Decision making about medical care in an adolescent with a life-threatening illness.
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Biomedical subjects
Publications and source records attributed to S Stephenson.
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Both countries face considerable challenges to their rehabilitation services. Although contextually different, the problems and challenges are common to both. Two contrasting views of disability have been presented. In the UK disability may be viewed as a disaster, while in Asia illness and disability may be viewed as inevitable. Personal independence is not a universal goal of rehabilitation, because in some cultures dependence on others is an expected consequence of disability. Disability in Indonesia translates into a large burden of care for the family, whereas English families may expect greater help from the government in caring for their relative. Western rehabilitation is increasingly patient directed, whereas the Indonesian model is more likely to be determined solely by professionals. The problems observed by the team in Indonesia were remarkably similar to those experienced in the UK. A patient centered goal setting approach can be considered vital to neurological rehabilitation, although the focus of the goals set is likely to be very different in these two cultures. The fundamental importance of a multidisciplinary team is recognized in both cultures, although team working may not be easy in either situation. Managerial commitment is essential for the survival of a team, yet both structures sometimes fail to provide the necessary support. Hierarchical leadership can inhibit team development both in the UK and in Indonesia, as can frequent rotation of staff. Prescription of therapy by doctors inhibits the development of therapists in both cultures, and therefore the overall effectiveness of the team. In both the UK and Indonesia, the value of rehabilitation as a specialty is not widely recognized. The absence of life and death situations means that services are often out of the public eye, and poorly understood. However, the prevalence of disability will increase the need for rehabilitation services worldwide. Many challenges remain in both the UK and Indonesia to the development of more effective rehabilitation services. Issues like the lack of recognition of rehabilitation as a specialty, the importance of team work, the paucity of managerial support, and increasing demand for rehabilitation services will need to be recognized and addressed. Despite the different approaches to disability in the two cultures, the problems faced are similar. These problems will need to be solved if there is to be significant progress in this multidisciplinary field.
A temperature-sensitive line of thymic nurse cells (tsTNC-1) that maintains the ability to selectively internalize immature alpha beta TCRloCD4+CD8+ thymocytes in vitro was used in long-term coincubation experiments to determine nurse cell function during the process of MHC restriction. The thymocyte subset released from its association with TNCs contained both viable and apoptotic cells. The cells that remained within intracytoplasmic vacuoles died through the process of programmed cell death. Surviving or rescued thymocytes in the released population displayed an increase in Bcl-2 protein expression. The rescue activity of TNCs was drastically reduced with the addition of antibodies against either class I or class II MHC antigens to cocultures. A subset of the TNC-rescued population matured from the alpha beta TCRloCD69- phenotype to alpha beta TCRhiCD(69+)-expressing cells only when IL-1 beta was added to cocultures. These results suggest that TNC rescue of early double-positive thymocytes from apoptosis is associated with an interaction between the TCR and the MHC and the onset of Bcl-2 expression. Maturation of thymocytes within the TNC-rescued population requires the costimulatory effects of IL-1 beta.
OBJECTIVE: To investigate the incidence of injury in English professional rugby league over a period of four playing seasons. METHODS: All injuries that were received by players during match play were recorded. Each injury was classified according to site, type, player position, team playing for, activity at the time of injury, and time off as a result of injury. RESULTS: The overall injury rate was 114 (95% confidence interval 105 to 124) per 1000 playing hours, the most frequent type of injury were muscular injuries [34 (29 to 40) per 1000 playing hours], while the most frequently injured site was the head and neck region [38 (16 to 25) per 1000 playing hours]. Players received the largest percentage of injuries when being tackled [46.3% (41.9 to 50.7)], most injuries required less than one week away from playing and training [70.1% (66.1 to 74.2)], and forwards had a higher injury rate than backs (139 v 93 injuries per 1000 hours). CONCLUSIONS: The high rates of injury in rugby league are undoubtedly due to the high amount of bodily contact in the game. Being tackled has the highest risk of injury, because of being hit forcibly by other players. Forwards suffer higher injury rates than backs, probably because they are involved in a larger number of physical collisions.
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In days past, employees ate almost anywhere but the cafeteria of the Butterworth Hospital in Grand Rapids, Mich. That's not true anymore.
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This study investigated the nature and extent of impairments in the use of hypotheses and cognitive strategies in medicated subjects with idiopathic Parkinson's disease (PD) and matched control subjects. PD subjects did not differ from controls in solving one- or two-dimensional discrimination learning problems, but showed impairment on four-dimensional problems which did not appear to be attributable to memory deficits. They achieved fewer correct solutions, used fewer hypotheses, and were less likely to use appropriate lose-shift strategies following negative feedback. The pattern of findings was similar to those previously reported for subjects with frontal lobe lesions.
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Fetal hydrops at 26 weeks' gestation was diagnosed following a massive fetomaternal hemorrhage. Fetal intravascular transfusion was performed, and the hydrops completely resolved within 72 hours. The fetus required one more transfusion at 27 weeks' gestation. A subsequent percutaneous umbilical blood sampling at 30 weeks' gestation demonstrated a normal fetal hematocrit. A vaginal delivery at term resulted in a normal newborn. Massive fetomaternal hemorrhage is a well-known cause of nonimmune hydrops and may occur spontaneously in an otherwise normal pregnancy. Confirmation by percutaneous umbilical blood sampling and treatment by intravascular transfusion is recommended when massive fetomaternal hemorrhage causes hydrops in preterm gestations.