Designing care for the long-term patient: how much change is necessary in the pattern of health provision?
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Biomedical subjects
Publications and source records attributed to R Morris.
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In the past 13 years, total expenditures for nursing home care under the Medicaid program have increased drastically. They show no signs of abating. Government, therefore, has become aware of the need to control this rapid increase. Families, who currently provide a large amount of informal, long-term care for their disabled elderly, are seen as a potential resource to maintain people in the community. Although demographic elements appear to mitigate against increased family responsibility, governmental incentives may be able to reverse the trend. While demographic variables cannot be modified by public policies, programs can be developed to modify family situations, increasing family capacity--and willingness--to care for disabled, elderly adults.
Intracellular recordings were made from caudate neurons in anesthetized kittens of 2-72 days of age. In adult cats, results of intracellular recordings indicate that caudate neurons respond most frequently to stimulation of their major afferents from cortex, thalamus and substantia nigra with a sequence of excitation followed by inhibition (EPSP-IPSP sequence). The results of the present study show that the prominent IPSP of this sequence is not well developed in young kittens and does not reach adult values in terms of frequency of occurrence until beyond 40 days of age. Amplitude and duration of the IPSP evoked by cortical stimulation also did not reach adult values until beyond 40 days of age. In contrast, EPSPs can be evoked in the youngest kittens by stimulation of afferents to the caudate. These findings suggest that the caudate nucleus may alter its role during development. In early postnatal periods it functions as a simple relay system transmitting incoming information to its outputs in a relatively unaltered fashion. Later in development it becomes a system capable of complex modulation and filtering of neural information.
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A technique utilizing the inferiorly based dermal pedicle nipple-areolar flap is described. The advantages of this technique are:(1) predictable breast shape based on preoperative markings; (2) direct visibility of all areas for ease of resection and hemostasis; (3) retention of normal nipple duct connections; (4) no impairment of subjective sensation; and (5) adequate blood supply. This technique has particular application in younger women, in whom nipple sensation is quite important. The interruption of the intercostal nerve branches is usually limited because of the thickness and width of the inferior pedicles. Utilizing our modifications of the technique originally described, this versatile flap can now be used routinely in reduction mammaplasties requiring the removal of either small amounts (200 gm) or quite large amounts (2,500 gm) of tissue with consistently satisfactory aesthetic results and excellent patient satisfaction.
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A simple, economical method is described for the radioimmunoassay of cortisol in serum. Extraction is avoided by heating the diluted serum to inactivate cortisol-binding globulin. The radioimmunoassay is carried out in a single disposable scintillation vial without centrifugation. Free and bound steroid is separated by partition between ammonium sulphate solution and liquid scintillation fluid. Accuracy, precision and sensitivity are satisfactory. Normal ranges obtained are comparable to those obtained by other radioimmunoassay methods for cortisol.
This study investigated relationships between MMPI scale elevations and WAIS subtest deviation scores and Full Scale intelligence quotients in 272 psychiatric patients. Analysis indicated few significant relationships between MMPI elevations and WAIS deviation scores, especially when compared with the high proportion of significant relationships found between demographic variables and WAIS measures. MMPI elevations were significantly related to Full Scale IQ. Although the results do not support the idea that specific WAIS subtest scores are related to psychopathology, they do support the idea that general intelligence is negatively related to psychopathology.
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A micro-scale method is presented for measurement of cortisol. Serum or plasma, 2 microliter, is diluted with buffer and the solution heated at 60 degrees C in the presence of high-affinity antibody and [3H] cortisol. Corticosteroid-binding globulin in the serum is denatured, releasing cortisol and making it available to the antibody, which is stable during the incubation. After cooling, ammonium sulfate solution is added, followed by a toluene-based scintillant that does not dissolve in the aqueous phase. The vial is shaken to extract the free cortisol into the scintillant. Antibody bound cortisol remains in the aqueous phase and does not produce any scintillation. The amount of [3H] cortisol that is free at the end of the incubation, and which therefore gives rise to the measured counts, is related to the concentration of cortisol in the original serum, and may be calculated from a standard curve. The assay is sensitive and precise. Ranges are presented for normal and pathologic subjects.
