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PubMedDate not supplied

Tube-feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison.

OBJECTIVE: To compare the costs associated with caring for severely demented residents nursing homes with and without feeding tubes. DESIGN: Retrospective cohort study. SETTING: A 700-bed long-term care facility in Boston Participants: Nursing home residents aged 65 years and over with advanced dementia and eating problems for whom long-term feeding tube had been discussed as a treatment option. MEASUREMENTS: Costs were compared over the 6 months that followed the tube-feeding decision for those residents who did and did not undergo feeding tube placement for the following items: nursing time, physician assessments, food, hospitalizations, emergency room visits, diagnostic tests, treatment with antibiotics and parenteral hydration, and feeding tube insertion. RESULTS: Twenty-two subjects were included, 11 were tube-fed (mean age 84.3 years +/- 6.0) and 11 were hand-fed (mean age 90.2 years +/- 9.1). The daily costs of nursing home care were higher for the residents without feeding tubes compared with residents with tubes ($4219 +/- 1546 vs $2379 +/- 1032, P = 0.006). Nonetheless, Medicaid reimbursement to nursing homes in at least 26 states is higher for demented residents who are tube-fed than for residents with similar deficits who are not tube-fed. Costs typically billed to Medicare were greater for the tube-fed patients ($6994 +/- 5790 vs. $959 +/- 591, P < 0.001), primarily because of the high costs associated with initial feeding tube placement and hospitalizations or emergency rooms visits for the management of complications of tube-feeding. CONCLUSIONS: Nursing homes are faced with a potential fiscal incentive to tube-feed residents with advanced dementia: tube-fed residents generate a higher daily reimbursement rate from Medicaid, yet require less expensive nursing home care. From a Medicare perspective, tube-fed patients are expensive due to the high costs associated with feeding tube placement and acute management of complications. Further work is needed to determine whether these potential financial incentives influence tube-feeding decisions in practice.

Activities of Daily Living↗
PubMed2005

Left-handed and right-handed metamaterials composed of split ring resonators and strip wires.

The behavior of two structures composed of split ring resonators (SRRs) and strip wires (SWs) is examined through full wave simulations. It is shown that both structures exhibit a transmission peak in the region where the real parts of the electric permittivity and magnetic permeability are presumed to be negative, a property which is usually assumed to imply a negative index of refraction. However, an analysis of the dispersion characteristics and insertion phase of the two structures shows that the first structure, in which the SRRs and SWs are printed on opposite sides of a dielectric substrate, is a left-handed medium in the passband, whereas the second structure, in which SRRs and SWs are printed on the same side, is a right-handed medium in the passband. Hence the transmission magnitude alone does not provide sufficient evidence of a negative index of refraction. To determine the sign of the index correctly, the insertion phase for propagation through several lengths of the structure or calculations of dispersion diagrams are necessary. The impact of the unit cell size on the "handedness" of the structure is also examined.

Journal Article↗
PubMed2006

Spontaneous emission field of a two-level atom embedded in one-dimensional left-handed- and right-handed-material photonic crystals.

We investigate the spontaneous emission (SpE) of a two-level atom embedded in one-dimensional photonic crystals composed of left-hand material (LHM) and right-hand material. A complete set of mode functions is constructed for quantizing the radiation field. The radiated field distribution under the condition of impedance matching is calculated. The radiated field is focused in each layer and propagates along the direction normal to each layer due to the LHM. With such a structure we can control the propagation of the SpE field without changing the SpE rate.

Journal Article↗
PubMed2005

Determination of optical isomers for left-handed or right-handed chiral double-wall carbon nanotubes.

The handedness relationship between adjacent layers in nested double-wall carbon nanotubes (DWNTs) has been investigated for the first time. Our high-resolution electron microscopy analysis on a series of specimen tilts can successfully tell the handedness of each constituent nanotube in a DWNT, and therefore the chiral indices (n, m) including their optical isomers [(n, m) or (m, n)] of inner and outer nanotubes can be uniquely determined. It is shown that right-handed and left-handed nanotubes are equally distributed for both the inner and outer nanotubes in the examined specimens and a preferable handedness relationship between the adjacent layers in DWNT may exist.

Journal Article↗
PubMed2006

Chiral nematic phase of suspensions of rodlike viruses: left-handed phase helicity from a right-handed molecular helix.

