Generalised peritonitis complicating diverticulitis of the sigmoid colon.
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Adult↗
Biomedical subjects
K A Moore
Publications and source records attributed to K A Moore.
Assessment of the acuteness of heroin deaths from the analysis of multiple blood specimens.
Data was compiled from 126 morphine-involved cases investigated by the Office of the Chief Medical Examiner, State of Maryland, USA. An investigation was conducted into whether comparison of morphine concentrations from a central and peripheral site could be used to determine whether a morphine death was acute or delayed. Fifty cases were identified as 'acute' because the urine free morphine concentration by radioimmunoassay (RIA) was less than 25 ng/mL; 76 cases were classified as 'random' because they had a urine morphine concentration greater than 25 ng/mL by RIA. The average heart blood to peripheral blood morphine concentration ratio in the acute deaths was 1.40. The average heart blood to peripheral blood morphine concentration ratio in the random deaths was 1.18. Because there was considerable overlap between the two groups of data, the authors conclude that it was not possible to predict 'acute' opiate intoxication deaths versus 'delayed' deaths when the only information available is heart and peripheral blood free morphine concentrations.
Drug Overdose↗
Alcohol concentration and the ability to form intent.
The ability to form intent to commit a particular act is often a significant issue in criminal litigation. Often, a complicating factor in the resolution of this issue is the presence of ethanol and drugs in the individual whose motives are to be ascertained. To determine whether an intoxicating blood ethanol concentration (BAC) in the absence of other information is sufficient to establish intent, we reviewed cases investigated by the Office of the Chief Medical Examiner, State of Maryland over a two-year period. Specifically, we identified cases of suicide with a suicide note, the presence of ethanol and the absence of other psychoactive drugs. The BACs ranged from 0.01 to 0.37 g/dL. The average BAC was 0.14 g/dL and the median BAC was 0.13 g/dL. Twenty-five of the 37 cases had a BAC greater than 0.08 g/dL. We conclude that a BAC alone is not sufficient to determine the capability of an individual to form intent to commit a particular act.
Alcohol Drinking↗
alpha-Benzyl-N-methylphenethylamine (BNMPA), an impurity of illicit methamphetamine synthesis: I. Physical characterization and GC-MS analysis of BNMPA and anticipated metabolites in urine.
alpha-Benzyl-N-methylphenethylamine (BNMPA) is an impurity of illicit methamphetamine synthesis. We synthesized BNMPA and three of its anticipated metabolites: N-demethyl-alpha-benzyl-phenethylamine, 1,3-diphenyl-2-propanone, and 1,3-diphenyl-2-propanol. The purity and structure of these compounds and their heptafluorobutyric anhydride (HFBA) derivatives were confirmed by melting point, gas chromatography-mass spectrometry (GC-MS), and nuclear magnetic resonance. A GC-MS method to detect these compounds in urine, using liquid-liquid extraction and derivatization with HFBA, was developed. Interference studies showed BNMPA and its proposed metabolites to be well-resolved from other common phenethylamine drugs and Health and Human Services-Forensic Urine Drug Testing required analytes. The limit of detection of BNMPA and its metabolites was 2.5 ng/mL; the limit of quantitation (LOQ) of the four compounds was 25 ng/mL. The calibration curves were generally linear from 25 to 500 ng/mL. Typical within-run coefficients of variation (CVs) at the LOQ ranged from 13 to 20% (n = 8). Between-run CVs over 1 month at 25 ng/mL were from 9 to 28%, and at 500 ng/mL, they were from 2.6 to 3.9%. The detection of BNMPA or its metabolites in urine samples may provide a marker of use of illicitly synthesized methamphetamine.
Aluminum↗
alpha-Benzyl-N-methylphenethylamine (BNMPA), an impurity of illicit methamphetamine synthesis: II. Metabolism and urinary excretion (human).
