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Biomedical subjects

C Moore

Publications and source records attributed to C Moore.

At least 37 records · Page 2Linked to original sources
PubMed2001

Factors affecting the initiation of substance abuse treatment in managed care.

AIMS: A long-standing concern of clinicians in addiction treatment is that a large number of individuals who are admitted to treatment do not return to actually begin the program. We identified characteristics that predict treatment initiation. DESIGN: In-person structured interviews were conducted with consecutive admissions to a large outpatient program (N = 1204), and the health plan's automated registration data were used to determine treatment attendance. We compared those who returned to begin treatment with those who did not. SETTING: The study was conducted at the Chemical Dependency program of a large group model health maintenance organization (HMO). PARTICIPANTS: Study subjects were individuals age 18 or over admitted to the program. MEASUREMENT: Study variables included DSM-IV alcohol and drug dependence and abuse, Addiction Severity Index problem severity, motivation and treatment entry measures. FINDINGS: Those who were drug-dependent were less likely to begin treatment than those dependent only on alcohol. Measures of motivation, such as work-place pressures and the patient's perception of the importance of alcohol treatment, predicted starting treatment for individuals who were alcohol-dependent only or alcohol- and drug-dependent. Among patients who were dependent only on alcohol, women were more likely than men to start treatment, and for those who were drug-dependent, being employed and having higher drug severity scores predicted starting treatment. CONCLUSIONS: Screening at intake may identify those at risk of not returning after admission to start treatment. Clinicians may consider making additional efforts during the intake process to engage individuals who are unemployed and have drug (as opposed to alcohol) disorders and less motivation.

Adolescent↗
PubMed2001

Ultrasonography by emergency physicians in patients with suspected cholecystitis.

This article investigates the use of bedside abdominal ultrasonography (BAU) performed by emergency physicians (EPs) to screen patients for cholelithiasis and cholecystitis. In this prospective study EPs performed BAU on 116 patients. Agreement between BAU and formal abdominal ultrasound (FUS) performed in the radiology department for detecting cholelithiasis and cholecystitis was determined using Kappa statistics. Test characteristics of BAU for detecting cholelithiasis and acute cholecystitis were calculated. Agreement between BAU and FUS was 0.71 for cholelithiasis and 0.46 for acute cholecystitis. Test characteristics of BAU for cholelithiasis were sensitivity 92%, specificity 78%, positive predictive value (PPV) 86%, negative predictive value (NPV) 88%. Test characteristics of BAU for acute cholecystitis compared with clinical follow-up were sensitivity 91%, specificity 66%, PPV 70%, NPV 90%. BAU may be used to exclude cholelithiasis and is sensitive for cholecystitis. However, when EPs with limited experience identify cholecystitis a confirmatory test is warranted before cholecystectomy.

Acute Disease↗
PubMed2001

Outcome of liver transplantation for hepatitis B: report of a single center's experience.

Results of liver transplantation (LT) for hepatitis B have improved significantly with the use of hepatitis B immune globulin (HBIG) and/or lamivudine. The aim of this study is to review the long-term outcome of patients who underwent LT for hepatitis B. Records of 41 patients who underwent LT for hepatitis B and survived 3 months or longer post-LT were reviewed. Twenty patients were administered no immunoprophylaxis or short-term intramuscular HBIG, whereas 21 patients were administered high-dose intravenous (IV) HBIG. Median post-LT follow-up in these 2 groups was 76 months (range, 4 to 155 months) and 25 months (range, 4 to 68 months), respectively. Hepatitis B recurred in 15 (75%) and 4 patients (19%) who underwent LT in the pre-HBIG and post-HBIG eras, respectively. Cumulative rates of recurrent hepatitis B at 1 and 3 years post-LT in these 2 groups were 66% and 77% and 20% and 20%, respectively (P <.001). Recurrent hepatitis B in the post-HBIG era correlated with antibody to hepatitis B surface antigen titer less than 100 IU/L. Nine patients with recurrent hepatitis B were administered lamivudine for 13 to 49 months (median, 28 months); 6 patients continued to have stable or improved liver disease, whereas 3 patients developed virological breakthrough with slow deterioration of liver disease. Long-term IV HBIG is effective in preventing recurrent hepatitis B. The risk for recurrent hepatitis B is negligible after the first year post-LT. Among patients with no virological breakthrough, lamivudine can stabilize or improve liver disease for up to 4 years in patients with recurrent hepatitis B post-LT.

