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Biomedical subjects

M H Williams

Publications and source records attributed to M H Williams.

At least 19 recordsLinked to original sources
PubMed1992

Exploitation and inference. Mapping the damage from therapist-patient sexual involvement.

A growing body of evidence documents a clinical pattern of harmful effects of therapist-patient sexual involvement. In addition, surveys suggest that 1 to 12% of all therapists may have engaged in this behavior at least once in their careers. In order to develop a more comprehensive research agenda, several of these studies are reviewed in terms of inferences that may or may not be drawn. Case studies and surveys may provide for inference of clinical harm and syndrome, but they are limited in terms of generalizations about incidence in the overall population. A population approach coupled with case sampling may provide a useful tool by which to approximate a minimum level of incidence and of effects.

Adaptation, Psychological↗
PubMed1992

Ergogenic and ergolytic substances.

Genetic endowment and proper training are the major factors contributing to athletic success in endurance and ultraendurance events. Proper nutrition, primarily adequate carbohydrate and fluid, prior to and during the event is also critical. Endurance athletes often utilize other nutritional substances or practices, often referred to as ergogenics, in attempts to obtain a competitive edge by enhancing energy utilization and delaying the onset of fatigue. Numerous nutritional ergogenics have been used in attempts to enhance endurance performance, but with several exceptions most have been shown to be ineffective, including bee pollen, L-carnitine, CoQ10, inosine, amino acids, alkaline salts, and vitamin E at sea level. Research findings are equivocal relative to the ergogenicity of caffeine, phosphate salts, and vitamin E at altitude. Loss of excess body fat, a nutritional practice, may be an effective ergogenic. Conversely, some agents such as alcohol may impair performance, an ergolytic effect. Additional research is necessary to support the efficacy of several nutritional ergogenics to enhance prolonged endurance performance, such as caffeine, phosphates, specific amino acids, and various commercial products. Such research should involve exercise tasks comparable in intensity and duration to that experienced in the marathon and similar endurance events.

Amino Acids, Branched-Chain↗
PubMed1992

The involvement of schizophrenic insanity acquittees in the mental health and criminal justice systems.

This article described the mental health and criminal justice involvement of a large group of schizophrenic insanity acquittees and the program designed to manage and treat these individuals. Most insanity acquittees in our system are chronically mentally ill individuals who fit well into the psychosocial rehabilitation models that have developed over the past 15 years. In addition, the use of conditional release and monitored care in the community appears to be the most realistic approach to this group of individuals who show a high degree of involvement with the mental health and criminal justice service systems. This research has continued implications for the development of outpatient civil commitment and for the attempt to give people as much liberty as they are capable of handling while being realistic about their capacities to survive in the community.

Adolescent↗
PubMed1991

In vitro and in vivo effects of a peptide mimetic (SC-47643) of RGD as an antiplatelet and antithrombotic agent.

Platelet aggregation requires binding of fibrinogen (fgn) to activated platelets and inhibition of this binding blocks platelet aggregation. Synthetic peptides modeled after the platelet binding sequence on fgn block the platelet glycoprotein IIb/IIIa receptor and effectively inhibit aggregation. SC-47643 (SC) is a mimetic of the RGD-containing peptide sequence that is recognized by the platelet IIb/IIIa receptor. SC inhibited fgn binding to activated platelets (IC50: 1.0 x 10(-5) M) and prevented platelet aggregation in response to a variety of platelet agonists in both washed human platelets and platelet rich plasma (IC50's ranging from 4 x 10(-6) to 1 x 10(-5) M, respectively). SC inhibited collagen induced thrombocytopenia in the rat (ED50 0.07 mg/kg and t1/2 36 min). In dogs ex vivo collagen induced platelet aggregation was inhibited 50% after a bolus injection of 1.7 mg/kg. After a steady state infusion (2 hr), the ED50 was 0.03 mg/kg/min, with no effects on blood pressure, heart rate or platelet count. These data demonstrate that SC, a peptide mimetic of the natural fgn binding sequence, is capable of blocking platelet-fgn interactions and platelet aggregation.