Two types of mitochondria-rich cells were found in the interplatelet areas of the gills of sexually mature, male river lampreys. Type 1 cells (previolsy referred to as "male glandular cells") showed some ultrastructural characteristics in common with ion-transporting cells but were readily distinguished by large lipid structures with electron-lucent centres. Type 2 cells were found to be identical to the presumed ion-uptake cells during other stenohaline freshwater phases of the animal's life history. In the sexually mature female, only Type 2 cells were positively identified. This sexual dimorphism in gill structure is discussed in relation to the possible functions of the lamprey gill, with particular reference to ionic regulation.
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1. Centrifugation in density gradients was used to study the fragments produced during intraluminal and intracellular digestion, after the injection of 125I-labelled immunoglobulin G (IgG) into different regions of the small intestine of 14 to 15-day-old (pre-closure) and 24-day-old (post-closure/ rats. 2. After injection into the proximal small intestine and into the ileum of pre-closure animals, the bulk of the radioactivity recorded for gut washes and gut homogenates was located at 4S-7S. The serum from animals which had received injections into the proximal small intestine had high radioactivity and one peak at 7S; the serum from animals which had received injections into the ileum had low radioactivity and no activity in the 7S region. 3. After injection into the proximal small intestine of post-closure animals, the bulk of the radioactivity recorded for gut wash samples was located at 3-5S--5S. Gut homogenates had peak activity at 2-5S--4S. Thus large molecular weight products can be absorbed by the proximal enterocytes of post-closure rats and degraded. The sera of these animals had low radioactivity. 4. After injection into the distal small intestine of post-closure animals, the bulk of the radioactivity recorded for gut wash and gut homogenate samples was located at 4S-7S and in this respect the radioactivity plots resembled those for (2) above. Serum radioactivity was low. 5. The effect of precipitation with trichloroacetic acid and incubation with specific antiserum upon the radioactivity of gut washes, gut homogenates and serum samples was recorded. 6. The relevance of these findings to studies on the transmission of protein by the rat small intestine is discussed.
Density gradient centrifugation of samples prepared from proximal gut homogenates after intra-lumenal injection of 125I-labelled IgG, was used to prepare batches of IgG fragments according to sedimentation coefficients. 2. Ultrafiltration was employed to partition the radioactivity in the vascular compartments, viscera and carcasses of rats aged 14-15 days, 2 hr after the injection of standard doses of labelled IgG into the proximal and distal regions of the small intestine. 3. Radioactive samples prepared by these methods were re-introduced into young rats by intra-cardiac injection, and the rate at which they were removed from the vascular compartment was assessed. 4. Proximal enterocytes transmitted about 39% of the IgG which had been removed from the intestine in intact form. Most of this was retained in the vascular compartment; they degraded up to about 57% of the total removed into fragments less than 1000 mol. wt. and about 4% into intermediate sized fragments. 5. Distal enterocytes degraded almost 90% of the IgG processed into fragments less than 1000 mol. wt., about 8% as fragments greater than 100,000 mol. wt. 6. Fragments, of all sizes, were cleared rapidly from the circulation into the viscera and carcass. 7. The relevance of these results to protein transmission and digestion by the rat small intestine is discussed.
Sera from chicken, turkey, pheasant, quail and their intergeneric hybrids were compared by their reactions in two-dimensional immunoelectrophorsis with homologous and heterologous antisera. As many as 44 antigenically distinguishable components were resolved in these sera by use of this technique. Sera from the intergeneric hybrids, when allowed to react with rabbit anti-White Leghorn antiserum, gave more precipitin peaks than did any of the parental sera in reaction with this same antiserum. Thus it appeared that intergeneric hybridization induced a propagation of avian serum antigens recognized by rabbit antiserum to a single parental serum. For example, all parental sera, in reaction with homologous or heterologous antisera, appeared to contain only one precipitin peak which migrated in the albumin area. Sera from the intergeneric hybrids of chicken X turkey, chicken X pheasant, and chicken X quail had two antigenetically distinguishable peaks in the albumin area. Sera from turkey X pheasant and pheasant X quail had only one peak in this region. These results agree with the observations obtained from polyacrylamide disc gel electrophoresis of the plasma proteins.