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Biomedical subjects

D A Moore

Publications and source records attributed to D A Moore.

At least 19 recordsLinked to original sources
PubMed2000

Motivations for and barriers to engaging in continuing veterinary medical education.

OBJECTIVE: To identify reasons for engagement in continuing veterinary medical education (CVME) activities, obstacles to participation, ways to provide more effective programs, and ideas to improve participation in CVME. DESIGN: Focus group interviews. SAMPLE POPULATION: Selected practicing veterinarians from a state that did mandate continuing education for relicensure. PROCEDURE: 12 focus group interviews were held throughout the state of California between May and September 1998. Practitioners were asked to respond to questions about where they obtain information to improve their practice, what value they see in CVME, what motivates them to participate, what obstacles to CVME participation exist, and ways CVME providers and practitioners could overcome those obstacles. RESULTS: 84 practitioners participated in the focus group interviews. In addition to the educational value of CVME, participation was used to rejuvenate practice life and prevent feelings of isolation. Continuing education activities ranged from problem-oriented chats with colleagues to formal educational programs. Timing of events, distance, money, solo practice, stage of career, and family demands were identified as barriers to participation. Designing and marketing CVME with specific learning objectives and for specific career stages and using new educational delivery technologies were suggested to overcome some of these barriers. CONCLUSIONS AND CLINICAL RELEVANCE: If CVME is to improve practice and patient care, it should be integrated into a practice's strategic planning and considered a legitimate business expense. Decisions about CVME participation are made easier if program objectives are clearly outlined.

Animals↗
PubMed2000

Continuing education needs assessment for on-farm food safety services.

OBJECTIVE: To identify the perceived market or client demand for dairy on-farm food safety services by veterinarians, the need for a food safety continuing education program, and the educational issues that might be addressed in an on-farm food safety curriculum. DESIGN: Survey. STUDY POPULATION: Consulting dairy veterinarians, government veterinarians located in California, and meat packers slaughtering cull dairy cows in California. PROCEDURE: Results of a questionnaire supplied to veterinarians and telephone interviews with meat packer representatives were analyzed by use of univariate and multivariate logistic regression procedures. RESULTS: Some meat packers considered the quality of incoming cull dairy cattle as a control point for food safety hazards. More than 50% of dairy and government-employed veterinarians believed that a current market for on-farm food safety services exists; > 85% believed that a potential market exists. Duration since graduation was negatively correlated with belief in a current market. Government-employed veterinarians were more likely to believe in a current market. Veterinarians were more likely to express a strong interest in offering on-farm food safety services if they believed a current market exists, indicated that they already offer such services, or listed residues and pathogens as the most important issues facing the dairy industry. CONCLUSIONS AND CLINICAL RELEVANCE: Although a potential market for on-farm food safety services is perceived, veterinarians are unsure of their role in this area. new demands of meat packers slaughtering cull dairy cows may be the motivation practitioners need to broach the subject of food safety with clients.

Animals↗
PubMed2000

Animal bite epidemiology and surveillance for rabies postexposure prophylaxis.

OBJECTIVES: To understand the epidemiology of animal bites and exposure, evaluate the animal exposure reporting system for surveillance of rabies postexposure prophylaxis (PEP), and identify opportunities to reduce PEP. DESIGN: Period prevalence survey. STUDY POPULATION: Pennsylvania residents in 1995. PROCEDURE: Data from animal bite reports from Pennsylvania county health offices were summarized for 1995. Animal bite incidences for the state, counties, various age groups, and various population densities were calculated. Animal species, treatment, location of wounds, and PEP recommendations were evaluated for exposures. RESULTS: More than 16,000 animal-related potential rabies exposures were reported from 65 of 67 counties in Pennsylvania. The highest incidence was in children less than 5 years old (324/100,000). Of the 75% of victims requiring wound treatment, 50% received antimicrobials, 29% received a tetanus toxoid, and 19% had wounds sutured, were admitted to hospitals, or were referred for plastic surgery. Although 75% of exposures were to dogs, victims exposed to cats were 6 times as likely to receive PEP (relative risk, 6.1; 95% confidence interval, 5.1 to 7.4). Thirty percent of 556 PEP were given for exposures to dogs, 44% for cats, 7% for raccoons, 4% for bats, 2.5% for squirrels, 2.1% for groundhogs, 2% for foxes, and 8% for exposures to other species. Fifty-nine percent of owned dogs were up-to-date on rabies vaccinations compared with 41% of owned cats. CONCLUSION: Interventions, such as dog bite prevention education, vaccination of pets against rabies, appropriate use of PEP, and reduction of feral cat populations, should be instituted, enhanced, or better enforced in communities.

