The influence of load on the lifetime distribution

This paper derives lifetime distributions for components that fail due to overloading. We introduce the notion of energy similarity. This makes it possible to use knowledge about how components behave under different loads in order to establish a probability model. To obtain parametric families, we consider two physically distinct cases: (1) components that function individually and (2) components that function as part of a system. The former leads to univariate and the latter to multivariate models. The results are particularly useful when little or no data is available.     

The nursing home comprehensive eye examination

BACKGROUND: There is significant need for optometric care in long-term care facilities which can be expected to increase in the next decade. METHODS: The previous ophthalmic and medical literature was reviewed and the practical aspects of providing eye care in a nursing home were analyzed. RESULTS: Comprehensive nursing home care requires the integration of portable ophthalmic equipment, a modification of standard testing procedures, clear and concise documentation, and close communication with other health care providers on the nursing home clinical staff. CONCLUSION: Optometrists must consider the incorporation of nursing home care into their clinical practice, while recognizing the unique aspects of providing eye care within a long-term care facility.     

Dementia, agitation, and care in the nursing home

OBJECTIVE: To examine the behavioral and functional problems of the cognitively impaired. DESIGN: A survey of a cohort of residents from six nursing homes. PARTICIPANTS: Subjects were randomly selected based on a minimum age of 70 years and a Resource Utilization Group (RUG) classification of the Physical or Behavioral type. Of those eligible, 44% (n = 366) agreed to participate. The participants and non-participants had similar demographics except for a higher incidence of mental illness in the non-participant group, which did not have a significant impact on agitation. SETTING: Six nursing homes in New York City, three voluntary non-profit and three proprietary. MEASUREMENT: The study used chart review, assessment of residents' cognitive and functional abilities, nursing assistants' ratings of residents' functional abilities, behavioral problems, and the amount of effort required in care, and time-motion observations of staff-resident interactions. RESULTS: Residents' level of cognitive impairment had a significant impact on problem behaviors during ADL tasks, along with supervision required in patient care (P < 0.05). These results were validated by time-motion analysis. Regression analysis revealed that for non-demented subjects, the best indicator of care needs was health status, while for demented residents the best indicator was cognitive status (P < 0.0001). CONCLUSIONS: The care needs of residents with dementia are better estimated by a mental status test for cognitive impairment then by ADL assessment alone. Greater agitation is associated with increasing cognitive impairment. Further, agitation and behavioral problems associated with care result in a need for increased staff supervision.     

The impact of ownership type on nursing home outcomes

This paper examines the sorting of residents between for-profit and nonprofit nursing homes and the health outcomes of those residents conditional on ownership type. Using data from the 1987 National Medical Expenditure Survey, we find evidence of systematic sorting of residents by ownership type, and significant effects of ownership type on outcomes. These results are broadly consistent with the hypothesis that for-profit and nonprofit homes exploit their informational advantages to differing extents in a market characterized by asymmetric information.     

Incontinence, dementia and multiple morbidity--predictive factors for nursing care requirement and nursing home admission

The present survey monitored all new admissions to 4 homes for the aged/nursing homes in the area of Velbert/Neviges (Nordrhein-Westphalia, Germany) over a 12-month period in 1996 and 1997, respectively. The study concentrated on the importance of incontinence, dementia and comorbidity when predicting need of care and removals to nursing homes. The statistical evaluation reveals a net coherence between dementia, nursing level and incontinence, and stresses the importance of these factors for the nursing home situation in Germany as the position increasingly develops into providing for and serving a clientele which is dement and heavily in need of care. Furthermore, the evaluation clearly shows that incontinence is still taboo to doctors as well as to their patients, and that, in spite of the medical and economical importance, the affected and their relatives are generally poorly informed. The described results imply a change in how to treat incontinence, dementia and comorbidity and should lead to renewed therapeutical concepts.     

Determinants of subsequent home health care nursing service use by hospitalized patients with cancer

BACKGROUND: The authors examined the extent to which specific patient characteristics and length of hospital stay were capable of independently explaining the use of home health care nursing services by hospitalized patients with cancer after discharge. METHODS: The current study represents a secondary analysis of a data set originally gathered to identify the home health care needs of patients with cancer. The sample involved 87 patients with cancer who received home health care after hospitalization and 43 patients who did not receive such services. RESULTS: A logistic regression analysis indicated that home health care use was related to patient age, length of hospital stay, and level of symptom distress. Specifically, the likelihood of home health care use was found to increase among subjects older than 50 years of age, subjects with hospital stays of more than 7 days (apparently related to surgery), and those who experienced moderate to high levels of symptom distress. CONCLUSIONS: The results indicate a need for home health care nurses to be skilled in the management of cancer symptoms and in the complex problems commonly experienced by the postsurgical patient with cancer.     

The role of a psychologist in a nursing home.

Comments that psychologists are rarely found in nursing homes but that they have a great deal to offer as full-time members of the staff. The role of the psychologist in this setting may be quite varied and may include that of "change agent," advocate for the resident, psychodiagnostician, counselor/therapist, educator, researcher, consultant, program developer, and liaison person to the broader community. The setting, the characteristics of the population, and some of the conflicts, contradictions, and confusions existing in nursing homes are described. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of current and lifetime substance use in schizophrenia

