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Biomedical subjects

J Moloney

Publications and source records attributed to J Moloney.

15 recordsLinked to original sources
PubMed2000

New crown annelated tetrathiafulvalenes: synthesis, electrochemistry, self-assembly of thiol derivatives, and metal cation recognition

The synthesis of new S(2)O(4)-crown annelated tetrathiafulvalene (TTF) derivatives substituted with one terminal thiol group is described. Self-assembled monolayers (SAMs) of these compounds have been assembled on gold and platinum surfaces, the latter substrate giving improved quality films. SAMs of TTF derivative 16b are the most stable of those we have studied. Electrochemical data for SAMs of 5a, 5b, 8, 16a, and 16b in acetonitrile reveal two reversible one-electron waves, typical of the TTF system; the current increased linearly with scan rate, indicating a surface wave response. SAMs of 8, 16a, and 16b exhibited an electrochemical response in aqueous electrolytes, which was observed between 50 and 100 cycles. Moreover, if the potential scanned was limited to the first TTF oxidation, the cyclic voltammetry response was observed for at least 1000 cycles. Metal complexation by the crown ionophore of the SAMs in acetonitrile has been monitored by a positive shift in the first oxidation potential of the TTF unit (maximum DeltaE(1)(1/2) = 80 mV for Ag(+)). We also report the X-ray crystal structure of TTF-crown derivative 21 bearing two hydroxymethyl substituents, synthesized during the course of this work. The structure is characterized by infinite chains of molecules linked by strong intrachain hydrogen bonds between the terminal hydroxy groups.

Journal Article↗
PubMed2000

Psychiatric training in New Zealand.

OBJECTIVE: The aims of this study were to develop a profile of current psychiatric trainees in New Zealand, to identify factors important in their recruitment to and retention in psychiatric training and to identify factors that predict failure to complete training. METHOD: A survey was sent to all current psychiatric trainees in New Zealand and to all trainees who could be traced who had left psychiatric training in New Zealand In the last 5 years without completing the Fellowship of the Royal Australian and New Zealand College of Psychiatrists. RESULTS: General characteristics of the two groups are presented, as well as information about recruitment, burnout, general health and experiences of work and training. The only significant difference in general characteristics between the two groups was that more of those who had left training prematurely had been born overseas. The levels of family and personal mental illness were high, but there was no difference in these rates between those who had stayed in training and those who had left permaturely. Most trainees had decided to pursue a psychiatric career during their house-officer years. The most important factors determining the choice of a career in psychiatry were philosophical interest and house-officer experience in psychiatry. With respect to retention, despite high rates of burnout and psychological morbidity, and dissatisfaction with various aspects of the work setting, 94% of current trainees indicated satisfaction with their decision to train in psychiatry and over 90% intended to practise in New Zealand in the future. Most trainees who left training prematurely did so during the first 2 years of training. Dissatisfaction with work conditions, and stress or burnout were the main reasons for leaving. CONCLUSIONS: This study provides information on some of the complex determinants of psychiatric recruitment and retention in the New Zealand setting. Areas that could be addressed in order to improve recruitment, work satisfaction and retention in training are considered.

Adult↗
PubMed2000

Thyroiditis induced by interferon in dialysis.

We describe a dialysis patient who acquired acute Hepatitis C infection. Her primary renal disease was systemic lupus erythromatosis. She was having goitre but clinically euthyroid and her thyroid function test was normal. To avoid long term complications of Hepatitis C we elected to treat her with Interferon 3 million units subcutaneously 3 times a week. During treatment she developed some transient side effects initially which subsided but later she felt pressure symptoms around her neck. When we checked her TSH and thyroid antibodies these were elevated. Though this could be related to HCV, rarely, but we think the thyroid change is mostly related to Interferon. Some possible explanation of the effect of Interferon on thyroid have been reviewed and we think patients getting such drugs should be under close monitoring to avoid permanent thyroid dysfunction.

Acute Disease↗
PubMed1999

Continuous arterial blood gas monitoring during bilateral sequential lung transplantation.

OBJECTIVE: To determine the accuracy and clinical utility of a continuous arterial blood gas (ABG) monitor during lung transplantation. DESIGN: Prospective, observational cohort study. SETTING: University hospital. PARTICIPANTS: Eleven patients undergoing bilateral sequential lung transplantation (BSLTx). INTERVENTIONS: Repeated ABG sampling. MEASUREMENTS AND MAIN RESULTS: Agreement was measured by the bias (limits of agreement): pH, 0.006 (-0.10 to 0.10); PaO2, -22 mmHg (-130 to 86 mmHg); and PaCO2, -1.6 mmHg (-13.4 to 10.2 mmHg). Sensitivity and specificity of the Paratrend 7 (Biomedical Sensors, Ltd, Malvern, PA) PaO2 measurements (to detect PaO2 < 100 mmHg) were 84.6% and 97.6%, respectively. CONCLUSION: Continuous ABG monitoring with the Paratrend 7 shows sufficiently good agreement with laboratory blood gas analysis during BSLTx and thus is a convenient alternative to intermittent laboratory blood gas measurement. Because of the potential for significant (and sometimes rapid) acid-base disturbances, continuous ABG monitoring may have a role during most lung transplantation procedures.