Adolescent↗
PubMed2000

Negotiation.

The first part of this paper traces a short history of the psychological study of negotiation. Although negotiation was an active research topic within social psychology in the 1960s and 1970s, in the 1980s, the behavioral decision perspective dominated. The 1990s has witnessed a rebirth of social factors in the psychological study of negotiation, including social relationships, egocentrism, motivated illusions, and emotion. The second part of this paper reviews five emerging research areas, each of which provides useful insight into how negotiators subjectively understand the negotiation: (a) mental models in negotiation; (b) how concerns of ethics, fairness, and values define the rules of the game being played; (c) how the selection of a communication medium impacts the way the game is played; (d) how cross-cultural issues in perception and behavior affect the negotiation game; and (e) how negotiators organize and simplify their understandings of the negotiation game when more than two actors are involved.

Collective Bargaining↗
PubMed2000

A retrospective study of neutropenia in HIV disease.

In aiming to define the characteristics of HIV-infected subjects developing neutropenia and describe the causes, features and effects of neutropenia we undertook a retrospective study in a dedicated HIV unit in London, UK. Two hundred and forty-four patients with documented neutropenia, defined as absolute neutrophil count (ANC) < 1,000/mm3, during a 12-month period were studied. First neutropenia occurred at a median CD4 count of 30 cells/mm3. Low CD4 count was associated with longer episodes of neutropenia with a more profound nadir. Two-thirds of episodes lasted less than 2 weeks. ANC nadir was < 500 cells/mm3 in 45% of episodes. Infections were most frequent in patients with profound but brief neutropenic episodes. Neutropenia was generally mild, short-lived and associated with late-stage disease. However, profound neutropenia did develop suddenly in some patients with no prior history of neutropenia (in 13% first neutropenic ANC recorded was < or =500 cells/mm3), and at CD4 count > 200 cells/mm3. Most patients were receiving multiple myelosuppressive therapies. Infection was associated with brief, profound neutropenia.

Anti-HIV Agents↗
PubMed1999

Spatial diffusion of raccoon rabies in Pennsylvania, USA.

Identification of the geographic pattern of diffusion of a wildlife disease could lead to information regarding its control. The objective of this study was to model raccoon-rabies diffusion in Pennsylvania to identify geographic constraints on the diffusion pattern for potential use in bait-vaccination strategies. A trend-surface analysis (TSA) was used as a spatial filter for month to first report by county location. A cubic polynomial model was fitted (R2 = 0.80). Velocity vectors were calculated from the partial derivatives of the model and mapped to demonstrate the instantaneous speed of diffusion at each location. A main corridor of diffusion through the ridge and valley section of the state was evident early in the outbreak. Once the disease reached the northern counties, the disease moved west toward Ohio. I believe that TSA was useful in identifying the pattern of raccoon-rabies diffusion across the stage from the inherent noise of disease-reporting data.

Animals↗
PubMed1999

Upper respiratory tract infections.

