The development of a program for juvenile fire offenders.
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Biomedical subjects
Publications and source records attributed to S Williams.
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The effects of high-dose vitamin C therapy (170 mg, 340 mg, and 680 mg/kg/day) were evaluated in 70% body surface area third-degree burns in guinea pigs that were resuscitated with 1 ml/kg/%burn Ringer's lactate solution. The water content measurements of the burned skin at 24 hours after burn injury in the vitamin C-treated groups were significantly lower than those of the control group (1 ml/kg/%burn) and those of the standard resuscitation group (4 ml/kg/%burn). The cardiac outputs in the group that received 340 mg vitamin C were significantly higher than those of the control group but not significantly different than those of the standard therapy group at 2 hours after burn injury and thereafter. In comparison with the regimen of 340 mg vitamin C, the regimen of 680 mg vitamin C was no more beneficial, and the regimen of 170 mg was less effective. With administration of adjuvant high-dose vitamin C, we were able to reduce the total 24-hour resuscitation volume from 4 ml/kg/%burn to 1 ml/kg/%burn, while a comparable cardiac output was maintained.
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We have used blood oxygenation level dependent imaging with functional magnetic resonance imaging (fMRI) to investigate the visual cortex response to photic stimulation during and in the absence of continuous visual hallucinations. A patient with cortical Lewy body dementia who experienced persistent and vivid complex hallucinations underwent fMRI on and off treatment with risperidone. When he was not hallucinating, photic stimulation produced a normal bilateral activation in striate cortex. During hallucinations, very limited activation in striate cortex could be induced. We interpret this result as indicating that at least part of the activity in the brain responsible for the experience of visual hallucinations is located in the primary visual cortex.
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A prospective analysis of telephone calls to an accident and emergency (A&E) department during weekday evenings/nights and weekends was undertaken over a 3-month period. A telephone consultation record (TCR) proforma was developed to record information about each call for advice. The volume of calls, characteristics of callers and patients, nature of presented problems, and advice given were analysed. An average of 9.3 calls were documented during each weekend 24-hour period, and 3.3 calls during each weekday evening/night. Junior nurses took 93% of calls. Advice was sought for a broad range of problems, of which only 11% were musculoskeletal conditions or injuries. Twenty-six per cent of patients were advised to attend A&E, 35% were given self-care advice, and the remainder were advised to contact or see their GP. There is considerable potential to develop a nurse-provided telephone advice service, but the need for staff training and guidelines has to be addressed.
A case of oro-antral fistula associated with an apparent foreign body following antral packing for a zygomatic complex fracture 10 years previously is presented. This was treated by antral exploration, removal of the antral contents and repair of the fistula. The complications of antral packing for zygomatic and orbital floor fractures are reviewed and those situations where antral packing may be the treatment of choice are defined.
The frequency of the dawn phenomenon has been studied in non-insulin-dependent diabetic (NIDDM) patients while they continued with their conventional therapy. Plasma glucose (PG) and immunoreactive insulin (IRI) were estimated hourly from 0300 to 0900 h in 19 NIDDM patients; 9 patients were treated by diet alone (group 1), and 10 patients were treated by diet and oral hypoglycemic agents (group 2). The dawn rise of plasma glucose was demonstrated in 17 (89.5%) of the 19 patients with mean +/- SE plasma glucose at 0300 h of 7.0 +/- 0.5 mM and at 0800 h of 8.4 +/- 0.6 (P less than .01). IRI in all patients rose from 14.7 +/- 1.3 microU/ml at 0500 h to 18.1 +/- 1.8 microU/ml at 0700 h (P less than .05). The changes in IRI levels at any time from 0300 to 0800 h in groups 1 and 2 when considered separately were insignificant. Thus, the dawn phenomenon occurs commonly in NIDDM patients taking their conventional therapy.
Glycosylated hemoglobin (HbA1) is widely used as an index of glycemic control in diabetic patients. However, due to the long survival time of erythrocytes (120 days), it remains elevated for several weeks after improved control. Other plasma proteins are similarly glycosylated, and as glycosylated serum albumin (GSA) has a shorter half-life (20 days), it should detect glycemic changes earlier. Fasting blood glucose (FBG), GSA, and HbA1 were measured weekly in newly diagnosed diabetic patients (N = 12) for 8 wk after beginning treatment. After 4 wk, a similar fall in FBG and GSA levels, i.e., 72% and 58% respectively, was observed. In contrast, HbA1 fell significantly less (P less than 0.01), by only 39% of its initial value. By 8 wk there was no significant difference between the percentage reduction in the three indices of control. Therefore, GSA provides the clinician with earlier objective evidence of the metabolic response to therapeutic intervention and can be regarded as an intermediate index of diabetic control.
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