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Biomedical subjects

S Maxwell

Publications and source records attributed to S Maxwell.

90 records · Page 5Linked to original sources
PubMed1982

New disinfecting apparatus for gastrointestinal fibre-endoscopes.

Bacterial contamination of gastrointestinal fibre-endoscopes is a potential source of clinically significant infection. Aqueous 2% alkaline glutaraldehyde adequately disinfects fibre-endoscopes but may cause serious sensitivity reactions among endoscopy staff. A new 'closed-system' disinfecting apparatus is described that disinfects with glutaraldehyde for 30 minutes before an endoscopy session, for two minutes between patient procedures, and for 10 minutes before storage. Bacteriological cultures of the endoscope after disinfection were virtually sterile. Extremely low glutaraldehyde vapour levels were detected by gas chromatography in endoscopy room air during disinfection procedures. This relatively simple apparatus offers rapid, effective, and safe disinfection of fibre-endoscopes.

Disinfection↗
PubMed1981

In vitro proteolytic cleavage of Gazdar murine sarcoma virus p65gag.

Moloney murine leukemia virus, disrupted in concentrations of 0.1 to 0.5% Nonidet P-40, catalyzed the cleavage of p65, the gag gene polyprotein of the Gazdar strain of murine sarcoma virus, into polypeptides with sizes and antigenic determinants of murine leukemia virus-specified p30, p15, pp12, and p10. Cleavage performed in the presence of 0.15% Nonidet P-40 in water yielded polypeptides of approximately 40,000 (P40) and 25,000 (P25) Mr. In vitro cleavage performed in a buffered solution containing dithiothreitol in addition to 0.1% Nonidet P-40 allowed the efficient processing of P40 to p30 and a band migrating with p10. Immunoprecipitation with monospecific sera indicated that P40 contained p30 and p10, whereas P25 contained p15 and pp12 determinants. P40 and P25 are similar in size and antigenic properties to Pr40gag and Pr25gag observed in infected cells (Naso et al, J. Virol. 32:187-198, 1979).

Antigens, Viral↗
PubMed1981

Inter-rater reliability and concurrent validity of the Goodenough-Harris and McCarthy Draw-A-Child scoring systems.

Inter-rater reliability of the Goodenough-Harris and McCarthy Draw-A-Child scoring system was examined for a sample of 60 children, including 20 school-labeled learning disabled, 20 mentally retarded, and 20 normal children between the ages of 6 and 8 1/2 yr. (M = 7-8; 44 males and 16 females; 36 whites and 24 blacks). The inter-rater reliabilities of the Goodenough-Harris system were .938 and .934 for the McCarthy Draw-A-Child. The scores from both drawing tests correlated significantly, .57 to .87, with the WISC-R Full Scale IQ and McCarthy General Cognitive Index. Implications are discussed as they relate to the use of the Goodenough-Harris and McCarthy Draw-A-Child systems.

Art↗
PubMed1980

Classification and characteristics of coagulase-negative, methicillin-resistant staphylococci.

Sixty-five clinical isolates of coagulase-negative, methicillin-resistant staphylococci have been classified as Staphylococcus epidermidis (63.0%), "phosphatase-negative S. epidermidis" (12.3%), coagulase-negative Staphylococcus aureus (6.2%), Staphylococcus hemolyticus (6.2%), Staphylococcus hominis (3.1%), and Staphylococcus warneri (1.5%). Five of the organisms (7.7%) could not be classified with certainty as currently recognized species. Novobiocin resistance was encountered in eight of the strains, but these were not classified as the accepted novobiocin-resistant staphylococcal species. Some differences in antibiotic resistance patterns to those typical of methicillin-resistant S. aureus were noted in that, although 29 strains were resistant to methicillin, penicillin, sulfamethizole, streptomycin, and tetracycline, the remainder of the strains were sensitive to streptomycin or tetracycline or both. In a majority of the strains (42 of 65), methicillin susceptibility testing by the disk method at 30 or at 37 degrees C in the presence of NaCl did not appear to enhance resistance expression. Most of the strains produced beta-lactamase (EC 3.5.2.6), but none of the 21 strains tested produced enterotoxin B.

Anti-Bacterial Agents↗
PubMed1976

The relationship between occupational therapy and physical therapy test scores in children with learning disabilities.

Twenty-seven children with learning disabilities associated with perceptual deficits were studied in order to determine what relationship might exist between occupational therapy and physical therapy test scores. Intercorrelations were computed and multivariate models were developed for the occupational therapy test items. Numerous positive relationships were demonstrated between the two groups of test items, consistent with previous clinical and experimental data. One test, however, did not duplicate the other, and both are essential in the evaluation of the learning-disabled child with perceptual deficits. Negative correlations also emerged, which might have been caused by compensation for deficits.

Child↗
PubMed1975

Effectiveness of aides in a perceptual motor training program for children with learning disabilities.

A program for children with learning disabilities associated with perceptual deficits was designed that included elements of gross and fine motor coordination, visual and somatosensory perceptual training, dance, art, music and language. The effectiveness of nonprofessional "perceptual-aides," who were trained in this program, was evaluated. Twenty-eight children with learning disabilities associated with perceptual deficits were treated by occupational, physical, recreational and language therapists; and 27 similarly involved children were treated by two aides, under supervision, after training by therapists. Treatment in both groups was for four hours weekly over a four to seven month period. There was significant improvement in motor skills, visual and somatosensory perception, language and educational skills in the two programs. Although there was no significant difference between the two groups, there was a slight advantage to the aide program. The cost of the aide program was 10 percent higher than the therapist program during the first year, but 22 percent lower than the therapist program during the second year.

Allied Health Personnel↗
PubMedDate not supplied

Tetanus antibody levels among adolescent girls in developing countries.