We report a study on charged, filamentous virus called M13, whose suspensions in water exhibit a chiral nematic (cholesteric) phase. In spite of the right-handed helicity of the virus, a left-handed phase helicity is found, with a cholesteric pitch which increases with temperature and ionic strength. Several sources of chirality can be devised in the system, ranging from the subnanometer to the micrometer length scale. Here an explanation is proposed for the microscopic origin of the cholesteric organization, which arises from the helical arrangement of coat proteins on the virus surface. The phase organization is explained as the result of the competition between contributions of opposite handedness, deriving from best packing of viral particles and electrostatic interparticle repulsions. This hypothesis is supported by calculations based on a coarse-grained representation of the virus.

Bacteriophage M13↗
PubMed2004

Comparison of hand-to-hand bioimpedance and anthropometry equations versus dual-energy X-ray absorptiometry for the assessment of body fat percentage in 17-18-year-old conscripts.

In the present study, hand-to-hand bioelectrical impedance analysis (BIA), skinfold (SKF) thickness and height-weight (body mass index, BMI)-based equations and dual-energy X-ray absorptiometry (DEXA), as a criterion method, were compared with each other in the assessment of body fat percentage (BF%) in 17-18-year-old Estonian conscripts (n = 32). The Omron BF body fat monitor estimated that BF% was lower than that of the criterion method DEXA. The difference between DEXA and Omron BF 300 (III) was higher (1.1 +/- 3.0%; P = 0.04) and that between DEXA and Omron BF 306 lower (0.2 +/- 3.0%; P>0.05). Omron BF 300 (I) and (II) (series 8) had intermediate difference (0.9 +/- 3.0 and 0.9 +/- 3.0; P>0.05) when compared with DEXA. Three anthropometric equations estimated a higher BF% than cthat of DEXA. The Durnin & Womersley SKF equation BF% (1.0 +/- 2.4; P = 0.03) was higher than that of the DEXA. Deurenberg et al. and Gallagher et al. BMI-based equations overestimation yielded 0.9 +/- 3.7 and 0.6 +/- 3.8 BF% (P>0.05). From the anthropometric equations, only the Deurenberg et al. SKF equation slightly underestimated 0.5 +/- 3.4 BF% (P>0.05). DEXA-assessed BF% had highest correlation with SKF equations (r = 0.93), less so with BIA (r = 0.88-0.89) and lowest with BMI equation-assessed BF% (r = 0.81-0.84). All values were significant at P<0.001. We can conclude that the Omron BF 306 body fat monitor and the anthropometric Deurenberg et al. SKF equation yielded results close to the DEXA BF%.

Absorptiometry, Photon↗
PubMed1992

A study of right unilateral spatial neglect in left hemispheric lesions: the difference between right-handed and non-right-handed post-stroke patients.

We report 20 cases of right unilateral spatial neglect caused by lesions in the left cerebral hemisphere. Differences in neuropsychological symptoms and lesions sites are discussed in connection with handedness. Of the right-handed patients, 6 had severe aphasia, 4 had Gerstmann's syndrome, and 1 had pure agraphia, but unilateral spatial neglect in these cases disappeared after a number of months. Six of the non-right-handed patients had moderate-to-severe aphasia, while the other 3 cases had no aphasia at all. Eight of the 9 cases in this group continued to have right unilateral spatial neglect for more than 6 months. Lesion site as determined by CT differed as to hemisphere, but all fell into the common area previously mentioned in connection with such disorders: i.e., the temporal, parietal and occipital lobes.

Adult↗
PubMed2003

Myosin V walks hand-over-hand: single fluorophore imaging with 1.5-nm localization.

Myosin V is a dimeric molecular motor that moves processively on actin, with the center of mass moving approximately 37 nanometers for each adenosine triphosphate hydrolyzed. We have labeled myosin V with a single fluorophore at different positions in the light-chain domain and measured the step size with a standard deviation of <1.5 nanometers, with 0.5-second temporal resolution, and observation times of minutes. The step size alternates between 37 + 2x nm and 37 - 2x, where x is the distance along the direction of motion between the dye and the midpoint between the two heads. These results strongly support a hand-over-hand model of motility, not an inchworm model.

Actin Cytoskeleton↗
PubMed1996

Asymmetric metabolic profile in mesial temporal lobes: localized H-1 MR spectroscopy in healthy right-handed and non-right-handed subjects.