Methamphetamine is a popular drug of abuse, which is readily synthesized in clandestine laboratories. Illicit synthesis results in the formation of various contaminants. Few impurities have been studied in vivo, and their metabolic fate is unknown. One such impurity is alpha-benzyl-N-methylphenethylamine (BNMPA). The detection of BNMPA or its metabolites in urine samples may provide a marker of use of illicitly synthesized methamphetamine. Benzphetamine is structurally similar to BNMPA. Based on metabolic studies of benzphetamine, we predicted the four major metabolites of BNMPA to be the N-demethyl compound, diphenyl-2-propanone (DP2P), p-hydroxy-N-demethyl BNMPA, and p-hydroxy-BNMPA. One male volunteer ingested 5 mg BNMPA. Seventeen urine specimens were collected over 50 h post ingestion. These specimens were analyzed for BNMPA and its four predicted major metabolites by gas chromatography-mass spectrometry following beta-glucuronidase hydrolysis or acid hydrolysis, liquid-liquid extraction, and derivatization with heptafluorobutyric anhydride. Specimens were also analyzed without hydrolysis to determine the abundance of nonconjugated ("free") metabolites. Only trace amounts of BNMPA and its N-demethyl metabolites were detected, and maximum excretion was from 2 to 4 h post ingestion. In the nonhydrolyzed samples, the phenyl-OH metabolites were also present in only trace amounts. Maximum excretion of DP2P was at 2 h. Following either hydrolysis procedure, phenyl-OH-BNMPA and phenyl-OH-N-demethyl BNMPA were the major metabolites detected. Maximum excretion of these two metabolites occurred at 4 h. With the exception of the parent compound and the N-demethyl metabolite, excretion of metabolites was greater than the limit of detection of this procedure (2.5 ng/mL) up to 21 h post ingestion. Metabolites were detectable in sufficient quantities to serve as an adequate marker of illicit methamphetamine consumption within the preceding 24 h.
Benzphetamine↗
alpha-benzyl-N-methylphenethylamine (BNMPA), an impurity of illicit methamphetamine synthesis: III. Detection of BNMPA and metabolites in urine of methamphetamine users.
Eighty urine specimens collected from drug rehabilitation programs, which had been screened by immunoassay and confirmed positive by gas chromatography-mass spectrometry (GC-MS) for methamphetamine, were further analyzed for alpha-benzyl-N-methylphenethylamine (BNMPA) and its urinary metabolites, N-demethyl-BNMPA, diphenyl-2-propanone (DP2P), diphenyl-2-propanol, p-OH-N-demethyl-BNMPA, and p-OH-BNMPA. BNMPA is an impurity of illicit methamphetamine synthesis. Analysis of BNMPA and its metabolites was performed by quantitative GC-MS following beta-glucuronidase hydrolysis, liquid-liquid extraction, and derivatization with heptafluorobutyric anhydride. Two urine specimens contained detectable amounts of BNMPA and/or its metabolites. One contained trace amounts (greater than the limit of detection but less than the limit of quantitation) of N-demethyl-BNMPA and DP2P, as well as 0.04 mg/L p-OH-N-demethyl-BNMPA. The other contained trace amounts of BNMPA, p-OH-BNMPA, and p-OH-N-demethyl-BNMPA, as well as 0.03 mg/L N-demethyl-BNMPA. Prior to analyzing these urine specimens, pure reference material of p-OH-BNMPA was made available, and analysis confirmed our previous tentative identification of p-OH-BNMPA as a major metabolite of BNMPA. Detection of BNMPA or its metabolites in biological samples may serve as a marker of illicit methamphetamine administration.
Amphetamine↗
Nonvoluntary sexual activity among adolescents.
Data from the 1987 round of the National Survey of Children indicate that seven percent of Americans aged 18-22 have experienced at least one episode of nonvoluntary sexual intercourse. Women were more likely than men to report having had such an experience, with just under half of all nonvoluntary experiences among women occurring before the age of 14. Multiple classification analysis reveals that white women who had lived apart from their parents before age 16, those who had been brought up in poverty, those who had had a physical, emotional or mental limitation when they were young, those whose parents had been heavy drinkers, those whose parents had used illegal drugs and those whose parents had smoked cigarettes when they themselves were teenagers were at significantly greater risk for experiencing sexual abuse. Six percent of young white women with no risk factors, nine percent of those with one, 26 percent of those with two, and 68 percent of those with three or more had been sexually abused before or during adolescence.
Adolescent↗
Teenage motherhood: its social and economic costs.
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Adolescent↗
Teenage childbirth and welfare dependency.
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Adolescent↗
Teenage childbearing and welfare: preventive and ameliorative strategies.
The results of seven computer simulations suggest that strategies to prevent teenage childbearing may be more effective in reducing the number of young women who require welfare assistance than are strategies to improve the circumstances of teenagers who have already given birth. The first simulation constitutes a baseline projection, in which current levels and patterns of adolescent childbearing are assumed to continue to 1990. Three "preventive" simulations assume that no births or fewer births occur among teenagers during the projection period; and three "ameliorative" simulations assume that changes occur in the completed family size, marriage rate and educational attainment of teenage childbearers. Compared with the baseline projection, the three preventive strategies are estimated to reduce by 22-48 percent the number of adolescent childbearers who, as 20-24-year-olds in 1990, will be receiving welfare payments; the three ameliorative strategies cause only a 6-12 percent drop. The strategy with the least impact is the education scenario, in which adolescent mothers are assumed to be no more likely to drop out of school than are other comparable teenagers. The primary reason for the surprisingly small effect appears to be the relatively low earnings of women--even when they are high school graduates. All of the experimental scenarios tested, however, bring about at least some reduction in projected government spending for the three major public assistance programs considered (Aid to Families with Dependent Children, Medicaid and Food Stamps).
