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Biomedical subjects

S Daniels

Publications and source records attributed to S Daniels.

101 records · Page 6Linked to original sources
PubMedDate not supplied

Intestinal permeability of Irish setter puppies challenged with a controlled oral dose of gluten.

A combined test of intestinal permeability using lactulose (L) and rhamnose (R), and absorptive function using xylose (X) and 3-O-methylglucose (G), was carried out at four, six, eight and 16 weeks of age in 22 healthy control and six gluten-sensitive Irish setter (IS) dogs fed a diet containing a controlled dose of gluten from weaning. Comparisons were made with two groups of 12 healthy control dogs of breeds other than IS, one fed the same diet as the setters and the other fed a gluten-free diet. Gluten-sensitive IS showed a rise in permeability (mean [SEM] urinary L/R) from 0.23 (0.07) at four weeks to 0.39 (0.05) at eight weeks, remaining at 0.36 (0.04) at 16 weeks. These results were significantly higher in gluten-sensitive than control IS at six, eight and 16 weeks, compatible with jejunal biopsy lesions characteristic of gluten-sensitive enteropathy demonstrated in affected dogs at 16 weeks. Urinary L/R ratios of control dogs of breeds other than IS peaked at six weeks 0.27 (0.02), and were significantly higher than those of control IS at six and eight weeks, demonstrating differences in permeability between Irish setter dogs and other breeds at this age. There were no significant differences in urinary X/G ratios at six, eight and 16 weeks of age between any of the groups of dogs challenged with gluten. Urinary L/R and X/G ratios were similar in the control dogs of breeds other than IS fed gluten-containing and gluten-free diets. These findings indicate that intestinal permeability testing of puppies during controlled oral gluten challenge provides a practical screening test for gluten sensitivity in Irish setter dogs at an early age.

Administration, Oral↗
PubMedDate not supplied

Species variation and the mechanism of pressure-anaesthetic interactions.

The mechanism of general anaesthesia has proved difficult to elucidate (see ref. 1 for a review), although the relative potencies of anaesthetic agents have been used to establish that the site at which anaesthetics act is hydrophobic in nature. One further clue to their mode of action is that the effects of anaesthetics on vertebrates can be eliminated by pressures of approximately 100 atm (refs 3, 4). However, the effects of anaesthetics are not always reversed in model systems, where there is evidence that the pattern of pressure reversal varies significantly. We now find that pressure fails to reverse the effects of anaesthetics on the freshwater shrimp (Gammarus pulex), although the sensitivity of these crustaceans to anaesthetics is comparable with that of higher animals. This is hard to reconcile with traditional bio-physical mechanisms and indicates that anaesthetics may act at a specific protein site rather than having a general effect on cell membranes. The pharmacology of pressure in mammals seems to be more similar to that of strychnine than of any other central stimulant. As glycine, whose action is blocked by strychnine, is absent as a neurotransmitter in the arthropod central nervous system, we believe that this substance may be involved in determining pressure-anaesthetic interactions in vertebrates.

Anesthesia↗
PubMedDate not supplied

Safety and efficacy of debridement under anesthesia in patients with burns.

Burn wound debridements requiring blunt or sharp manipulations are extremely painful even when large nonanesthetic doses of morphine are used. In this study we describe the use of debridement while the patient is under anesthesia (DUA) when manipulation of the wound is required. Seventy-one debridements were performed on 46 patients. One patient required additional fluids during the DUA, but no deaths, extensive blood losses, or significant changes in nutrition attributable to the DUA occurred. The mean number of required DUAs was 1.6 per patient compared with 6.0 per patient reported in a previous study from the same burn center that involved standard parenteral analgesic doses of morphine sulfate. Patients were completely anesthetized during the procedure. Therefore, they were free of pain and were amnestic for the experience. We conclude that DUA is a safe, efficacious procedure that permits full relief from the pain usually experienced during a manipulative burn wound debridement.

Adult↗
PubMedDate not supplied

Posttraumatic stress disorder in patients with burns.

Among 39 patients with burns evaluated a mean of 12 months after hospital discharge, 38% met DSM-III-R criteria for post-traumatic stress disorder (PTSD) for at least 1 month. With proposed DSM-IV criteria, 43% met criteria for past or current PTSD. Analysis of specific symptom clusters of PTSD revealed that 74% of patients had been affected by a reexperience symptom for at least 1 month, but only 30% were currently experiencing flashbacks. No correlation was found between several clinical correlates (TBSA, length of hospitalization, and age) and development of PTSD. There was no correlation between presence of a DSM-III-R psychiatric diagnosis at the time of hospitalization and later development of PTSD and no correlation between whether or not a psychiatric diagnosis emerged during hospitalization and later development of PTSD. Finally, patients who had injuries that they could not prevent were no more likely to experience PTSD.

Adult↗
PubMedDate not supplied

Alcohol disorders among patients with burns: crisis and opportunity.

A burn injury so severe that inpatient treatment is necessary is a crisis in any patient's life. For patients who also suffer from an alcohol use disorder, hospitalization may offer a unique opportunity to facilitate entry into appropriate treatment. In this study, 442 hospitalized patients with burns were evaluated, and 50 (11%) were diagnosed with an alcohol use disorder by DSM-III-R criteria. All but one of the injuries were deemed preventable. The average length of stay in hospital was 9 days longer for the alcohol group compared with the average stay in the burn center, resulting in additional costs of $337,500. Referral for treatment of the underlying alcohol disorder was recommended for fewer than half the patients. Thus, although the patients with alcohol use disorders had lengthy hospitalizations and were in circumstances that might permit the characteristic denial of alcoholism to be relinquished, the treatment team usually did not capitalize on this opportunity.

Alcoholic Intoxication↗
PubMedDate not supplied

Case management: a formula for resource conservation.

Case management as a concept of efficiency and effectiveness has demonstrated its applicability in acute care. This article addresses one model of case management that integrates the traditional structure of independently functioning, nonrevenue-producing activities of quality, risk, and utilization management under the comprehensive umbrella of quality resource management. The model transformed existing full-time equivalent services at an acute care hospital in Florida into value-added services on behalf of patients, physicians, the hospital, and payers and presented a practical approach to organizing a case management program. Issues in the transformation process also are addressed.

Case Management↗
PubMedDate not supplied

Black-on-black homicide: Kansas City's response.

In many metropolitan areas, homicide continues to be the scourge of black Americans despite increasing awareness of the overrepresentation of blacks among victims and perpetrators. The risk of being a homicide victim among black males is so high that the Department of Health and Human Services has set a priority of reducing the risk to 60 per 100,000 by 1990. The recent escalation in the number of homicides in the United States associated with drugs makes attainment of that goal unlikely. In Kansas City, a black community grassroots organization, the Ad Hoc Group Against Crime, commissioned a multidisciplinary task force to study black-on-black homicide in 1986. The report generated by this task force identified factors placing Kansas Citians at high risk of being homicide victims or perpetrators, including being black, male, unemployed, between the ages 17-29, a high school nongraduate, frequently involved in or around violence, and having prior arrests on weapons charges. One hundred recommendations were made, of which 12 were targeted for immediate implementation. These included increasing public awareness of the incidence of black-on-black homicide, involvement of black men in role model programs for young black males, training in anger control and alternatives to violence for those identified as being at high risk for homicide, and providing a role for ex-offenders in violence prevention. Working with community organizations has inherent strengths and weaknesses for public health workers. However, such a group can successfully impact the affected community in ways which would be difficult for traditional resources.

Adolescent↗
PubMedDate not supplied

Too fragile to hold.

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Adaptation, Psychological↗