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PubMed1985

Medicare program; schedule of limits on skilled nursing facility inpatient routine service costs--HFCA. Proposed notice.

This proposed schedule of limits would revise the single Medicare reimbursement limit that was published in the Federal Register (47 FR 42894) on September 29, 1982 insofar as that notice applied to hospital-based skilled nursing facility (SNF) inpatient routine service costs. Separate reimbursement limits for freestanding and hospital-based SNFs are required by the Deficit Reduction Act of 1984 (Pub. L. 98-369). This notice proposes different cost limit schedules for hospital-based SNFs for cost reporting periods beginning on or after October 1, 1982 and prior to July 1, 1984, and for cost reporting periods beginning on or after July 1, 1984. Freestanding SNF cost limits would remain the same as those published in the September 29, 1982 cost limits notice.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

The influence of age, sex, and race on the upper reference limit of serum C-reactive protein concentration.

OBJECTIVE: The recommended reference range for serum C-reactive protein (CRP) concentrations is usually not adjusted for age and sex. We sought to determine if age, sex, and race or ethnicity influence the distribution of CRP values, and if upper reference limits of CRP should be adjusted by demographic factors. METHODS: Interviews, physical examinations, and blood draws were performed on > 22,000 individuals age > or = 4 yrs representative of the noninstitutionalized population of the United States, as part of the Third National Health and Nutrition Evaluation Survey (NHANES III). Serum CRP concentrations were measured by nephelometric immunoassay. RESULTS: The 95th percentile value of CRP in the overall population was 0.95 mg/dl for males and 1.39 mg/dl for females, and varied with age and race. For ages 25-70 yrs, the age adjusted approximate upper reference limit (mg/dl) was CRP = age/50 for males, and CRP = age/50 + 0.6 for females. The upper limits for Mexican-Americans and non-Hispanic whites were similar, whereas for non-Hispanic black adults the approximate upper limit was CRP = age/30 for males and CRP = age/50 + 1.0 for females. Even after accounting for identified inflammatory conditions, demographic factors influenced the reference limits of CRP. The 95th percentile values were uniformly lower in children than in older adults. CONCLUSION: Demographic factors, including age, sex, and race, should be used to adjust the upper reference limit for CRP. Clinicians should be aware of these factors when using CRP values to assess inflammatory diseases.

Adolescent↗
PubMed2000

[A case of limited Wegener granulomatosis with hypereosinophilia].

A 51-year-old female was admitted to Nagano Matsushiro General Hospital because of fever, cough and dyspnea on exertion. Her laboratory data revealed leukocytosis with hypereosinophilia, a high erythrocyte sedimentation rate and c-reactive protein. Chest radiography revealed an infiltration shadow with a cavity in the right upper lobe. A lung abscess was diagnosed and antibiotics were administered. Laboratory results showed improvement, but chest radiography continued to show cavities. She was admitted to our hospital because of fever, left pleural effusion and progression of cavities on chest radiographs. She showed no abnormalities of the upper airway or kidney, and was negative for c-antineutrophil cytoplasmic antibody (c-ANCA). Because a positive c-ANCA was seen on day 8 of hospitalization, L-type limited Wegener granulomatosis (WG) was diagnosed according to Gross et al. Prednisolone (PSL) was administered, which improved the anemia, eosinophilia and the cavities. On day 7 of PSL administration, of the left pneumothorax occurred as a complication caused by perforation of the left chest cavity, but her clinical course was good after a cavernectomy was performed. Some studies have reported that limited WG shows a negative c-ANCA, and that antibiotic therapy improves inflammation. The L-type of limited WG revealed a low-grade positive ratio and titer of c-ANCA. Moreover, L-type limited WG responds well to therapy. We therefore selected PSL administration only against L-type limited WG. We have reported L-type limited WG with eosinophilia and the negative effects of c-ANCA at an early clinical stage.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2001

Relationships among selected measures of impairment, functional limitation, and disability in patients with cervical spine disorders.