In reviewing recent advances in upper respiratory tract infections, we focus on five key topics. First, the use of ribavirin in the treatment of respiratory syncytial virus infection has been limited to the immunosuppressed. Prophylaxis in high-risk patients with specific immunoglobulin is effective and a new monoclonal antibody shows promise. Second, the efficacy of neuraminidase inhibitors in the treatment of influenza has become established. There are unresolved concerns about early implementation of therapy without a firm diagnosis; resource implications are enormous. Third, an outbreak of influenza due to avian influenza virus (H5N1) raised the possibility of a new pandemic. However, there was minimal person-to-person spread although much was learned about pathogenesis of infection. Fourth, evidence favoring the use of ciprofloxacin rather than rifampicin for meningococcal chemoprophylaxis is reviewed. Efficacy in eradicating nasopharyngeal carriage is excellent. Finally, the management of sore throat has been considered. This remains controversial but evidence supporting antibiotic therapy in adults is lacking. If treatment is indicated in childhood, shorter courses of antibiotics may be effective.

Adult↗
PubMed1998

Persistence of Pseudomonas aeruginosa strains in respiratory infection in AIDS patients.

OBJECTIVES: To establish the clinical pattern of Pseudomonas aeruginosa respiratory infections in HIV-seropositive patients and to determine whether repeated isolation of the organism represents reinfection or recurrence and to assess whether common source, nosocomial infection occurred. DESIGN AND METHODS: Evaluation of the clinical pattern of P. aeruginosa respiratory infections by case note review and epidemiological characterization of P. aeruginosa by serotype determination and Xbal DNA macrorestriction analysis. Serum sensitivity testing of strains was performed to further define phenotypic characteristics of the isolated organisms. RESULTS: Seventy-three per cent (29 out of 40) of individuals had P. aeruginosa isolated on two or more occasions in the setting of clinical respiratory infection. Overall, 85% had evidence of P. aeruginosa to within 2 months of study completion or death. Epidemiological characterization revealed persistence of unique single strains in 93% of individuals where multiple isolates were available for testing, whereas only two patients harboured a common strain. The serotype distribution of strains was similar to that reported from non-HIV-positive patients. CONCLUSIONS: Once established, eradication of P. aeruginosa from the respiratory tract of HIV-seropositive individuals with advanced immunosuppression is problematic and a chronic infective state appears common. There was no evidence of nosocomial transmission. Serotype loss and development of sensitivity to normal human serum were both observed and were highly correlated. This represents truncation of O-antigenic lipopolysaccharide on the cell surface of P. aeruginosa and may reflect progression to phenotypes commonly associated with chronic infection in other clinical settings such as cystic fibrosis.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Neutrophil adhesion molecules in HIV disease.

Neutrophil dysfunction in HIV disease is well described. We examined the expression of neutrophil adhesion molecules amongst 72 HIV-infected subjects using a whole blood flow cytometric assay with FITC- and R-PE-labelled isotype-specific MoAbs. We report lesser expression of CD11a (LFA-1) and L-selectin (CD62L) on the circulating neutrophils of HIV+ subjects compared with HIV- controls. Expression of CD11b (Mac-1) was unchanged. Shedding of L-selectin and up-regulation of CD11b in response to in vitro stimulation with N-formyl-methionyl-leucyl-phenylalanine (fMLP) were less in HIV+ compared with HIV- subjects, most markedly in subjects with CD4 cell counts < 100 cells/mm3. These results suggest that neutrophil dysfunction in HIV disease, which increases with disease progression, may be attributable to dysregulated adhesion molecule expression.

Adult↗
PubMed1998

Paediatric enema syndrome in a rural African setting.

We have observed a distinct clinical syndrome amongst acutely unwell children frequently associated with the administration of a traditional medicine enema. We describe the clinicopathological features of this 'enema syndrome' based on retrospective case note review of 50 consecutive admissions to a South African rural district hospital. Admission was frequently prompted by sudden, marked clinical deterioration following enema administration (68% seen within 24 h). Respiratory distress with tachypnoea, abdominal distension, hypotonia and loss of consciousness occurred frequently. In-hospital mortality was 28% and was higher in those receiving herbal (43%) rather than chemical (21%) enemas. Hyperkalaemia, leucocytosis (> 15,000 mm3) and respiratory distress occurred more frequently in those who died. Diagnosis of an underlying illness was established in 78%. Whilst the majority of enemas are given without incident, children struggling with an underlying illness may be unable to tolerate rectally administered traditional medicines. Toxic chemical substances in frequent use may increase complication rates.

