Dr Moore Research Articles

Gambling And The UK National Lottery

The British National Lottery has now been running for almost three years and it arouses social and ethical misgivings in several quarters, whether in its contribution to the British gambling scene or in the size and distribution of its prizes or in its contributions to the good causes which it was introduced to benefit. Bringing wide experience and an expert eye to analyse and comment on the lottery, Dr Moore, DSc PhD FIA, is Emeritus Professor of Decision Sciences at London Business School, Sussex Place, Regent’s Park, London NW1 4SA.

A Miracle and a Privilege: Recounting a Half Century of Surgical Advance

This reviewer, as all medical students and surgical residents of 40 years ago, lived by Francis D. Moore'sMetabolic Care of the Surgical Patient. UntilA Miracle and a Privilege, his remarkable autobiography, I was quite uninformed as to Dr Moore's contributions to medicine and surgery during the past 50 years. Dr Francis Moore was born with a silver scalpel in his mouth, and he makes no apologies for this good fortune. There is a distinguished air to his description of his family background, making the reading that much more enjoyable. His grandfather graduated from Harvard and his father from the Massachusetts Institute of Technology. It was no surprise, then, that Francis Moore became an undergraduate at Harvard College, a medical student at Harvard Medical School, and a surgical resident at the Massachusetts General Hospital (MGH). From the moment he entered medical school, and throughout his training, Moore demonstrated an

Edward Elgar: letters of a lifetime

Jerrold Northrop Moore, editor of to his Publishers (1987) and Windflower Letters (1989), here completes his selection from Elgar's ten thousand letters. He concentrates on letters to friends, including the dramatis personnae of the Enigma Variations, and such prominent literary and musical figures as George Bernard Shaw, Richard Strauss, Delius, Vaughan Williams, Arthur Bliss, and Adrian Boult. The letters reveal Elgar in all his many moods - now happily discussing details of his works with conductors, now reflective or despairing of his works being properly understood, now delighting in merry japes with his friends. The whole is linked by Dr Moore's informative commentary, and the result is a fascinating record of over fifty years of a creative life. The book should appeal to those interested in Elgar and students of 20th-century English music.

Information on Nicotine Abuse

In Reply.— We appreciate the opportunity to respond to Dr Moore's letter and to add to the documentation of nicotine and its metabolite cotinine in the milk of nursing mothers who smoke. Luck and Nau1,2 have published a series of papers that demonstrate that infants of smoking mothers have measurable concentrations of both nicotine and cotinine in their serum and urine. Transfer of nicotine from maternal serum to milk is rapid (increase can be seen within minutes of a mother smoking a cigarette) and dose-dependent; the more cigarettes smoked per day, the higher the milk concentrations of nicotine and cotinine.2,3

The Doctor as Patient Advocate

<h3>To the Editor.—</h3> The Journalcontinues to challenge the status quo and stimulate professional introspection. I have just read the commentary by Dr Moore¹entitled "The Need for a Patient Advocate." Never have I felt so offended by a colleague. As a senior medical resident, I have spent 7 challenging and rewarding years in an attempt to become a physician. What, may I ask, is any physician if not foremost a patient advocate? Am I naive? The profession of medicine is under siege on many fronts. I, too, share many of Dr Moore's concerns about the new conflicting roles that physicians are increasingly asked to play. It seems clear to me that only by the vigilant preservation of a patient advocacy role for<i>all</i>physicians will we ever weather the storm. When did we throw in the towel?