Amino Acid Sequence↗
PubMed1991

High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma.

BACKGROUND: Despite oral corticosteroid therapy, some patients with asthma have frequent exacerbations requiring emergency room visits, hospitalization, and occasionally, mechanical ventilation. We compared the effects of high-dose intramuscular triamcinolone with oral prednisone in patients with severe chronic asthma. METHODS: In a double-blind, placebo-controlled, cross-over study that spanned all seasons, we treated 12 patients with high-dose intramuscular triamcinolone (360 mg over the first three days of the treatment period) or low-dose oral prednisone (median dose, 12.5 mg per day throughout the period; range 0 to 30). The two three-month treatment periods were separated by a three-month washout period. During all periods the patients were allowed to take additional doses of prednisone for acute exacerbations of asthma. RESULTS: After receiving triamcinolone, the patients had significantly better peak expiratory flow rates than while receiving prednisone (the average [+/- SEM] weekly percent of the predicted value during the triamcinolone period was 91.5 +/- 6.9, as compared with 75.0 +/- 5.9 for the prednisone period; P less than 0.05). During the prednisone period there were 21 emergency room visits and 10 hospitalizations, but there were none during the triamcinolone period (P less than 0.05). There were two episodes of ventilatory failure during the prednisone period. Total steroid doses were significantly smaller during the triamcinolone period than during the prednisone period (P less than 0.04). Steroidal side effects were more pronounced after treatment with triamcinolone than after treatment with prednisone (P less than 0.1). CONCLUSIONS: We conclude that high-dose intramuscular triamcinolone is more effective than low-dose prednisone in patients with severe, chronic, life-threatening asthma, but steroidal side effects are somewhat worse.

Administration, Oral↗
PubMed1991

Psychiatric consultation to a state board of medical examiners.

This article describes the evolution of psychiatric consultation to the Oregon Board of Medical Examiners. The board is charged with the licensing and regulation of physicians in the state of Oregon in order to protect the public and uphold the standards of the medical profession. Psychiatric consultation has focused on the board's investigations of physicians with mental illness and/or substance abuse and physicians who inappropriately prescribe psychoactive drugs or sexually abuse patients. Each of these physician groups is described, and remedial programs for each group are discussed. The authors conclude that psychiatric consultation to medical boards is a feasible and productive activity that can make a positive contribution to the lives of a large number of physicians and patients.

Drug Prescriptions↗
PubMed1991

Monitored conditional release of persons found not guilty by reason of insanity.

This article reviews the recent literature documenting changes that have taken place in the management and treatment of insanity defense acquittees with the development of conditional release and monitored community treatment. The review demonstrates that conditional release is particularly important as a means of balancing the protection of society with the treatment of insanity defense acquittees in the least restrictive environment. The review also highlights the development of community programs based on treatment models for the chronically mentally ill. In addition, monitored community treatment programs appear cost-effective when compared with hospital-based programs. These factors point to the development in the 1990s of program standards for the release of insanity defense acquittees.

Civil Rights↗
PubMed1991

A biopsychosocial examination of symptomatic and asymptomatic HIV-infected patients.

This study evaluated twenty-nine symptomatic and asymptomatic HIV-infected homosexual/bisexual men between eighteen and forty-five in the areas of psychiatric/psychosocial, neuropsychological, family, and immunological functioning. The subjects were referred by physicians, nurses, and mental health professionals from the Tulane/Louisiana State University AIDS Clinical Trials Unit and the C-100 outpatient Primary Care Clinic for HIV-infected patients served within the Charity Hospital of Louisiana at New Orleans. All subjects and their significant others were evaluated between November 1987 and October 1988 at the C-100 Clinic. The outcome measures were mood disturbance, psychological distress, and CD4 cell count. The most significant other family member, as selected by each subject, completed family measures. The subjects experienced psychological distress and neuropsychological problems. Active-behavioral coping appeared adaptive (related to enhanced mood) as did perceived social support (related to positive mood and lower psychological distress). Higher levels of neuropsychological functioning (verbal memory, visual memory, motor speed, and visual-motor sequencing) were associated with enhanced psychosocial functioning and/or immunological status. The findings from this study highlight the importance of conducting longitudinal studies using a multidimensional approach in which HIV-infected persons and their most significant other family members are evaluated within a biopsychosocial model.

