Evaluation of various infused cryoprotective ingredients for their freeze-thaw stabilizing and texture improving properties in frozen red hake muscle.

Various cryoprotective ingredients were evaluated for their freeze-thaw stabilizing and texture improving properties during 6-mo frozen storage when red hake (Urophycis chuss) fillets were injected with sorbitol-sodium tripolyphosphate (STPP) (40% to 60% : 3%), 1.5% alginate, or 0.75% alginate with soy protein isolate (SPI)-sorbitol-STPP (5% to 10% : 40% : 3%). Injection of 10% SPI, 1.5% alginate, or 0.75% alginate-5% SPI effectively improved water binding and retarded the freeze-induced texture changes when drip and cooking loss, centrifugal expressible moisture, protein extractability, SDS-PAGE profile, and Instron and sensory texture were assessed. The sorbitol and STPP combination was not as effective as alginate and SPI. Freeze-susceptible whitefish can be injected with proper cryoprotective ingredients for improved frozen storability.

Variations in the treatment culture of nursing homes and responses to regulations to reduce drug use.

OBJECTIVE: The study examined the relationship between treatment cultures of nursing homes and their responses to regulations to reduce use of psychotropic drugs mandated by the 1987 Omnibus Budget Reconciliation ACT: The authors hypothesized that reduction in use of antipsychotic drugs was more likely to occur in homes with a resident-centered culture emphasizing psychosocial care, avoidance of psychotropic drugs, pharmacist feedback, and involvement of mental health workers. The authors also predicted greater reductions in drug use in facilities with a less severe case mix and better capacity for change. METHODS: Data were collected in a stratified random sample of 16 skilled nursing facilities in Wisconsin. Participants included 1,181 residents in the baseline study and 1,650 residents in the follow-up study. Treatment culture was measured with a questionnaire for assessing nurses' beliefs and philosophies of care and their interactions with pharmacists and mental health workers. RESULTS: No significant change was observed in the use of benzodiazepines, antidepressants, or polymedicine (two or more psychotropic medications). However, use of antipsychotic drugs decreased significantly, from 24 percent to 16 percent. The change in use varied dramatically across facilities, from an 85 percent reduction to a 19 percent increase. Findings also revealed significant variability in treatment cultures. Greater reductions in use of antipsychotic drugs were found in facilities with a resident-centered culture, a less severe case mix, and a higher nurse-to-resident staffing ratio. CONCLUSIONS: Future policy and quality improvement efforts must address treatment cultures, staffing, and other organizational barriers to nursing home reform.

Residential care supply and cognitive and physical problem case mix in nursing homes.

OBJECTIVES: A rapid evolution has occurred in state policy and industry practices relative to assisted living and expanded use of residential care facilities for people with physical and cognitive frailty, yet relatively little is known about the interrelationship between this housing supply and nursing-home case mix. METHODS: The association between residential care supply and the proportion of cognitively and physically impaired nursing facility residents was examined in more than 1,500 facilities in five states. RESULTS: The proportion of nursing-home cases with only physical and cognitive impairment likely to be affected by emerging long-term care policy appears to be well under 10%. This effect is more persistent among admissions than continuing cases. DISCUSSION: The findings raise caution about the optimistic assumptions of the interplay between residential care/assisted living policy and nursing-home use.

A controlled letter intervention to change prescribing behavior: results of a dual-targeted approach.

