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The special health and personal problems that can accompany aging demand a special kind of home care worker. Two Boston agencies combined resources to bring the community's "difficult-to-serve" elders the experience, patience, and persistence they needed.
The Secretary issues regulations governing the Special Demonstration Programs. These regulations are needed to implement changes in the Rehabilitation Act Amendments of 1998. The regulations provide definitions and requirements for grants and contracts under the expanded authority of the Special Demonstration Programs.
A prerequisite for the successful immunotherapy of solid tumours with interleukin-2 (IL-2)-activated lymphocytes is their ability to home to the tumour tissue. Lymphocyte homing is a complex process which is known to involve at least two independently regulated events: adhesion to the luminal surface of vascular endothelium and the subsequent transendothelial migration of lymphocytes. In this study we have used an in vitro model of lymphocyte homing which employs specialized high endothelium to ask whether IL-2-activated lymphocytes are able to migrate across vascular endothelium in order to leave the blood vessel. Both the adhesion of IL-2-activated cells and their migration across monolayers of cultured high endothelial cells (HEC) were increased in comparison with non-activated lymphocytes. The adhesion of IL-2-activated lymphocytes was mediated by lymphocyte function-associated antigen-1 (LFA-1) and a very late activation antigen-4 (VLA-4)-related pathway. LFA-1-dependent adhesion was mediated by ligands on HEC other than the intercellular adhesion molecule-1 (ICAM-1) and the VLA-4-related pathway was mediated by ligands other than the CS1 domain of fibronectin. HEC-adherent lymphocytes were enriched in natural killer (NK) cells and CD8+ T cells which are known to be the tumour-cytotoxic cells in IL-2-activated lymphocytes. However, there was no evidence of cytotoxicity towards the endothelial layer using a syngeneic model. The interaction of IL-2-activated lymphocytes and endothelial cells was not specific for high endothelium since equal numbers of activated lymphocytes bound to and migrated across aortic endothelium. The inability of IL-2-activated lymphocytes to discriminate between high endothelium and non-specialized 'flat' endothelium could be responsible for the widespread dissemination of the cells throughout the body following their adoptive transfer and the unwanted side-effects at non-involved sites.
Reviews management training for doctors undertaken in the special health authorities in London. These are postgraduate research institutes in clinical medicine. Compares methodology and outcome issues with the national research programme completed a year earlier, and identifies the context of comparative change between the research programmes. The finds, although similar to the national evaluation the previous year, identify some additions, in particular the lack of formal accountability for the management role in the NHS being undertaken by these university employees, and the differing nature of the working arrangements for these academic doctors who are usually working as knowledge-based networkers across a number of organizations.
Special groups of persons with mental illness require individually tailored programs.
Nursing facility staff may not be properly trained to deal with behavioral symptoms of Alzheimer's disease. We collected data about specialized dementia training and turnover among licensed nurses and nursing assistants in 400 nursing units in 124 Minnesota nursing facilities. Staff training may affect the retention of paraprofessional and professional nursing staff. A diversity of training methods, including workshops or seminars, films or videos, outside consultants, reading materials, training manuals, in-house experts, role playing techniques, or an orientation program for new staff, might be used to develop more effective training programs and reduce rates of nursing assistant turnover.
"Because I'm a hemophiliac, I have always had to be protected. Camp Barnabas was the first place I could put that aside and do anything I wanted." This comment by a 9-year-old boy eloquently captures the spirit and reality of Camp Barnabas, a site that has had camp programs for special-needs children and their siblings for the past year. Camp Barnabas, located near Monett, Missouri, held its first summer sessions in 1994 and 1995 at a nearby camp, Kanakuk/Kanakomo. Camp Barnaba's founders, Paul and Cyndy Teas, were inspired by a Kanakuk/Kanakomo camper with cancer to create a camping experience paced and equipped for children with terminal or serious, chronic illnesses.
Tris(pentafluorophenyl)borane is best known for its role as an excellent activator component in homogeneous Ziegler-Natta chemistry. However, the special properties of B(C6F5)3 have made this strong boron Lewis acid an increasingly used catalyst or stoichiometric reagent in organic and organometallic chemistry. This includes catalytic hydrometallation reactions, alkylations and catalyzed aldol-type reactions. B(C6F5)3 catalyzes tautomerizations and can sometimes stabilize less favoured tautomeric forms by adduct formation. It induces some rather unusual reactions of early metal acetylide complexes and can help in stabilizing uncommon coordination geometries of carbon. The growing number of such examples indicates an increasing application potential of the useful Lewis acid B(C6F5)3 aside from its established role in olefin polymerization catalysis.
