1
|
Tsouknidas I, Perez S, Kunkel E, Tiko-Okoye C, Buckley ME, Gefen JY. Use of sugammadex in prevention of post-operative urinary retention in minimally invasive hernia surgery. Hernia 2024:10.1007/s10029-024-03038-4. [PMID: 38683482 DOI: 10.1007/s10029-024-03038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Post-operative urinary retention (POUR) is a known complication of hernia surgery. Minimally invasive inguinal hernia repair (IHR) is typically done under general anesthesia with neuromuscular blockade (NMB), which is commonly reversed with an anticholinesterase inhibitor paired with an anticholinergic agent. Sugammadex is a unique NMB reversal agent that does not have to be paired with an anticholinergic. We sought to explore the role of sugammadex in reducing the rate of POUR following these procedures. METHODS Data were collected retrospectively at a single institution between February 2016 and October 2019. We identified and studied patients who underwent minimally invasive IHR and received either sugammadex or neostigmine/glycopyrrolate for NMB reversal. The primary endpoint was POUR requiring bladder catheterization. Secondary endpoints included post-operative and 30-day readmissions. RESULTS 274 patients were included in this study (143 received neostigmine and glycopyrrolate, 131 sugammadex). The sugammadex patients were on average 5 years older than the neostigmine/ glycopyrrolate patients (63.2 vs 58.2, p = 0.003), and received less median intravenous fluids (IVF) (900 ml vs 1000 ml; p = 0.015). There was a significant difference in the rate of POUR between the sugammadex and neostigmine/glycopyrrolate patients (0.0% vs 8.4%, p ≤ 0.001). The difference remained significant after controlling for age and IVF. The odds of POUR for those who received neostigmine/glycopyrrolate were 25 × higher than the odds of those who received sugammadex. CONCLUSION The results of this study reflect the protective role of sugammadex against POUR in minimally invasive IHR cases.
Collapse
Affiliation(s)
- I Tsouknidas
- Department of Surgery, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA.
| | - S Perez
- Department of Surgery, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA
| | - E Kunkel
- Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego (UCSD), San Diego, CA, USA
| | - C Tiko-Okoye
- Department of Acute Care, Trauma & Critical Care Surgery, Duke University Hospital, Durham, NC, USA
| | - M E Buckley
- Main Line Health Center for Population Health Research, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - J Y Gefen
- Department of Surgery, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA
| |
Collapse
|
2
|
Mahgoub Y, Forrest LN, Luther J, Singh N, Kibler J, Noel J, Zug D, Swigart A, Kunkel E. The Impact of COVID-19 on Psychiatric Acuity in a Community Psychiatric Hospital. J Nerv Ment Dis 2023; 211:910-918. [PMID: 37983367 DOI: 10.1097/nmd.0000000000001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
ABSTRACT The COVID-19 pandemic has had extensive impacts on mental health care delivery. Anecdotal observations of inpatient care teams at Pennsylvania Psychiatric Institute suggested increased patient acuity during the pandemic. The authors found no consensus definition for measuring psychiatric acuity in the literature. We performed an interrupted time series analysis to identify whether COVID-19 was associated with changes in several hospital parameters that might reflect our patients' access to psychiatric services and acuity. We found increases in inpatient parameters for length of stay, rates of involuntary admissions, and the incidence of restraints, seclusion, and 1:1 observation orders. Observing these increasing trends can inform mitigation efforts to improve the quality of mental health care treatment and care delivery. We suggest the use of these metrics for objective measurements of psychiatric acuity.
Collapse
Affiliation(s)
- Yassir Mahgoub
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania
| | - Lauren N Forrest
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joy Luther
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Nirmal Singh
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Jason Kibler
- Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania
| | - Jason Noel
- Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania
| | - David Zug
- Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania
| | - Alison Swigart
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania
| | | |
Collapse
|
3
|
Graziane JA, Ghahramani A, Bowen JL, Horton S, Swigart A, Kunkel E, Dalke KB. Psychiatry's Obligation to Promote Voting Among Patients With Mental Illness. Psychiatr Serv 2023; 74:1291-1293. [PMID: 37287229 DOI: 10.1176/appi.ps.20230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The American Medical Association adopted a resolution in June 2022 recognizing voting as a social determinant of health. As psychiatric professionals and trainees with experience in civic health, the authors argue that psychiatrists must consider the relationship between voting and mental health as part of care delivery. People with psychiatric illness can experience unique barriers to voting and garner mental health benefits from civic engagement. Provider-led activities to promote voting are accessible and simple. Given the benefits of voting, and the availability of interventions to foster voter engagement, psychiatrists have an obligation to promote voting access among their patients.