BACKGROUND AND PURPOSE: Little is known about the relationship among impairments, functional limitations, and disability in people with cervical spine disorders (CSD) despite the fact that these concepts are routinely used in clinical practice. The primary purpose of this study was to investigate the relationships among commonly assessed impairment, functional limitation, and disability measures in patients with CSD. A secondary purpose was to determine the influence of payment source and time since onset of symptoms on these same measures. SUBJECTS: Eighty patients (mean age=45.7 years, SD=15.9, range=20-88) with CSD who were referred for physical therapy participated in the study. METHODS: Data were obtained for 3 measures of impairment, 2 measures of functional limitation, and 3 measures of self-reported disability during the initial visit. RESULTS: All 3 sets of variables (ie, impairment, functional limitation, disability) correlated with each other, with the highest correlation occurring between the impairment measures and the functional limitation measures (r=.82). Other correlations were noted between individual variables. There was no effect of payment type or time since onset of symptoms on the variables. CONCLUSION AND DISCUSSION: Positive correlations were noted among the 3 sets of measures, which supports the assumption that impairments, functional limitations, and disability are related in patients with CSD.

Activities of Daily Living↗
PubMedDate not supplied

Limited hip abduction in the infant.

This article addresses two important questions: What is the relationship between limited abduction and hip dysplasia in infants? Does untreated limited abduction in the infant ultimately lead to developmental dysplasia of the hip? In the authors' population of 683 babies, limitation of abduction had a sensitivity for the diagnosis of hip dysplasia of 69%, a specificity of 54%, a positive predictive value of 43%, and a negative predictive value of 78%. In the group with sonographically proven hip dysplasia, 70 of 226 babies (31%) showed no limitation of abduction, and in the group without dysplasia 210 of 457 (46%) showed manifest limitation of abduction. One hundred thirty-six babies with limited abduction but a normal sonographic examination were left untreated. They were re-examined at an average age of 5+3 years (range 2+0-9+5). All had developed normally, both clinically and radiographically.

Female↗
PubMed1975

The flammability limits of lean fuel-air mixtures: thermochemical and kinetic criteria for explosion hazards.

The present state of knowledge is reviewed concisely in terms of the experimental methods used, the effect of apparatus size, accuracy of data, methods of data presentation, and the sensitivity of the limits to initial temperature and pressure. The heat of combustion per mole of gas mixture at the lean limit is a reliable thermochemical criterion for the flammability of organic fuels with comparable reactivities. The limit calorific value for the heavy paraffins is 11.5 +/- 0.1 kcal mole -1. However, kinetic effects strongly influence this value. Highly reactive fuels (hydrogen, acetylene) require lower energy contents, whereas less reactive fuels (ammonia) require higher values. Hydrogen-starved fuels (carbon monoxide, cyanogen) show marked anomalies and are sensitive to impurities that can provide H-atom chain carriers. These kinetic effects are reflected in the experimentally measurable burning velocity of the fuel. This parameter is a key ingredient in the theory of flammable limits, which is briefly sketched. Five competing processes dissipate power from the combustion wave and quench it at some characteristic limit velocity. The prevalent consensus that the limits are controlled by natural convection is clearly demonstrated, and the complex interplay of kinetics and thermochemistry follows logically therefrom.

Accident Prevention↗
PubMedDate not supplied

Limit setting: a useful strategy in rehabilitation.

Limit setting is a concept familiar to most mental health clinicians, but much less familiar to staff not specifically trained in mental health care. This paper presents guidelines developed for rehabilitation staff on the strategy of limit setting. The aim of these guidelines was to provide a starting point for ongoing education on limit setting and behavioural management for staff working in a non-psychiatric rehabilitation environment. Limit setting is presented, not only as a response to challenging behaviour, but also as fundamental to all patient care within the rehabilitation context. The guidelines draw on the concepts of limit setting, acting out, therapeutic relationships and therapeutic milieu as described in the psychiatric literature. A humanistic framework for helping people underpins the guidelines. Principles for selecting and enforcing limits are described. Finally, a list of clarification prompts is provided for clinicians to use when faced with challenging patient behaviour.

Behavior Therapy↗
PubMed2003

Field trials of no-decompression stop limits for diving at 3500 m.

