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Biomedical subjects

S Berman

Publications and source records attributed to S Berman.

At least 163 records · Page 9Linked to original sources

Electrically heated simulator for relative evaluation of alternative infant incubator environments.

A 10.9-cm diameter, copper ellipsoid was electrically heated to provide a simulation of sensible heat transfer from a newborn infant. The use of this simulator to determine mean radiant temperature and convective heat-transfer coefficient was demonstrated in three commercial incubators: the Isolette (Model C-86, Narco/Air Shields); the Armstrong Care-ette (Ohio Medical Products); and the I. C. (Ohmeda). The relative performance of these environmental therapeutic devices in shielding an infant against radiant heat loss was judged by the deviation of mean radiant temperature from incubator air temperature, which was varied from 32-36 degrees C. Whereas the I. C. incubator exhibited a radiant temperature always 0.5 degrees C less than air temperature, the Care-ette incubator showed radiant temperatures of 4.0-5.5 degrees C below air temperature, and the Isolette displayed radiant temperatures of 2.7-4.7 degrees C (inner wall removed) and 2.0-3.8 degrees C (inner wall inserted) below air temperature. The relative performance of the incubators in preventing convective heat loss was judged from the magnitude of the convective heat-transfer coefficient, hv. The I. C. incubator had an hv = 4.52 W/m2/degrees C; the Care-ette, 5.55 W/m2/degrees C; and the Isolette 7.19 W/m2/degrees C (inner wall removed) and 6.23 W/m2/degrees C (inner wall inserted). Although an ellipsoid simulator is not an anatomically correct substitute for an infant, it does provide a reliable and convenient comparison of steady-state heat transfer characteristics of alternative environmental devices.

Body Temperature Regulation↗

Medical management of chronic middle-ear effusion. Results of a clinical trial of prednisone combined with sulfamethoxazole and trimethoprim.

Prednisone for seven days plus the combination drug sulfamethoxazole and trimethoprim for 30 days was assessed in treating chronic middle-ear effusion present for at least eight weeks. Pneumatic otoscopy, tympanometry, and audiology at entry into the study, and one week and one month after therapy, documented the status of the middle-ear effusion. Clearing in both ears or in one when only one was involved was called complete resolution; clearing in one of two affected ears was called partial resolution. In the initial open trial, 13 of 24 patients experienced partial or complete resolution one month after therapy. Subsequently, 28 patients were enrolled in a randomized, double-blind, placebo-controlled clinical trial in which patients whose effusion failed to clear were crossed over to the alternative regimen. In this trial, ten treated children (71%) experienced partial or complete resolution one month after therapy compared with three (21%) in the control group. Patients enrolled in both trials whose effusion cleared were followed up monthly for six months. Seven of 29 patients required referral for ventilation tubes.

Child↗

Prevention of shigellosis by a Salmonella typhi-Shigella sonnei bivalent vaccine.

We genetically modified attenuated Salmonella typhi strain Ty21a to express the form I O polysaccharide antigen of Shigella sonnei. Three doses of this bivalent, live oral vaccine strain (1-8 X 10(9) organisms/dose) were given to young adults who, along with unvaccinated controls, were challenged one month later with pathogenic S. sonnei. The vaccinees had 40% protection against diarrhea and 56% against Hematest-positive diarrhea. Two of three vaccine lots provided higher levels of protection (53% against diarrhea and 71% against Hematest-positive diarrhea), but the third lot, prepared for a large-scale field trial, demonstrated no protective efficacy. Vaccinees had serum and local intestinal immune responses to S. sonnei lipopolysaccharide, and the presence of specific serum IgA or IgG antibody before challenge with pathogenic S. sonnei was correlated with protection from illness. Some lots of this bivalent vaccine strain provide significant protection against S. sonnei disease, but the problem of lot-to-lot variability must be overcome.

Adult↗

C-reactive protein is involved in natural killer cell-mediated lysis but does not mediate effector-target cell recognition.