7 The influence of cytoreductive surgery on progression-free interval and survival in epithelial ovarian cancer

In 1980, Dr George E. Moore published an editorial in Surgery, Gynecology and Obstetrics entitled 'Debunking debulking'. He included advanced ovarian cancer in his personal list of 'faulty' debulking procedures. Some of hist statements have merit. He contends that overly aggressive procedures that leave microscopic tumour cells that will soon grow and kill the patient are unindicated. He further points out that one cubic centimetre of tumour will contain approximately a billion cells. However, there are factors in ovarian cancer that should cause one to take exception to Dr Moore's statement. First, there is good evidence that the use of cisplatin-based multidrug chemotherapy may eradicate microscopic tumour deposits in a significant number of patients. Secondly, even multiple aggregates of tumour with a billion or more cancer cells can be eradicated in some cases, and in others can be reduced sufficiently to allow significant palliation. In evaluating the information which has been reviewed in this discussion of cytoreductive surgery for advanced ovarian cancer, it is apparent that cytoreductive surgery is not only indicated, but mandated in many facets of the management of ovarian cancer. The following principles seem to be supported by the existing literature: 1. Current diagnostic techniques do not enable us to diagnose ovarian cancer while still confined to the ovary. Therefore, in the immediate future we will still encounter a large number of patients with advanced disease. 2. The number of complete clinical responses and the number of complete pathological responses (negative second-look surgical reassessments) are greatest in those patients who begin adjunctive therapy with minimal residual disease. 3. Median duration of survival is longer, and long-term survival more likely, in those patients giving complete clinical or complete pathological responses. 4. Some patients appear to benefit from secondary cytoreductive surgery. However, at the present time, evidence of benefit from secondary cytoreductive surgery appears to be limited to those patients who have responded to adjunctive therapy and are found to have residual disease at surgical reassessment. There is no good evidence to support secondary cytoreductive surgery as an 'interval' procedure or its use in patients with progression on primary adjunctive therapy. This development of better chemotherapy regimens, such as cisplatin-based chemotherapy, has resulted in a greater need for effective primary cytoreductive surgery as it is apparent that, on utilizing these new regimens, better results are obtained in patients with minimal residual disease.(ABSTRACT TRUNCATED AT 400 WORDS)

The State and Peasant Politics in Sri Lanka

Dr Moore's enterprising book focuses on an apparent paradox: the failure of Sri Lanka's highly politicized smallholder electorate to place on the national political agenda issues relating to the public distribution of material resources. Sri Lanka has more than fifty years' history of pluralist democracy and such issues directly affect the interests of the smallholder population. Yet successive Sri Lankan governments have pursued economic policies favouring food consumers and the state itself at the expense of agricultural producers. In exploring the features of Sri Lanka's history, geography, politics and economy which explain this paradox, the author looks in detail at some of the dominant features of contemporary Sri Lanka: the political consequences of the plantation experience; the persistence of elite political leadership; and the causes and consequences of ethnic conflict.

Space, Text and Gender: An Anthropological Study of the Marakwet of Kenya.

As well as being the first major anthropological study of the Marakwet, Space, Text and Gender strikingly illustrates how the idea of a cultural text can aid the analysis of ethnographic material. Dr Moore focuses in particular on the relationship between the organisation of household space and gender relations, and on the ways that relationship is changing as a result of wage labour and education. She does not, refreshingly, treat household space as a direct or distorted reflection of social relations, but combines instead insights of Geertz, Ricoeur and Foucault with material drawn from Marxist and literary-critical approaches to develop a new theoretical perspective. This seeks to analyse the organisation of domestic space as a cultural representation linked to the social and economic conditions within which it is produced and maintained. The book provides a striking example of what anthropology has to offer to the study of contemporary, culture and will attract many with no specialist interest in Africa.

Prophylactic Hypomagnesemia During Cisplatin Therapy-Reply

In Reply. —Dr Moore's article points out two additional causes of hypomagnesemia with which we agree. The issue of whether or not to supplement magnesium in these patients is a controversial one. Most investigators find that, despite supplementation, the renal loss of magnesium is such that the patients remain hypomagnesemic. We have found, in our patients, that we can increase the serum magnesium level over a short time by supplementation with intravenous or intramuscular magnesium. On the other hand, long-term oral magnesium supplementation has not been optimal, because the level absorbed is small, and diarrhea often results when the dose of oral magnesium is escalated. We have adopted the policy of individualizing magnesium supplementation; those patients who develop symptoms are supplemented both parenterally and orally, and those who do not have symptoms do not receive supplemental magnesium. Using this philosophy, we have had no serious sequelae from hypomagnesemia. Several patients

