Effect of chemotactic factors on calcium levels of rabbit neutrophils.

Studies were undertaken to provide a systematic investigation of the effect of the chemotactic factor, formyl-methionyl-leucyl-phenylalanine (F-Met-Leu-Phe), on the levels of total and exchangeable calcium in rabbit neutrophils. The 45Ca2+ specific activity of the cells was thus determined before and after stimulation by chemotactic factors. Total cell calcium was found to be constant in neutrophils equilibrated with 50-1,000 microM extracellular calcium but decreased by 30% at an extracellular calcium concentration of 5 microM. F-Met-Leu-Phe had little, if any, statistically significant effect on the level of total cell calcium. In contrast, F-Met-Leu-Phe affects greatly the steady-state levels of radioactive calcium in the neutrophils. The primary effect is an initial loss followed by an increase of cell-associated radiolabeled calcium. The extent and even the direction of the effect depends on the level of extracellular calcium as well as the concentration of the chemotactic factor and the duration of its interaction with the cell. The results are discussed in terms of the hypothesis that the binding of the chemotactic factor to its receptor leads to, among other things, a graded displacement of previously bound Ca2+.     

Delayed life-threatening hemorrhage after transrectal prostate needle biopsy

Minor hematochezia after transrectal ultrasound and prostate needle biopsy is well reported. We present a case report of a 64-yr-old man on aspirin and with poorly controlled hypertension who developed severe hematochezia requiring blood transfusion. The bleeding was stopped with digital compression. The literature on hemorrhagic complications after prostate needle biopsy is reviewed.     

Prescription drug coverage among Medicare beneficiaries

The Medicare Current Beneficiary Survey (MCBS) is a longitudinal survey of a nationally-representative sample of Medicare enrollees. The survey collects information on a variety of topics, including beneficiaries' health status; health care use and financing; and social, economic, and demographic characteristics. Medicare administrative data is regularly coupled with the information collected through the survey for validation purposes.     

Computer literacy

This article is a short, nontechnical introduction to the computer and how it works. This basic information includes such information as input and output devices, internal hardware components, external memory, and an introduction to software.     

Testosterone replacement therapy and motor function in men with spinal cord injury: a retrospective analysis

OBJECTIVE: To evaluate motor function in men with spinal cord injury (SCI) given testosterone replacement therapy (TRT). DESIGN: American Spinal Injury Association (ASIA) rehabilitation discharge motor index scores were compared between men with SCI given TRT (testosterone cypionate, 200 mg, monthly; n = 50) and a comparison group (n = 480) in a retrospective study. Covariates included admission motor and FIM scores, level of injury (paraplegia/tetraplegia), days since injury, and age. RESULTS: ASIA discharge motor scores for ASIA impairment scale grades C and D were significantly different (P < 0.05) in men with incomplete SCI given TRT, relative to the comparison group. The covariate-adjusted mean discharge score for the TRT group was higher than for the comparison group. There were no significant differences in discharge FIM scores (P = 0.34) for men with incomplete injuries and no differences in the adjusted discharge ASIA motor scores (P = 0.92) or adjusted discharge FIM scores (P = 0.16) for men with complete injuries. CONCLUSION: The data support a relationship between TRT and strength gains in men with residual motor function after SCI. Prospective studies are necessary to validate these findings.     

Field testing, refinement, and psychometric evaluation of a new measure of quality of care for assisted living

Field test results are reported for the Observable Indicators of Nursing Home Care Quality Instrument-Assisted Living Version, an instrument designed to measure the quality of care in assisted living facilities after a brief 30-minute walk-through. The OIQ-AL was tested in 207 assisted-living facilities in two states using classical test theory, generalizability theory, and exploratory factor analysis. The 34-item scale has a coherent six-factor structure that conceptually describes the multidimensional concept of care quality in assisted living. The six factors can be logically clustered into process (Homelike and Caring, 21 items) and structure (Access and Choice; Lighting; Plants and Pets; Outdoor Spaces) subscales and for a total quality score. Classical test theory results indicate most subscales and the total quality score from the OIQ-AL have acceptable interrater, test-retest, and strong internal consistency reliabilities. Generalizability theory analyses reveal that dependability of scores from the instrument are strong, particularly by including a second observer who conducts a site visit and independently completes an instrument, or by a single observer conducting two site visits and completing instruments during each visit. Scoring guidelines based on the total sample of observations (N = 358) help guide those who want to use the measure to interpret both subscale and total scores. Content validity was supported by two expert panels of people experienced in the assisted-living field, and a content validity index calculated for the first version of the scale is high (3.43 on a four-point scale). The OIQ-AL gives reliable and valid scores for researchers, and may be useful for consumers, providers, and others interested in measuring quality of care in assisted-living facilities.     

Contraction force generated by tarsal joint flexion and extension in dogs with golden retriever muscular dystrophy.

Force generated due to torque caused by tarsal joint flexion and extension was measured noninvasively at 3, 4.5, 6, and 12 months of age in dogs with the Duchenne homologue, golden retriever muscular dystrophy (GRMD). Absolute and body-weight-corrected GRMD twitch and tetanic force values were lower than normal at all ages (P<0.01 for most). Tarsal flexion and extension were differentially affected. Flexion values were especially low at 3 months, whereas extension was affected more at later ages. Several other GRMD findings differed from normal. The twitch/tetany ratio was generally lower; post-tetanic potentiation for flexion values was less marked; and extension relaxation and contraction times were longer. The consistency of GRMD values was studied to determine which measurements will be most useful in evaluating treatment outcome. Standard deviation was proportionally greater for GRMD versus normal recordings. More consistent values were seen for tetany versus twitch and for flexion versus extension. Left and right limb tetanic flexion values did not differ in GRMD; extension values were more variable. These results suggest that measurement of tarsal tetanic force should be most useful to document therapeutic benefit in GRMD dogs.     

Changes in the Use of Postacute Care during the Initial Medicare Payment Reforms

Objective. To examine changes in postacute care (PAC) use during the initial Medicare payment reforms enacted by the Balanced Budget Act of 1997.
Data Sources. We used claims data from the 5 percent Medicare beneficiary sample in 1996, 1998, and 2000. Linked data from the Denominator file, Provider of Service file, and Area Resource File provided additional patient, hospital, and market-area characteristics.
Study Design. Six disease groups with high PAC use were selected for analysis. We used multinomial logit regression to examine how PAC use differed by year of service, controlling for patient, hospital, and market-area characteristics.
Principal Findings. There were major changes in PAC use, and a portion of services shifted to settings where reimbursement remained cost-based. During the first reform, the home health agency interim payment system, home health use decreased consistently across disease groups. This decrease was accompanied by increased use in skilled nursing facilities (SNFs). Following the implementation of the prospective payment system for SNFs, the use of inpatient rehabilitation facilities increased.
Conclusions. The shift in usage among settings occurred in two stages that corresponded to the timing of payment reforms for home health agencies and SNFs. Evidence strongly suggests the substitutability between PAC settings. Financial incentives, in addition to clinical needs and individual preferences, play a major role in PAC use.