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Biomedical subjects

J J McGovern

Publications and source records attributed to J J McGovern.

16 recordsLinked to original sources
PubMed2000

A program evaluation study of a nursing home operated as a modified therapeutic community for chemically dependent persons with AIDS. Project Samaritan AIDS Services, Inc.'s Residential Health Care Facility, Highbridge Section, Bronx, NY.

An interagency evaluation of the treatment effectiveness of a speciality nursing home (NH) run as a therapeutic community (TC) for residents diagnosed with acquired immunodeficiency syndrome (AIDS) and substance abuse/dependence (SA/D) was conducted. A total of 79 chemically dependent men and women with AIDS were: (a) administered the Tennessee Self-Concept Scale (TSCS; Roid & Fitts, 1991) at initial testing (T(1)) and 8 months after their initial testing (T(2)); and (b) assessed on specific physical health indicators (i.e. , weight, CD-4 count, and viral load) and other treatment outcomes (e.g., abstinence) over the same two time periods. The TSCS results identified a valid and invalid TSCS test group and further distinguished among three subgroups of invalid responders. Significant improvements were observed from T(1) testing to T(2) testing on the TSCS, on the physical health indicators, and on other treatment outcomes. The need for additional and continued mental health services for this population was noted.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Right ventricular injury in young swine: effects of catecholamines on right ventricular function and pulmonary vascular mechanics.

Acute right ventricular (RV) injury is commonly encountered in infants and children after cardiac surgery. Empiric medical therapy for these patients results from a paucity of data on which to base medical management and the absence of animal models that allow rigorous laboratory testing. Specifically, exogenous catecholamines have unclear effects on the injured right ventricle and pulmonary vasculature in the young. Ten anesthetized piglets (9-12 kg) were instrumented with epicardial transducers, micromanometers, and a pulmonary artery flow probe. RV injury was induced with a cryoablation probe. Dopamine at 10 microg/kg/min, dobutamine at 10 microg/kg/min, and epinephrine (EP) at 0.1 microg/kg/min were infused in a random order. RV contractility was evaluated using preload recruitable stroke work. Diastolic function was described by the end-diastolic pressure-volume relation, peak negative derivative of the pressure waveform, and peak filling rate. In addition to routine hemodynamic measurements, Fourier transformation of the pressure and flow waveforms allowed calculation of input resistance, characteristic impedance, RV total hydraulic power, and transpulmonary vascular efficiency. Cryoablation led to a stable reproducible injury, decreased preload recruitable stroke work, and impaired diastolic function as measured by all three indices. Infusion of each catecholamine improved preload recruitable stroke work and peak negative derivative of the pressure waveform. Dobutamine and EP both decreased indices of pulmonary vascular impedance, whereas EP was the only inotrope that significantly improved transpulmonary vascular efficiency. Although all three inotropes improved systolic and diastolic RV function, only EP decreased input resistance, decreased pulmonary vascular resistance, and increased transpulmonary vascular efficiency.

Animals↗
PubMed1999

Bedside transseptal balloon dilation atrial septostomy for decompression of the left heart during extracorporeal membrane oxygenation.

A 10-year-old male presented with severe heart failure secondary to myocarditis. Venoarterial extracorporeal membrane oxygenation was instituted. He developed severe left heart distention with acute pulmonary hemorrhage. Balloon dilation of the atrial septum to decompress the left atrium was performed at the bedside with transesophageal echocardiographic guidance.

Cardiomyopathy, Dilated↗
PubMed1998

Increasing tidal volumes and pulmonary overdistention adversely affect pulmonary vascular mechanics and cardiac output in a pediatric swine model.

