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Biomedical subjects

M D Murphy

Publications and source records attributed to M D Murphy.

36 records · Page 2Linked to original sources

Metamemory in older adults: the role of monitoring in serial recall.

Older and younger adults were asked to think aloud while studying sets of pictures matched in difficulty for immediate serial recall. When instructed only to remember, young adults tended to study longer, rehearse more, and recall better than did older adults on the most difficult lists. Young adults were also much more likely to spontaneously test themselves during study in the most difficult condition. Older adult groups instructed either to study longer or to self-test, both showed improved recall. Only the older adults who had been instructed to self-monitor, however, recalled better on tests of short-term maintenance and generalization; overt rehearsal data showed that these older adults continued to test themselves. Metamemory deficits may be present with older adults when a strategy, like self-testing, is needed to generate metamemorial knowledge. Strategies such as self-testing can be easily taught, however, and they hold promise of being useful across situations.

Aged↗

Illness with fatalities in premature infants: association with an intravenous vitamin E preparation, E-Ferol.

Three clusters of an unusual syndrome in premature infants were investigated in three intensive care nurseries in 1984. A retrospective cohort study of 68 infants weighing less than or equal to 1,250 g at birth and surviving at least 72 hours revealed that in 13 infants ascites developed and in four at least two of the following abnormal laboratory values were found within a seven-day period: serum direct bilirubin greater than or equal to 2 mg/dL, blood urea nitrogen greater than or equal to 40 mg/dL or serum creatinine greater than or equal to 2 mg/dL, and platelet count less than or equal to 60,000/microL. All cases occurred after the introduction and use of intravenous E-Ferol, a vitamin E preparation that was new on the market when the clusters were reported. All 17 case infants but only 23 of 51 (45%) noncase infants received E-Ferol (P less than .0001). Case and noncase infants were similar with respect to other complications and to receipt of medications and parenteral nutrition. A dose-response relationship was found; cases occurred in infants receiving E-Ferol dosages of greater than 20 U/kg/d. Case infants who had higher daily doses of E-Ferol had a shorter latency. No new cases were reported after use of E-Ferol was stopped. Results of these investigations led to a nationwide recall of intravenous E-Ferol.

Adult↗

Enzyme-linked immunosorbent assay for evaluation of immunity to measles virus.

An enzyme-linked immunosorbent assay for the determination of immunity to measles virus was developed and standardized; it was compared to the hemagglutination inhibition and plaque reduction neutralization methods for sensitivity and specificity. The conditions of the enzyme-linked immunosorbent assay were adjusted such that groups of susceptible and immune individuals were clearly separable on the basis of the reactivity of a single (1:100) dilution of their sera to viral and control antigens. The range of values corresponding to susceptibility and immunity was defined by using the distribution of values observed from testing sera obtained from susceptible and immune control groups. The enzyme-linked immunosorbent assay was then applied in a study of measles vaccinees and found to be more sensitive than the hemagglutination inhibition method and equal in sensitivity to the plaque reduction neutralization method. The three methods were equal in specificity. Thus, the measles virus enzyme-linked immunosorbent assay is a rapid, reproducible, sensitive, and specific method for screening for the presence of measles antibody.

Adult↗

Effect of early immunization on antibody response to reimmunization with measles vaccine as demonstrated by enzyme-linked immunosorbent assay (ELISA).

A measles epidemic in San Antonio, Texas provided a population of children who were immunized at less than or equal to 10 months of age and reimmunized at greater than or equal to 15 months of age. Of these children, 302 were evaluated for measles antibody by the sensitive enzyme-linked immunosorbent assay (ELISA), and their responses were compared with those of 300 children who had been immunized at the customary time (greater than or equal to 15 months) with a single immunization. There were only five seronegative findings in each group. The children immunized at the customary time did have significantly higher (P less than .001) antibody titers than the children immunized at less than or equal to 10 months and reimmunized at greater than or equal to 15 months. These results indicate that early immunization followed by reimmunization may be indicated when young infants are at significant risk of measles exposure. This approach should not create an increased number of serologically nonresponsive children when reimmunized at greater than or equal to 15 months.

Age Factors↗

Antibody response following measles-mumps-rubella vaccine under conditions of customary use.

A study of 301 children who had been immunized two to 19 months previously with measles, mumps, and rubella (MMR) vaccine at 36 different sites in San Antonio, Tex, including physicians' offices and clinics, revealed that 99.7% had antibody against rubella and 98.3% had antibody against measles and mumps. None of the 49 infants who were tested prior to receipt of MMR vaccine had antibody against any of these viruses, indicating that the antibody found after immunization was unlikely to be due to false-positive results. The lack of antibody in these infants confirmed that there had not been a significant number of cases of these diseases that could contribute to the high frequency of antibody found after immunization. A single dose of MMR vaccine administered under customary conditions appears to be an effective method of conferring immunity against these diseases.

Antibodies, Viral↗

Evaluation of the pertussis components of diphtheria-tetanus-pertussis vaccine.

