Biomedical subjects

P McNamara

Publications and source records attributed to P McNamara.

8 recordsLinked to original sources

PubMed1992

The sagging safety net. Emergency departments on the brink of crisis.

U.S. hospitals are facing an emergency care crisis. At the same time emergency departments are overflowing with uninsured patients seeking primary care, violence-related trauma cases are soaring, leaving underfunded trauma systems on the verge of collapse. In a special cover package, we explore the causes of the crisis, the current prospects for change, and related issues in emergency care today. Beginning on page 26, we present an overview of the crisis, with particular attention to the breakdown of trauma systems. Starting on page 30, we look at the growing threat of violence itself entering hospital EDs; on pages 34-35, we examine how hospitals are attracting and retaining critically needed clinicians, and how trauma systems are dealing with ongoing shortages of specialists. On pages 37-38, we explore the patient satisfaction question; and on pages 38-39, we present the latest data on emergency care utilization from the American Hospital Association.

American Hospital Association↗

PubMed1992

Speech monitoring skills in Alzheimer's disease, Parkinson's disease, and normal aging.

We examined the abilities of 15 patients with dementia of the Alzheimer type (DAT), 22 patients with Parkinson's Disease (PD), and 141 healthy subjects (ranging in age from 30 to 79 years) to detect and correct their own speech errors. Each subject was shown the Cookie Theft picture of the BDAE (Goodglass & Kaplan, 1972. The assessment of aphasia and related disorders. Philadelphia: Lea & Febiger.) and instructed to tell the examiner the "...story of what's happening in the picture." Self-monitoring performance was assessed by tabulating the number of uncorrected errors as well as repaired errors. We divided repairs into two types based on the psycholinguistics literature (van Wijk & Kempen, 1987. Cognitive Psychology, 19, 403-440). Speech corrections were judged to be lemma repairs when the reparandum was a single word, and reformulation repairs when a new syntactic constituent was added to the reparandum. Patients with DAT corrected only 24% of their total errors and patients with PD only 25%. Healthy subjects, by contrast, corrected from 72 to 92% of their total errors. Patients with DAT tended to rely on reformulation repairs while patients with PD used both repair types about equally often. While healthy elderly Ss (in the 70s group) utilized lemma repairs more often than the reformulation strategy, all other healthy Ss used both strategies about equally often. Across all groups naming performance correlated negatively with numbers of undetected errors. Results point to a previously unrecognized communication disorder associated with PD and DAT and manifested by an impairment in the ability to correct output errors. This impairment may be related to attentional and frontal dysfunction in the two patient groups.

Adult↗

PubMed1992

Processing complexity and sentence memory: evidence from amnesia.

This study examines sentence memory as a function of linguistic processing complexity in amnesic patients. Sentence length as well as lexical and syntactic complexity were manipulated in two sentence repetition experiments. It was found that the amnesic patients performed considerably worse than the control subjects and that performance decreased: (1) when sentence length was increased by the addition of adjuncts compared to arguments of the verb; (2) when the verb selected more thematic frames; and (3) when sentences involved "empty" argument positions that must be linked to antecedents, particularly across clausal boundaries. These data showed how linguistic complexity affects sentence memory and implied that the amnesic deficit did not involve a generalized difficulty for materials of similar length, rather, the deficit was specific to certain representational types and processing routines.

Alcohol Amnestic Disorder↗

PubMed1991

Curved DNA without A-A: experimental estimation of all 16 DNA wedge angles.

The principal sequence feature responsible for intrinsic DNA curvature is generally assumed to be runs of adenines. However, according to the wedge model of DNA curvature, each dinucleotide step is associated with a characteristic deflection of the local helix axis. Thus, an important test of a more general view of sequence-dependent DNA curvature is whether sequence elements other than A-A cause the DNA axis to deflect. To address this question, we have applied the wedge model to a large body of experimental data. The axial path of DNA can be described at each step by three Eulerian angles: the helical twist, the deflection angle (wedge angle), and the direction of the deflection. Circularization and gel electrophoretic mobility data on 54 synthetic DNA fragments, both from other laboratories and from our own, were used to compare the theoretical predictions of the wedge model with experiment. By minimizing misfit between calculated and observed DNA curvature, we have found that the stacks AG/CT, CG/CG, GA/TC, and GC/GC, in addition to AA/TT, have large wedge values. We have also synthesized seven sequences without AA/TT elements but with these other wedges correctly phased to cause appreciable predicted curvature. All appear curved as demonstrated by anomalous gel mobilities. The full set of 16 roll and tilt wedge angles is estimated and, together with the known 10 helical twists, these allow prediction of the general sequence-dependent trajectory of the DNA axis.