Adult↗
PubMed2001

The determination of 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) in hair using negative ion gas chromatography-mass spectrometry and high-volume injection.

The determination of 11-nor-delta9-THC-9-carboxylic acid (THC-COOH) in hair specimens at the sensitivity required to detect marijuana users is a difficult analytical problem. A sensitive and specific method has been developed for the quantitative assay of THC-COOH in hair. Hair specimens were washed, incubated in sodium hydroxide, subjected to solid-phase extraction, and analyzed using high-volume injection coupled with negative chemical ionization (NCI) mass spectrometry. A common disadvantage of chemical ionization, the production of a single mass-to-charge ratio ion, was also addressed. By specific selection of the derivatizing agent, three ions were monitored, allowing the calculation of two ion ratios, as in electron impact mode. The method was applied to several hair specimens taken from known marijuana users and workplace specimens. This is the first publication describing the use of high-volume injection and NCI mass spectrometry for the determination of THC-COOH in hair.

Adult↗
PubMed2001

Association of outpatient alcohol and drug treatment with health care utilization and cost: revisiting the offset hypothesis.

OBJECTIVE: This study examines the hypothesis that treatment reduces medical utilization and costs of patients with substance use problems. METHOD: Adult patients (N = 1.011; 67% men) entering the outpatient chemical dependency recovery program at Sacramento Kaiser Permanente over a 2-year period were recruited into the study. Medical utilization and costs were examined for 18 months prior and 18 months after intake. To account for overall changes in utilization and cost, an age, gender and length-of-enrollment matched nonpatient control group (N = 4,925) was selected from health-plan members living in the same service area. Multivariate analyses controlling for age and gender were conducted using generalized estimating equation methods, allowing for correlation between repeated measures and nonnormal distributions of the outcome variable. RESULTS: The treatment cohort was less likely to be hospitalized (odds ratio [OR] = 0.59; p < .01) and there was a trend for having spent fewer days (rate ratio [RR] = 0.77; p < .10) in the hospital in the posttreatment period compared to pretreatment period. These patients were also less likely to visit the emergency room (ER) (OR = 0.64; p < .01) and had fewer ER visits (RR = 0.81; p < .01) following treatment. Inpatient, ER and total medical costs declined by 35%, 39% and 26%, respectively (p < .01). Reductions in cost were greater for the treatment cohort when compared with the matched sample (p < .05). Among women, there were significant reductions (p < .05) in inpatient, ER and total costs for the study cohort when compared with the matched sample; among men, the reductions in inpatient and ER cost (but not total cost) were significantly larger (p < .05) for the study cohort when compared with the matched sample. For the treatment cohort, the change in medical cost was not significantly different by gender. Changes in cost were significantly different across the various age groups (p < .05) for the study cohort and the matched sample. Among those in the group aged 40-49 years, the decline in cost for study cohort was significantly larger (p < .05) than for the matched sample. CONCLUSIONS: For patients with substance use disorders entering treatment, there was a substantial decline in inappropriate utilization and cost (hospital and ER) in the posttreatment period. The disaggregated pattern of posttreatment decline in utilization and cost is suggestive of long-term reductions that warrant a longer follow-up.

Adolescent↗
PubMed2001

Predictability of hypocalcemia using early postoperative serum calcium levels.

