Use of nursing care in continuing care retirement communities.
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Biomedical subjects
Publications and source records attributed to C E Bishop.
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We present genetic and molecular data demonstrating linkage of the gene for steroid sulfatase (Sts) to the mutation sex reversed (Sxr) definitively showing the existance of a functional allele for Sts mapping to the pseudoautosomal region of the mouse Y chromosome. Thus, in mouse, functional Sts genes are present in the pseudoautosomal region of both the X and Y chromosomes. This is in contrast to man where Sts has been mapped to the short arm of the X just centromeric to the pseudoautosomal region. Only a single recombinant separating Sts and Sxr was found out of 103 male meioses analyzed; double recombinants were not found between sex (Tdy), Sts and Sxr. If the rate of recombination in the pseudoautosomal region in male mice is equivalent to that in man and thus 7-10X higher than normal, then our data suggest that the distance between Sts and Sxr (or the telomere of the Y) is approximately 100-200 kb in length. Our data is in contrast to a recent report of a recombination frequency separating Sts and Sxr of as high as 6.2-9.8%.
Using a Y specific probe (pY353/B) taken from a flow sorted mouse Y chromosome library we have identified a family of RNA transcripts encoded by the Y chromosome. These transcripts which are approximately 1.3 Kb in length are present in testis PolyA+ RNA but can not be detected in either male liver, spleen, kidney, brain, heart or lung tissues. Isolation and sequence analysis of a corresponding cDNA shows it to contain a potential coding sequence of 696bp. These data show that the Y chromosome is transcriptionally active in the adult mouse testis.
The mouse Y chromosome plays a fundamental role in the control of primary sex determination and fertility. Both genetic and molecular biological evidence has shown that much of the necessary information is contained in a minute piece of the Y (the Sxr region) which has arisen by a duplication of the pericentric region of the normal Y and the transposition of one copy to the distal pseudoautosomal region. The present article describes the isolation of random Y-chromosome probes and their use to investigate this Sxr region at the molecular level. Total mouse Y-chromosome libraries were constructed from flow-sorted material and a Sxr regional library after specific microdissection and cloning. Transcription has been detected in the testis using both Sxr-specific and non Sxr-located genomic probes taken from these libraries. In addition, we have been able to confirm the presence of an active steroid sulphatase gene on the mouse Y. This gene is located in the distal portion of the pseudoautosomal region and is tightly linked to Sxr. Finally, using an Sxr-specific probe we can define multiple Y-chromosome haplotypes in the mouse showing that the region is evolving very rapidly.
A genomic sequence (12f3), derived from the long arm of the human Y chromosome, detects a 1.6 kb mRNA, expressed in human and mouse testis, but not in other tissues tested by Northern blot analysis. Using 12f3 as a probe, a mouse cDNA, designated PL5, was isolated from an adult mouse testis cDNA library. The profile obtained by Southern blot analysis using PL5 as probe under high-stringency conditions, reveals that 12f3 probably represents a Y-located pseudogene which was derived from an autosomally located gene. Southern blot analysis of different vertebrate species, using probe PL5, shows that this gene has been highly conserved during evolution. Preliminary in situ hybridizations on testis tissue sections indicate that PL5 is expressed during the postmeiotic stages of male germ cell differentiation and thus may play a role during spermatogenesis. A second cDNA, also obtained from the testis cDNA library, weakly cross-reacts with 12f3. This cDNA, designated PL10, detects a mRNA of approximately 4 kb which is highly expressed in mouse testis, but not in male or female mouse liver. The gene corresponding to this cDNA is also well conserved among vertebrates.
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Logit regression is used to explain living arrangement choice of elderly single individuals. The propensity to live independently is found to increase with income and decrease with disability; an interaction effect for females suggests that income may lessen the impact of disability on the propensity to seek shared living arrangements. Independent living is less likely for people who are not white, foreign-born males, those with at least one adult child, and those in States with higher living costs; and more likely for the ever-married and those in States with high per capita nursing home use. If home care services are preferentially allocated to disabled elderly who live alone, resources may flow to higher income individuals who have been able to maintain independent households.
