Bibliography on ceroid-lipofuscinoses, II.
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Biomedical subjects
Publications and source records attributed to L Black.
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The authors studied 11 patients with developmental malformations and seizures originating from the frontal and central regions. Patients with centrally located seizures had primary involvement of the face or mouth; clonic activity involving the limb was also seen. Seizures among those with frontal lesions were primarily unilateral or bilateral tonic motor. Secondary generalized tonic-clonic seizures preceded by focal manifestations occurred infrequently in those with central localization, but were not rare in the frontal group. MRI revealed abnormalities in 10 patients, nine of whom underwent surgical resection with good results. Focal cortical dysplasia may be the underlying epileptogenic abnormality in young patients with clinical features suggestive of central or frontal cortical involvement.
Using data on 295 patients entering Medicare home health care at discharge from Medicare hospital stays, we explain receipt of Medicare home health nursing, PT and OT visits, and length of stay. Care reflected need, but other factors also affected service allocation. Medicare program requirements, as well as variation in provider structure and case load, appear to introduce inequities. Critical in light of recurrent proposals to change Medicare coverage and benefits, findings underline the need to reconsider Medicare home health policies that lead to denial of needed services, inequitable allocation of benefits, and premature termination of care.
Oxygen-free radical production and reperfusion injury are complex mechanisms. New and improved methods for maximizing the benefits of reperfusion while minimizing reperfusion injury are on the horizon in the 1990s. Critical care nurses play a crucial role in the assessment, planning, and intervention of patients experiencing the deleterious effects of free radicals and reperfusion injury. Thus, a sound knowledge base in the pathophysiology of reperfusion injury, the detrimental effects of free radicals, and the potential benefits of free-radical scavengers is essential.
Specialized interfacility transport teams are capable of delivering critical care medicine to the patient at the referring hospital and while en route to the tertiary care center. To do so effectively, however, requires adequate financial and human resources; management of equipment, supplies and personnel; ongoing education for transport team members; and an aggressive quality assurance program. Team members and team management should always be prepared for worst-case scenarios, and develop a method for problem resolution as troublesome issues arise. The ultimate goal of serving the needs of the critically ill child can be consistently met only if there is a high level of commitment of all involved--from the hospital administrator and medical director to the transport coordinator and team members.
Each critical care unit has a responsibility to develop a quality assurance process to evaluate nursing practice. Staff members at Shawnee Mission Medical Center (SMMC) developed a protocol, based on the Marker Model, to establish standards of care related to care of the patient requiring mechanical ventilation. The quality assurance process used to monitor implementation of the standards is described.
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1. Although nurses are at considerable risk for assaults, there are few practical and specific guidelines for controlling anger and aggression. 2. A training course was developed to give staff the necessary skills and knowledge to cope with clients who have the potential to become angry and assaultive, or those who have already become violent. 3. Participants in the training course felt more confident in managing potentially violent situations, and they reported relying on methods to de-escalate the situation to halt a sequence that would ultimately lead to violence.
Recognition of the clinical markers of reperfusion and comprehension of the effects of reperfusion injury in acute myocardial infarction provide a unique challenge for today's critical care nurse. In this article we will explore the processes of reperfusion injury. A review of relevant literature and presentation of a clinical case study and care plan will enable the critical care nurse to construct a larger knowledge base and assist in the nursing management of patients with acute myocardial infarction. Evaluation and treatment of reperfusion and reperfusion injury remains under investigation, but through the skills of assessment, planning, and intervention the critical care nurse can coordinate prompt and appropriate care to the patient with an acute myocardial infarction.
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Anger is a poorly understood but very common emotion. When it is misdirected or uncontrolled it becomes dangerous. An analysis of anger and a treatment paradigm is presented, and we outline a research project in which we are using the approach with a group of mentally handicapped adults.