AIDS Dementia Complex↗
PubMed1991

Antiplatelet and antithrombotic effects of platelet glycoprotein IIb/IIIa (GPIIb/IIIa) inhibition by arginine-glycine-aspartic acid-serine (RGDS) and arginine-glycine-aspartic acid (RGD) (O-me)Y (SC-46749).

Arginine-glycine-aspartic acid (RGD) is the minimal sequence in fibrinogen that leads to recognition and binding to the glycoprotein IIb/IIIa platelet receptor during aggregation. Analogs of tetrapeptides containing the RGD sequence have been previously shown to block fibrinogen binding to activated platelets in vitro. SC-46749 is an analog of arginine-glycine-aspartic acid-phenylalanine in which the phenylalanine is replaced by O-methyltyrosine. In this study the biological activities of SC-46749 were examined and its actions compared with the tetrapeptide arginine-glycine-aspartic acid-serine (RGDS), one of the natural sequences on the fibrinogen alpha chain that binds to platelets. In vitro, SC-46749 was more potent than RGDS in inhibiting fibrinogen binding (IC50: SC-46749, 27 microM; RGDS, 47 microM), in preventing ADP-induced aggregation in human platelet-rich plasma (IC50: SC-46749, 32 microM; RGDS, 95 microM) and in inhibiting thrombin-induced aggregation in washed human platelets (IC50: SC-46749, 23 microM; RGDS, 64 microM). In rats, SC-46749 prevented collagen-induced thrombocytopenia with an ED50 of 0.87 mg/kg whereas RGDS did not inhibit the response by 50% at doses up to 10 mg/kg. SC-46749 inhibited thrombus formation in an electrically damaged rat carotid artery in a dose-dependent fashion whereas the effects of RGDS were biphasic. RGDS appeared to delay thrombus formation at lower doses but had no effect at higher doses. When infused in dogs for 15 min, SC-46749 prevented ex vivo collagen-induced aggregation at 4 mg/kg/min. These data demonstrate that SC-46749 is a potent inhibitor of platelet aggregation and platelet-dependent thrombus formation.

Animals↗
PubMed1991

Relationship of coping style to affective state and perceived social support in asymptomatic and symptomatic HIV-infected persons: implications for clinical management.

The authors describe the relationship of three coping styles to affective state (mood) and perceived social support in 29 human immunodeficiency virus (HIV)-infected homosexual/bisexual men between the ages of 18 and 45 years. Active-behavioral coping was significantly related to enhanced mood and greater perceived social support. Avoidance coping was significantly related to greater mood disturbance and lower social support. No relationships were found for active-cognitive coping. Recommendations for clinical management of HIV-infected persons and their traditional and/or nontraditional family follow from the findings.

Acquired Immunodeficiency Syndrome↗
PubMed1990

What is sarcoidosis?

Explore the source record for details and available documents.

Adrenal Cortex Hormones↗
PubMed1990

Asthma: the pulse is not the paradox.

Some interesting, unusual features of asthma are discussed: that patients may be better able to evaluate the severity of their asthma than physicians; that expiratory obstruction indirectly increases the work of inspiration; that 1 of the responses to airflow obstruction is hyperventilation; that localized areas of airflow obstruction may cause increased ventilation/perfusion ratios by decreasing perfusion more than ventilation; that increasing tidal volume may cause a reduction in alveolar ventilation; and, finally, that there is evidence that asthma has worsened in recent years, despite advances in the understanding and treatment of this disease.

Airway Obstruction↗
PubMed1990

The pregnant psychiatric inpatient: a missed opportunity.

