Objectives: To compare end‐of‐life preferences in elderly individuals with dementia and congestive heart failure (CHF).
Design: Retrospective case‐control study.
Setting: Geriatrician‐led ...interdisciplinary house‐call program using an electronic medical record.
Participants: Homebound individuals who died while under the care of the house‐call program from October 1996 to April 2001.
Measurements: Medical records review for demographics, functional status, advance medical planning, hospice use, and place of death.
Results: Of 172 patients who died in the program, 29 had CHF, 79 had dementia, 34 had both, and 30 had neither. Patients with CHF were younger (82.6 vs 87.0, P=.011) and less functionally dependent (activities of daily living score 9.1 vs 11.5, P=.001). Time from enrollment to death was not significantly different (mean±standard deviation=444±375 days for CHF vs 325±330 days for dementia, P=.113). A do‐not‐resuscitate (DNR) directive was given in 62% of patients with CHF and 91% with dementia (P<.001). Advance medical planning discussions were not significantly different (2.10 in CHF vs 1.65 in dementia, P=.100). More patients with CHF participated in their advance medical planning than those with dementia (86% vs 17%, P<.001). Hospice was used in 24% of CHF and 61% of dementia cases (P<.001). Finally, 45% of patients with CHF and 18% of patients with dementia died in the acute hospital (P=.006). Multivariate analysis showed that the fact that more patients with CHF were involved in their medical planning was not significant in predicting end‐of‐life preferences. Alternatively, Caucasian ethnicity was an independent predictor of having a documented DNR and death outside of the acute hospital.
Conclusion: In the months before death, patients with CHF were more likely to have care plans directed at disease modification and treatment, whereas dementia patients were more likely to have care plans that focused on symptom relief and anticipation of dying. Several factors may contribute to this difference.
Pet (dog and cat) animal numbers have substantially increased in modern society. There is concern over transmission of Staphylococcal infection including methicillin-resistant Staphylococcus aureus ...(MRSA) between animals and humans. The objective of the present study was to determine the prevalence of MRSA from apparently healthy and diseased dog and cat of different veterinary Hospital, clinics and pet animal market in Dhaka city. Samples collected for detection of MRSA were nasal swab, pus and wound swab. Among the 93 samples, 40.86% (n=38/93) were confirmed as positive for S. aureus and4.30% (n=4/93) as MRSA. The detection of MRSA was confirmed phenotypically and also by PCR targeting mec Agene specific for MRSA. All isolates isolated S. aureus were coagulase positive and hence pathogenic. Antibiogram study showed that all these isolates were sensitive to vancomycin and tetracycline. The overall prevalence of MRSA was higher in dog (4.91%) compared to cat (3.13%). The highest prevalence of MRSA (5.88%) was recorded in samples collected from Kataban Pet Animal Market, Dhaka. On sample basis MRSA was higher in nasal swab compared to pus and wound swab. On age basis, the prevalence of MRSA was higher in younger animal compared to older animal. The highest prevalence of S. aureus was found in diseased dog and highest prevalence of MRSA was found in diseased cat. None of the healthy cat was found positive for MRSA. Present study emphasizes that dogs and cats may act as a possible reservoirs for transmission of MRSA to human.
This study was conducted to determine the writing skills of bilingual students whose mother tongue is Kurdish and monoligual students whose mother tongue is Turkish in the fifth grade of secondary ...school. More specifically, the story and essay writing skills of bilingual students are compared with the writing skills of monolingual students based on their reading habits and their parents’ educational backgrounds. The research is a descriptive study based on scanning model and aims to reveal the current situation as it is. The study group of the research consists of a total of 104 fifth grade secondary school students, 52 bilingual and 52 monolingual, studying in 4 different secondary schools in the central district of İpekyolu in Van, Turkey. In order to determine students’ writing skills, stories and essays were written to them at different times in one lesson hour (average forty minutes). The stories were evaluated according to the Story Writing Evaluation Form (İzdeş, 2011). The essays were evaluated according to the Written Expression Rating Scale (Deniz, 2003). According to the results of Mann Whitney-U and Kruskal - Wallis-H tests, monolingual students outperformed bilingual students in both story and essay writing. While a significant difference was found between bilingual and monolingual students’ essay and story writing skills, no significant difference was found in terms of parents› education status or the number of books their parents read. The findings have interesting implications for the researchers and teachers in the area.
