Biomedical subjects
Publications and source records attributed to J E Moore.
A profile of 333 patients admitted to the intensive therapy unit, Waikato Hospital, over one year ending 30 June 1990, is presented. A close costing of a representative sample of 30 of those patients was done. The average cost of their intensive care stay was $2948 per patient. Twenty-four of the patients cost an average $2200 and the other six cost an average $5700.
The infrarenal abdominal aorta is a common site for clinically significant atherosclerosis. As has been shown in other susceptible locations, vessel geometry, flow division rates, and pulsatility may result in hemodynamic conditions which influence the preferential localization of disease in the abdominal aorta segment. Pulsatile flow visualization was performed in a glass model of the aorta constructed from measurements of angiograms and cadaver aortas. Flow rates and pulsatile waveforms were varied to reflect typical physiological conditions. Under normal resting conditions, the flow patterns in the infrarenal aorta were more complex than those in the suprarenal location. Time varying vortex patterns appeared at the level of the renal arteries and propagated through the infrarenal aorta into the common iliac arteries. A region of oscillating velocity direction extended from the renal arteries to the aortic bifurcation along the posterior wall. Dye became trapped along the posterior wall, requiring several cardiac cycles for clearance. In contrast, there was rapid clearance of the dye in the anterior aorta. Under postprandial conditions, the flow patterns in the aorta were basically unchanged. Simulated exercise conditions created laminar hemodynamic features very different from the resting conditions, including a decrease in dye residence time. This study reveals significant time-dependent variations in the hemodynamics of the abdominal aorta under differing physiologic conditions. Hemodynamic factors such as low wall shear stress, oscillating shear direction, and high particle residence time may be related to the clinically seen preferential plaque localization in the infrarenal aorta.
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Objectives of this study were 1) to measure small-particle and liquid mean retention time (MRT) of 12 grass hays similar in NDF (61.3 +/- 1.9% NDF) but differing in morphological composition and to relate passage rates to proportions of blade, sheath and stem and 2) to evaluate the influence of MRT of small and large blade and stem fractions and large sheath fractions, in addition to morphological composition, on intake and digestibility of the 12 hays. In each of two periods, 24 sheep (wethers) were offered one of 12 hays at three consecutive levels of feeding: (L1) ad libitum, allowing 15% refusal; (L2) restricted to 100% of hay consumed ad libitum by an individual wether during L1; and (L3) 1.8% of BW on a DM basis. Hays offered included two sorghum-sudan, four barley, four oat and two pearl millet. Marked particles were pulse-dosed in L2 and L3. Large and small particles of stem and leaf were extracted with neutral detergent and marked with Cr or rare earth metals. Marked large and small stem particle MRT generally were longer (P less than .05) than those of corresponding large and small blade particles. Large sheath particles generally had an intermediate (P less than .05) MRT between those of large stem and blade particles. Mean retention times of marked fractions were lower (P less than .05) in L2 than in L3. Small particle MRT in L2 was longer than MRT for liquid, though correlations were high (r = .74 to .86, P less than .01). Large particles were retained longer than small particles. Particle size, morphology, and percentage of stem in the forage influenced the mean retention time. Use of representative samples of all fractions fed to measure retention times may lead to a better understanding of ruminal function and to improvements in explanations of intake regulation, because marked fractions do not behave identically for all forages.
Animals on pasture do not always have the opportunity for ad libitum consumption. Our objectives were to determine effects of intake level on digestibility of 12 grass hays, and to relate differences in intake and digestibility to proportions of leaf blade, leaf sheath and stem. In each of two periods, 24 wethers were offered one of 12 hays at three consecutive levels of feeding: (L1) ad libitum, allowing 15% refusal; (L2) restricted to 100% of hay consumed ad libitum by individual wether during L1; and (L3) 1.8% of BW on a DM basis. Hays offered included two sorghum-sudan, four barley, four oat and two pearl millet. Hays were similar in NDF concentration but differed in morphological composition Organic matter intake averaged 1.99 +/- .04, 1.79 +/- .04 and 1.52 +/- .01% of BW for L1, L2 and L3, respectively. Organic matter digestibilities averaged 71.8 +/- .55 72.4 +/- .60 and 72.3 +/- .65% for L1, L2 and L3, respectively. Intake SEM within hays were lower with restricted intakes (L3), whereas the opposite was observed for the SEM for digestibility. Forage morphological composition within feeding level influenced intake and digestibility by altering diet selection capabilities of wethers. Wethers did not consume equal NDF amounts, ranging form .95 to 1.47% of BW, because hays differed in morphological composition. Ash-free ADF and 72% sulfuric acid lignin were higher (P less than .01) in stem than in blade or sheath. In vivo digestibilities measured under restricted feeding conditions were related more closely (P less than .05) to in vitro estimates of digestibility than were digestibilities measured under ad libitum conditions (r = .72, .79 and .85 for L1, L2 and L3, respectively). This study demonstrates that variation in morphological characteristics of forages may account for part of the difference in voluntary intake of forages of similar chemical composition. New knowledge in this area will be valuable in developing improved forage quality prediction procedures.