Influences on Prescribing Practices-Reply

In Reply.— As Dr Moore suggests, several characteristics of the drug educator (a pharmacist) and the physician-counselors might have influenced the receptivity of the visited physicians to the educational message that was presented in our study. In addition to age, one can speculate concerning the influence of gender, race, ethnic background, presentability, personality, and the like. Incidentally, as regards age, it would be equally valid to wonder whether the young pharmacist was perceived as a recent graduate with the latest information, whereas the senior physician-counselors might have been viewed as possibly out of date. Because of these subtle interpersonal nuances, both the drug educator and physician-counselors were trained to present themselves as representatives of the Tennessee Medical Association. Our concept of the drug educator was based on the model of the pharmaceutical sales representative, known to be an effective method of changing prescribing habits. We believe that our drug educator

The Study of Trauma

To the Editor.— his recent article (241:2269, 1979), Francis D. Moore, MD, appropriately focused on the need for novel directions—and interdisciplinary cooperation—in seeking solutions to the social, epidemiologic, and medical problems of trauma. It is therefore unfortunate and surprising that Dr Moore perceives the surgeon to be such a lonely laborer in the care of the trauma patient: In the field of trauma, the surgeon is alone.... It is the surgeon who sees, feels, and senses the urgency and immediacy of the problems. There is no other professional group concerned. Such self-indulgent hyperbole fails to nurture that interdisciplinary cooperation on which Dr Moore focuses; more to the point, it does a disservice to the other professionals who definitely are as intimately involved in the care of the trauma patient as the surgeon. many communities, an emergency medical system, planned and administered by nonsurgeons, renders care at the scene

Thiazide-lnduced Hypomagnesemia-Reply

ABSTRACT In Reply.— I agree with the comments made by Dr Moore regarding my article. Other electrolyte problems have at times been overlooked in view of the more well-known effects of thiazides and other diuretics on serum potassium levels. However, it was not the intent of this particular study to be all-inclusive and to review other electrolyte changes in patients receiving thiazides.

Toxic Effects of Local Anesthetics-Reply

Most all we know about modern drugs was, perforce, gained from laboratory experiments. So it is with local anesthetics and their side effects. Few humans would wish to volunteer for studies that carry with them the threat of convulsions, however remote it might be. As Dr Moore must know, the efficacy of diazepam as an anticonvulsant in preventing and treating CNS reactions to local anesthetics was established not only by me, but also by Munson, Wagman, Lesse, Feinstein, Wesseling, and other investigators referenced in my textbook.1Animal species tested were cats, rabbits, rodents, and monkeys. Since all reacted to diazepam in a similar manner, it would seem that extrapolation to man was not an unreasonable step—all the more since not just lidocaine (as Dr Moore intimates) but also procaine, tetracaine, bupivacaine, and etidocaine reactions were reduced in both frequency and intensity by previous administration of diazepam. I

Discussion

Dr M. K. Williams: Dr Moore’s paper is a little confusing. It seems to me that the hypothesis that the association between soft water and coronary heart disease may be due to lead, was not disproved by his data. His data tended to confirm that there might be such a causal relationship but there have been mortality studies on lead workers, notably by Dingwall, Fordyce and Lane, which were followed up by data from Malcolm and recently by Tabershaw and Cooper in the States, who did not find any association between lead in lead workers and coronary heart disease. Their C.H.D. mortality was no different from the control population. I wonder if Dr Moore would care to comment on this?