OBJECTIVES: To determine whether aerobic capacity is associated independently with insulin‐like growth factor‐I (IGF‐1) levels in healthy community‐dwelling men and women.
SETTING: The Baltimore ...Longitudinal Study on Aging (BLSA).
DESIGN: A cross‐sectional analysis of data from the population‐based cohort of the Baltimore Longitudinal Study of Aging (BLSA).
PARTICIPANTS: We studied 181 men and 92 women aged 20 to 93 years, volunteers in the Baltimore Longitudinal Study on Aging (BLSA). Subjects were free of endocrine, renal, hepatic, gastrointestinal, or cardiac diseases, and they were taking no medications known to interfere with the growth hormone‐IGF‐1 axis.
MEASUREMENTS: All subjects underwent a single measurement of serum IGF‐1 in the fasting state, as well as peak V̇o2 determinations during maximal treadmill exercise testing performed within one visit of the IGF‐1 determination. Dual energy X‐ray absorptiometry (DEXA) scans were performed in a subset of 171 subjects (64 women and 107 men) for determination of fat free mass (FFM).
RESULTS: In the pooled group of women and men, univariate regression analysis revealed that age was correlated strongly with decreasing IGF‐1 levels (r = −0.53, P < .001) and with peak V̇o2 r = −0.56, P < .001). IGF‐1 levels were also significantly correlated with peak V̇o2 (r = 0.29, P < .001). There were no significant gender‐related differences in these relationships. On multivariate analysis, age (β = −0.54, P < .001), but not peak V̇o2 (β = −0.01, P = .840), remained strongly associated with IGF‐1 levels. After adjustment of peak V̇o2 for FFM in subjects with DEXA scans, results were similar.
CONCLUSIONS: These findings indicate that although both peak aerobic capacity and circulating IGF‐1 levels decline with age, aerobic capacity is not independently related to circulating IGF‐1 in healthy men and women across the adult life span. J Am Geriatr Soc 48: 139–145, 2000.
The presence or absence of early repolarization on the electrocardiogram at rest was correlated with aerobic exercise capacity in healthy volunteers from the Baltimore Longitudinal Study of Aging. ...Patients with early repolarization had both longer treadmill exercise duration and higher peak oxygen consumption than age-and gender-matched control subjects.
Background and aims:
To evaluate the effect of interdisciplinary outpatient geriatrics on the use, cost, and quality of health services in a fee-for-service (FFS) environment of two networks of ...primary care clinics operated by a not-for-profit provider organization in Dallas County, Texas.
Methods:
The Senior Health Network (SHN) provides interdisciplinary primary care to patients aged 55 years or older; the Health Texas Provider Network (HTPN) provides “usual” primary care to patients of all ages. We conducted a two-year retrospective cohort study of 13,098 fee-for-service Medicare beneficiaries who had 2+ visits to one of the networks in 2000. In the SHN, interdisciplinary teams supplemented primary care with social services, specialized clinics, andhealth education. We compared the use, cost and quality of health services, as reflected by paid Medicare claims, provided to eligible patients in the SHN vs the HTPN.
Results:
Medicare payments for hospital, skilled nursing facility, and home health care services were lower for SHN patients than HTPN patients (−32.7%, −19.8%, and −23.8%, respectively, p≤0.05). SHN patients had a lower likelihood of admission to hospitals for treatment of five “ambulatory care sensitive conditions” (aOR 0.69, 95% CI 0.58–0.81), and they were less likely to receive several preventive services. Total Medicare payments for the two cohorts did not differ significantly.