The adjuvant and antigen components of the pertussis fraction of diphtheria-tetanus-pertussis (DTP) vaccine were evaluated. Four preparations of DTP vaccine composed of either whole cell (Wc) or extracted (E) pertussis antigen combined with either an aluminum phosphate (Ph) or alum (Al) adjuvant were compared. Local reactions were similar in all four vaccines after the first two immunizations but were significantly increased in incidence and severity following the third immunization with vaccine WcPh. This appeared to be due to the Ph adjuvant rather than the antigen component. Febrile reactions were experienced more often (P = .0009) and with higher temperatures (P = .0001) with the WcPh vaccine following the first immunization. This appeared to be due to the Wc component. Comparing the pooled Wc groups with the pooled E groups revealed a greater febrile response in the Wc group after both the first (P = .0008) and the second (P = .03) immunization. Local reactions appear temporally and etiologically to be distinct from febrile reactions. The pooled Wc antigen group produced a higher geometric mean titer than the pooled E antigen group (P = .05). Serologic responses, with respect to geometric mean titer, were not significantly different among the individual vaccines. This study suggests that the combination of whole cell and aluminum phosphate, which is currently in use in the United States, is probably not the optimal formulation for pertussis vaccine.

Adjuvants, Immunologic↗

Metamemory in the aged.

College age (mean age 20 years) and older adults (mean age 69 years) were asked to predict their memory spans and to indicate readiness to recall sets of line drawings in Experiment 1. Although no age differences were found in span prediction accuracy, clear differences were obtained in recall readiness. When given unlimited study time with sets of items matched in difficulty, young adults chose to study longer and then recalled more accurately than did older adults. In Experiment 2 the recall of a chunking and rehearsal trained group of older adults was better than that of a control group given standard instructions. However, the best recall was obtained in a group required to take extra study time but given no strategy training. The older adult recall readiness deficit may thus not have been due to lack of available memory strategies. Instead, we hypothesize that older adults may have failed to monitor their readiness to recall so that they did not know how long to study.

Aged↗

Training older adult free recall rehearsal strategies.

Three groups of older adults (mean age 72.1 years) were compared on a free recall task with categorizable lists. The nine females and two males in each group were instructed to rehearse overtly while studying. A group instructed to rehearse by category showed higher levels of free recall and category organization than either a control group instructed only to remember or a group instructed to rehearse actively at study. Strategy instructed subjects' rehearsal was organized serially early in a list and then categorically organized for the remainder of a list. Activity instructed subjects showed a high number of same-item repetitions but adopted no clear pattern of strategic category rehearsal. Control subjects' rehearsal was essentially inactive and nonstrategic, mainly consisting of single mentions of each list item and an associate. These data show that older adults' memory performance is modifiable and that efficient performance is obtained when instructional training is aimed at the processes that are crucial to task performance. Direct strategy measures, such as those used as here, yield important information about the processes underlying age differences in memory and can aid greatly in the design of training aimed at exploring older adult potential.

Aged↗

Age differences in free recall rehearsal strategies.

Younger (mean age = 23.9 years) and older (mean age = 73.9 years) adults were compared on a free recall task with lists of categorizable words. One-half of the subjects were given instructions to rehearse overtly during list study, and the remainder received standard (covert) instructions. Relative to covert rehearsal, overt rehearsal did not appear to affect the type of study strategy used by subjects. Age differences in free recall and category clustering were found, paralleled by clear age differences in rehearsal strategies. Young adults' rehearsal was active, serially organized early in a list, and then categorically organized for the rest of a list. Older adults' rehearsal was inactive and essentially nonstrategic, consisting mostly of single mentions of each list item. These results also show that direct strategy measures provide more information about the processes underlying age differences in memory than do outcome measures alone.

Adult↗

Series: infectious diseases and the office laboratory. Office laboratory diagnosis of sexually transmitted diseases.

The office laboratory can be a tremendous resource for the physician. This is particularly true in the evaluation of STD, where many simple procedures may provide at least a preliminary diagnosis. Instead of waiting for more expensive culture results, the physician can make the diagnosis of Candida, Trichomonas or Gardnerella in the female and N. gonorrhoeae in the male, while the patient is in the office. Cultures for N. gonorrhoeae can be, with the use of the Phadebact or newer enzymatic sugar tests, completed in the office. This, however, is not recommended for an office which performs this test infrequently, because quality control procedures and known positives and negatives which should be incorporated into these procedures are often neither practical nor readily available. The wrong diagnosis in the area of STD leads not only to medical mismanagement but also to tremendous emotional and personal trauma. A good working relationship with a referral laboratory will augment the care and services you and your office laboratory can offer to the patient.

Adolescent↗

A clinical laboratory program to improve performance of resident physicians.

In summary residents entering our program lacked many basic clinical laboratory skills. Without an organized curriculum in this area, residents make marginal or no gains in competence. A clinical laboratory program which is accessible and clinically relevant does influence residents' knowledge and skills. Whether supervised performance of tests or didactic teaching was responsible for improved test results in our residents remains to be determined. This is important to determine because of the financial restraints of most programs and the demands already present on most residents' time.

Clinical Laboratory Techniques↗