Collapse
Affiliation(s)
- Julie A Graziane
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Aria Ghahramani
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Joy Luther Bowen
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Sarah Horton
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Alison Swigart
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Elisabeth Kunkel
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| | - Katharine B Dalke
- Department of Psychiatry and Behavioral Health, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania (Graziane, Ghahramani, Bowen, Horton, Swigart, Kunkel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dalke)
| |
Collapse
|
4
|
|
5
|
Brown D, Henau HD, Garrigan JT, Gerike P, Holt M, Kunkel E, Matthijs E, Waters J, Watkinson RJ. Removal of Nonionics in Sewage Treatment Plants II / Abbauwerte für Nonionics in Klaranlagen II. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1987-240108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
6
|
|
7
|
Schöberl P, Kunkel E, Espeter K. Vergleichende Untersuchungen über den mikrobiellen Metabolismus eines Nonylphenol- und eines Oxoalkohol- Ethoxylates. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1981-180204] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
8
|
|
9
|
Keck E, Kunkel E, Matthijs E, Waters J, Watkinson RJ. Abbauwerte von Haushaltswaschmitteln in einer Belebungsanlage/ Removal of Nonionics in a Sewage Treatment Plant. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1986-230414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
10
|
Marks JH, Salem JF, Adams P, Sun T, Kunkel E, Schoonyoung H, Agarwal S. SP rTaTME: initial clinical experience with single-port robotic transanal total mesorectal excision (SP rTaTME). Tech Coloproctol 2021; 25:721-726. [PMID: 33881657 DOI: 10.1007/s10151-021-02449-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The technical difficulty and steep learning curve of transanal total mesorectal excision (taTME) has limited widespread adoption. The single-port (SP) daVinci robot is designed to facilitate single-incision and natural-orifice transluminal endoscopic surgery (NOTES). This paper describes the first clinical experience of single-port robotic taTME (SP rTaTME). METHODS This was a prospective study on consecutive patients with rectal cancer who underwent SP rTaTME proctosigmoidectomy with handsewn coloanal anastomosis in December 2018 and January 2019. The primary outcome was technical feasibility of the procedure. The secondary outcomes include blood loss, intraoperative complications, length of hospital stay, quality of the TME specimen, short- and long-term morbidity and mortality, as well as short-term oncologic follow -up. RESULTS There were two patients, a 48-year-old male and a 38-year-old female. Both operations were completed successfully without complications or conversion. Estimated blood loss was 200 mL and 130 mL. In both cases the TME was completed transanally using the SP robot. In the first patient, the abdominal portion was completed through an abdominal single-incision; in the second patient the operation was entirely performed transanally as a pure NOTES procedure. In both cases, the final pathology report showed a complete TME with negative margins. Patients were discharged on postoperative day 3 and 4,respectively. There was no long-term morbidity or mortality. CONCLUSIONS SP rTaTME is feasible and can be safely performed. It provides excellent optics and dexterity to work in a limited space. Future studies are required to further define the safety profile and the ultimate utility of the SP robot for taTME.
Collapse
Affiliation(s)
- J H Marks
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA.
| | - J F Salem
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - P Adams
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - T Sun
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - E Kunkel
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - H Schoonyoung
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| | - S Agarwal
- Lankenau Medical Center Division of Colorectal Surgery, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
| |
Collapse
|
11
|
Akbari A, Kunkel E, Bota S, Harel Z, Le Gal G, Cox C, Hundemer G, Canney M, Clark E, Massicotte-Azarinouch D, Eddeen A, Knoll G, Sood M. POS-468 PROTEINURIA AND VENOUS THROMBOEMBOLISM IN PREGNANCY: A POPULATION-BASED COHORT STUDY. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
12
|
Kawasaki S, Dunham E, Mills S, Kunkel E, Gonzalo JD. The opioid epidemic: Mobilizing an academic health center to improve outcomes. J Subst Abuse Treat 2021; 121:108199. [PMID: 33357608 PMCID: PMC7770331 DOI: 10.1016/j.jsat.2020.108199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/11/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
Since 2000, opioid use disorder (OUD) has become an epidemic in the United States with more than 600,000 total deaths and a $51 billion annual cost. Patients with OUD require services from community-based organizations, local and state health departments, and health systems, all of which necessitate communication and collaboration among these groups to develop an effective strategy for diagnosis, treatment, and coordination of care. Academic health centers (AHCs) are poised to make significant contributions to the care of patients with OUD given in-house expertise across multiple medical specialties and the mission to care for patients in need. Despite the potential for AHCs to provide necessary services and address this public health crisis, progress has been slow. Many AHCs lack a clear roadmap for moving this agenda forward in their local regions. In response to rising deaths due to OUD, the authors' AHC undertook a significant redesign effort to facilitate the necessary processes and interdepartmental collaboration to provide patient-centered, comprehensive care for patients with OUD. In this article, using an organizational development framework (McKinsey 7S model), the authors describe their transformation process, and articulate strategies and potential barriers to implementing this framework. The goal of the article is to highlight the structural, procedural, and cultural changes that have occurred in one AHC so we can assist other AHCs in addressing the opioid epidemic.