INTRODUCTION: In 1990, Boğaziçi University (Istanbul, Turkey) launched an altitude diving program to develop techniques and safe decompression profiles for diving at high terrestrial altitudes. Following pioneering diving expeditions to lakes at high elevations in 1990-1992, it was deemed necessary to calculate new tables. METHODS: Bottom time limits for dives requiring no decompression stops (no-d) were calculated for 3500 m using linear extrapolation of U.S. Navy M-values decreased by 4 ft of sea water (M4 limits). These limits were tested for 15, 18, 21, 24, 27, and 30 m of depth by diving in the Great Sea Lake at Mt Kaçkar (3412 m) with 10 dives per profile. RESULTS: The mean decompression sickness (DCS) risk estimated from precordial bubble scores (Spencer Scale) ranged from 0.3% to 2.8% per profile. After three expeditions, 165 dives had been achieved with a cumulative bottom time of 3199 min. No DCS occurred in dives that adhered to the M4 no-d limits. However, two cases of Type I and one case of Type II DCS were encountered where the divers accidentally exceeded those limits. DISCUSSION: Considering the estimated risk of DCS and the relatively small number of trials, a more conservative approach was used to develop a final set of high altitude dive tables. This conclusive approach used continuous compartment half-lives. It is based on fitting a surface of allowable supersaturation limits using the empirical M-values from existing tables as well as our altitude diving data, together with an added constraint that forces calculated M-values to stay below the available M-value data.

Adult↗
PubMedDate not supplied

Determination of in-process limits during parenteral solution manufacturing using Monte Carlo Simulation.

The purpose of this study is to utilize Monte Carlo Simulation methodology to determine the in-process limits for the parenteral solution manufacturing process. The Monte Carlo Simulation predicts the distribution of a dependable variable (such as drug concentration) in a naturally occurring process through random value generation considering the variability associated with the depended variable. The propagation of variation in drug concentration from batch to batch is cascading in nature during the following four formulation steps: 1) determination of drug raw material potency (or purity), 2) weighing of drug raw material, 3) measurement of batch volume, and 4) determination of drug concentration in the mix tank. The coefficients of variation for these four steps are denoted as CV1, CV2, CV3, and CV4, respectively. The Monte Carlo Simulation was performed for each of the above four cascading steps. The results of the simulation demonstrate that the in-process limits of the drug can be successfully determined using the Monte Carlo Simulation. Once the specification limits are determined, the Monte Carlo Simulation can be used to study the effect of each variability on the percent out of specification limits (OOL) for the in-process testing. Demonstrations were performed using the acceptance criterion of less than 5% of OOL batches, and the typical values of CV2 and CV3 being equal to 0.03% and 0.5%, respectively. The results show that for the in-process limits of +/- 1%, the values of CV1 and CV4 should not be greater than 0.1%. These assay requirements appear to be difficult to achieve for a given chemical analytical method. By comparison, for the In-process limits of +/- 4%, the requirements are much easier to achieve. The values of CV1 and CV4 should not be greater than 1.38%. In addition, the relationship between the percent OOL versus CV1 or CV4 is nonlinear per se. The number of OOL batches increases rapidly with increasing variability of CV1 or CV4.

Chemistry, Pharmaceutical↗
PubMed2003

[Sentinel node navigation surgery in early-stage gastric carcinoma: a limited gastric resection with lymphatic basin dissection in sentinel node-negative patients].

The high accuracy of sentinel node biopsy in clinical T1 gastric cancer leads to the idea of excluding conventional D2 from node-negative patients. The question now arises of what to do when sentinel nodes are missed during surgery and micrometastases are over looked in frozen tissue sections. To avoid and correct a mistaken diagnosis, surgeons should remove the lymphatic basin even in the case of negative sentinel nodes, because the basin is exclusively associated with the involved nodes. We call this procedure "lymphatic basin dissection." Gastric lymphatic basins were divided into five compartments corresponding to the feeding artery, and clinical T1 gastric cancer involved a single basin in 42% of patients, two in 47% and three in 12%. Patients with one or two basins can be treated with limited gastric resection, because the devascularization does not cause insufficient blood supply to the remnant stomach. Since 1995, 123 patients have undergone lymphatic basin dissection and limited gastric resection (segmental resection, local resection, proximal gastrectomy, and limited distal gastrectomy) in our institution. There was no recurrence in the limited surgery patients with a median follow-up period of 3.8 years. The overall survival curve after surgery in the limited group is almost the same as that in the conventional group. Quality of life was significantly higher in the limited group than in the conventional group.