A structured interview and standardized rating scales were used to assess a sample of 194 outpatients with schizophrenia in a regional Australian mental health service for substance use, abuse, and dependence. Case manager assessments and urine drug screens were also used to determine substance use. Additional measurements included demographic information, history of criminal charges, symptom self-reports, personal hopefulness, and social support. The sample was predominantly male and showed relative instability in accommodations, and almost half had a history of criminal offenses, most frequently drug or alcohol related. The 6-month and lifetime prevalence of substance abuse or dependence was 26.8 and 59.8 percent, respectively, with alcohol, cannabis, and amphetamines being the most commonly abused substances. Current users of alcohol comprised 77.3 percent and current users of other nonprescribed substances (excluding tobacco and caffeine) comprised 29.9 percent of the sample. Rates of tobacco and caffeine consumption were high. There was a moderate degree of concordance between case manager determinations of a substance-use problem and research diagnoses. Subjects with current or lifetime diagnoses of substance abuse/dependence were predominantly young, single males with higher rates of criminal charges; however, there was no evidence of increased rates of suicide attempts, hospital admissions, or daily doses of antipsychotic drugs in these groups compared with subjects with no past or current diagnosis of substance abuse or dependence. Subjects with a current diagnosis of substance use were younger at first treatment and currently more symptomatic than those with no past or current substance use diagnosis. The picture emerging from this study replicates the high rate of substance abuse in persons with schizophrenia reported in North American studies but differs from the latter in finding a slightly different pattern of substances abused (i.e., absence of cocaine), reflecting relative differences in the availability of certain drugs.     

The role of therapeutic group programs in a nursing home.

Notes that nursing homes have traditionally focused their care on 3 areas—basic custodial services (e.g., food and shelter), physical health care, and personal care (e.g., grooming and toileting). Psychosocial services have been absent from the long-term care setting. A range of group therapeutic options is available, including activities therapy, occupational therapy, reality orientation, remotivation, and behavioral therapy; these and other approaches are discussed. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The epidemiology, clinical characteristics, and natural history of older nursing home residents with a diagnosis of Parkinson''s disease

This study investigated the occlusal stress distribution to the implant and soft tissue for the implant-retained overdenture. The stress at the molar residual ridge and the strain around the implant were measured on an experimental resin cast using static and dynamic loading. The influence of connecting structures of stud attachments on stress distribution was discussed. The occlusal stress had a tendency to concentrate on the implant, especially in the areas distal to the implant. The modified magnetic attachment system, using a silicone-covered magnet, provided the optimal stress distribution.     

Managed primary care of nursing home residents

The mechanisms responsible for immediate adjustments in cardiac output at onset of exercise, in the absence of neural drive, are not well defined in heart transplant (HT) recipients. Seven male HT recipients (mean +/- SD 57 +/- 6 years) and 7 age-matched sedentary normal control subjects (mean age 57 +/- 5 years) performed constant load cycle exercise at 40% of peak power output (Watts). Cardiac output and plasma norepinephrine were determined at rest and every 30 seconds during the first 5 minutes of exercise and at minutes 6, 8, and 10. All subjects were admitted to the General Clinical Research Center for determination of plasma volume. After 3 days of equilibration to a controlled and standardized diet, plasma volume was measured using a modified Evans Blue Dye (T-1824) dilution technique. Heart rate at rest was higher in the HT group (105 +/- 12 vs 74 +/- 6 beats/min), but during submaximum exercise, heart rates in the control group increased more rapidly (p < or = 0.05) and to a greater magnitude (54 +/- 7% vs 17 +/- 4% above rest). Stroke volume at rest was lower in HT recipients (45 +/- 4 vs 68 +/- 9 ml) but was significantly augmented immediately after onset of exercise (30 seconds) and the relative increase was greater than controls at peak exercise (61% vs 38% greater than baseline). Cardiac output at rest was within the normal range in both groups (4.58 +/- 0.27 vs 4.94 +/- 0.40 L/min). Relative increases in cardiac output were similar (p > or = 0.05) for the HT (106 +/- 12%) and control groups (97 +/- 10%). Plasma norepinephrine did not become significantly greater than resting values until approximately 4 minutes after onset of exercise in both groups. Blood volume, normalized for body weight, was 12% greater in the HT group. Thus, HT recipients with expanded blood volume (12%) augment stroke volume immediately after the onset of exercise. Plasma norepinephrine levels contribute negligibly to the rapid adjustment in cardiac output. Rather, we speculate that abrupt on-transit increases in stroke volume are due to augmented venous return, secondary to expanded blood volume.     

Stability and improvement of health after nursing home admission

This prospective study investigated stability of residents' mental status, function (activities of daily living), and mood during the first and second week following nursing home admission. New residents (N = 647) in eight urban nursing homes were assessed three times. Mental status was measured using the Short Portable Mental Status Questionnaire, function was measured using Scaled Outcome Criteria, and mood was measured using the Mood Adjective Checklist. A repeated measures multivariate analysis of variance, controlling for admission from hospital and readmission to the nursing home, documented stable mental status during the first and second week of nursing home residence. Hygiene, grooming, dressing, and transferring improved, whereas feeding, ambulation, urination, and defecation were stable. Tired and depressed mood adjectives improved, and angry, cheerful, afraid, lonely, and alert mood adjectives were stable. Residents admitted from a hospital had lower mental status and function scores, and readmitted residents had lower urination scores.     

The hippocampus, collateral behavior, and timing.

Male Sprague-Dawley rats with hippocampal (HC) lesions, cortical control lesions, or sham operations were trained to leverpress on a DRL schedule requiring 12 sec between responses. In 4 experiments, factors affecting performance efficiency in this paradigm were manipulated. Providing extra opportunities for collateral mediating behavior (Exp I) aided all groups nondifferentially. Adding a limited hold (Exp II) or administering chlordiazepoxide HCl (Exp III) reduced DRL efficiency in all groups nondifferentially. However, adding an auditory stimulus marking the halfway point in the DRL requirement (Exp IV) differentially aided the HC group. Implications for theories of HC function are discussed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)