Collapse
Affiliation(s)
- Sarah Kawasaki
- Assistant Professor of Psychiatry and Medicine, Penn State College of Medicine, Hershey, Pennsylvania; Director of Addictions Services at Advancement in Recovery, Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania
| | - Eleanor Dunham
- Penn State College of Medicine, Hershey, PA, United States of America
| | - Sara Mills
- Penn State College of Medicine, Hershey, PA, United States of America
| | - Elisabeth Kunkel
- The Joyce D. Kales University Chair of Community Psychiatry, Penn State College of Medicine, Hershey, PA, United States of America; Pennsylvania Psychiatric Institute, Harrisburg, PA, United States of America
| | - Jed D Gonzalo
- Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America.
| |
Collapse
|
13
|
Rojas K, Raker C, Onstad M, Kunkel E, Clark M, Stuckey A, Gass J. 031 The Impact of Mastectomy Type on the Female Sexual Function Index (FSFI) and Parameters of Intimacy such as Appearance, Satisfaction, and the Breast’s Role in Intimacy. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
|
15
|
Fogarty S, Onstad M, Stuckey A, Kunkel E, Clark M, Lopes V, Raker C, Robison K, Flores L, Boggis J, Manning L, Blake R, Sargent R, Gass J. Surgical management of breast cancer and impact on sexual function. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2014.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Brovko L, Anany H, Bayoumi M, Giang K, Kunkel E, Lim E, Naboka O, Rahman S, Li J, Filipe C, Griffiths M. Antimicrobial light-activated materials: towards application for food and environmental safety. J Appl Microbiol 2014; 117:1260-6. [DOI: 10.1111/jam.12622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/20/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
- L. Brovko
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
| | - H. Anany
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
- Microbiology Department; Faculty of Science; Ain Shams University; Cairo Egypt
| | - M. Bayoumi
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
- Food Control Department; Faculty of Veterinary Medicine; Zagazig University; Zagazig Egypt
| | - K. Giang
- Department of Chemical Engineering; McMaster University; Hamilton ON Canada
| | - E. Kunkel
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
| | - E. Lim
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
| | - O. Naboka
- Department of Chemical Engineering; McMaster University; Hamilton ON Canada
| | - S. Rahman
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
| | - J. Li
- Department of Chemical Engineering; McMaster University; Hamilton ON Canada
| | - C.D.M. Filipe
- Department of Chemical Engineering; McMaster University; Hamilton ON Canada
| | - M.W. Griffiths
- Canadian Research Institute for Food Safety; University of Guelph; Guelph ON Canada
| |
Collapse
|
17
|
Auth T, Kunkel E, Grummt F. Interaction between HP1alpha and replication proteins in mammalian cells. Exp Cell Res 2006; 312:3349-59. [PMID: 16950245 DOI: 10.1016/j.yexcr.2006.07.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 07/01/2006] [Accepted: 07/05/2006] [Indexed: 12/01/2022]
Abstract
HP1 is an essential heterochromatin-associated protein known to play an important role in the organization of heterochromatin as well as in the transcriptional regulation of heterochromatic and euchromatic genes both in repression and activation. Using the yeast two-hybrid system and immunoprecipitation, we report here that murine HP1alpha interacts with the preRC proteins ORC1, ORC2 and CDC6. Immunofluorescence staining and EGFP/DsRed fusion proteins revealed a colocalization of HP1alpha with ORC1, ORC2 and CDC6 in heterochromatin, supporting the notion that ORC and probably CDC6 play an important role in murine HP1alpha function. Besides that, we also observed a colocalization of HP1alpha with gamma-tubulin suggesting a centrosomal localization of HP1alpha in murine cells. To gain insight into HP1alpha function, we applied the RNAi technique. Depletion of HP1alpha leads to a slow down of cell proliferation, an aberrant cell cycle progression as well as to multinucleated cells with insufficiently organized microtubule. These results together indicate that HP1alpha exerts functions in mitosis and cytokinesis.