Gastrectomy↗
PubMed2004

Limited-sequence magnetic resonance imaging in the evaluation of the ultrasonographically indeterminate pelvic mass.

OBJECTIVE: To evaluate the usefulness of limited-sequence magnetic resonance imaging (MRI) in the elucidation of ultrasonographically indeterminate pelvic masses. This study focused only on pelvic masses in which the origin of the mass (uterine v. extrauterine) could not be determined by ultrasonography (US). The origin of a pelvic mass has clinical implications. A mass arising from the uterus is most likely to be a leiomyoma, which is a benign lesion, whereas an extrauterine mass will have a higher likelihood of malignancy and usually requires surgery. METHODS: Eighty-one female patients whose pelvic mass was of indeterminate origin on US also underwent limited-sequence MRI of the pelvis. Most of the MRI examinations were performed on the same day as the US. Limited-sequence MRI sequences included a quick gradient-echo T1-weighted localizer and a fast spin-echo T2-weighted sequence. Final diagnoses were established by surgical pathology or by clinical and imaging follow-up. RESULTS: Limited-sequence MRI was helpful in 79 of the 81 cases (98%). Fifty-two of the 81 masses (64%) were leiomyomas. One was a leiomyosarcoma. The extrauterine masses (26/81 [32%]) were identified as 14 ovarian malignancies, 4 endometriomas, 3 dermoids, an ovarian fibroma, an infarcted fibrothecoma, an infarcted hemorrhagic cyst, a sigmoid diverticular abscess and a gastrointestinal stromal tumour of the ileum. In the other 2 cases (2/81 [2%]), the origin of the pelvic mass remained indeterminate. Both of these indeterminate masses showed low signal on T2-weighted images and were interpreted as probable leiomyomas. They were not surgically removed but were followed clinically and had a stable course. CONCLUSION: Limited-sequence MRI is a quick and efficient way to further evaluate ultrasonographically indeterminate pelvic masses. Limited-sequence MRI of the pelvis can suffice, in these cases, without requiring a full MRI examination.

Adult↗
PubMed2004

Effectiveness of Glenohumeral-Joint Stability Braces in Limiting Active and Passive Shoulder Range of Motion in Collegiate Football Players.

OBJECTIVE: To determine the effectiveness of glenohumeral-joint stability braces in limiting active and passive shoulder abduction and external rotation in collegiate football players. DESIGN AND SETTING: A 2-factor, repeated-measures design was used. The independent variables were brace condition (Denison and Duke Wyre harness, Sawa shoulder brace) and force application (active, passive). The dependent variables were shoulder abduction (45 degrees braced limit) and external-rotation angular displacements. SUBJECTS: Fifteen National Collegiate Athletic Association Division I male college football players (age = 19.9 +/- 1.37 years, height = 183.2 +/- 7.85 cm, mass = 89.9 +/- 14.79 kg) participated in the study. MEASUREMENTS: We used the PEAK Motus motion analysis system to measure angular displacements. RESULTS: Neither brace maintained the arm position at the 45 degrees braced limit during active or passive shoulder abduction (motion ranged from 56.8 degrees to 73.0 degrees ). Although we did not use a priori external-rotation limits in this study, motion ranged from 71.6 degrees to 93.9 degrees with the braces. A repeated-measures multivariate analysis of variance indicated no significant interaction effect (P =.41), but main effects were significant for brace condition and force application (P <.001). Reported differences are statistically significant. For abduction, the Denison and Duke Wyre harness resulted in 12.3 degrees (21%) greater angular displacement than the Sawa shoulder brace, and passive abduction resulted in 3.9 degrees (6%) more angular displacement than active abduction. For external rotation, the Denison and Duke Wyre harness resulted in 6.7 degrees (9%) more angular displacement than the Sawa shoulder brace, and passive external rotation resulted in 15.6 degrees (21%) more angular displacement than active external rotation. CONCLUSIONS: Preset, braced abduction motion limits were not realized during active and passive physiologic loading of the glenohumeral joint. However, protection against the vulnerable position of 90 degrees of abduction and external rotation was attained at a preset braced limit of 45 degrees of abduction (the exception was the Denison and Duke Wyre harness during passive external rotation). The Sawa shoulder brace was most effective for this purpose.