PURPOSE: To determine a possible asymmetric metabolic profile in right- handed and non-right-handed healthy subjects by comparing proton spectra from temporal lobes. MATERIALS AND METHODS: Twenty-eight healthy adults (17 right-handers, 11 non-right-handers) underwent magnetic resonance (MR) imaging and single-voxel MR spectroscopy. N-acetylaspartate (NAA), choline (Cho), and creatine (Cr) peak areas were measured. RESULTS: Volume of hippocampal formations was larger on the right in right-handers (right volume: 4.04 cm3 +/- 0.67 vs left volume: 3.84 cm3 +/- 0.62; P = .00004) and in non-right-handers (right volume: 4.22 cm3 +/- 0.78 vs left volume: 4.05 cm3 +/- 0.80; P = .004). NAA/Cho was significantly higher in the left temporal lobe of right-handers (right lobe: 1.53 +/- 0.18 vs left lobe: 1.89 +/- 0.18; P=.00004) as was NAA/Cr (right lobe: 1.79 +/- 0.36 vs left lobe: 2.45 +/- 0.45; P=.0001). No statistically significant difference was noted for these ratios in non-right-handers: NAA/Cho (right lobe: 1.49 +/- 0.18 vs left lobe: 1.61 +/- 0.35) and NAA/Cr (right lobe: 1.93 +/- 0.45 vs left lobe: 2.40 +/- 0.70). CONCLUSION: A clear metabolic asymmetry observed in right-handers is less clear-cut in non-right-handers. Both tendencies should be considered when assessing the brain metabolism of patients with uni- or bilateral disorders, such as temporal lobe epilepsy.

Adult↗
PubMed2003

Electrical and contractile remodeling during the first days of atrial fibrillation go hand in hand.

BACKGROUND: The mechanisms of the atrial contractile dysfunction induced by atrial fibrillation (AF) are not completely understood. In particular, the relation between the atrial dysfunction and electrical remodeling has not yet been studied. METHODS AND RESULTS: Seven goats were chronically instrumented with electrodes sutured to the atria and with ultrasonic piezoelectric crystals to record the atrial diameters. A pressure transducer was implanted in the right atrium. After 5 minutes, 3 hours, and throughout the first 5 days of artificially maintained AF, atrial contractile function was measured and the atrial effective refractory period (AERP) was monitored for comparison. Also, the positive inotropic effects of the L-type Ca2+-channel agonist BayY5959 and short trains of rapid atrial pacing were studied. After resumption of sinus rhythm, the recovery of atrial contractile function was followed. After 5 minutes of AF, atrial contractility was decreased by approximately 55% but recovered completely within 10 minutes. Five days of AF nearly completely abolished the atrial contractile function, and recovery took 2 days. During the first days of AF, the development of the contractile dysfunction followed the same time course as the shortening of AERP (electrical remodeling). In remodeled atria, BayY5959 increased atrial contractility to the same extent as it prolonged AERP. The inotropic effect of short trains of rapid atrial pacing was similar in normal and remodeled atria. CONCLUSIONS: Depending on the duration of AF, different mechanisms contribute to the AF-induced atrial hypocontractility. Atrial contractile remodeling during several days of AF goes hand in hand with electrical remodeling and might be caused by a reduction of the L-type Ca2+-current.

Adaptation, Physiological↗
PubMed1994

Analysis of data from Reichler's (1979) The Baseball Encyclopedia: right-handed pitchers are taller and heavier than left-handed pitchers.

In 1989 Coren concluded right-handed Major League pitchers whose careers began up to 1975 are significantly taller and heavier than left-handed pitchers. His source of data, Reichler's 1979 edition of The Baseball Encyclopedia, however, lists heights and weights for pitchers whose careers began through 1978 and for individuals who pitched but who almost always appeared at a different position or positions. Coren did not indicate why he did not analyze all of the relevant data in Reichler nor did he explain how he decided that an individual's usual position was that of pitcher. Further, there is evidence from Topp which suggests that the era during which the pitchers began their careers should be considered when comparing their heights and weights because relatively recent rookies (from 1980 through 1986) are taller and heavier than rookies who began their careers 50 and 100 years prior to that era. Classifying an individual as a pitcher if he pitched in at least 50% of the games in which he played at a position, using all relevant data in Reichler, and considering the era during which dextral and sinistral pitchers began their careers, we found strong corroborative evidence for Coren's 1989 findings.

Baseball↗
PubMedDate not supplied

Fighting hand to hand over physician workforce policy.