Adult↗
PubMed1999

Randomized trial of informed consent and recruitment for clinical trials in the immediate preoperative period.

BACKGROUND: The standard process of obtaining informed consent sometimes prevents physicians or patients from participating in clinical trials, partly because they are concerned about eventual treatment allocation or the physician is concerned the patient might harbor some uncertainty about the best treatment. Alternative randomization methods have been advocated that may address these and other concerns. METHODS: After institutional ethics committee gave its approval, the authors interviewed 770 patients before operation and asked them to consider enrolling in a mock anesthesia trial. Patients were allocated randomly to one of five methods of randomization and consent: one-sided informed consent (the most common approach), prerandomized consent to experimental treatment, prerandomized consent to standard treatment, one-sided physician-modified informed consent, or one-sided patient-modified informed consent. Recruitment rates were compared and sociodemographic and perioperative predictors of recruitment were identified. RESULTS: The randomization method did not result in any significant difference in recruitment rates: one-sided informed consent, 55.6%; prerandomized consent to experimental treatment, 53.3%; prerandomized consent to standard treatment, 53%; one-sided physician-modified informed consent, 60.7%; and one-sided patient-modified informed consent, 56.7% (P = 0.66). Multivariate predictors of recruitment were patient age >45 yr (odds ratio, 1.44; 95% confidence interval [CI], 1.08 to 1.93), English-speaking at home (1.49; 1.0 to 2.21), and male researcher-male patient interaction (1.37; 1.20 to 1.57). CONCLUSIONS: No evidence emerged that alternative randomization and consent designs resulted in increased recruitment rates compared with simple one-sided informed consent for a sham anesthesia trial in patients awaiting elective surgery. Older, male patients were more likely to provide consent.

Adolescent↗
PubMed1999

Clonidine and cardiac surgery: haemodynamic and metabolic effects, myocardial ischaemia and recovery.

Clonidine may have beneficial effects in patients undergoing major surgery. We enrolled 156 patients having elective CABG surgery in a double-blind, randomized trial. Patients were randomized to receive either two doses of placebo (Group PP) or clonidine 5 micrograms/kg (Group CC). Perioperative measurements included haemodynamics, anaesthetic and analgesic drug usage, creatinine clearance, cortisol excretion, recovery times and quality of life (SF-36) after surgery. Overall, there was no significant difference with time to tracheal extubation (median [10-90 centile]): CC 7.1 (3.4-18) h vs PP 8.0 (4.3-17) h, P = 0.70; but there was a higher proportion of patients extubated within four hours: CC 20% vs. PP 8%, P = 0.038. Clonidine resulted in a number of significant (P < 0.05) haemodynamic changes, particularly pre-CPB: less tachycardia and hypertension, more bradycardia and hypotension. Clonidine was associated with a significant (P < 0.05) reduction in anaesthetic drug usage, higher creatinine clearance, lower cortisol excretion and improvement in some aspects of quality of life. This study lends support to consideration of clonidine therapy in patients undergoing CABG surgery.

Adrenergic alpha-Agonists↗
PubMed1998

A case of monosomy 21 found to be an unbalanced de novo t(5p;21q) by fluorescence in situ hybridization.

A case is presented in which monosomy 21 was detected by routine cytogenetics and fluorescence in situ hybridization (FISH) studies demonstrated an unbalanced translocation t(5;21). The patient was partially monosomic for both 5p and 21q. The phenotype of the infant showed some features of the 5p- (cri-du-chat) syndrome, but there were also features present which were uncharacteristic of this syndrome. The present findings, combined with similar cases reported in the literature, provide further support for a proximal monosomy 21q syndrome.

Chromosome Aberrations↗
PubMed1993

Reproductive axis suppression in acute illness is related to disease severity.

Changes in the adrenal and thyroid axes in critically ill patients are accentuated by increasing disease severity. However, the relationship of gonadal axis suppression to severity of illness is not well defined. We evaluated serial serum levels of LH, FSH, and testosterone (T) in 59 men and 42 postmenopausal women admitted to critical care units with a spectrum of disease severity. Patients were grouped according to severity of illness by the Acute Physiologic and Chronic Health Evaluation II (APACHE II) scores and by survival. Patients with surgery, renal or hepatic failure, alcohol abuse, endocrine disease, or head trauma were excluded to avoid these confounding factors. In men, mean admission serum T levels in all groups were lower than in healthy controls (P < 0.005). In addition, T levels in men with severe illness (APACHE > 15) were lower than in men with relatively mild (APACHE < 10; P < 0.01) or moderate illness (APACHE 10-15; P < 0.05). These differences were accentuated as hospitalization progressed. In postmenopausal women and men, nadir serum FSH but not LH levels during hospitalization were lower in patients with APACHE greater than 15 than in patients with APACHE scores of 10-15 or less than 15 (P < 0.05). Grouping patients by survival yielded similar results. Analysis of drug effects, age, and PRL did not explain these relationships. We conclude that the degree of both central and peripheral suppression of the reproductive axis in acute illness is related to disease severity. This suppression could not be attributed to other factors known to alter the reproductive axis independently from critical illness (e.g. age, drugs, head trauma, hepatic failure, etc.). These findings further document a general endocrine response to acute illness involving several axes which is graded according to disease severity.