Child, Preschool↗
PubMed1997

Use of physiologic variables to predict milk yield after clinical mastitis in dairy cattle.

OBJECTIVE: To determine the association between intramammary infections caused by various bacteria and hepatic damage, as measured by serum sorbitol dehydrogenase (SDH) activity, WBC counts, and PCV and the association of clinical variables with milk production after a case of clinical mastitis. DESIGN: Prospective, cohort study. ANIMALS: 82 cows with clinical mastitis. PROCEDURE: Information on milk production, mastitis status, and selected physiologic variables was collected during a 1-year period. Milk samples for bacteriologic evaluation were collected on day 1 of an episode of clinical mastitis. Physical examination was performed and blood samples for laboratory evaluation were collected on days 1, 5, and 9. Primary outcome was mature equivalent 305-day (ME305) milk production. Correlations were assessed using a multiple regression model. RESULTS: Higher WBC counts were associated with higher ME305 values. For cows with coliform mastitis, increases in SDH values were associated with higher ME305 values. For cows with coliform and streptococci/staphylococci mastitis, PCV was associated with ME305 values. Higher PCV values were associated with lower ME305 values for streptococci/ staphylococci and coliform infections. CLINICAL IMPLICATIONS: The association between milk production and WBC count indicated that cows mobilizing WBC were better able to neutralize mammary gland infections, which may result in better milk production. The association between milk production and PCV suggested that maintaining hydration in cows with clinical mastitis may be a critical aspect of treating all cows with mastitis.

Animals↗
PubMed1997

Central venous line infections in AIDS.

UNLABELLED: The relative infection rates of Port-a-Cath and Hickman lines used for the maintenance treatment of cytomegalovirus retinitis were studied by retrospective casenote review. Seventy-five lines were inserted over an 18 month period. The overall infection rates were significantly greater for Hickman lines: 0.97/100 line-days compared to 0.39/100 line-days for Port-a-Caths, with a trend towards higher infection rates in those prescribed ganciclovir. A total of 56 episodes of septicaemia were recorded with a significantly greater incidence of septicaemia within 1 month of line insertion in those with a neutrophil count < 1.0 x 10(3)/mm3. Ten infectious episodes were associated with death, six of which were due to Pseudomonas spp. CONCLUSIONS: In HIV seropositive patients, use of a Port-a-Cath is associated with a significantly lower rate of line associated sepsis than use of a Hickman line. Insertion of long term central venous catheters should be avoided if possible when the neutrophil count is < 1.0 x 10(3)/mm3.

AIDS-Related Opportunistic Infections↗
PubMed1996

Evaluation of the results of a survey of dairy producers on dairy herd biosecurity and vaccination against bovine viral diarrhea.

A survey on biosecurity and vaccination practices was sent to 632 dairy producers in Pennsylvania to determine the proportion of the approximately 12,500 dairy herds in Pennsylvania that might be at risk for outbreaks of vaccine-preventable diseases. Most producers relied on their veterinarian for vaccination information and vaccine purchases, but administered the vaccine to the cattle themselves. Many producers did not vaccinate all susceptible groups of cattle in their herd. Also, many producers did not administer a booster vaccination after administration of an initial killed-virus vaccine, as recommended by vaccine manufacturers. As a result, although 309 of 376 (82.2%) dairy producers indicated that they routinely vaccinated their herds, only 73 of 266 (27.4%) herds were considered adequately vaccinated. Veterinarians were as likely to administer vaccines to cattle in adequately vaccinated herds as to cattle in inadequately vaccinated herds. Adequately vaccinated herds were more likely to be larger herds (> 121 cattle) than smaller herds. Analysis of survey results indicated that veterinarians are not taking full advantage of their pivotal role in dairy herd vaccination programs.

Animal Husbandry↗