Journal Article↗
PubMed2004

Probing protein structure by limited proteolysis.

Limited proteolysis experiments can be successfully used to probe conformational features of proteins. In a number of studies it has been demonstrated that the sites of limited proteolysis along the polypeptide chain of a protein are characterized by enhanced backbone flexibility, implying that proteolytic probes can pinpoint the sites of local unfolding in a protein chain. Limited proteolysis was used to analyze the partly folded (molten globule) states of several proteins, such as apomyoglobin, alpha-lactalbumin, calcium-binding lysozymes, cytochrome c and human growth hormone. These proteins were induced to acquire the molten globule state under specific solvent conditions, such as low pH. In general, the protein conformational features deduced from limited proteolysis experiments nicely correlate with those deriving from other biophysical and spectroscopic techniques. Limited proteolysis is also most useful for isolating protein fragments that can fold autonomously and thus behave as protein domains. Moreover, the technique can be used to identify and prepare protein fragments that are able to associate into a native-like and often functional protein complex. Overall, our results underscore the utility of the limited proteolysis approach for unravelling molecular features of proteins and appear to prompt its systematic use as a simple first step in the elucidation of structure-dynamics-function relationships of a novel and rare protein, especially if available in minute amounts.

Animals↗
PubMed2004

Rate of change in functional limitations for patients with rheumatoid arthritis: effects of sex, age, and duration of illness.

OBJECTIVE: To estimate the rate of change in functional limitations for patients with rheumatoid arthritis (RA) as a function of age, duration of illness, and sex. METHODS: Patients with RA (n = 700) aged 21-65 years in 1988 were interviewed yearly for 6 years in The National Rheumatoid Arthritis Study. Functional limitations scores based on a Rasch measurement model of 20 Health Assessment Questionnaire items were analyzed in mixed-effects models to estimate the rate of change in functional ability as a function of age, duration of illness, sex, and interactions. RESULTS: Models for both patient age and duration of illness significantly predicted limitations in functional ability for men and women. The model for age included a significant cubic effect; the model for duration of illness included a significant linear effect only. Sex was significant in both models and no interactions were significant in either model. The AIC index of fit, an indicator of the information value of the model, favored the model for duration of illness over the model for age. While both models showed higher levels of functional limitations in women than men, the rate of change for women was similar to men. CONCLUSION: Limitation in functional ability in RA progressed in a linear manner with duration of illness and progressed at the same rate for both men and women, but functional limitations were greater for women.

Activities of Daily Living↗
PubMed2004

[The rate of airflow limitation among the elderly undergoing spirometry in a university hospital].

The aim of this study was to examine the rate of airflow limitation among the elderly undergoing spirometry prior to surgical operation, and to evaluate whether or not spirometry is useful for the early detection of COPD. A total of 3,086 patients (1,717 men and 1,369 women) ranging in age from 40 to 93 underwent screening spirometry from January to December 2003 in Tokyo Medical and Dental University Hospital. Among the total population, 2,135 patients (1,188 men and 947 women) were ordered to undergo the spirometry prior to surgical operation, airflow limitation (FEV1/FVC < 70%) was observed in 19.5% (n=417) of the cases and was considerably more frequent in men than in women(27.0%[n=321] vs. 10.1%[n=96]). The rate of FEV1/FVC < 70% in those 2,135 patients increased with age: 6.2%, 9.9%, 19.2%, 32.5% and 34.1% of patients in their 40s, 50s, 60s, 70s, 80s and over, respectively. Among the patients with airflow limitation, 35% of the cases revealed FEV1 > or = 80% predicted; 50%, 50 < or = FEV1 < 80% predicted; 14%, 30 < or = FEV1 < 50% predicted; 1%, FEV1 < 30% predicted. Patients with mild to moderate airflow limitation rarely consulted the pulmonary medicine department. The prevalence of airflow limitation was more frequent among in- and out-patients than in the random sample population. Spirometry prior to surgical operation is useful for the early detection of COPD and these data could be an important source for medical staff seeking a definitive diagnosis of patients revealing airflow limitation.

