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Biomedical subjects

D W Young

Publications and source records attributed to D W Young.

At least 91 records · Page 5Linked to original sources
PubMed1983

Stereochemistry of the rearrangement of 2-aminoethanol by ethanolamine ammonia-lyase.

(1R)-2-Amino[1-2H1]ethanol and (1S,2RS)-2-amino[1,2-2H2]ethanols have been synthesised by decarboxylation of (2S,3R)-[3-2H1]serine and (2S,3S)-[2,3-2H2]serine respectively. The stereochemical integrity of these labelled 2-aminoethanols has been ascertained from the 1H-NMR spectra of their N,O-dicamphanoyl derivatives. This assay has also been used to confirm that samples of (2R)- and (2S)-2-amino [2-2H1]ethanols prepared from (2R)- and (2S)-[2-2H1]glycines are stereochemically pure. Ethanolamine ammonia-lyase rearranges (1R)-2-amino[1-2H1]ethanol to acetaldehyde at approximately the same rate as it rearranges unlabelled 2-aminoethanol, whilst (1S,2RS)-2-amino[1,2-2H2]ethanol is rearranged at the same rate as the (1,1-2H2)-labelled substrate. The isotope effect is approximately kH/k2H = 8. The 2H-NMR spectra of the 3,5-dinitrobenzoates of the ethanol produced by reduction in situ of the acetaldehyde formed in the rearrangements show that the 1-2H1 label migrates in (1S,2RS)-2-amino-[1,2-2H2]ethanol and 2-amino[1,1-2H2]ethanol but not in (1R)-2-amino[1-2H1]ethanol. The above results indicate that the adenosylcobalamin-dependent ethanolamine ammonia-lyase catalyses the rearrangement of 2-aminoethanol with migration of the 1-pro-S-hydrogen atom.

Ammonia-Lyases↗
PubMed1983

Prospective reimbursement and the hospital power equilibrium: a matrix-based management control system.

Prospective rate-setting programs have not yet made significant inroads in containing hospital cost inflation. Because these programs are essentially hospital management control systems, they must be conceptually grounded in general management control theory if they are to succeed. Specifically, a rate-setting agency must: 1) perceive itself as "top management" of the hospitals being controlled, 2) incorporate hospital physicians into a matrix-based control structure that assigns physicians financial as well as clinical responsibilities, and 3) develop hospital budgeting and reporting systems that disaggregate costs according to their controlling forces, thereby permitting the alignment of responsibility with controllability.

Costs and Cost Analysis↗
PubMed1982

A survey of decision aids for clinicians.

Inconsistency in applying medical knowledge is a major reason for varying standards of medical care. Five types of aid have been introduced into medicine to help decision-making: questionnaires, algorithms, database systems, diagnostic systems, and, finally, computer-based decision-support systems. Of these, the most effective act as reminder or prompt systems to assist doctors without threatening their clinical freedom.

Bayes Theorem↗
PubMed1982

Medical practice, case mix, and cost containment. A new role for the attending physician.

Present political pressures for hospital cost containment appear to make some form of case-specific reimbursement system inevitable. For such a system to be able to control hospital costs effectively, however, its design must reflect the fundamental and traditional principles of management control systems. Although the diagnostic-related group (DRG) approach is the most frequently discussed form of case-mix-sensitive reimbursement, DRGs do not satisfy basic management control principles. Under a more appropriate hospital control system, however, physicians would be incorporated directly into the hospital's management structure. Consequently, to ensure that this new control system is medically as well as financially appropriate, physicians should seize the initiative in determining the standards against which their performance will be measured.

Cost Control↗
PubMed1981

Hydrogen-1 nuclear magnetic resonance study of the complexes of two diastereoisomers of folinic acid with dihydrofolate reductase.

