Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients

To examine the effects of recombinant human erythropoietin (rHuEPO) on hospital utilization, hospital costs, and Medicare reimbursements for hospital care, a longitudinal, matched cohort study was conducted using Medicare claims data of 23,806 Medicare-eligible, dialysis patients who received rHuEPO, did not have a transplant, and were alive for 18 mo or longer and 22,720 controls matched on age, sex, race, cause of ESRD, and dialysis modality. The relative odds (rHuEPO versus control) of admission for all causes and for specific causes over 9 mo, adjusted for admission in the prior 9 mo and the per patient change in total admissions, inpatient days, hospital costs, and Medicare hospital payments between the prior 9-mo period and the subsequent 9-mo period was examined. The adjusted relative odds (95% confidence interval) of admission (rHuEPO versus control) was: higher and statistically significant for all causes, 1.08 (1.03 to 1.14); seizure, 1.52 (1.28 to 1.75); vascular access revision, 1.11 (1.06 to 1.17), and heart failure, 1.17 (1.09 to 1.26); higher but not statistically significant for angina, 1.09 (0.99 to 1.20) and stroke, 1.08 (0.86 to 1.31); and lower but not statistically significant for myocardial infarction, 0.91 (0.72 to 1.10); peripheral vascular disease, 0.81 (0.60 to 1.02); anemia, 0.86 (0.56 to 1.17); and depression, 0.89 (0.37 to 1.40). The mean change per 1,000 patients in admissions was less by 38 (P = 0.03) because of fewer readmissions, and in days was 1,309 less (P < 0.001), for patients treated with rHuEPO versus controls. The mean change per patient in hospital costs was $371 less and was statistically significant (P = 0.03) and in Medicare hospital payments was $132 less but was not statistically significant (P = 0.43) for patients treated with rHuEPO versus controls. rHuEPO was associated with an increase in the probability of hospital admission (particularly admissions potentially related to adverse effects) but a decrease in readmissions, overall admissions, hospital days, and cost to hospitals in this cohort of patients surviving for 18 mo. Although not realized short term, Medicare savings from potential rHuEPO-related reductions in hospital care may be long term through future adjustments in diagnosis-related group-based hospital payment.     

Magnetization reversal in ferromagnets

Quantum and classical reversal of magnetization in ferromagnets are considered. Expressions for the tunnelling and thermal activation rates of the magnetization reversal with the effect of magnetoelastic dissipation to the lowest order are presented with the prefactors included. The results are given for low temperatures, near the cross-over temperature and for high temperatures, so that an experimental check would be possible to perform. The results are within the transition state theory.     

Behavior of Fe, Mn, Cu and Cd in the duwamish river estuary downstream of a sewage treatment plant

The behavior of dissolved Fe, Mn, Cu and Cd in the Duwamish River downstream of a sewage treatment plant located near Seattle, Washington, was investigated in three distinct zones: (1) immediately downstream of the effluent outfall, (2) further downstream in the freshwater portion of the river and (3) in the estuarine mixing zone. A three-end-member tracer model utilizing salinity and dissolved inorganic nitrogen was developed to distinguish physical mixing processes from biogeochemical reactions. The results of this investigation indicate that Fe was removed from the dissolved phase onto particulates near the plant. Although no additional reactions controlled the distribution of dissolved Fe, Mn and Cu in the freshwater portion of the river, Cd was removed from the dissolved phase. In the estuarine mixing zone, a significant fraction of the dissolved Fe and Cu was removed from solution, while Mn and Cd desorbed from particulates. The chemical forms of the trace metals rather than their sources appear to determine their participation in these reactions.     

Angiotensin II interacts with nitric oxide-cyclic GMP pathway in the central control of drinking behaviour: mapping with c-fos and NADPH-diaphorase