Adenine↗

PubMed1989

Angiotensin converting enzyme inhibitors: spirapril and related compounds.

The synthesis of spirapril (5), spiraprilat (25), their RSS stereoisomers, and their glycyl (18b) and lysyl (36, 37) analogues is described. These compounds were evaluated in vivo for inhibition of angiotensin converting enzyme (ACE), and selected compounds were evaluated for in vitro ACE inhibition (spirapril ID50 16 micrograms/kg; spiraprilat IC50 0.8 nM, ID50 8 micrograms/kg). In anesthetized rats, iv, esters 5 and 36 are more potent than enalapril, and diacids 25 and 37 are more potent than enalaprilat in vitro. In the conscious rats, orally, 5 and enalapril (2) showed potent and sustained activity at doses of 0.03-1 and 0.1-1 mg/kg, respectively. From this work, spirapril was selected for clinical evaluation as an antihypertensive agent.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1989

Stereoselective binding of propranolol in the elderly.

The influence of age on the stereoselective serum protein binding of propranolol was investigated. Serum was obtained from 10 young (mean age 23 +/- 2 years) and ten elderly (mean age 68 +/- 2 years) healthy male volunteers. The free fraction of propranolol (fu) was measured by equilibrium dialysis, using tritium labeled (+/-)- and (-)-propranolol. The fu values were 0.159 +/- 0.049 and 0.148 +/- 0.028 (+/-), 0.135 +/- 0.041 and 0.136 +/- 0.04 (-), 0.174 +/- 0.056 and 0.161 +/- 0.028 (+) in the young and elderly subjects, respectively. Serum alpha 1-acid glycoprotein (AAG) concentrations were 81.4 +/- 33.0 and 81.0 +/- 21.6 mg 100 ml-1 in young and elderly respectively (P greater than 0.05). Variability in AAG concentration accounted for most of the observed intersubject variability in the binding of both propranolol isomers. The stereoselective binding of propranolol does not appear to be affected by age.

Adult↗

PubMed1978

Interaction of chloramphenicol with phenytoin and phenobarbital. Case report.

The effect of chloramphenicol therapy (48 mg/kg/day) on the serum concentrations of phenytoin and phenobarbital was studied in a patient previously stabilized on anticonvulsant medications. Phenytoin, 12 mg/kg/day, and phenobarbital, 5 mg/kg/day resulted in serum concentrations averaging 10.8 microgram/ml before and 30.5 microgram/ml, after chloramphenicol therapy. A reduction in dose of both phenytoin and phenobarbital was required to minimize adverse effects during the course of chloramphenicol therapy. An average daily dose of phenytoin of 9.1 mg/kg resulted in an average serum concentration of 17.8 microgram/ml. A daily dose of phenobarbital of 4.0 mg/kg resulted in an average serum concentration of 37.1 microgram/ml. These changes indicate 50.5% and 40.4% decreases in clearance of phenytoin and phenobarbital. Multiple-dose nonlinear regression analysis of phenytoin and phenobarbital serum concentration data obtained during chloramphenicol therapy indicated a 62.5% and a 29.5% decrease in clearance. Subsequent serum concentration monitoring demonstrated a similar reduction in phenobarbital clearance when chloramphenicol was added to phenobarbital alone.

Adult↗

PubMedDate not supplied

Reversible pathologic jealousy (Othello syndrome) associated with amantadine.

We describe a case of pathologic jealousy (Othello syndrome) in a patient with Parkinson disease, which abated after discontinuing amantadine. We indicate that early recognition and treatment of the syndrome in this disease may avert physical violence. We also believe that our report further suggests a link between this specific behavioral disorder and dopaminergic activity.

Aged↗