The 1H chemical shifts for the formyl and benzoyl protons of the individual diastereoisomeres of folinic acid bound to dihydrofolate reductase have been measured. For the tightly bound biologically active 6S, alpha S isomer, the "bound" signals were assigned by using transfer of saturation methods. In this case, only one of the two rotameric states of the formyl group in folinic acid (form I) is bound to the enzyme. The H3' and H5' benzoyl protons have identical shifts in the bound state (as do the H2' and H6' protons). This equivalence is attributed to flipping of the benzoyl ring about the N10-C4' and C1'-CO bonds in the bound state. In the case of the biologically inactive 6R, alpha S isomer, both rotameric forms (I and II) bind to the enzyme. The "bound" shifts for the formyl and aromatic protons are different in the complexes with the 6S, alpha S and 6R, alpha S isomers, indicating that the pteridine ring and benzoyl moiety are binding in different environments in their enzyme complexes. The glutamic acid moiety is probably binding at the same site in the two complexes.

Lacticaseibacillus casei↗
PubMed1981

Properties of velocity-mechanosensitive neurons of the cat ventrobasal thalamic nucleus with special reference to the concept of convergence.

Neurons in the ventrobasal (VB) thalamic nucleus of lightly anesthetized cats were studied in order to analyze their discharge properties in response to controlled mechanical stimuli. Properties of the vast majority of the neuronal population largely resemble those of peripheral sensitive mechanoreceptors in their response to the velocity and, to a more limited extent, the amplitude component, of skin and hair displacement within restricted receptive fields. Detailed examination reveals some 'complex' characteristics suggestive of central integration in about 11% of VB neurons. Complex properties appear to indicate convergent input reflecting receptive field organization, the variety of velocity-related discharges and patterns of inhibition. The rarity of isolated 'surround' inhibition and the definition of what constitutes 'lemniscal' properties are discussed in the context of these and other related findings.

Afferent Pathways↗
PubMed1981

Hereford Hospital Prescribing Study: description and usefulness.

The mode of operation of a computer-based information system designed to link information about drug usage to diagnostic data is described. Details of the cost of this system are given. It is shown that the running costs are approximately £20000 per year. Examples are given of the uses made of the data collected.

Computers↗
PubMed1981

The hospital power equilibrium: an alternative view of the cost containment dilemma.

In-patient hospital costs have grown at an annual rate of 15 percent for the last fifteen years, and the cumulative impact of these increases has created tremendous political pressure to contain this growth. Yet despite numerous attempts to pinpoint the causes of this inflation-and nearly as many recommended policy approaches-the outlines of an effective cost containment program still elude us. Previous approaches to cost containment have tended to emphasize the mechanics of how hospital costs are incurred rather than seeking to explain the underlying causal factors that generate these costs. This analytic focus appears to reflect the lack of a political theory of the hospital which can comprehend the unique character of the hospital's internal decision-making process. One suitable basis for such a theory is Crozier's model of a "conflictive equilibrium." In this model, the hospital's decision-making authority is lodged in a complex power relationship which reflects the respective intra- and extra- institutional resources of its occupational groups, and particularly of physicians and administrators. This analysis of hospital behavior can both explain the hospital's reaction to present cost containment program as well as predict its response to other likely policy approaches. It also may enable us to begin to design more effective programs through which to control the financial consequences of hospital decisions.

Cost Control↗
PubMed1980

An aid to reducing unnecessary investigations.

The number of investigations carried out on patients with the same condition varies greatly. The reason is largely inappropriate investigation. The known progressive increase in the use of laboratory facilities could be slowed down if unnecessary tests were eliminated. A computer-based medical information system, house officer information system, was used to eliminate the ordering of unnecessary tests. Analysis showed that patients cared for while the system was in operation were less likely to have unnecessary tests, which lead to a saving of pound1.34 per patient in laboratory costs.

Clinical Laboratory Techniques↗
PubMed1980

House Officer Information System--HOIS.

The design and operation of a clinical information system called HOIS (House Officer Information System) is described. Information about the management of 78 common acute medical problems is available to the user from this system. An analysis is presented of the medical problems found in 631 medical in-patients. It is reported that 98% of patients had at least one of the 78 problems found in HOIS's data base, and that 82% of all problems in these patients were found in this database.

Diagnosis, Computer-Assisted↗
PubMed1980

Clinical information system for junior doctors.

The effect of a computer-based clinical information system is described. The information system, called House Officer Information and Scheduling System, was designed to guide junior medical staff in their decisions about the investigation of common medical problems. By comparing the management of similar groups of patients at two hospitals it is demonstrated that the system influences decisions concerning investigations. In particular, the least common condition reviewed was most affected.

Airway Obstruction↗