Anti-CRP and complement treatment of human peripheral blood lymphocytes significantly reduces natural killer (NK) cell-mediated cytotoxicity to K562 target cells as well as to MOLT-4 target cells. Although not all activity is eliminated by treatment of effector cells with antibody and complement, the reduction of NK function indicates that C-reactive protein (CRP) is present on a significant proportion of NK cells. Higher concentrations of anti-CRP or anti-CRP F(ab')2 fragments also reduce NK function; this suggests that CRP is not only present on these effector cells but may also play a role in NK-mediated killing. We initially suspected that CRP-ligand interactions might be involved in effector-target cell recognition. Several lines of evidence suggest that this is not the case. While F(ab')2 anti-CRP will block NK function, Fab anti-CRP will not, suggesting that the NK response is not impaired when surface CRP (S-CRP) is blocked but is only inhibited when the S-CRP is cross-linked and modulated. Neither CRP-C polysaccharide complexes (CRP-CPS) nor concentrations of CPS ranging from 0.1 microgram/ml to 200 micrograms/ml have any effect on NK cell-mediated killing. Treatment of target cells with a ligand for CRP or CRP prior to co-culture with NK effectors does not augment NK function. Single cell assays clearly demonstrate that high concentrations of anti-CRP have no effect on the formation of effector-target cell conjugates. Although these concentrations of anti-CRP do not block effector-target cell conjugation in the single cell assay, they do block the killing of conjugated target cells. In total, this evidence strongly suggests that although CRP appears to be involved in NK-mediated killing, it is not involved in effector-target cell-mediated recognition.

Antibodies↗

Binding of C-reactive protein to nucleated cells leads to complement activation without cytolysis.

C-reactive protein (CRP) is an acute-phase reactant that is found bound to cells at sites of inflammation. We have passively sensitized HEp-2 cells for CRP binding and examined the effect of this treatment on complement activation and cell lysis. When cells were treated with protamine sulfate and CRP and were incubated with normal human serum in a 4-hr 51Cr-release assay, no significant lysis was noted. In contrast, HEp-2 cells treated with antibody and normal human serum were lysed. The consumption of complement components in normal human serum after incubation with cells treated with protamine and CRP was measured by hemolytic assays. CRP-treated cells consumed over 80% of C1, C4, and C2 and about 40% of C3 present. No significant consumption of C5 through C9 components was observed. Cells treated with antibody and complement showed consumption of C1 through C9. Cells were also sensitized for CRP binding by using diazophenylphosphocholine. This treatment also led to CRP binding and activation of the early classical pathway (C1, C4, C2, and to a lesser extent C3). The components of the membrane attack complex (C5 through C9) were not activated. Both a mouse monoclonal IgM and a human IgG antibody to phosphocholine activated the entire classical pathway. These results indicate that CRP activation of the classical complement pathway is restricted to the early part of the pathway. In the absence of activation of the membrane attack complex, complement-mediated cell lysis cannot occur.

Animals↗

Effect of carbohydrate ingested on outcome in infants with mild gastroenteritis.

Children with mild acute gastroenteritis have not been observed for specific evidence of lactose intolerance yet are frequently fed a nonlactose formula. To determine whether such intervention is justified, 85 infants with mild acute gastroenteritis were followed prospectively. Infants were blindly and randomly assigned to 20 calorie/oz formula containing one of four carbohydrates: lactose, sucrose, polycose, or combined sucrose-polycose. Daily diaries were kept by parents, and patients were reexamined on days 2, 7, and 14 of the study. Evidence for rotavirus was detected in 23 infants, and five had bacterial pathogens. Symptoms resolved in most patients within 7 days, but five infants were subsequently hospitalized. Stool frequency, weight gain, and need for hospitalization did not differ significantly among the groups. Recovery from mild acute gastroenteritis occurred within 2 weeks irrespective of carbohydrate ingested.

Dietary Carbohydrates↗

Safety and antigenicity of typhoid-Shigella sonnei vaccine (strain 5076-1C).

The form-1 antigen of Shigella sonnei was transferred to the avirulent Salmonella typhi strain 21a and the resulting 5076-1C transconjugate strain was tested for safety and immunogenicity as a candidate oral vaccine. The transconjugant strain was shown to be well tolerated and safe in 19 human volunteers who were fed from 1 X 10(7) to 1 X 10(10) organisms. Only two of 10 volunteers tested had developed a rise in antibody titer to the lipopolysaccharide of the hybrid 5076-1C strain.

Administration, Oral↗

Telephone encounters in a university pediatric group practice. A 2-year analysis of after-hour calls.