The authors describe a group of pregnant psychiatric patients admitted to a psychiatric service in an urban hospital. A high rate of involuntary admission (44%), homelessness (36%), and substance abuse (64%) was noted. In this group of high-risk obstetric patients, we identified risk factors associated with noncompliance with ongoing prenatal care. Brief psychiatric hospitalization can be an important aspect in improving obstetric outcome by providing an opportunity to collect obstetric information and promote ongoing prenatal care.

Adolescent↗
PubMed1990

Multiple peptide synthesis using a single support (MPS3).

An automated multiple peptide synthesis method to synthesize, cleave, and purify several peptides simultaneously in a single batch has been developed. The technique is based on the synthesis of multiple peptides on a single solid phase support and is easily adapted to manual or to automated methods. The approach relies on coupling of amino acid mixtures to the resin and it has been found that DCC/HOBt gives the best coupling performance. Fast Atom Bombardment Mass Spectrometry (FAB-MS) was used to rapidly and efficiently identify the peptides in each synthetic mixture which significantly assisted the purification process by HPLC. The method has been successfully applied to the synthesis of magainin 2 and angiotensinogen peptides.

Amino Acid Sequence↗
PubMed1990

Post-Hinckley insanity reform in Oregon.

The 1983 Oregon legislature responded to public pressure to narrow the application of the insanity defense by eliminating personality disordered individuals from consideration for an insanity verdict. This article examined the effects of the statutory change, and found no significant change in the frequency of insanity acquittals of personality disordered subjects between the three pre-reform years (n = 21) and the three post-reform years (n = 14). We also reviewed how the Psychiatric Security Review Board handled these patients once committed to their jurisdiction. We constructed a matched comparison group of psychotic acquittees and found that in the pre-reform years the personality disordered subjects spent less time in the system and less time in the hospital than the psychotic patients. However, in the post-reform years their time in the system and time in the hospital was the same as the psychotic controls. There were fewer decisions to discharge personality disordered patients from the system after the reform, although this difference may be due to factors other than the statutory reform itself. The conclusion is that narrowing the insanity defense is a worthy goal which may be difficult to achieve.

Adult↗
PubMed1990

Effects of phosphate loading on oxygen uptake, ventilatory anaerobic threshold, and run performance.

Seven male competitive runners (VO2max 73.9 +/- 6.3 ml.kg-1.min-1) participated in a two-session, placebo, double-blind study to determine the effects of phosphate loading on oxygen uptake, ventilatory anaerobic threshold, and 5-mile run performance. Subjects ingested 1000 mg of tribasic sodium phosphate or a placebo four times daily for 6 d. A maximal running stress test or a 5-mile performance run was performed randomly on either the 3rd or the 6th d. Test sessions were separated by a 2-wk washout period and repeated with alternating phosphate and placebo regimens. Venous blood samples were collected prior to and following each max and run session. Results revealed that placebo resting serum phosphate levels were mildly elevated and that phosphate loading significantly increased resting and post-exercise serum phosphate values. Resting and post-exercise 2,3-diphosphoglycerate values were decreased while hemoglobin values were elevated with phosphate ingestion. Phosphate loading significantly increased maximal oxygen uptake from 4.77 +/- 0.29 to 5.18 +/- 0.25 l.min-1 and ventilatory anaerobic threshold from 3.74 +/- 0.28 to 4.18 +/- 0.14 l.min-1. Five-mile run times were nonsignificantly different between placebo and phosphate sessions. However, mean performance run oxygen uptake was significantly lower (3.87 +/- 0.3 to 3.80 +/- 0.3 l.min-1) with phosphate ingestion. Data demonstrate that maximal and run performance were influenced by elevations in serum phosphate eliciting an increased maximal oxygen uptake, ventilatory anaerobic threshold, and variable effects on 5-mile run performance. These adaptations occurred without observable increases in red cell 2,3-diphosphoglycerate.

Anaerobic Threshold↗