OBJECTIVE: In operations involving the thyroid or parathyroid glands, postoperative serum calcium levels are one contributing factor to patients' length of hospital stay. In this study, we wanted to determine whether early postoperative serum calcium levels could be used to predict hypocalcemia following operations of the thyroid or parathyroid glands. METHODS: A retrospective chart review was performed on 203 patients who had undergone operations involving risk to the parathyroid glands. This included patients who had bilateral thyroid operations or those who had one or more parathyroid glands removed for various disease processes. Postoperative calcium levels were plotted as a function of time, and the slope between the first two levels was examined. Both serum calcium levels were drawn within 12 hours after the operation. RESULTS: A positive slope predicted normocalcemia in 100% of patients undergoing thyroid or parathyroid procedures. A negative slope was predictive in magnitude. Patients who developed hypocalcemia had an average slope two to three times more negative than those remaining normocalcemic. CONCLUSIONS: It appears that early serum calcium levels may be predictive for postoperative hypocalcemia in operations that put the parathyroid glands at risk.

Biomarkers↗
PubMed2001

Improving alcoholism treatment across the spectrum of services.

This article represents the proceedings of a symposium at the 2000 RSA Meeting in Denver, Colorado. The chair was Michael E. Hilton. The presentations were (1) The effects of brief advice and motivational enhancement on alcohol use and related variables in primary care, by Stephen A. Maisto, Joseph Conigliaro, Melissa McNiel, Kevin Kraemer, Mary E. Kelley, and Rosemarie Conigliaro; (2) Enhanced linkage of alcohol dependent persons to primary medical care: A randomized controlled trial of a multidisciplinary health evaluation in a detoxification unit, by Jeffrey H. Samet, Mary Jo Larson, Jacqueline Savetsky, Michael Winter, Lisa M. Sullivan, and Richard Saitz; (3) Cost-effectiveness of day hospital versus traditional alcohol and drug outpatient treatment in a health maintenance organization: Randomized and self-selected samples, by Constance Weisner, Jennifer Mertens, Sujaya Parthasarathy, Charles Moore, Enid Hunkeler, Teh-Wei Hu, and Joe Selby; and (4) Case monitoring for alcoholics: One year clinical and health cost effects, by Robert L. Stout, William Zywiak, Amy Rubin, William Zwick, Mary Jo Larson, and Don Shepard.

Alcoholism↗
PubMed2001

[Treatment of endometriosis with dienogest: preliminary report].

AIM OF THE STUDY: Influence of two hormonal therapies (GnRH agonist--leuprolein acetate and a new progestin--dienogest) on symptoms of endometriosis in patients with different clinical grade of disease. MATERIAL AND METHODS: 34 women with endometriosis confirmed by laparoscopy and histology were included into the study. Patients were randomized and divided into two therapeutic groups. One group was treated with dienogest and the second with leuprolein acetate during 6 month of study. The intensification of pain was assessed with Visual Analog Scale (VAS) and pelvic symptoms scale before, during (3 month) and after therapy. Dyspareunia was assessed with pelvic symptoms scale before, during (3 month) and after therapy. Frequency of adverse effects was assessed in 1, 3 and 6 month of therapy. Emotional state, bone density and basic serum parameters were assessed before and after therapy. RESULTS AND CONCLUSIONS: Dienogest as well as leuprolein acetate decreased pelvic pain and dyspareunia. There were no differences between these influences. Dienogest did not reveal androgenic activity (did not reveal activity nor intense seborrheic lesions, nor hirsutism, nor voice tone). Dienogest did not reveal hot flashes. Bleeding (caused by dienogest therapy) did not influence hematologic indices nor affected the patients' decision on preterm end of treatment.

Adult↗
PubMed2000

Sexual maturational changes circulatory inhibin concentration in relation to FSH concentration and testicular size in Suffolk and DLS rams.