101 cases of Wilms' tumor (nephroblastoma) were investigated by light microscopy. In 80 cases a diagnosis of triphasic nephroblastoma was made. 21 cases were classified as special variants of Wilms' tumor. These included congenital mesoblastic nephroma (n = 5), fetal rhabdomyomatous nephroblastoma (n = 2), cystic partially differentiated nephroblastoma (n = 3), nephroblastoma with focal or diffuse anaplasia (n = 2), clear cell sarcoma or bone metastasizing renal tumor of childhood (n = 4), rhabdoid tumor (n = 2) and rhabdomyosarcomatous nephroblastoma (n = 3). Based on our own follow-up data and on information from the literature we propose to separate the group of nephroblastomas into three categories of different prognosis: 1. Nephroblastomas of low risk (congenital mesoblastic nephroma, fetal rhabdomyomatous nephroblastoma, cystic partially differentiated nephroblastoma) - in most of these cases simple nephrectomy sufficient as adequate therapy. 2. Nephroblastomas of standard risk (triphasic nephroblastomas) - therapy according to stage of disease. 3. Nephroblastomas of high risk (nephroblastomas with focal or diffuse anaplasia, clear cell sarcoma, rhabdoid tumor, rhabdomyosarcomatous nephroblastoma) - successful therapy has as yet to be developed.
After the menopause the consequences of hypertension in women change. Their risks of myocardial infarction and stroke rise steeply, a rise that has been blamed in part on the loss of estrogen and the onset of menopausal metabolic syndrome, with endothelial dysfunction, hyperlipidemia, insulin resistance and derangement in coagulation. Hypertensive menopausal women have not had optimum treatment. They have poorer prognoses than men of the same age. Their antihypertensive management therefore merits special attention. Hormone replacement, aspirin prophylaxis and lipid-lowering drugs have their place. The antihypertensive drug chosen should not worsen the metabolic syndrome: angiotensin-II converting enzyme (ACE) inhibitors are therefore among the first-line drugs. Few drugs have been specifically aimed at menopausal hypertension and these are reviewed here.
Records of 116 violent incidents perpetrated by special care patients over a twelve-month period were retrospectively examined. There was a marked seasonal variation in the number of incidents. Incidents took place predominantly in the seclusion rooms and in communal areas having relatively high patient density. Patients admitted from the National Health Service following unmanageable violent behaviour were over-represented. A small number of patients were responsible for a high proportion of incidents. Implications for prevention are discussed.
To protect the consumer, consistency is needed in what one can expect when a long-term care facility (LTCF) advertises having an Alzheimer's special care unit (SCU). Arkansas recently passed disclosure legislation, which has led to the development of criteria for licensure of SCUs. This study compared the extent to which Arkansas LTCFs, with and without SCUs, met these criteria. We conducted a statewide survey of 238 LTCFs prior to the enforcement of these regulations and will conduct the same survey following their enforcement. Of the 147 (62 percent) facilities responding, 24 (16 percent) had a SCU. None of the LTCFs with SCUs met all the state criteria. The number and quality of services provided in SCUs and non-SCUs were similar.
Mammals contain various cells differentiated in both morphology and function, which play vital roles in tissue-specific functions. Late endosome/lysosome and lysosomal-related organelles are involved in these specialized functions including antigen presentation, bone remodeling and hormone regulation. To fulfill these diverse roles, lysosomes are present at different levels in different tissues and cell types; however, their morphology within these different tissues varies and the regulation of their activities differs with lysosomal compartments in some cells also functioning as secretory compartments. The luminal acidification of these organelles is closely correlated with their functions. This review will discuss the functions of lysosomes and lysosomal-related organelles, with particular emphasis on the major proton pump, the vacuolar-type proton ATPase (V-ATPase), which is responsible for luminal acidification.
This Federal Register notice seeks the input and comments of interested parties on a Special Advisory Bulletin being developed by the OIG and HCFA designed to address requirements of the patient anti-dumping statute and the obligations of hospitals to screen all patients seeking emergency services and provide stabilizing medical treatment to enrollees of managed care plans if their condition warrants it. In developing this proposed issuance and soliciting public comment, it is our goal to provide clear and meaningful advice with regard to the application of the anti-dumping provisions, and ensure greater public awareness of the hospitals' obligations in providing emergency medical services to those individuals insured by managed care plans.
General surgical chief residents in all approved training programs were surveyed to evaluate the influence of fellowships, specialization, and research. Respondents represented 76% of programs and 60% of residents. Most chief residents plan to take post-residency fellowships. This is most common among those from university training programs and residents planning an academic career. Vascular surgery and cardiothoracic surgery represent half of all fellowships. Sixty-two percent of residents plan to enter private practice compared with 28% who plan to join a medical school faculty. More than one third of university trainees plan an academic career. More than 90% plan fellowships. The practice of general surgery alone or combined with a specialty was more common among trainees from independent training programs. Practice of a subspecialty was more common among university trainees. More than 80% of residents did research during training. Research leading to publication was more common among university trainees planning academic careers and least common among future general surgeons. This survey suggests that general surgery is predominant among residents in independent training programs who then enter private practice. University programs produce subspecialists who are predominant among future academic surgeons. This trend has vital implications for the future of academic general surgery.
Technological revolution involves an increased risk of negative impact of adverse factors on human health in the whole world. The authors analyze the tendencies of burn traumas incidence in Russia in the latest decade. They necessitate creation in each district of centers for monitoring burnt patients, which should be engaged in registration of burn traumas, organization of emergency care and specialized outpatient and inpatient care, medical and sociopsychological rehabilitation of the victims.
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