A vexing problem in health policy is getting the right number of physicians in the right specialties in the right locations at the right time. I examine market and public planning approaches to getting the number "right." After discussing the basic premises of the invisible hand of the market and the heavy hand of government regulation, I apply these concepts to a review of the past century of U.S. physician supply and workforce policy. I conclude by examining recent health system trends that make clear the need for a firm regulatory grasp on physician workforce policy.

Health Care Sector↗
PubMed2004

Nanometer localization of single green fluorescent proteins: evidence that myosin V walks hand-over-hand via telemark configuration.

Myosin V is a homodimeric motor protein involved in trafficking of vesicles in the cell. It walks bipedally along actin filaments, moving cargo approximately 37 nm per step. We have measured the step size of individual myosin heads by fusing an enhanced green fluorescent protein (eGFP) to the N-terminus of one head of the myosin dimer and following the motion with nanometer precision and subsecond resolution. We find the average step size to be 74.1 nm with 9.4 nm (SD) and 0.3 nm (SE). Our measurements demonstrate nanometer localization of single eGFPs, confirm the hand-over-hand model of myosin V procession, and when combined with previous data, suggest that there is a kink in the leading lever arm in the waiting state of myosin V. This kink, or "telemark skier" configuration, may cause strain, which, when released, leads to the powerstroke of myosin, throwing the rear head forward and leading to unidirectional motion.

Adenosine Triphosphate↗
PubMed2005

Hand-assisted retroperitoneoscopic nephroureterectomy without hand-assisted device.

Various laparoscopic nephroureterectomy techniques for urothelial carcinoma of the upper urinary tract have been developed to minimize postoperative discomfort and the necessity for a lengthy convalescence. We performed hand-assisted retroperitoneoscopic nephroureterectomy without hand-assisted device in 3 male patients with urothelial carcinoma of the distal ureter. Average operative time and estimated blood loss were 251 min (range 235 to 280) and 250 mL (range 200 to 300), respectively. Complication did not occur and conversion to open surgery was not necessary in all cases. Postoperative analgesic requirements were moderate and the time to regular diet intake averaged 3 days (range 2 to 4). None of the patients had a positive margin on the final pathologic specimen. At the average follow-up of 8.1 months, no regional recurrence, port-site metastasis, bladder recurrence, or distant metastasis were noted in any patient. We described our initial experience with the described technique, which obviates the need for midprocedural patient repositioning.

Aged↗
PubMed2005

Impetigo in soldiers after hand-to-hand combat training.

Bacterial skin infections are very common and trigger destruction of the skin integrity. Impetigo is a consequence of group A beta-hemolytic streptococcus or Staphylococcus aureus infection. The clinical presentation in general is very typical and empiric treatment is usually successful. In cases of close contacts such as between classmates, athletes, or soldiers, the prompt recognition and appropriate treatment of the infection may stop an epidemic. We report a group of six soldiers who shared the same military equipment (physical shields) during hand-to-hand combat training. All of the soldiers had skin lesions and two of them suffered from systemic symptoms. Group A beta-hemolytic streptococcus and S. aureus were cultured from the impetiginous lesions. All patients recovered after systemic and/or local antibiotic treatments. These cases emphasize the need for the maintenance of proper hygiene throughout the training program to prevent spread of the disease and the importance of rapid diagnosis by bacteriological identification.

Anti-Bacterial Agents↗
PubMed2006

Pyogenic granuloma on the hand subsequent to friction blister in a hand surgeon.

A case of pyogenic granuloma in a 62-year-old hand surgeon secondary to friction blister is reported. He developed a fast growing, hypertrophic inflammatory papule consisting of exceptionally richly vascularized granular tissue. This dusky red lesion was located on the thenar part of the hand. We find no prior report of PG attributed to friction blister.

Friction↗
PubMed1994

Growth of hand-reared American kestrels. II. Body composition and wingloading of fledglings hand-fed two different diets.

The body composition of young American kestrels (Falco sparverius) hand-fed either a protein-rich diet (day-old cockerels Gallus domesticus) or a fat-rich diet (laboratory mice Mus musculus) was determined one day after fledging. Mouse-fed fledglings (n = 16) had significantly greater fat deposits than cockerel-fed birds (n = 15), while the crude protein content of the carcass was unaffected by the diets. At fledging, mouse-fed birds showed a significantly greater wingloading than cockerel-fed birds. Larger fat reserves (as in mouse-fed birds) might be mobilised in the event of a food shortage and thus these birds would be at an advantage in relation to fledglings with smaller reserves. On the other hand, large fat deposition, which alters wingloading, might impair the flight performance of the fledglings.

Analysis of Variance↗