Biomedical subjects
T Heller
Publications and source records attributed to T Heller.
Information producing responses in normal and retarded children.
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Management of respite and personal assistance services in a consumer-directed family support programme.
BACKGROUND: The present study explores the management of respite and personal assistance services by families with relatives with developmental disability (DD). It focuses on the control of families over recruiting, hiring, training, scheduling, directing and negotiating wages of the staff they hire to provide services. METHODS: Surveys from 97 families using paid respite or personal assistance services were used to test associations between: 1) level of control of services and outcome variables; 2) hiring relatives to provide services and outcome variables. RESULTS: More control by families in the management of their respite/personal assistance services was associated with increased service satisfaction, increased community involvement of individuals with DD and increased employment of mothers. Families tended to hire friends, neighbours, and to a great extent, other family members. Hiring of other relatives to provide services was associated with the increased community involvement of individuals with DD. CONCLUSIONS: The present study supports the idea that there are benefits for both caregivers and individuals with DD with increased control of respite and personal assistance services. The study also supports benefits associated with hiring relatives and recommends additional research in this area to guide policies.
Residential transitions from nursing homes for adults with cerebral palsy.
PURPOSE: The impact of moving out of nursing homes into community-based settings for adults with cerebral palsy was assessed by comparing the health and community functioning of movers and non-movers at time 1 and 3 years later at time 2. SUBJECTS: The sample included 83 non-movers and 28 movers age 30 years and older who initially were living in nursing homes. The majority of residents had severe to profound mental retardation. The movers transferred to 15 community-based settings between 1 and 3 years (mean of 2 years) prior to the time 2 assessment. Assessments of residents at baseline and at follow-up included health measures (health status, health limits, mobility limits, days hospitalized and depression) and community functioning measures (adaptive functioning, maladaptive behaviour, community inclusion, day programme hours and monthly wages). RESULTS: Findings indicated that movers showed benefits in terms of improved health and community functioning. For movers, health status, mobility limitations, and community inclusion improved, while there were no significant changes for non-movers. This research corroborates previous research on the effects of deinstitutionalization and expands its implications to a group with severe disabilities.
Remifentanil in the horse: identification and detection of its major urinary metabolite.
Remifentanil (4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic acid methyl ester) is a mu-opioid receptor agonist with considerable abuse potential in racing horses. The identification of its major equine urinary metabolite, 4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic+ ++ acid, an ester hydrolysis product of remifentanil is reported. Administration of remifentanil HCl (5 mg, intravenous) produced clear-cut locomotor responses, establishing the clinical efficacy of this dose. ELISA analysis of postadministration urine samples readily detected fentanyl equivalents in these samples. Mass spectrometric analysis, using solid-phase extraction and trimethylsilyl (TMS) derivatization, showed the urine samples contained parent remifentanil in low concentrations, peaking at 1 h. More significantly, a major peak was identified as representing 4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic+ ++ acid, arising from ester hydrolysis of remifentanil. This metabolite reached its maximal urinary concentrations at 1 h and was present at up to 10-fold greater concentrations than parent remifentanil. Base hydrolysis of remifentanil yielded a carboxylic acid with the same mass spectral characteristics as those of the equine metabolite. In summary, these data indicate that remifentanil administration results in the appearance of readily detectable amounts of 4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic+ ++ acid in urine. On this basis, screening and confirmation tests for this equine urinary metabolite should be optimized for forensic control of remifentanil.
Personal and medical memories from Hillsborough.
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Regression and clonally distinct recurrence of human immunodeficiency virus related Burkitt-like lymphoma during antiretroviral therapy.
An increased incidence of intermediate to high-grade Non Hodgkin's Lymphoma is found in individuals with AIDS. Although immune function in AIDS patients can be improved through the use of antiretroviral therapy, the contribution of these drugs to lymphoma regression is not known. Here we describe the complete regression and subsequent recurrence of high grade, Burkitt-like lymphoma during antiretroviral therapy in a patient with AIDS. Antiretroviral therapy resulted in diminished viral load and modest improvement in CD4+ T cell counts. Lymphoma regressed initially, but relapsed 3 months later. Tissue taken from the initial and recurrent tumor demonstrated different clonal rearrangements. The recurrent lymphoma did not respond to continued antiretroviral therapy. In Conclusion, antiretroviral therapy may contribute to lymphoma regression in AIDS lymphoma. Clinically recurrent disease may be clonally distinct.
You're in charge, so keep calm. The care and handling of psychiatric emergencies.
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