Adult↗
PubMed2004

Community analysis of ammonia oxidizer in the oxygen-limited nitritation stage of OLAND system by DGGE of PCR amplified 16S rDNA fragments and FISH.

OLAND (oxygen limited autotrophic nitrification and denitrification) nitrogen removal system was constructed by coupling with oxygen limited nitritation stage and anaerobic ammonium oxidation stage. Ammonia oxidizer, as a kind of key bacteria in N cycle, plays an important role at the oxygen limited nitritation stage of OLAND nitrogen removal system. In this study, specific amplification of 16S rDNA fragment of ammonia oxidizer by nested PCR, separation of mixed PCR samples by denaturing gradient gel electrophoresis (DGGE), and the quantification of ammonia oxidizer by fluorescence in situ hybridization (FISH) were combined to investigate the shifts of community composition and quantity of ammonia oxidizer of the oxygen limited nitritation stage in OLAND system. It showed that the community composition of ammonia oxidizer changed drastically when dissolved oxygen was decreased gradually, and the dominant ammonia oxidizer of the steady nitrite accumulation stage were completely different from that of the early stage of oxygen limited nitritation identified by DGGE. It was concluded that the Nitrosomonas may be the dominant genus of ammonia oxidizer at the oxygen limited nitritation stage of OLAND system characterized by nested PCR-DGGE and FISH, and the percentage of Nitrosomonas was 72.5% +/- 0.8% of ammonia oxidizer at the steady nitrite accumulation stage detected by FISH.

Ammonia↗
PubMed2004

[The impact of the type of anesthesia on stress-realizing and stress-limiting mechanisms of the immune system in gerontological patients at abdominal surgeries].

Surgical stress resulting from the operative morbidity and narcosis aggravates the associated age-related and secondary immunodeficiency of gerontological patients at surgeries. Stress hormones have a strong depressing effect on the immunity by forming stress immunodeficiency. Not only high blood level determines the damaging effect of stress hormones but also the activity of stress-limiting mechanisms of the immune system protect it from the damaging effect of stress hormones. In this connection, the impact of operative morbidity and anesthetic aggression on the activity of stress-realizing and, in particular, stress-limiting mechanisms plays an important role because of the frequency of postoperative complications in gerontological patients namely. We observed patients operated on the abdominal cavity by urgent indications with a delay or based on a schedule under conditions of epidural anesthesia (45 patients), spinal anesthesia (43 patients) and general anesthesia (41 patients). The analysis of data obtained shows that different types of anesthesia have different effect on the plasmic cortisol level and activity of stress-realizing and stress-limiting systems. Thus, in case of epidural anesthesia of gerontological patients it was possible to observe the reduction of the high plasmic cortisol level and activation of stress-limiting reception of immunocompetent cells contributing to the preservation of the immune function. The increased plasmic cortisol level accompanied spinal anesthesia applied to such patients. However, it did not suppress the stress-limiting reception protecting the immunity against the damaging action of cortisol. In case of general anesthesia of gerontological patients it was possible to observe the increased blood cortisol level and decreased activity of protective stress-limiting receptors contributing to the formation of glucocorticoid immunosuppression.

Abdominal Cavity↗
PubMed2004

[Investigation on optical limiting performance in solution of cobalt porphyrin].

The nonlinear optical effects of cobalt porphyrin have been investigated with three CW laser lines of 457.9, 488 and 514.5 nm, respectively. Three curves with peak followed by valley using the single beam z-scan technique were obtained. According to M Sheik-bahae's theory the sample has a negative nonlinear refractive index, that is, there is a thermal self-defocusing effect. Three curves of transmittance show a decrease with the increase in the incident laser power, which means that the sample has reverse saturated absorption property under the three laser wavelengths. It's well known that both thermal self-defocusing effect and reverse saturated absorption can lead to optical limiting. It was found that cobalt porphyrin has the optical limiting effect under those wavelengths, and that the critical value of optical limiting decreases with the decrease in laser wavelength. Furthermore, the effect of optical limiting is very good and the critical value is very low, so it's a new optical limiting material with a great potential application value. For that, it is possible to use the co-operation of both effects from cobalt porphyrin to produce a new kind of optical limiting device.

Absorption↗