Sudden infant death syndrome occurs with increased frequency in low birth weight infants and in black infants. The degree to which the higher LBW rate among blacks might explain this higher SIDS rate is unknown. To address this question, we analyzed the 1233 SIDS deaths that occurred among 252,376 neonatal survivors in Cook County from 1975 to 1980, using computer-coded matched infant birth and death records. Birth weight and ethnic group were identified. The overall SIDS rates in blacks, Hispanics, and whites were 5.1, 1.2, and 1.3/1000 neonatal survivors, respectively. Within each ethnic group, the SIDS rates increased progressively with decreasing birth weight. Within the less than or equal to 1500 gm birth weight groups, the SIDS rates were 16.4, 3.9, and 5.5/1000 neonatal survivors in blacks, Hispanics, and whites. Using direct standardization, we found that 27% of the SIDS rate disparity between blacks and whites could be explained by the higher LBW rate in blacks (14% vs 6% in whites). The good outcomes in both LBW and SIDS rates for the Hispanic population were unexpected because, like blacks, Hispanics are socioeconomically disadvantaged. Findings for this group suggest that the remaining 73% of the increased SIDS rate in blacks cannot be attributed in a straightforward manner to differences in income or educational attainment.
Four groups of sows were inoculated, either once or twice, with O1BFS 1860 foot and mouth disease oil-emulsion vaccine during pregnancy and samples of serum, for analysis, were collected at intervals for greater than 300 days. The pregnant sows responded well to vaccination regardless of their state of gestation. Single vaccination produced protective levels of antibody (greater than 1.53 log10SN50) in 3 out of 4 sows while double vaccination produced protective levels in all 6 sows tested. Anti-FMD IgM antibodies could be detected for 40-60 days after vaccination or revaccination. Anti-FMD IgG antibodies appeared within 10 days of vaccination and persisted, in each sow, for the duration of the study. The anti-FMD IgA response observed was less easy to characterize due to significant animal to animal variation. Although there was no evidence of a fall in the neutralizing antibody titres over one year post vaccination the anti-FMD IgG antibody population did show signs of a change in its heterogeneity and avidity.
Residual cellular material present in foot-and-mouth disease (FMD) vaccines has been implicated as a possible cause of hypersensitivity in cattle. This study was designed to identify and characterize the potentially allergenic components involved. After fractionating baby hamster kidney (BHK) cell lysate, by preparative electrofocusing and gel filtration chromatography, the eluates which were potentially allergenic for cattle were identified by passive cutaneous anaphylaxis (PCA) and PCA-inhibition methods. The potential allergen identified had a molecular weight of approximately 43 000 daltons, sedimentation coefficient of 3.65 S20 and isoelectric points between pH 5.37 and 6.25. Based on these results an immunogenic FMD vaccine was produced which failed to provoke clinical sensitization after repeated inoculations. This information should enable manufacturers to identify, monitor and subsequently control the levels of any such potentially allergenic material present in current vaccines produced using BHK cells.
Groups of 68 and 66 cattle aged 12 and 24 months respectively were each subdivided into 16 groups and inoculated with foot-and-mouth disease vaccines containing O1 Campos, A24 Cruzeiro and C3 Pando virus strains. The 140S antigen mass of the O1 and A24 valencies was varied while that of C3 was held constant. Multifactorial comparisons between the 21 day serum neutralising antibody titres showed that over most of the range there was a linear log dose response relationship. Doubling the antigen dose increased the serum antibody titres against both A24 Cruzeiro and O1 Campos by approximately 0.15 log10. The A24 antigen was about 30 times more immunogenic than the O1 with C3 intermediate between the two. At high antigen doses the responses flattened but the level at which this occurred depended on the immunogen administered. No difference could be demonstrated between the responses of 12- and 24-month-old cattle and there was no evidence of competitive inhibition or enhancement between the virus strains included in the vaccines.
Serum samples and bodyweights were taken at regular intervals for six to seven months from piglets, born to foot-and-mouth disease (FMD) vaccinated or unvaccinated sows, which had been vaccinated at one, two, four or eight weeks old. Young pigs, devoid of maternally derived antibodies (MDA), were capable of responding to FMD vaccination at one week old, with no deleterious effects on their growth rate. However, their immunity to experimental infection at six to seven months old was poor (33.3 per cent). Vaccination of four or eight-week-old piglets, born to unvaccinated sows, protected 87.5 per cent from a similar challenge. In piglets, born to FMD vaccinated sows, the MDA had a suppressive effect on the early vaccination response. This suppression, which was affected by the titre of MDA present in the piglets at the time of vaccination, was complete in one-, two- and four-week-old piglets and partial in eight-week-old piglets. Furthermore, none of these piglets were immune to experimental infection at six to seven months old.