Recognition of the role of nitric oxide in cell-to-cell communication has changed the concept of traditional neurotransmission. We have shown previously that N-methyl-D-aspartate receptors mediate dipsogenic responses and c-Fos expression induced by intracerebroventricular infusion of angiotensin II. Since these receptors are known to be linked to the nitric oxide-cyclic GMP pathway, the present study explores the contribution of this path to the behavioural and cellular effects of intracerebroventricular angiotensin II by using behavioural testing, NADPH-diaphorase histochemistry and immunocytochemical staining for the immediate-early gene, c-fos. N(G)-nitro-L-arginine methyl ester (125 and 250 microg, intracerebroventricular), an inhibitor of nitric oxide synthase, and Methylene Blue (100 microg), an inhibitor of guanylate cyclase activation, antagonized water intake induced by intracerebroventricular injection of 25 pmol angiotensin II. The effects of N(G)-nitro-L-arginine methyl ester were reversed by co-injection of L-arginine, the substrate for nitric oxide synthase. However, N(G)-nitro-L-arginine methyl ester did not alter the pattern of angiotensin II-induced c-fos expression in the organum vasculosum of the lamina terminalis, median preoptic nucleus, hypothalamic paraventricular nucleus and supraoptic nucleus. Double staining with NADPH-diaphorase histochemistry and c-Fos immunocytochemistry showed that neurons staining for both were localized to the anterior third ventricle. However, only 19-25% of the c-Fos-positive neurons expressed NADPH. There were also substantial numbers of neurons in which angiotensin II induced c-Fos that were NADPH-negative. Extensive co-distribution of NADPH-diaphorase-stained cells and those expressing c-fos in response to intracerebroventricular injection of angiotensin II, especially in the median preoptic nucleus, imply that nitric oxide might participate in the mechanism of angiotensin II-induced drinking behaviour. However, a low rate of co-localization of the two markers to individual cells suggests that angiotensin II stimulated the production of nitric oxide and c-Fos in different populations of neurons. Since our previous results showed that glutamate blockade, but not nitric oxide synthase inhibition, suppressed angiotensin II-induced c-Fos, the experiments reported here further suggest that nitric oxide release is not an essential requirement for the expression of c-fos elicited by angiotensin II. They also provide evidence that the dipsogenic and c-Fos responses to angiotensin II are dissociated at a cellular level.     

Calibration of human locomotion and models of perceptual-motor organization.

People coordinate the force and direction of skilled actions with target locations and adjust the calibrations to compensate for changing circumstances. Are the adjustments globally organized (adjusting a particular action to fit a particular circumstance would generalize to all actions in the same circumstance); anatomically specific (every effector is adjusted independently of others); or functional (adjustments would generalize to all actions serving the same goal and generating the same perceptible consequences)? Across 10 experiments, changes in the calibration of walking, throwing, and turning-in-place were induced, and generalization of changes in calibration to functionally related and unrelated actions were tested. The experiments demonstrate that humans rapidly adjust the calibration of their walking, turning, and throwing to changing circumstances, and a functional model of perceptual-motor organization is suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of low-volatile additives on the structure and strength of cokes

Blends of medium-volatile or high-volatile coals have been carbonized in a 7 kg oven with low-volatile coals (6–16% VM, dmmf). A comparison is made of the strength and structural properties of these cokes with those of the cokes made under corresponding conditions from the medium or high-volatile coals alone. With increasing levels of addition of the low-volatile coals the tensile strength of the blend cokes generally attains a maximum and then decreases. These strength changes are related to changes in porosity, pore-wall thickness and pore dimensions. Coals which display some degree of plasticity and which are weakly caking improve coke quality by altering the pore-structure due to the combined effects of decreasing the pore diameter and slightly increasing the wall thickness. Those additives which are non-caking act primarily as wall thickeners.     

Modification of avoidance behavior: Expectancy, autonomic reactivity, and verbal report.

Evaluated the effects of manipulated cognitive expectancy on avoidance behavior in an experimental paradigm that simulated systematic desensitization. 72 female undergraduates with moderate fear of spiders were divided among 4 expectancy conditions ranging from a set to improve to a set that fear would increase. 2 measures of electrodermal activity were continuously recorded while the Ss, who relaxed in a reclining chair, were exposed to a preserved tarantula. Results indicate that both overt avoidance behavior and 2 verbal indexes were differentially affected by expectancy and that no relationship between avoidance behavior and autonomic reactivity was evident. It is concluded that the processes which mediate systematic desensitization can not adequately be explained by the counterconditioning model alone. (34 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sampling improvements in atomic absorption spectroscopy

Atomic absorption spectroscopy is being used as a routein method to determine sodium, potassium, calcium, magnesium, copper and many other metallic elements in oils, fats, milk and other substances. Copper and iron can be measured directly in milk without sample preparation. When highly acidified samples are run, a new plastic-lined nebulizer is useful to prevent spurious results due to corrosion. A new sampling device, the Graphite Furnace, can analyze extremely small samples and gives detection limits in the picogram (10⁻¹² g) range. One of 28 papers presented at the Symposium, “Metal-Catalyzed Lipid Oxidation,” ISF-AOCS World Congress, Chicago, September 1970.     

The Scintillation Mechanism in Thallium Doped Alkali Halides

In the scintillation mechanism for alkali iodides doped with thallous iodide: 1. Most of the luminescence, and possibly all of it, is from recombination and therefore energy transfer is predominantly from charge transport to thallium. 2. There are two modes of recombination at thallium which differ in the sequence of charge trapping at Tl+. The electron may be trapped before a mobile hole recombines with it, or the hole may be trapped before recombination with a free electron. 3. Thermal hole diffusion is an important process at room temperature and determines which mode a recombination event follows. 4. Both modes of recombination are active. 5. There is non-thermal hole trapping which is a significant part of the scintillator mechanism.