OBJECTIVES: In a pediatric swine model, the effects of increasing tidal volumes and the subsequent development of pulmonary overdistention on cardiopulmonary interactions were studied. The objective was to test the hypothesis that increasing tidal volumes adversely affect pulmonary vascular mechanics and cardiac output. An additional goal was to determine whether the effects of pulmonary overdistention are dependent on delivered tidal volume and/or positive end-expiratory pressure (PEEP, end-expiratory lung volume). DESIGN: Prospective, randomized, controlled laboratory trial. SETTING: University research laboratory. SUBJECTS: Eleven 4- to 6-wk-old swine, weighing 8 to 12 kg. INTERVENTIONS: Piglets with normal lungs were anesthetized, intubated, and paralyzed. After median sternotomy, pressure transducers were placed in the right ventricle, pulmonary artery, and left atrium. An ultrasonic flow probe was placed around the pulmonary artery. MEASUREMENTS AND MAIN RESULTS: The swine were ventilated and data were collected with delivered tidal volumes of 10, 15, 20, and 25 mL/kg and PEEP settings of 5 and 10 cm H2O in a random order. Pulmonary overdistention was defined as a decrease in dynamic compliance of > or =20% when compared with a compliance measured at a baseline tidal volume of 10 mL/kg. At this baseline tidal volume, airway pressure-volume curves did not demonstrate pulmonary overdistention. Tidal volumes and airway pressures were measured by a pneumotachometer and the Pediatric Pulmonary Function Workstation. Inspiratory time (0.75 sec), FIO2 (0.3), and minute ventilation were held constant. We evaluated the pulmonary vascular and cardiac effects of the various tidal volume and PEEP settings by measuring pulmonary vascular resistance, pulmonary characteristic impedance, and cardiac output. When compared with a tidal volume of 10 mL/kg, a tidal volume of 20 mL/kg resulted in a significant decrease in dynamic compliance from 10.5 +/- 0.9 to 8.4 +/- 0.6 mL/cm H2O (p = .02) at a constant PEEP of 5 cm H2O. The decrease in dynamic compliance of 20% indicated the presence of pulmonary overdistention by definition. As the tidal volume was increased from 10 to 20 mL/kg, pulmonary vascular resistance (1351 +/- 94 vs. 2266 +/- 233 dyne x sec/cm5; p = .004) and characteristic impedance (167 +/- 12 vs. 219 +/- 22 dyne x sec/cm5; p = .02) significantly increased, while cardiac output significantly decreased (951 +/- 61 vs. 708 +/- 48 mL/min; p = .001). Each of these effects of pulmonary overdistention were further magnified when the tidal volume was increased to 25 mL/kg. The tidal volume-induced alterations in pulmonary vascular mechanics, characteristic impedance, and cardiac output occurred to a greater degree when the PEEP was increased to 10 cm H2O. Pulmonary vascular resistance and characteristic impedance were significantly increased and cardiac output significantly decreased for all tidal volumes studied at a PEEP of 10 cm H2O as compared with 5 cm H2O. CONCLUSIONS: Increasing tidal volumes, increasing PEEP levels, and the development of pulmonary overdistention had detrimental effects on the cardiovascular system by increasing pulmonary vascular resistance and characteristic impedance while significantly decreasing cardiac output. Delivered tidal volumes of >15 mL/kg should be utilized cautiously. Careful monitoring of respiratory mechanics and cardiac function, especially in neonatal and pediatric patients, is warranted.

Animals↗
PubMed1997

The O-specific polysaccharide chain of Campylobacter fetus serotype A lipopolysaccharide is a partially O-acetylated 1,3-linked alpha-D-mannan.

A polysaccharide fraction liberated from Campylobacter fetus subsp. fetus serotype A lipopolysaccharide by mild acid hydrolysis followed by gel-permeation chromatography contained a partially O-acetylated D-mannan chain, as an O-specific polysaccharide, with a core oligosaccharide attached. The structure of the polysaccharide was studied by O-deacetylation, methylation, and 1H- and 13C-NMR spectroscopy, including computer-assisted analysis of the 13C-NMR spectrum. A structure of -->3)-alpha-D-Manp2Ac-(1--> was established as the structure of the O-specific polysaccharide, the degree of O-acetylation of the mannose residues at position 2 being estimated as 80-90%. As judged by the ratio of mannose to core constituents, the D-mannan chain consists on average of 10-12 monosaccharide units.

Acetylation↗
PubMed1997

Effects of commonly used adrenergic agonists on left ventricular function and systemic vascular resistance in young piglets.