Conclusions:
Interdisciplinary outpatient geriatric care in a FFS setting has the potential to avert hospital admissions for ambulatory care sensitive conditions and to reduce Medicare payments for hospital, skilled nursing facility, and home health care services.
تمت دراسة الزوج المجري Sip-39 باستخدام طرق القياس الضوئي والطيفي. البيانات الرصدية اخذت من اصدار البيانات السابع عشر (DR17) من "Sloan Digital Sky Survey (SDSS)" وتمت عمل ال fitting لصور المجرتين ...باستخدام برنامج (IRAF) من خلال المكتبةSTSDAS باستخدام ELLIPS task.تم دراسة وحساب كل من اللمعان السطحي للمجرتين في الزوج ، بالإضافة إلى الانبعاث الكلي ، وشكل القطع الناقص ، وزوايا انحراف المحور الكبير، الانحرافات العمودية والأفقية ، ومعاملات كيرشوف للشكل (B4)، والاقدار ، ومعدلات تشكل النجوم (SFR) ، بالإضافة إلى خواص القياسات الفلكية للزوج ، حيث ظهر من خلال تحليل البيانات أن زوج Sip-39 هو قريب مع علامات تفاعل واضحة ، ويعتبر نظامًا فيزيائيا مع معدلات محسنة ل .SFR
The Sip-39 pair’s galaxies have been investigated using photometric and spectroscopic methods; the observation data was collected from the SDSS's Data Release (DR17) and fitted to ellipses through utilizing the Image Reduction and Analysis Facility (IRAF) with STSDAS Library using ELLIPS task. The surface brightness of the two galaxies in the pair, as well as total flux, ellipticities, major axis position angles, both vertical and horizontal shifts, isophotal shape factors (B4), magnitudes, and the star-forming rates (SFR), in addition to the astrometric parameters of the pair, were evaluated. It appeared through data analysis that the Sip-39 pair is a closely interacting pair with clear interaction signs, and it is deemed to be a physical system with enhanced SFR.
High-energy land-mine explosions cause extensive soft-tissue and bone defects in the heel area, which mostly require free flap coverage. In this article, the authors present the long-term functional ...outcomes of 72 patients who had free muscle flap reconstructions for composite heel defects caused by land-mine explosions.
The composite heel defects of 72 male patients caused by land-mine explosions were reconstructed by means of free muscle flaps. The mean follow-up was 6.5 years (range, 1 to 12 years). Each patient completed a questionnaire rating his level of satisfaction. Dynamic foot pressure distribution testing, three-dimensional motion analysis, and dynamic electromyography were performed for all patients. The data were compared with the control group of 20 volunteers. Statistical analysis was performed by Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests.
Dynamic pressure distribution tests revealed significantly higher pressure and load in the injured feet of the patients (p < 0.05). Three-dimensional motion analysis showed restricted range of motion at the ankle joints of the injured extremity (p < 0.05). Seventeen patients were able to stand as long as the control group; the mean standing time for the others was 2.85 hours per day (range, 36 minutes to 5.32 hours). Many of the patients (71 percent) declared their satisfaction of having their own feet instead of prostheses.
This is the longest series documenting the long-term functional results of patients injured by land mines who were treated with free muscle flaps. Reconstructive options should be preferred to amputation procedures in extensive tissue loss caused by land-mine explosion where possible.
The KLOE detector is designed primarily for the study of direct CP violation in K
0 decays. The electromagnetic calorimeter, EmC, is a most demanding element of the detector. Two prototypes of the ...EmC (one for the
barrel and one for the
end-cap region) have been built at Frascati and tested at PSI (Switzerland) using beams of electrons, muons and pions of 40 to 290 MeV/
c momentum, and at the Frascati LADON facility using photons of 20 to 80 MeV. We observe excellent linearity from 20 to 290 MeV. The energy resolution is
σ(E)/E ∼ 4.4% / ”E(
GeV)
and the time resolution is ∼ 34 ps/”
E(GeV). We found little dependence on incidence angle and entry position. We also determined that some
π
μ
identification is possible.
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