibition of procollagen production induced by the cytokines. Cytokine-stimulated endogenous fibroblast PG accounted for 35 and 68% of the inhibition induced by TNF …

A Model To Promote Activity Competence In Elders., Ruth E. Levine, Laura N. Gitlin

Department of Occupational Therapy Faculty Papers

This paper describes an occupational therapy home-based intervention in which purposeful activities were used to promote adaptation and competence in older adults with chronic disabilities. Seven home care therapists visited 17 randomly selected, community-living elders who were chronically disabled and who volunteered to participate in the program. The number of visits ranged from 3 to 10 and occurred over a 3-month period according to clients' needs and wishes. Therapists enhanced their ability to enter the client's social and cultural system by using participant-observation techniques and collaboratively identified activities. Therapists documented each home visit with a structured fieldnote form. An analysis …

Gender Differences In Dementia Management Plans Of Spousal Caregivers: Implications For Occupational Therapy., Mary A. Corcoran

Department of Occupational Therapy Faculty Papers

Occupational therapists treating older people with Alzheimer disease know that they must also consider the others who are affected by the disease, the informal caregivers. Intervention is most effective when it enables both the impaired person and the primary caregiver to manage the secondary symptoms of dementia. Unfortunately, little is understood about how caregivers approach and carry out their tasks and about why male and female caregivers respond differently to their caregiving role in terms of depression, burden, stress, and substance abuse. This paper discusses the effects of gender on dementia management plans of spousal caregivers. Husbands and wives have …

Childhood Typhoid Fever Diagnosed In An Urban U.S. Setting., Surinder K. Sodhi, Stephen C. Eppes, Joel D. Klein

Department of Pediatrics Faculty Papers

The majority of cases of childhood typhoid fever diagnosed in the United States occur in persons recently returned from travel abroad. We report two childhood cases of typhoid fever acquired in Mexico and India and diagnosed in an urban United States setting. This report describes these cases and provides insights into the pitfalls in recognizing this condition in a nonendemic setting as well as information concerning differential diagnosis and treatment.

Dementia Management: An Occupational Therapy Home-Based Intervention For Caregivers., Mary A. Corcoran, Laura N. Gitlin

Department of Occupational Therapy Faculty Papers

This paper describes an occupational therapy intervention designed for family caregivers of persons with dementia. The intervention, based on the framework of a competence-environmental press model and the principle of collaboration, was implemented during 5 home visits. Each visit was designed to build caregiving skills through collaboration in identifying problem areas, developing and implementing environmental strategies, and modifying management approaches. A case vignette illustrates the therapeutic process and outcomes. The theoretical rationale and structure of the intervention and innovative documentation for evaluation of the theoretic process are also presented.

An Emerging View Of Mastery, Excellence, And Leadership In Occupational Therapy Practice., Janice P Burke, Elizabeth Depoy

Department of Occupational Therapy Faculty Papers

The recent focus on clinical reasoning in occupational therapy, specifically on how therapists solve complex problems, has stimulated interest in how master clinicians think in practice. By gaining insight into how clinicians think and what they think about when they identify and solve problems, we may be able to identify clinical reasoning patterns and processes that occupational therapy students and novice therapists need to experience in order to progress in their practice or to emerge as leaders in their field. Observation of the way in which clinical masters and leaders view challenges and solve problems as manifested in their clinical …

Malignant External Otitis And Mastoiditis Associated With An Igg4 Subclass Deficiency In A Child., Ricardo Castro, Md, Norman Robinson, Md, Joel Klein, Md, William Geimeier, Md

Department of Pediatrics Faculty Papers

We have presented the first child in Delaware with malignant external otitis associated with IgG4 deficiency. Our patient needed three courses of intravenous antibiotics and twice required mastoidectomy, but has recovered completely following the restoration of the natural barrier between the internal and external ear, using a fascial graft from the large temporalis muscle. Some hearing deficit remains.

Home Adaptations For Persons With Chronic Disabilities: An Educational Model., Ruth E. Levine, Laura N. Giltin

Department of Occupational Therapy Faculty Papers

This paper offers a method by which to train students in the provision of culturally relevant, in-home environmental adaptations for persons with chronic disabilities. On the basis of a theoretical framework, the student therapist learns about the client's life-style and offers adaptations that evolve from a collaborative problem-solving process. The training process has been developed and refined over a 3-year period. A case study illustrates the student's application of theory and practice and the outcome for the client of this service provision approach.

Recurrent/Persistent Pneumonia In A 3 1/2-Year-Old-Girl Due To Acquired Immune Deficiency Syndrome., Ricardo Castro, Md, Joel Klein, Md, Rajeswary Padmalingam, Md, Stephen C. Eppes, Md

Department of Pediatrics Faculty Papers

The following is the report of the first case of a Delaware born child who developed AIDS, born from a mother who was not in a high risk camp.

Animal Bite Infections., Joel D. Klein, Md

Department of Pediatrics Faculty Papers

Animal bites have become alarmingly common and may represent a quiet epidemic. It is estimated that between 1 and 3.5 million animal bites occur annually in the United States. The highest incidence has consistently been in 5-to-14-year-old schoolchildren, who have greater contact with animals, especially house pets, on a daily basis. This article discusses the epidemiology, microbiology, clinical findings and management of animal bites infections.