OBJECTIVE: To determine the effectiveness of a drug utilization review (DUR) letter intervention sent only to physicians, sent only to pharmacists, or sent to both physicians and pharmacists in changing physician prescribing behavior for dipyridamole. DATA SOURCES/STUDY SETTING: A Wisconsin Medicaid prescription drug database for data from March 1991 through May 1992 related to both long-term care and ambulatory patient settings. STUDY DESIGN: The effects of a DUR letter intervention were tested using a field study, pre-post, nonequivalent control group, quasi-experimental design. The effects of the letter intervention in terms of dipyridamole expenditures (dollars reimbursed to pharmacies by Medicaid), expenditures for related drugs (aspirin, ticlopidine, sulfinpyrazone) and numbers of patients for whom dipyridamole was discontinued were examined across three experimental groups and a control group. DATA COLLECTION/EXTRACTION METHODS: Dipyridamole expenditures for each study patient during a six-month preintervention and six-month postintervention period were collected from Medicaid prescription drug claims. Patients who had zero dipyridamole expenditures throughout the six-month postintervention period were classified as having had dipyridamole discontinued. PRINCIPAL FINDINGS: Letters sent to both physicians and pharmacists resulted in a greater percentage of patients discontinuing dipyridamole relative to controls and statistically significant differences in postintervention dipyridamole expenditures relative to controls in both the long-term care and ambulatory patient populations. CONCLUSIONS: Interventions that focus on another person in the drug use process in addition to the physician may have greater effects on a change in the prescribing of a targeted drug than letters to physicians alone.

Data linkages for research on outcomes of long-term care.

Medicaid claims were linked with a sample of data gathered for nursing home quality assurance and case mix reimbursement (N = 14,917). This generated patient level records of medical resource use combined with standardized assessments of health and functional status. We describe the linkage process and the characteristics of the combined set of information-its strengths, limitations, and potential uses. The two data sources, one cross-sectional and the other longitudinal, complemented one another and provided a more complete description of patient resource use and health status. However, methodological and ethical issues must be resolved before data linkages are used routinely for research.

Effect of interfacial variables on metal-porcelain bonding.

While ceramic-to-metal bonding has been used in many applications, the actual chemical and physical factors leading to optimum bond strength are not well understood. In this work, several variables affecting the bonding between dental porcelain and a palladium alloy (85% Pd, 10% Cu, and 5% Ga) were investigated: 1) precoating the metal by sputtering various oxides before porcelaining; 2) peroxidation of the metal base before porcelaining; 3) porcelaining under reducing atmosphere; and 4) surface roughening at controlled levels before porcelaining. Using a modification of the push doughnut shear bond strength test to measure bond strength the following results were obtained. 1) Compared with standard "control" samples, the aluminum oxide precoated specimens showed a bond strength improvement of 46%, while the copper, manganese, and tin oxide precoatings exhibited smaller effects. 2) Preoxidation of the metal base led to pronounced bond strengthening (152%) by surface roughening as well as oxide formation. 3) Porcelaining under a reducing atmosphere severely reduced bond strength (88% lower than the controls) indicating the role of oxidation during the standard firing cycle. 4) Mechanical roughening of the surface by controlled amounts gave pronounced improvements with greater notch depth. Coarse roughening produced the highest bond strength improvements (486%).

Eagle's syndrome: a comparison of intraoral versus extraoral surgical approaches.

Eagle first described vague orofacial pain associated with styloid elongation in 1937. Since that time, many authors have described the various clinical symptoms, radiographic features, and treatment regiments seen with Eagle's syndrome. Two cases of Eagle's syndrome treated surgically are presented in this article. Both extraoral and intraoral approaches were separately used. These two surgical approaches are critically discussed in depth. The extraoral approach is advocated. In addition, diagnostic procedures and nonsurgical treatment alternatives are discussed.

A new fallout prediction model.

The standard method for the calculation of nuclear weapon fallout radiation doses and dose rates in operational type studies for the last 20 yr has been the computer algorithm known as WSEG-10. WSEG-10 uses empirical functions rather than numerical analyses and computes fallout dose (rates) in seconds or less on modern computers. WSEG-10 has long been criticized for its inability to allow for variations in the activity-particle size distribution of the fallout, for its inability to account for fractionation and for the absence of realistic settling rates. At the other end of the scale, the Defense Land Fallout Information Code, DELFIC, is currently used for research work and as a comparison standard. DELFIC produces fallout footprints on the ground by numerical integration, employing discrete cells in space, time and particle size. A new fallout prediction method is presented here which, unlike WSEG-10, does allow variations in activity with particle size, does account for fractionation and does model variable settling rates. This new model, like WSEG-10 but unlike DELFIC, computes in seconds or less. Some results are presented and compared to DELFIC and to WSEG results. Additionally, this new model will treat the far-field problem of interest in a massive strategic attack which cannot be easily done using DELFIC.