The records of off-hours calls received by the University of Colorado Pediatric Group Practice from 4:30 p.m. throughout 8:00 a.m. weekdays and all day Saturday, Sunday, and holidays were audited. An answering service and pageboy system ensured 24-hour, 7-day-a-week accessibility through a single telephone number. The four practices received 2386 after-hours calls from November 1978 to October 1980. An average of 104 calls per month were received with approximately four calls per day on weekday evenings and six calls per day on Saturday, Sunday, and holidays. Five concerns accounted for 49 percent of all after hours calls: fever, vomiting and/or diarrhea, upper respiratory infection (URI), earache, and rash. While 75 percent of families made fewer than four calls per year, 4 percent made at least 12 calls per year, accounting for 18 percent of all calls. Families calling three or more times a month were defined as "frequent users" and accounted for 22 percent of a given month's calls. Most calls from the same families (55%) occurred within a 24-hour period and dealt chiefly with parental concerns about fever, vomiting and diarrhea, URIs, ear infection, accident, and rashes. The additional responsibility that residents assume in taking calls for the Pediatric Group Practice while on other off-hour assignments was not excessively demanding, and cost of the answering service was easily absorbed by group practice revenues.

Colorado↗

Social work and Alzheimer's disease: psychosocial management in the absence of medical cure.

Because the illness erodes and destroys an individual's humanness and personality, patients and families affected by Alzheimer's Disease have particularly critical needs for help with its psychosocial sequelae. This article develops a model of psychosocial management and details specific interventions to help patients and caregivers develop and maintain adaptations during the long course of the disease.

Adaptation, Psychological↗

Projective assessment of the relationships between the salience of death, religion, and age among adults in America.

The relationships between age, religious orientation, and perception of death are investigated utilizing a sample of 1428 respondents randomly selected from two larger representative national samples. Although a statistically significant relationship is found between religion and perception of death, when age is introduced as a control the relationship remains only among young adults. The finding that religion mitigates concerns about death concurs with results found in previous studies. The data relative to young adults, however, suggest the need for a broader conceptualization of the relationship between death anxiety and religion, which incorporates developmental influences over the adult life cycle.

Adult↗

Effect of maternal nutritional status on immunological substances in human colostrum and milk.

Substances in colostrum and breast milk confer significant disease resistance to the breast-fed infant. The influence of maternal nutritional status on both immunological and nonimmunological milk factors was studied in a group of 23 Colombian women during the first 2 months of lactation. Maternal malnutrition was characterized by significantly lower weight/height ratio, creatinine/height index, total serum proteins, serum albumin, and serum IgG and IgA. The colostrum of malnourished mothers contained only one-third the normal concentration of immunoglobulin G and less than half the normal level of albumin. Significant reductions in colostrum levels of IgA and the fourth component of complement (C4) were also observed in the malnourished group. No differences were observed in colostral concentrations of lysozyme, C3 complement, or IgM. Titers of antibody in milk directed against respiratory syncytial virus were not influenced by maternal nutritional status. The differences noted above tended to disappear in mature milk, concomitant with improvement in the nutritional status of malnourished mothers during the first several weeks postpartum. We conclude that the protective qualities of colostrum and milk may be significantly influenced by maternal nutritional status.

Adult↗

Use of a seminar as an aid in helping interns care for dying children and their families.

An annual seminar held by the University of Colorado, Department of Pediatrics, is designed to assist interns to cope more effectively with the emotional strains of caring for dying patients and their families. In the seminar, interns are randomly divided into four small groups consisting of six interns, a chief resident, two pediatric faculty members, and a nurse or social worker from an intensive care unit. This paper reviews the resident evaluations of the seminar, as well as the results of a questionnaire which explored attitude formation toward death. Interns felt that the opportunity to discuss death and dying early in their training program helped them gain an understanding of their own feelings about death, which enabled them to cope better with the stress involved in caring for dying children. Additional benefits from the seminar included more effective interpersonal communication, the establishment of deeper and more meaningful friendships, and a stronger esprit de corps.

Attitude of Health Personnel↗

An inpatient program for Vietnam combat veterans in a Veterans Administration hospital.

The Veterans Administration's first inpatient program for Vietnam War veterans was opened in January 1978 at the VA Medical Center in Palo Alto, California. The unit treats a range of psychiatric disorders; however, the typical patient is a 34-year-old white male with a diagnosis of posttraumatic stress disorder and at least one previous hospitalization. The program is designed as a three-phase therapeutic community based on mutual support and group solidarity. Medication is minimized. The program also reflects the assumptions that a debriefing, however belated, from military experience is essential, and that the clinical regimen should enable veterans to resume the transition to adulthood that the war interrupted. The average stay is five months; preliminary evaluation indicates that 60 per cent of the veterans achieve relief from acute psychological distress, resolve a crisis with a spouse or significant other, and begin a job or schooling.

California↗