Adolescent↗
Long-term results of combined heart-lung transplantation: the Stanford experience.
We assessed the long-term results of our experience with 109 patients with end-stage cardiopulmonary disease who underwent primary combined heart-lung transplantation at Stanford University Medical Center between March 1981 and January 1994. Average recipient age was 31 +/- 10 years (mean +/- standard deviation) median, 31 years; range, 1 month to 52 years. Recipient diagnoses included primary pulmonary hypertension (31%), Eisenmenger's syndrome (39%), complex congenital heart disease (8%), cystic fibrosis (14%), bronchiectasis (2%), and emphysema (3%). Immunosuppression was with cyclosporine and a tapering regimen of corticosteroids. In 1986 azathioprine was added, and since 1987 induction therapy with OKT3 has been employed. Actuarial survival rates at 1, 5, and 10 years were 68% +/- 4.6%, 43% +/- 5.4%, and 23% +/- 8.1%, respectively (mean +/- 1 standard error of the mean). Fourteen deaths occurred in the hospital for an operative mortality rate of 12.8% +/- 3.3%, and 61 deaths occurred overall. Causes of death included hemorrhage (five patients), infection (21), rejection (one), nonspecific pulmonary failure (four), graft coronary artery disease (six), and obliterative bronchiolitis (eight). Infection, rejection, and obliterative bronchiolitis were the major complications. Only 20% +/- 3.9% of patients were free from any infection 3 months after transplantation. Heart and lung rejection commonly occurred asynchronously; actuarial estimates of freedom from isolated lung rejection at 1 and 5 years were 47% +/- 5.2% and 40% +/- 5.6%, respectively. For simultaneous heart and lung rejection these estimates were 87% +/- 3.5% and 86% +/- 3.8%, and for isolated heart rejection 63% +/- 5.1% and 51% +/- 6.4%, respectively. Although graft coronary artery disease developed less frequently than in patients after isolated heart transplantation (90% +/- 4.6% of patients were free of graft coronary artery disease at 5 years), obliterative bronchiolitis remains a major long-term complication and cause of morbidity and mortality. Actuarial estimates of freedom from obliterative bronchiolitis at 1, 5, and 10 years were 71% +/- 5.1%, 51% +/- 6.1%, and 42% +/- 7.8%, respectively. These results show satisfactory early and medium-term outcome after combined heart-lung transplantation but also underscore that much progress is needed in controlling infection, rejection, and obliterative bronchiolitis, all of which remain as major impediments to long-term survival.
Actuarial Analysis↗
Elderly outpatients respond favorably to a physician-initiated advance directive discussion.
BACKGROUND: Little is known about the emotional impact of physician-initiated advance directive discussions. METHODS: One hundred ambulatory patients aged 65 years and older were randomly assigned to receive either a physician-initiated discussion of advance directive choices of a discussion of health promotion issues. Prediscussion, immediate postdiscussion, and 1-week postdiscussion measures of positive and negative affect were measured for both groups. RESULTS: Neither discussion topic resulted in adverse emotional or attitudinal responses. Only the advance directive participants showed positive affective and attitudinal responses to the discussion, including an increase in positive affect, an increased sense of physician-patient understanding, and increased thought and discussion about life-support issues in the week following the discussion. For those participants receiving the advance directive discussion, longer physician-patient relationships and higher educational levels significantly predicted a more positive affective response. Lower scores on indices of mental and physical health and a stronger belief that physicians should discuss advance directive issues significantly predicted a more negative affective response to the advance directive discussion. CONCLUSIONS: Physicians should anticipate positive emotional responses when they initiate advance directive discussions with their elderly outpatients. Advance directive discussions will be received most positively by patients who enjoy good psychological and physical health and when initiated in the context of an established physician-patient relationship.
Advance Directives↗
The effect of government policies on out-of-wedlock sex and pregnancy.
Neither the level of AFDC benefits nor the AFDC acceptance rate appear to serve as economic incentives to out-of-wedlock childbearing; nor does the availability of contraception and abortion seem to encourage teenagers to initiate sexual activity. However, the availability of subsidized family planning services does apparently lower pregnancy rates, especially among black teenagers; and the availability of abortion seems to reduce substantially the incidence of out-of-wedlock childbearing, especially among whites.
Abortion, Legal↗
Early childbearing and educational attainment.
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Achievement↗