Effect of gibberellic Acid on silica content and distribution in sugarcane.

The effect of gibberellic acid on the content and distribution of silicon in the stem, leaf sheath, and leaf lamina of sugarcane was analyzed in relation to the effect of gibberellic acid on stem growth. Silicon content was measured by neutron activation analysis, and its distribution was followed by scanning electron microscopy and X-ray analysis.Foliarly applied gibberellic acid increased stem length and fresh weight and decreased silicon content. Gibberellic acid treatments had little or no effect on growth or silicon content of leaf laminae or sheaths. The close correlation between increase in growth of an internode in response to gibberellic acid and the decrease in silicon content of that internode indicated a dilution effect of growth on the amount of silicon rather than a direct effect of gibberellic acid on silicon deposition. This conclusion was supported by scanning electrom microscopy, X-ray map photos, and counts of silica cells per unit of epidermis area.

Angiographic demonstration of blood supply of right atrial myxoma.

A 53-year-old woman underwent cardiac catheterization for assessment of coronary arterial disease. An unexpected finding of a gradient between right atrium and right ventricle led to the discovery of an unsuspected right atrial myxoma. The diagnosis was established by the presence of a filling defect in the right atrial angiocardiogram and by the demonstration of "tumour vessels" by selective right coronary angiography. Selective coronary angiography can visualize the blood supply to an intracardiac tumour and thus confirm the diagnosis preoperatively.

Biological strandard for electron microprobe analysis of intracellular sodium concentration.

A method is described for the determination of the intracellular concentration of sodium in individual cells using the electron microprobe analyzer. This method gives an accuracy equal to that obtained by using flame photometry on tissues with large cell populations. Intracellular sodium was precipitated in the cell by a fixative containing pyroantimonate. Cartilaginous needles from shark fins which were equilibrated in saline solutions of differing concentrations were used as biological standards.

Ischemic contracture of the left ventricle. Production and prevention.

Ischemic contracture of the left ventricle ("stone heart") is a recognized complication of prolonged periods of interruption of the coronary circulation during open-heart surgery. We have examined the effects of moderate hypothermia (28 degrees C.) and preoperative beta-adrenergic blockade (propranolol, 0.5 mg. per kilogram; 1.0 mg. per kilogram) on contracture development during ischemic arrest of the heart. Four groups of 8 dogs each were placed on total cardiopulmonary bypass, and ischemic arrest of the heart was produced by cross-clamping the ascending aorta and venting the left ventricle. Intramyocardial carbon dioxide tension was continuously monitored by mass spectrometry. When anaerobic energy production ceased, as indicated by a final plateau in the intramyocardial carbon dioxide accumulation curve, the ischemic arrest was terminated and the contractile state of the heart observed. These results are given in the text. We conclude that beta-adrenergic blockade delays, but does not prevent, the onset of ischemic contracture of the left ventricle under normothermic conditions. Moderate hypothermia appears to prevent this complication completely.

Late results of aortocoronary bypass grafts in 100 patients with stable angina pectoris.

From March 1969 to December 1972, 314 patients underwent elective aortocoronary saphenous vein bypass graft surgery at the Toronto General Hospital for the relief of stable disabling angina refractory to medical management. Inhospital mortality was 2.5%. Of these patients 100 agreed to return for follow-up hemodynamic and angiographic assessment at a mean interval of 19.7 months after operation. Seventy-four percent of patients were asymptomatic or had angina only with strenuous exertion at the time of follow-up. Seventy-five percent of the 142 grafts were patent, though a few had significant narrowings. Clinical improvement could be correlated with successful myocardial revascularization. Myocardial infarction was diagnosed by the presence of new Q waves after operation in 15% of patients. Many of these patients had patent grafts at follow-up and all were improved. Dyslipoproteinemia was not found to be a factor affecting late graft patency. Total left ventricular function was not shown to be improved by segmental revascularization. The trend toward improved survival in the intervening period for the total operated group is encouraging.