Collapse
Affiliation(s)
- Tanja Auth
- Institute of Genetics, University of Bonn, 53117 Bonn, Germany.
| | | | | |
Collapse
|
18
|
Wallisch M, Kunkel E, Hoehn K, Grummt F. Ku antigen supports termination of mammalian rDNA replication by transcription termination factor TTF-I. Biol Chem 2002; 383:765-71. [PMID: 12108541 DOI: 10.1515/bc.2002.080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A replication fork barrier at the 3'-end of mouse ribosomal RNA genes blocks bidirectional fork progression and limits DNA replication to the same direction as transcription. This barrier is an inherent property of a defined DNA-protein complex including transcription termination factor I, and specific protein-protein interactions occur between this factor and protein(s) of the replication machinery. Here we report that a second DNA-binding protein is essential for barrier activity. We have purified and functionally characterised the protein from HeLa cells. The final preparation contained two polypeptides with molecular masses of 70 and 86 kDa, respectively. Both polypeptides interact with a GC-stretch adjacent to the binding site of transcription termination factor I. The specificity of binding to the barrier DNA was demonstrated in an electrophoretic mobility shift assay. The biochemical properties of this protein resemble that of Ku antigen, a human nuclear DNA-binding heterodimer that is the target of autoimmune-antibodies in several autoimmune diseases. Recombinant Ku protein, purified as heterodimer from co-infected insect cells, is able to partially rescue the barrier activity in Ku-depleted HeLa cell extracts. These data demonstrate that transcription termination factor I and Ku act synergistically to prevent head-on collision between the replication and the transcription machinery.
Collapse
|
19
|
Abstract
We have used nascent strand determination analysis to map start sites of DNA replication in the mouse ribosomal gene cluster in which individual copies of the ribosomal genes are separated by intergenic spacer regions. One origin of bidirectional replication (OBR) was localized within a 3 kb region centered about 1.6 kb upstream of the rDNA transcription start site. At least one additional initiation site is situated near the 3' end of the transcription unit. Adjacent to the OBR at the transcription start site are located two amplification-promoting sequences, i.e., APS1 and APS2. Nuclease-hypersensitive sites were identified in both of the two APSs as well as in the OBR region, thus indicating that these sequences have an altered chromatin structure. In the OBR an intrinsically bent region, a purine-rich element and other prospective initiation zone components are found.
Collapse
Affiliation(s)
- E Gögel
- Institut für Biochemie, Universität Würzburg, Biozentrum, D-97074 Würzburg, Germany
| | | | | | | | | |
Collapse
|
20
|
Stephan E, Kunkel E. [A traffic psychology comment on "a cost-benefit analysis of courses for repeatedly intoxicated automobile drivers"]. Blutalkohol 1989; 26:347-51. [PMID: 2508728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hundhausen's statements to valuation of repeating training courses show essential deficiencies: Quotations of specialitic authors are placed in a not right context. Relevant empiric results which would withdraw the basis of all his conclusions are not reported by him. So he argues in opposition to published empiric dates (see Winkler 1988, Stephan 1988) and logical arguments (see Stephan 1988), which prove that persons comprised in reality examinations had a above-averades traffic risk. Moreover, he overlooks in his exclusive 'calculatory valuation' that his argue of 'detour production' on the one hand violates the public claim on traffic security and on the other hand the constitutional claim of the alcohol conspicious drivers on proportion of national sanctions and measures. Also in case subsequent trained drivers do not represent a population being specially high relapse dangered, they should be offered the possibility to choose their own milder alternative (shortening of blocking period when having been successful as a course member). This should only be realized when the traffic security is not affected. The attempt to achieve an own valuation of the course success by economic founded scales must be judged as failed because of the not exactly termed premises and the logical consequences as well.
Collapse
|
21
|
Kunkel E. [Disclosure of drinking behavior, social drinking and blood alcohol concentration]. Blutalkohol 1985; 22:341-56. [PMID: 4052234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
22
|
Kunkel E. [The probability of recidivism as a criterion of fitness in alcohol-related incidents among automobile drivers]. Blutalkohol 1984; 21:385-95. [PMID: 6536318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
23
|
Kunkel E. [The Frankfurt experiment. A group project with drunk traffic offenders under conditional discharge. II: Psychological aspects of a new sanction for traffic offenders?]. Blutalkohol 1984; 21:332-7. [PMID: 6536313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
24
|
Kunkel E, Reichelt I, Reißig HU. Ringöffnungsreaktionen von 2-Siloxycyclopropancarbonsäuremethylestern zu 4-Oxoalkansäurederivaten. ACTA ACUST UNITED AC 1984. [DOI: 10.1002/jlac.198419840416] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
25
|
|
26
|
Kunkel E, Geldermann H. Microdetermination of nitrogen with a modified pyrolysis-chemiluminescence system. Mikrochim Acta 1980. [DOI: 10.1007/bf01197613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
27
|
Frazer A, Hess ME, Mendels J, Gable B, Kunkel E, Bender A. Influence of acute and chronic treatment with desmethylimipramine on catecholamine effects in the rat. J Pharmacol Exp Ther 1978; 206:311-9. [PMID: 210273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
28
|
|
29
|
|