Acute Disease↗
PubMed1984

The diffusion of water across the stratum corneum as a function of its water content.

The flux of tritiated water (HTO) through pieces of stratum corneum at four different levels of hydration has been measured. The concentration of water in the stratum corneum, the concentration of HTO in the presenting solution, and the thickness, density, and weight per unit area of the dry stratum corneum are known. The thickness of the hydrated stratum corneum and the permeability and diffusion constants of HTO were calculated. From these in vitro data it is possible to calculate the in vivo thickness of the stratum corneum, its water concentration profile, and the flux of water (transepidermal water loss) at environments of different relative humidities. Both the transepidermal water loss and the water concentration profile change very little as the environmental relative humidity increases from 0 to 80%. The small decrease in the water concentration of the surface layers of cells as the relative humidity becomes very low, however, may cause an observable alteration in the physical characteristics of the surface layers.

Body Water↗
PubMed1982

Retinopathy and retinal function in insulin-dependent diabetes mellitus.

Sixty-six insulin-dependent diabetic patients with normal visual acuity were studied (132 eyes). The mean age was 27.7 years with a mean duration of diabetes mellitus of 8.7 years. Their mean electro-oculogram ratio, Arden grating and Munsell-Farnsworth scores were markedly abnormal (p much less than 0.00001). Background retinopathy was present in 53 eyes (40.2%), abnormal Arden grating scores (greater than 82) in 70 eyes (53%), abnormal Farnsworth-Munsell 100-hue score (greater than 100) in 88 eyes (56.7%), and 29 eyes (22%) had an electro-oculogram ratio less than 160. These abnormalities of retinal function did not correlate with retinopathy and were not secondary to it. Smoking caused a significant deterioration in contrast sensitivity.

Adult↗
PubMed1980

Inner-city community health centre: six years' experience.

Some aspects of the work of an inner-city community health centre administered by a large teaching hospital are described. Some sociodemographic characteristics and patterns of morbidity of persons attending the centre over the past six years are presented. Initial attempts of evaluation of clinical services provided by the centre are described.

Adolescent↗
PubMedDate not supplied

Hepatitis C among drug users: consensus guidelines on management in general practice.

BACKGROUND: Hepatitis C (HCV) is a common cause of morbidity among patients who attend general practitioners (GPs) in Ireland for methadone maintenance treatment. AIMS: To describe the development and content of guidelines for the management of HCV among current or former opiate users in the Eastern Regional Health Authority area attending GPs for methadone treatment. METHODS: The guidelines were produced in five stages: identification of key stakeholders; development of evidence-based draft guidelines; discussion of content; determination of 'Delphi'-facilitated consensus and review by a sample of GPs for whom the guidelines would be intended. RESULTS: The guidelines contain advice for GPs on all aspects of care of patients at risk of HCV, including general and preventative care, care of other bloodborne and hepatotoxic viruses, and the factors to be considered and appropriate evaluation prior to referring a patient for assessment at a hepatology unit. CONCLUSIONS: GPs have an important role to play in the care of patients at risk of, or infected with, HCV.

Adolescent↗
PubMedDate not supplied

High morbidity expected from cirrhosis in injecting drug users.

Hepatitis C infection commonly complicates injecting drug use. The outcome of end stage liver disease for this cohort in Ireland has not been estimated. (1) to estimate the prevalence of persistent hepatitis C viraemia and distribution of genotypes in a drug using cohort. (2) To measure the frequency of poor prognostic co-factors. (3) To extrapolate the burden of hepatitis C related disease nationally for this route of infection. A cross section survey of attendees at an East Coast Area drug treatment clinic. Of 94 patients studied (63 male), 70 were hepatitis C antibody positive and 39 were PCR positive. 26 had genotype 1 and 11 had genotype 2 or 3. Most displayed factors associated with a poor prognosis: 72% male, 83% problem drinkers and 87% abnormal liver blood tests. Using published data, we extrapolate over 1,214 cases of cirrhosis via this route of infection nationally, leading to approximately 35, 60 and 50 cases of hepatocellular carcinoma, hepatic decompensation and liver related death respectively per annum. A high prevalence of hepatitis C infection in injecting drug users, compounded by a high frequency of poor prognostic co-factors, means a significant burden of disease can be expected from this group.

Adult↗