Specific hemodynamic factors have been shown to be associated with atherosclerotic plaque localization at the human carotid bifurcation. Flow field characteristics may also determine plaque distribution in the abdominal aorta. We therefore characterized flow patterns in a glass model abdominal aorta that included its major branches under conditions of steady flow. Outflow resistances of the celiac, superior mesenteric, renal, inferior mesenteric, and iliac arteries were varied to produce flow distributions consistent with rest, the postprandial state, and vigorous lower limb exercise. Flow patterns were visualized with three colors of dye injected simultaneously through capillary tubes at selected locations and recorded as still photographs and by cinephotography on videotapes. Under resting conditions a large region of flow separation and stagnation occurred at the posterior wall of the aorta directly opposite the orifices of the superior and inferior mesenteric arteries. Similar separation regions were observed during the simulated postprandial state but diminished markedly when distal outflow was increased to levels consistent with exercise. In the highly susceptible infrarenal aortic segment, beginning about 2 cm below the renal artery orifices, multiple secondary flow patterns with three to four counterrotating vortex formations were observed under both resting and postprandial conditions but disappeared in the exercise state. Secondary flow patterns were not noted in the suprarenal abdominal aorta, which is usually relatively spared. Such features have been related to plaque localization elsewhere, and the disappearance of these patterns with increased flow velocity during exercise is consistent with the previously noted protective effect of unidirectional laminar high-flow states. The beneficial effects of physical fitness programs may be related in part to these hemodynamic modifications.
Effects of cane molasses at 0, 4, and 8% of DM in complete mixed diets were evaluated when molasses was fed to lactating dairy cows with cottonseed hulls, alfalfa haylage, or both combined. Thirty-six mature Holstein cows from mid to late lactation were used in a partially balanced incomplete block design with three 28-d periods. Variables measured were DM intake, milk yield, and composition. With cottonseed hull diets (30% of DM), molasses improved milk yield, milk fat percentage, solids-corrected milk, and feed efficiency. Dry matter intake was not affected by molasses. With alfalfa haylage diets (35% of DM), 8% molasses depressed actual milk yield and solids-corrected milk, DM intake, milk fat percentage, milk protein percentage, and feed efficiency. Milk fat percentage was increased with 4% molasses. With 65% alfalfa haylage diets, most variables measured were unaffected by molasses; however, with 8% molasses, DM intake increased and milk protein percentage decreased. In diets with both roughages combined, molasses did not affect any variable measured; however, these diets gave highest solids-corrected milk yields. Results show clearly that molasses effects depend on percentage molasses and type and amount of roughage in the diet.
This study examined elevated MMPI Sc scores among psychotic and nonpsychotic patients to determine whether homogeneous item-content dimensions could clarify the precise meaning of elevations on scale Sc. A total of 45 psychotic patients were compared with 56 nonpsychotic psychiatric patients on the Harris and Lingoes subscales of the Sc scale. All subjects had T-score elevations on scale Sc greater than or equal to 70. The two criterion groups did not differ on overall scale Sc scores, but a distinctive pattern of subscale scores emerged that discriminated the samples. Psychotic patients obtained significantly higher scores on subscales measuring bizarre thinking and perceived loss of control over impulses and emotions. Conversely, nonpsychotics endorsed significantly more items on subscales concerned with symptoms of depression, anxiety, and thinking difficulties. These data suggest that homogeneous item-content dimensions of the Sc scale provide a means for distinguishing between psychotic and nonpsychotic patients who otherwise appear similar on overall scale Sc.
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The ability of lay persons to learn and retain defibrillation skills using an automatic external defibrillator (AED) was assessed. Thirty-four family members of cardiac arrest survivors were trained in CPR techniques and defibrillation, and evaluated for performance of skills immediately following training and at six-week and three-month follow-ups. All but two were successfully trained to complete three cycles of CPR interspersed with three defibrillatory shocks in an average of four minutes with the first shock delivered in an average of two minutes. Although there were decrements in the speed and quality of performance at each follow-up period (P less than .01), we conclude that most lay persons can learn to operate an AED safely and under simulated conditions provide defibrillatory shocks an average of eight minutes faster than typical response times of emergency medical technicians. These results suggest that AEDs can be placed in many homes of patients at high risk for cardiac arrest.