This study compared the effects of high-dose infusions of various adrenergic agonists on cardiovascular function in piglets. We hypothesized that agonists would have different effects on systolic, diastolic, and vascular functions. Nine anesthetized 3-week-old piglets underwent cardiac catheterization. Manometric and conductance catheters measured pressures and volumes. Data were acquired at rest and during infusions of epinephrine, norepinephrine, dopamine, dobutamine, isoproterenol, and phenylephrine. End-systolic elastance, preload-recruitable stroke work, cardiac output, the maximum and minimum derivatives of left ventricular pressure, the relaxation constant tau, peak filling rate, and end-diastolic stiffness were obtained. Contractile efficiency and the cardiac output/pressure-volume area ratio were calculated. Regression was used for analysis of variance; p < 0.05 was considered significant. All agonists increased indexes of contractility. beta-Adrenergic agonists enhanced relaxation. Isoproterenol and dopamine increased efficiency. No drug changed diastolic stiffness. Therefore both alpha-adrenergic and beta-adrenergic agonists have inotropic effects in the 3-week-old piglet. Some beneficial effects of beta-agonists on cardiac output may be due to enhancement of relaxation and to afterload reduction. Various agents exert different effects on the cardiovascular system, and these differences may be clinically important.

Adrenergic Agonists↗
PubMed1996

The O-specific polysaccharide chain of Campylobacter fetus serotype B lipopolysaccharide is a D-rhamnan terminated with 3-O-methyl-D-rhamnose (D-acofriose).

An O-specific polysaccharide was liberated from Campylobacter fetus subsp. fetus serotype B lipopolysaccharide by mild acid hydrolysis followed by gel chromatography. This polysaccharide was found to contain D-rhamnose and 3-O-methyl-D-rhamnose (D-Rha3Me, D-acofriose) in a ratio of approximately 24:1, as well as lipopolysaccharide core constituents. The structure of the polysaccharide was studied by 1H-NMR and 13C-NMR spectroscopy, which included two-dimensional COSY, rotating-frame NOE spectroscopy (ROESY), and computer-assisted analysis of the 13C-NMR spectrum. Methylation analysis using [2H3]methyl iodide and Smith degradation followed by GLC/MS of the derived acetylated oligosaccharide-alditols was used to determine the location of D-acofriose. The O-specific polysaccharide is linear, consists on average of 12 disaccharide repeating units, and is terminated by a residue of D-acofriose. The following structure of the D-rhamnan chain was established: [sequence: see text]

Campylobacter fetus↗
PubMed1990

Medical waste regulations.

Medical waste generators are subject to federal and state waste tracking and reporting regulations. Failure to comply with regulations can result in the imposition of significant penalties.

Humans↗
PubMed1983

Food and chemical sensitivity. Clinical and immunologic correlates.

Six allergic patients and six normal controls were studied serologically before and after provocative challenge with allergic substances. The patients showed impaired modulation of the immune system prior to challenge. The challenge blood changes in patients with adverse clinical responses were consistent with type 1 and/or type 3 immune responses. Normal controls showed no abnormal laboratory or clinical changes. The data support the hypothesis that an abnormal immune reaction develops in allergic patients who sustain an adverse clinical response to ingestion of foods or inhalation of chemicals to which they are sensitive.

Adult↗
PubMedDate not supplied

Revise or preserve? A flurry of views on revision of tax-exemption standards.

Many groups would be affected if Congress changes the tax laws governing not-for-profit hospitals. The community benefit standard now in place focuses on nondiscriminatory treatment of patients whose care is paid for by public programs such as Medicaid. It also fosters universal access to emergency care regardless of ability to pay. In 1990, however, a U.S. General Accounting Office (GAO) report suggested that if Congress believes tax-exempt hospitals should provide more charity care, it should consider revising the criteria for exemption. This created a flurry of responses from the groups that would be affected. In response to the GAO's report, Rep. Edward R. Roybal, D-CA, introduced H.R. 790, and Rep. Brian J. Donnelly, D-MA, introduced H.R. 1374, bills linking tax exemption to charity care. The Roybal bill requires not-for-profit hospitals to have an open-door policy for Medicare and Medicaid patients and to provide services to a reasonable number of these patients. The Donnelly bill would in essence codify the IRS's interpretation of the community benefit standard and add to it a charity care requirement. The administration reported it was opposed to a change from the current community benefit standard to an express charity care standard. Nevertheless, it would not oppose a more limited change that codifies the current position. Not-for-profit hospitals have opposed any changes, arguing that the existing community benefit standard is sufficient and that the decision of how to benefit the community should be made by an individual hospital and its community.

Charities↗