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D D King

Publications and source records attributed to D D King.

12 recordsLinked to original sources

Use of the Natural Death Act in pediatric patients.

OBJECTIVE: To review the use of Natural Death Act declarations (living will procedures) in pediatric patients. The implementation of such declarations for children is now possible in six states, including Texas, by specific statutory provisions. DESIGN: Retrospective study. SETTING: Pediatric ICU in a university hospital. PATIENTS: Records of patients who had a Texas Natural Death Act declaration, either discussed and signed or discussed only, were studied. Patients who had another vehicle of limiting care (e.g., a do-not-resuscitate order) were excluded from the study. MEASUREMENTS AND MAIN RESULTS: Reviewed characteristics included age, primary diagnosis, and concurrent complications. Also examined were who raised the issue of limiting care (parent or physician), the initial reaction of the other party, what support was withdrawn, what support was added, the final outcome (including the time from implementing limited care to death), and the description of witnesses. Discussions were held with parents of 17 patients, and 13 Natural Death Act declarations were actually implemented. In all but three instances, the patient died within 4 hrs from the time support was withdrawn. The main supports that were withdrawn were ventilators and catecholamines. In half of the cases, morphine sulfate was added for anticipated pain relief and sedation. All decisions were reached by close consultation between the family and the physicians, with the physicians raising the issue in 11 of the 17 cases and the family raising the issue in six cases. In 15 of the 17 patients, consultation with the Bioethics Committee was not necessary. The majority of difficulties involved resolving issues that beset patients with HIV infections, and finding appropriate witnesses as prescribed by the statute. CONCLUSIONS: We conclude that the Natural Death Act works well in situations involving dying children and their parents.

Adolescent

Infection of a human leukemia K-562 cell line with Semliki Forest virus.

Infection of the human leukemia hematopoietic stem cell line, K-562, with Semliki Forest virus (SFV) can be characterized by three stages: (1) an early virus-proliferating stage lasting 1 to 4 days post-infection (pi) in which infectious virus is produced in high titers (10(3)pfu/cell) but in which there is minimal cytopathic effect. All cells appear viable by trypan blue dye exclusion, although they do not proliferate, and DNA and cell protein synthesis decrease to less than 3% of uninfected controls within 24 hours; (2) an intermediate stage extending from day 5 to about day 24-30 pi in which the amount of infectious virus declines to low levels. During this stage, viral protein synthesis decreases to undetectable levels, although viral gylcoproteins are readily demonstrated by immunofluorescence and by immunoblot; however, capsid protein appears to degrade within 21 days pi. Cell numbers remain constant but the viability of the non-proliferating cells determined by trypan blue exclusion could not be determined with confidence; (3) a final long-term stage in which viral glycoproteins, E1 and E2, are detectable by immunoblots and immunofluorescence for many months but the cells are metabolically inactive and do not synthesize viral proteins. These non-viable cells do not lyse for as long as 2 years.

Antigens, Viral

Treatment of captive giant Canada geese affected by avian cholera.

In the spring of 1975, an epornitic of avian cholera in Nebraska affected wild waterfowl, common crows (Corvus brachyrhynchos), and a captive flock of guant Canada geese (Branta canadensis maxima). Measures taken to control the disease in the captive geese included flushing the water of their pen with fresh well water, parenteral (50mg oxytetracycline intramuscularly) and feed (tetracycline 500 g/ton) antibiotic treatment, and removing dead waterfowl and crows from the pen, and keeping wild waterfowl and crows out of the pen. Other measures taken to prevent a recurrence of the outbreak included monitoring the area with susceptible sentinel birds and culturing nasal swabs for Pasteurella multocida. Young Canada geese and wood ducks (Aix sponsa) raised in the area also were cultured before release to assure that carriers would not be released into the wild. Presently, ponds in the pen have been dried up so that the area is less attractive to wild waterfowl. Swine feeders and waterers that have been modified to discourage their use by crows are being used to feed and water the geese.

Animals

Administrators and computerized maintenance management systems: a case study.

The dramatic success that the plant operations division experienced in the procurement, implementation, and application of the MMS is a direct result of the hospital administration's early involvement in the process. With the support of the administration, effective managers can rely on the MMS as a source for continued improvement and strategic planning, rather than just for documentation and justification of current levels of activity. With proper administrative support, progressive goals will continue to be formulated and achieved.

Biomedical Engineering