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Fifty-seven male chronic pain patients admitted to an inpatient multimodal pain treatment program at a Midwestern Veterans Administration hospital completed the MMPI, Profile of Mood States (POMS), Tennessee Self-Concept Scale (TSCS), Rathus Assertiveness Schedule (RAS), activity diaries, and an extensive pain questionnaire. All patients were assessed both before and after treatment, and most also were assessed 2-5 months prior to treatment. No significant changes occurred during the baseline period, but significant improvements were evident at posttreatment on most variables: MMPI, POMS, TSCS, RAS, pain severity, sexual functioning, and activity diaries. MMPI subgroup membership, based on a hierarchical cluster analysis in a larger sample, was not predictive of differential treatment outcome. Possible reasons for comparable treatment gains among these subgroups, which previously have been shown to differ on many psychological and behavioral factors, are discussed.
We performed a study to determine how many patients at highest risk for an episode of ventricular fibrillation (those who have already survived such an event) are potential candidates for automatic external defibrillator placement and accepting of such a device in their homes. All VF survivors in King County, Washington, during 1984 were screened for possible enrollment in the study. Of 95 survivors of out-of-hospital VF, 63 (66%) were eligible and of 47 patients approached, 38 (81%) agreed to participate in the study. These findings suggest that approximately half (product of 66% and 81% acceptance rate equals 53%) of VF survivors potentially could use automatic external defibrillators.
This study investigated the Luria-Nebraska Intellectual Processes Scale (IPS) as a predictor of Wechsler Adult Intelligence Scale (WAIS) IQs among alcoholic inpatients. Strong correlations were found between the IPS and WAIS Verbal IQ and Full Scale IQ; however, the correlation with Performance IQ was only -.41. IQ estimates based on Prifitera and Ryan's (1981) regression equations derived on psychiatric inpatients differed significantly from obtained IQs in the current alcoholic sample. The importance of adequately assessing Performance IQ among patients with alcohol-related problems is discussed.
Automatic external defibrillators (AEDs) will be used by spouses, family members, emergency first-responders, and the citizenry at large. Such use, however, raises a number of clinical, training, psychological, and public health issues. Clinical issues: Is cardiac arrest to be verified by the operator or the AED? Second verification systems, such as breath detectors, produce errors of omission, but greatly expand the pool of potential users. The relative merits of high sensitivity and low specificity in arrest verification must be defined by clinicians relative to the setting and the potential users. AEDs require cessation of basic CPR during their assessment periods; clinicians must determine the tradeoff between long interruption of basic life support and much earlier delivery of countershocks. Training issues: Criteria for those to be trained include consideration of who the patient will be and who the AED operator might be. AEDs pose a familiar adult education problem, that is, acquisition of a new psychomotor skill and retention of that skill for long periods before performance. What are the best teaching techniques? Currently available AEDs have different designs for device-operator interaction. Which design is most likely to assure proper performance during an actual arrest? Psychological issues: What are the psychological effects of learning about, living with, and eventually using an AED? The development of the automatic external defibrillator constitutes the most recent attempt to achieve early defibrillation of patients in cardiac arrest. The potential public health effect of such devices is enormous.
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Although it is widely held that patients' expectancies for therapeutic gain are related causally to treatment outcome, a recent review of expectancy research found scant evidence for the hypothesized expectancy-outcome relationship. Supportive findings were reported only in studies with serious methodological weaknesses. This study tested the relationship between the prognostic expectancies of hospitalized schizophrenic patients and several objective measures of hospital outcome. It also tested the hypothesis that expectancies may bear primarily a predictive, not causal, relationship to outcome. Multiple regression analyses found patients' expectancies to be correlated significantly with 8 of 15 measures of posthospital adjustment and with 14 of 15 measures of prehospital adjustment. The findings supported the expectancy-outcome relationship and also were consistent with a predictive interpretation of patients' expectancies.
Therapists' expectancies for therapeutic gain in patients reputedly are linked to the actual outcome of treatment for their patients. Theoretical papers have suggested that therapists' expectancies may cause or facilitate patient therapeutic response to treatment. Unfortunately, empirical data related to these notions are greatly lacking. The present study tested the relationship between therapist expectancy and treatment outcome for hospitalized schizophrenic patients. It also tested two opposing hypotheses re the nature of the link between therapist expectancy and outcome (causative vs. predictive). Multiple regression analyses revealed that therapists' expectancies are multi-dimensional, formed partly on the basis of therapists' knowledge of psychopathology in general and partly on their perception of their patients' pretreatment adjustment. The analyses also revealed that therapists' expectancies were associated significantly with treatment outcome; the data supported a predictive, not causative, interpretation of the nature of therapists' expectancies.