The Evaluation of a Media Resource-based Learning Project and its Modification of Traditional Classroom procedures

Dr Moore's report took the form of a case-study of a resource-based project in the teaching of introductory French at Sir George Williams (now Concordia) University, Montreal. Commencing in 1970, the project involved close collaboration between the Department of French and the university's Centre for Instructional Technology. Arising from cutbacks in the academic staff and increasing numbers of students enrolling for the French course, an instructional strategy was developed whereby the traditional pattern of three lecture periods plus a one-hour session in the language laboratory was replaced by a resource-based system designed to enable students to work more or less on their own. The resources included video and audiotapes to be used in the laboratory on an individual study access basis, and a specially prepared workbook with a self-correctional marking key so as to complement oral proficiency with written grammatical exercises. In addition a course text was selected for use in conjunction with the audi...

Redistribution of surface antigens--a general property of animal cells?

MEMBRANE antigens of animal cells are reported to be localized either in discontinuous discrete areas (H-21,2, HL-A3, organ4 and immunoglobulin (Ig)5–9 or continuously (species4 and blood group9,10). These results have been obtained by immunofluorescence (IFL) and electron microscopy performed by double layer principles except in the case of Ig where direct IFL technique has been used. The influence on the localization pattern of marker molecules by variables such as Ig concentration of the reagents used, effects of interactions between Ig molecules in the double layer and temperature dependence of the reaction steps have not been investigated. Redistribution of lymphocyte surface Ig molecules induced by anti-Ig antibody has been described and this was observed to be temperature dependent occurring at 20° C but not at 0° C11,12. Here I discuss the distribution and localization of different surface antigens (blood group substance A and B, species, H-2 and organ) on several cell types (monkey kidney, human lymphoid cells, HeLa, human thyroid cells, RK13 and L-cells of C3H/K) as recorded by direct and indirect IFL technique. I show that the temperature and Ig concentration used exert an influence on the distribution of these antigens. The cells used in IFL tests were cultured and harvested as described before10. IFL staining was performed according to Moller13. The stained cells were examined with a Leitz ‘Orthoplan’ ultraviolet microscope. Direct IFL technique was applied to two test systems. A FITC-conjugated rabbit antiserum to blood group substance A was used on monkey (Macaca fascicularis) kidney cells known to be A-positive10 and a FITC-conjugated horse anti-human thymocyte globulin were tested on a human lymphoid cell line Robinson (obtained from Dr Moore, Buffalo). In both test systems the staining pattern was completely confluent at all temperatures used: 4° C, 20° C and 37° C. The staining pattern was not related to antibody concentration.

Introductory note

The papers presented in this symposium were selected to give an objective assess­ment of the differing aspects of this complex problem; a problem which has often been confused by emotional overtones. The first paper by Dr Lewis gives details of the levels of contamination in foodstuffs, in the body tissues of man and animals and in the physical environment. The next two papers by Dr Wayland Hayes and Dr Moore deal with the dangers arising from pesticides to man and to wild life. These are followed by three papers from Professor Garnham, Sir Harold Sanders and Dr Reddy on the value of pesticides in human medicine and agriculture. The seventh paper by Dr Galley deals with possible new approaches to pest control.

Regression As An Analytical Tool

In this article Dr Moore first illustrates some pitfalls in the application of simple regression methods to industrial problems, and goes on to discuss the usefulness of multiple regression as an analytical tool. However, when there are potentially many independent variables, the amount of computation for a complete analysis is very large; two short‐cut methods are described here in which much less computation is required.

Dante and the "Cursus": A New Argument in Favour of the Authenticity of the "Quaestio de Aqua et Terra"

As is well known to all who have followed the controversy concerning the authenticity of the Quaestio de Aqua et Terra, those who deny Dante's authorship of the treatise maintain that it is a forgery of the end of the fifteenth or beginning of the sixteenth century, most probably by Moncetti, the first editor, who published the work at Venice in 15081. The arguments in favour of the genuineness of the treatise, which had previously been upheld in a paper read (in 1895) before the Oxford Dante Society by Dr C. L. Shadwell, have been stated with great force and ability by Dr Moore in his essay on the Quaestio in the second series of his Studies in Dante2, in which he examined in detail the