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M Mayers

Publications and source records attributed to M Mayers.

30 records · Page 2Linked to original sources
PubMed1992

Washington State's Basic Health Plan: choices and challenges.

The current turbulence characterizing the health sector has engendered a limited number of state-level experiments to provide health services for the nation's 37 million uninsured. The issues and challenges generated by each program's design and implementation vary. By examining the experience of one such state program, the Washington Basic Health Plan, in some detail, this paper contributes to the policy debate regarding the possible range of solutions available to address the issue of "the uninsured." By analyzing the array of design choices available at the time the program was enacted, and why certain options were chosen rather than others, this paper points to the complex interaction of political dynamics, public policy development, and program implementation.

Health Policy↗
PubMed1991

Pharmacokinetics of amikacin and chloramphenicol in the aqueous humor of rabbits.

Composite data describing ocular pharmacokinetics are unreliable because of intersubject variation. To address this problem, an animal model was developed in which multiple aqueous samples from single subjects were obtained. Following direct anterior chamber or intravenous administration of amikacin or chloramphenicol, pharmacokinetic analysis of drug concentrations in the serum and anterior chamber was performed by using a nonlinear least-squares regression program. The number of anterior chamber paracenteses performed did not alter the beta elimination rates or percent penetration into the anterior chamber. The aqueous humor and peripheral-compartment terminal slopes were identical. These data indicate that complete ocular concentration-time curves can be obtained without altering antibiotic pharmacokinetics. Following direct injection into the anterior chamber, the elimination rates for both antibiotics followed a one-compartment model, whereas those following intravenous administration best fit an open, first-order, two-compartment model. Following intravenous administration, the anterior chamber elimination rate constants for both drugs were equal to that of the serum and significantly longer than that following direct injection. The elimination rates of both drugs following direct injection were similar. Systemic administration resulted in drug levels in aqueous humor that persisted longer than those following direct injection. Chloramphenicol, a lipophilic compound, gave higher mean concentrations in aqueous humor than did amikacin. Our model provides a new approach which rigorously examines ocular pharmacokinetics and provides data which suggest that for selected compounds the parenteral route of administration is preferable.

Amikacin↗
PubMed1990

Additional evidence for lack of transmission of HIV infection by close interpersonal (casual) contact.

To further study the possibility of transmission of HIV infection by close personal but non-sexual, non-parenteral contact we have continued to enroll and evaluate household contacts of adult patients with AIDS. Two hundred and six household contacts of 90 patients with AIDS were evaluated with detailed interviews, physical examinations, and detection of HIV antibodies and p24 antigen from 1984 to 1987; 118 of these contacts were re-evaluated 6-12 months after cessation of household contact or death of the patient. The median duration of household contact from 18 months prior to symptoms in the AIDS patients to last contact was 23 months (range 3-101 months). The median time elapsed from first contact during this period to the last evaluation was 38 months (range 13-66 months). No household contact had signs or symptoms suggesting HIV infection. All 206 were negative for serum antibodies to HIV and HIV p24 antigen, despite extensive sharing of household facilities and items and personal interactions with AIDS patients. This study continues to show that household members without other risks remain at minimal to no risk for HIV transmission (95% confidence interval, 0-1.44) despite prolonged and substantial close non-sexual contact with AIDS patients, and after re-evaluation at a median of 10.9 months after initial evaluation.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Recombinant human interferon alpha D in HSV-1 recurrence in the rabbit.

Recombinant human interferon alpha subtype D (RIFN alpha D) was effective in reducing the shedding of herpes simplex virus type-1 (HSV-1) induced by 6-hydroxydopamine iontophoresis followed by topical epinephrine application in previously infected rabbit corneas. A treatment schedule of RIFN alpha D, two drops QID was superior to one drop BID. RIFN alpha A also appeared to be effective in reducing viral shedding. Rabbits treated with RIFN alpha D during two episodes of adrenergically induced HSV-1 shedding, but not during anticipated episodes of spontaneous shedding, did not show a significant reduction in shedding of virus. Interferon was present in significantly higher concentration in tear samples following treatment with RIFN alpha D as compared with RIFN alpha A.

Animals↗
PubMed1984

Use of recombinant interferon to prevent recurrent herpesvirus shedding.

Iontophoresis with 6-hydroxydopamine was performed in rabbits previously infected with herpes simplex virus, McKrae strain. Viral shedding into the tear film was significantly decreased by the use of recombinant alpha interferon subtype D given as one drop qid. Interferon was noted in the tear film of rabbits 16-18 hours after the last placement of interferon drops into the inferior cul-de-sac.

Animals↗
PubMed1980

Laparoscopy for presumed nonacute salpingitis: a new look at an old problem.

The increased prevalence of venereal disease among adolescents has resulted in a rise in nonacute salpingitis. Laparoscopy was evaluated as an aid in the diagnosis and treatment of presumed nonacute salpingitis in 29 adolescents. The patients had a mean duration of symptoms of 5.5 months, 50% had a recent history of discharge and/or bilateral pelvic pain, and on examination 50% had pain on motion of the cervix, 75% had adnexal tenderness, and 50% had a palpable adnexal fullness or mass. Anatomic findings at laparoscopy included normal pelvic structures in 8, active salpingitis in 13 and nonacute disease in 8. The anaerobic, aerobic, and viral peritoneal cultures obtained at laparascopy from 22 patients resulted in no growth in 18. The four with positive cultures had one organism identified in three cases and two organisms in one case. Anatomic findings were more helpful in diagnosis than the bacteriologic analysis, and our results suggest that laparoscopy increases diagnostic accuracy in the management of presumed nonacute salpingitis.

Adolescent↗
PubMedDate not supplied

Phototherapeutic keratectomy: strategies and results in 12 eyes.

As part of a multicenter study of excimer laser procedures, we performed phototherapeutic keratectomy (PTK) on 12 eyes in 11 patients. Three eyes had superficial corneal scarring, two Salzmann's degeneration, two Reis-Bückler's dystrophy; and one each with recurrent lattice dystrophy in a corneal graft, band keratopathy, recurrent erosion syndrome, after pterygium scarring, and contact-lens related keratopathy. Indications for treatment included poor visual acuity, severe glare symptoms, ocular surface discomfort, recurrent erosions, and monocular diplopia. Follow up ranged from 1 to 4 months. Best spectacle corrected visual acuity improved in ten eyes with no eyes suffering loss of best spectacle corrected visual acuity. A hyperopic refractive shift was found in eight of 12 treated eyes. Corneal surface regularity improved in six of 12 eyes and worsened in one eye as measured by computerized corneal topographic analysis. Ten patients (11 eyes) noted improvement in their visual perception and subjective symptoms. We review various strategies of phototherapeutic keratectomy designed to treat particular corneal disorders: patient selection criteria to optimize clinical outcome are reviewed as well.

Adult↗