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Because Government policy does much to determine the return available to nursing home investment, the profitability of the nursing home industry has been a subject of controversy since Government agencies began paying a large portion of the Nation's nursing home bill. Controversy appears at several levels. First is the rather narrow concern, often conceived in accounting terms, of the appropriate reimbursement of capital-related expense under Medicaid and Medicare. Second is the concern about how return to capital affects the flow of investment into nursing homes, leading either to inadequate access to care or to over-capacity. Third is the concern about how sources of return to nursing home investment affect the pattern of nursing home ownership and the amount of equity held by owners since the pattern of ownership and amount of equity have been linked to quality of care.
Detailed studies of the role of the mammalian Y chromosome in primary sex determination are limited by the lack of available specific markers and by the fragmentary knowledge of its molecular organization. Y-derived unique DNA sequences could provide powerful analytical tools to probe directly the structure of the Y chromosome and provide a means of searching for specific expressed sequences. We report here the construction of a partial cosmid library of the human Y chromosome. From independent clones we have isolated 30 unrelated DNA probes that are free of highly repetitive sequences, and have examined their reaction pattern on male and female genomic blots. Of the 30 probes tested, six were specific for the Y chromosome. In addition, four probes gave a male-female differential hybridization pattern and the remaining 20, although Y-derived, reacted similarly with both male and female DNA.
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An 'alien' MHC antigen has been previously described in the AKR tumour K36.16. We have attempted to establish the nature of this antigen by immunochemical techniques. Sequential immunoprecipitation and affinity purification of the 'alien' and regular antigens show that the same molecular entity is involved, the H-2Kd molecule being precipitated by anti H-2Dd sera. Absorption of the sera used to define this 'alien' antigen suggests that an interaction between endogenous viral antigens and H-2 is responsible. Genetic rearrangement within the MHC may well be a facet of tumour immunology but the AKR tumour K36.16 does not appear to be a suitable example for further study.
A study has been made of the H-2 profiles of the AKR thymoma K36 and two series of somatic cell hybrids derived from it. Despite expressing good amounts of the H-2Dk product, the H-2Kk antigen was barely detectable in this tumor, approximately only 1% of that expressed by a comparable AKR lymphoma, 339. The isoelectric focusing profile of the H-2kk product immunoprecipitated from K36 was found to be identical to that from normal AKR lymphocytes. The phenotype of K36 therefore results from regulatory constraints. Fusion of K36 with normal K-2k lymphocytes resulted in hybrids expressing the H-2Kk product. Fusion of K36 with normal H-2b lymphocytes resulted in good expression of the H-2Dk and H-2Db alleles in addition to good expression of the H-2Kb products. The expression of the H-2Kk antigen remained marginal. The data suggest a suppressive mechanism which is trans-acting and dominant and specific for the H-2Kk allele.
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This paper describes a miniaturised method of cell cloning in Terasaki plates. It is rapid and technically simple enabling large numbers of putative clones to be tested. As Terasaki plates are designed for use in tissue typing procedures, the wells can be screened and the exact number of cells in any particular well can be seen. Colonies derived from wells containing only one cell can then be chosen, eliminating the need for a second or third recloning usually necessary for statistical surety.
This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care.
Providers and recipients of nursing home care under Medicaid are currently classified into two levels of care to facilitate appropriate placement, care, and reimbursement. The inherent imprecision of the two level system leads to problems of increased cost to Medicaid, lowered quality of care, and inadequate access to care for Medicaid recipients. However, a more refined system is likely to encounter difficulties in carrying out the functions performed by the broad two-level system, including assessment of residents, prescription of needed services, and implementation of service plans. The service type-service intensity classification proposed here can work in combination with a three-part reimbursement rate to encourage more accurate matching of resident needs, services, and Medicaid payment, while avoiding disruption of care.
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