Neonatal and maternal tetanus infections remain an important cause of death in many countries. Few studies have reported tetanus toxoid antibody levels of adolescent girls. As part of the Expanded Programme on Immunization most girls receive up to 3 injections in early childhood, and many subsequently do not receive booster vaccinations until pregnant. We determined (by ELISA) tetanus antibody seropositivity in adolescent girls from Malawi (in 1996), Nigeria (in 1993) and Pakistan (in 1996), and response to tetanus vaccination in adolescent girls from Pakistan. Geometric mean titres (GMT, IU/mL) were 0.94 in 117 Malawian, 0.32 in 154 Nigerian and 1.08 in 162 Pakistani girls. In Nigeria, 54.7% of adolescents were seronegative, of whom 26.8% had a history of unsafe abortion. In Malawi and Pakistan all girls were seropositive and in Pakistan, following a booster vaccination, titres increased 3-fold, with a lower response in older girls. The results indicated that adequate childhood immunization is likely to provide protective levels through adolescence. Booster vaccination in late childhood/early adolescence should protect the majority of women throughout their reproductive lives. This practice would reduce the risks of girls exposed to infection through unsafe abortions, and may be the best option for countries seeking to improve their vaccination schedule, especially where tetanus vaccine coverage in pregnant women is unacceptably low.

Adolescent↗
PubMedDate not supplied

Temporal patterns of veterans' psychiatric service utilization, disability payments, and cocaine use.

This study examined temporal patterns of service utilization, disability benefits, and substance use. Specifically, it investigated whether the first day of the first week of each month (when disability payments are disbursed) was associated with increased emergency room (ER) use and more frequent cocaine use among psychiatric patients. All 1993 psychiatric ER presentations (n=1,448) at a Veterans Administration hospital were reviewed in order by the week of each month in which they occurred. A random subsample of only those admitted to an inpatient psychiatric service (n=143) was further assessed for amount of disability payments received and recent cocaine use. This study found that for the total population of patients utilizing the ER, most ER visits occurred during the first week, followed by weeks two, three, and four respectively. The highest percentage (49%) of patients who used cocaine were those admitted during the first week of the month, followed by week two (39%), week four (28%) and week three (25%). For the subsample of patients admitted to inpatient services, patients hospitalized during the fourth week of the month were those receiving the highest disability payments. This study found that cocaine users have the most ER visits during the first week of the month following receipt of benefits. Current data, if confirmed, would suggest public policy changes, such as payment of entitlement money to cocaine users through a third-party payee and stipulated treatment for psychiatric patients with substance use disorders as a condition of payment. Ethical and political issues, including confidentiality and patient autonomy, would need to be considered in any such policy changes.

Adult↗
PubMedDate not supplied

Optimizing response to methadone maintenance treatment: use of higher-dose methadone.

Using signs, symptoms and serum methadone levels to guide evaluation, the authors treated 164 patients in a methadone maintenance program with doses of methadone exceeding 100 mg/d. The mean dose of these higher dose (HD) patients was 211 mg/d (range 110-780 mg/d). A comparison group (C) of 101 patients was randomly selected from the general clinic population (mean dose 65 mg/d). At intake the HD group reported $153/day of heroin use versus $87/day in the C group. The HD group had more patients whose opiate of choice was an oral pharmaceutical (30% versus 2% of the C group). Sixty-three percent of the HD group had comorbid Axis I psychiatric diagnoses compared to 32% of the C group. Response to psychopharmacologic treatment was enhanced by increased methadone dose in HD patients with "refractory" psychiatric disorders. Urine toxicologies described as "before" were collected prior to increase over 100 mg/d in the HD group or at the first routine urine toxicology collection of the calendar year for the C group. These results were compared to the most recent urine toxicologies for both groups ("after"). The percentage of toxicologies positive for illicit drugs in the HD group dropped from 87% "before" to 3% "after". The C group were 54% positive "before" and 37% positive "after". We conclude that doses of methadone in excess of 100 mg/d (range 110-780 mg/d in our sample of 164 patients) are not only safe but necessary to prevent illicit opiate use, stabilize psychiatric symptoms, and diminish abuse of alcohol and benzodiazepines in many patients.

Dose-Response Relationship, Drug↗
PubMedDate not supplied

When "enough" is not enough: new perspectives on optimal methadone maintenance dose.

Some methadone maintenance treatment (MMT) programs prescribe inadequate daily methadone doses. Patients complain of withdrawal symptoms and continue illicit opioid use, yet practitioners are reluctant to increase doses above certain arbitrary thresholds. Serum methadone levels (SMLs) may guide practitioners dosing decisions, especially for those patients who have low SMLs despite higher methadone doses. Such variation is due in part to the complexities of methadone metabolism. The medication itself is a racemic (50:50) mixture of 2 enantiomers: an active "R" form and an essentially inactive "S" form. Methadone is metabolized primarily in the liver, by up to five cytochrome P450 isoforms, and individual differences in enzyme activity help explain wide ranges of active R-enantiomer concentrations in patients given identical doses of racemic methadone. Most clinical research studies have used methadone doses of less than 100 mg/day [d] and have not reported corresponding SMLs. New research suggests that doses ranging from 120 mg/d to more than 700 mg/d, with correspondingly higher SMLs, may be optimal for many patients. Each patient presents a unique clinical challenge, and there is no way of prescribing a single best methadone dose to achieve a specific blood level as a "gold standard" for all patients. Clinical signs and patient-reported symptoms of abstinence syndrome, and continuing illicit opioid use, are effective indicators of dose inadequacy. There does not appear to be a maximum daily dose limit when determining what is adequately "enough" methadone in MMT.

Adult↗