Developmental patterns in immunoactive inhibin and FSH concentrations in peripheral blood were determined for Suffolk and DLS (Dorset x Leicester x Suffolk) rams born in January Blood samples were taken every 3 to 4 wk when testes were developing during puberty (5 to 44 wk of age) and redeveloping in early adulthood (17 to 23 months of age). Suffolk lambs had a greater average daily gain (195 vs. 143 g/day, P<0.01), and they developed larger testes (P<0.01) than DLS lambs. Inhibin and FSH concentrations peaked at about the same pubertal (8 wk) and early adult (19 or 20 months) ages in both breeds. Elevations in FSH were greater (P< 0.05) in Suffolk than DLS rams at each stage of development. The pubertal inhibin peak was nearly 70% larger (P<0.01) in DLS than Suffolk rams, and the early adult peak was comparable in rams of both breeds, but much smaller (P<0.01) than the pubertal peak. Nonetheless, inhibin was positively correlated (r=0.48 to 0.57) with FSH in both breeds during each developmental stage. Inhibin and testicular size were negatively correlated in Suffolk (r=-0.74) and DLS (r=-0.86) rams during puberty, and positively correlated in DLS rams (r=0.46) in early adulthood. We conclude that 1) inhibin concentrations are higher in juvenile rams at the time Sertoli cell numbers are being established than in adult rams during testicular recrudescence and 2) rises in FSH concentration participate in regulating corresponding rises in inhibin concentration in both stages of testicular development.

Age Factors↗
PubMed2000

A triplet of differently shaped spin-zero states in the atomic nucleus 186Pb

Understanding the fundamental excitations of many-fermion systems is of significant current interest. In atomic nuclei with even numbers of neutrons and protons, the low-lying excitation spectrum is generally formed by nucleon pair breaking and nuclear vibrations or rotations. However, for certain numbers of protons and neutrons, a subtle rearrangement of only a few nucleons among the orbitals at the Fermi surface can result in a different elementary mode: a macroscopic shape change. The first experimental evidence for this phenomenon came from the observation of shape coexistence in 16O (ref. 4). Other unexpected examples came with the discovery of fission isomers and super-deformed nuclei. Here we find experimentally that the lowest three states in the energy spectrum of the neutron deficient nucleus 186Pb are spherical, oblate and prolate. The states are populated by the alpha-decay of a parent nucleus; to identify them, we combine knowledge of the particular features of this decay with sensitive measurement techniques (a highly efficient velocity filters with strong background reduction, and an extremely selective recoil-alpha-electron coincidence tagging methods). The existence of this apparently unique shape triplet is permitted only by the specific conditions that are met around this particular nucleus.

Journal Article↗
PubMed2000

Mean-field solution of the small-world network model.

The small-world network model is a simple model of the structure of social networks, which possesses characteristics of both regular lattices and random graphs. The model consists of a one-dimensional lattice with a low density of shortcuts added between randomly selected pairs of points. These shortcuts greatly reduce the typical path length between any two points on the lattice. We present a mean-field solution for the average path length and for the distribution of path lengths in the model. This solution is exact in the limit of large system size and either a large or small number of shortcuts.

Computer Simulation↗
PubMed2000

Alterations in rat striatal glutamate synapses following a lesion of the cortico- and/or nigrostriatal pathway.

Ultrastructural changes within the ipsilateral dorsolateral striatum were investigated 1 month following a unilateral ablation of the rat frontal cortex (CTX), removing corticostriatal input, or injection of the neurotoxin, 6-hydroxydopamine (6-OHDA), into the substantia nigra pars compacta, removing nigrostriatal input. In addition, a combined ipsilateral cortical and 6-OHDA lesion (CTX/6-OHDA) was carried out. We find that following a CTX, 6-OHDA, or CTX/6-OHDA lesion, there was a significant decrease in the density of striatal nerve terminal glutamate immunoreactivity compared to the control group. There was also a significant increase in all three lesion groups in the mean percentage of asymmetrical synapses associated with a perforated postsynaptic density. There was a large increase within the CTX/6-OHDA-lesioned group and a smaller but still significant increase in the CTX-lesioned group in the percentage of terminals or boutons with multiple synaptic contacts (i.e., multiple synaptic boutons, MSBs), compared to either the 6-OHDA or the control group. There was no change in any of these measurements within the contralateral striatum. There was a significant decrease in the number of apomorphine-induced contralateral rotations in the CTX/6-OHDA versus the 6-OHDA-lesioned group. Animals receiving just the single CTX or 6-OHDA lesion recovered in motor function compared to the control group as measured by the Rotorod test, while the CTX/6-ODA-lesioned group recovered to less than 50% of the control level. The data suggest that following a CTX and/or 6-OHDA lesion, there is an increase in striatal glutamatergic function. The large increase in the percentage of MSBs in the combined lesion group suggests that dopamine or other factors released by the dopamine terminals assist in regulating synapse formation.

Animals↗
PubMed2000

Electrical activity and postsynapse formation in adult muscle: gamma-AChRs are not required.

Skeletal muscle fibers will not accept hyperinnervation by foreign motor axons unless they are paralyzed, suggesting that paralysis makes them receptive to innervation, e.g., by upregulating extrasynaptic expression of gamma-AChRs and/or of the agrin receptor MuSK. To examine the involvement of these parameters in paralysis-mediated synapse induction, ectopic expression of agrin, a factor from motor neurons controlling neuromuscular synapse formation, was made dependent on the administration of doxycycline in innervated adult muscle fibers. In response to doxycycline-induced agrin secretion, adult fibers did form ectopic postsynaptic specializations, even when they were electrically active, lacked fetal AChRs, and expressed normal low levels of MuSK. These data demonstrate that paralysis and changes associated with it are not required for agrin-induced postsynapse formation. They suggest that paralyzed muscle induces synapse formation via the release of factors that make motor neurites contact muscle fibers and secrete agrin.

Agrin↗
PubMed2000

Antibody deficiency syndromes.

Antibodies have a crucial role in protecting against infections, and antibody deficiencies are the commonest primary and secondary immunodeficiencies. Antibody deficiencies may be the only abnormality present in a patient, or they may be present and aggravate the symptoms of various other conditions. Because the presence of an antibody deficiency is difficult to predict from clinical presentation, physicians should perform an evaluation of antibody-mediated immunity, even knowing that, in many cases, the results are normal. When immunizations are included as a part of the evaluation, many patients experience a benefit from enhanced immunity against common pathogens. Some alternative practical approaches to the evaluation of patients with recurrent infections are outlined in Figure 8. Referral to a clinical immunologist can be based on the presence of recurrent infections, a positive family history without prior evaluation by a pediatrician, or abnormal immunologic findings that require an advanced evaluation. In any case, a close collaboration between pediatrician and immunologist likely will result in an accurate diagnosis and better treatment of patients with antibody-deficiency syndromes and their families.

Antibodies↗
PubMed2000

A Porphyromonas gingivalis genetic locus encoding a heme transport system.

Porphyromonas gingivalis has been implicated in the onset and progression of periodontitis and the availability of hemin for in vitro growth has been associated with virulence of the bacterium in animal models. We report here the cloning and sequence analysis of a P. gingivalis TonB-linked outer membrane receptor gene tlr. This gene was previously identified as a TonB-linked adhesin gene tla and shown to be essential for growth at low concentrations of hemin. The tlr gene is immediately downstream of four open reading frames (htrABCD) that encode a putative ATP binding cassette transport system with sequence similarlity to heme transport systems of other bacteria. Analysis of P. gingivalis W50 mRNA revealed that the htrABCD genes are cotranscribed similar to hemin transport genes of other bacteria.

ATP-Binding Cassette Transporters↗
PubMed2000

Attention and joint attention in preschool children with autism.

Three experiments examined the role of attention in explaining dyadic (child-adult) and triadic (child-adult-object) joint attention difficulties in autism. Experiments 1 and 2 investigated children's ability to orient to an adult's attention bid and to follow the direction of a human or nonhuman cue. Experiment 3 tested ability to disengage and shift attention to objects. Results showed autism-specific difficulties at both dyadic and triadic levels. Children with autism were less responsive than developmentally delayed controls in orienting to attention bids and in following a human head-turn cue yet had no difficulty in shifting attention and were faster overall in orienting to targets. Results suggest a specific developmental delay in which children with autism rely on the presence of objects in the visual field to guide action. The relation between this problem and autistic children's difficulties with human communicative signals is discussed.

Attention↗