Longitudinal weight changes, length of survival, and energy requirements of long-term care residents with dementia

OBJECTIVE: We hypothesized that institutionalized patients with dementia, who frequently have feeding problems and require supervised and assisted feeding, would lose more weight during their residency than nondemented, independently functioning residents and have compromised survival. To test this hypothesis, we examined the survival and longitudinal changes in weight of two cohorts of institutionalized residents with dementia and compared these cohorts with a cohort of nondemented residents. We also measured the resting energy expenditures of a subset of the subjects with dementia as an indicator of their energy needs. DESIGN: A longitudinal cohort study with retrospective baseline chart review and subsequent follow-up of monthly weights and mortality over 4 years. SETTING: A 725-bed long-term care institution with specified levels of care. SUBJECTS: Two cohorts of residents with dementia, one consisting of subjects who required total care throughout their institutional stay (n = 31) and another group who did not initially require total care (n = 48); these were compared with a cohort with normal mentation who were functionally independent in their daily activities (n = 26). The total number of subjects was 105. MEASUREMENTS: Demographics, medical problems, and medications by chart review; functional and mental status evaluations; longitudinal monthly weights and mortality for the 48-month study period; and resting energy expenditures by indirect calorimetry. MAIN RESULTS: Residents with dementia had lower weights on admission and throughout their stay than nondemented, independently functioning residents, and they were more likely to have a weight loss of 10 lbs or more at some point during the 4-year study period. However, their mean weights did not change during the study period. The mean survival from admission of those demented residents who died was more than 3 years. Resting energy expenditures of women residents with advanced dementia were 12% lower than predicted from the Harris Benedict equations. CONCLUSION: Dementia is not necessarily associated with unremitting weight loss during institutionalization despite the frequent occurrence of feeding difficulties and temporary weight loss. This may be caused partly by the lower than expected resting energy expenditures and, hence, energy needs of affected residents as their dementia progresses. Demented residents weighed significantly less than nondemented, independently functioning residents throughout their institutional stay. Nevertheless, nursing staff are able to maintain weight and survival for extended periods even in very impaired residents.     

Percutaneous ethanol injection therapy by ethanol mixed with CO2 microbubble for hepatocellular carcinoma

One of the shortcomings of percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma (HCC) is that many sessions are necessary to accomplish the treatment. This may be caused by which the ultrasonography (US) image does not reflect correctly to the kinetics of injected ethanol into HCC nodule. It is considered that number of treatment sessions are able to be reduced if we just enough injected labelled ethanol under US into HCC nodule. Therefore, we tried PEIT by ethanol mixed with CO2 microbubble (CO2 ethanol). The injected CO2 ethanol was aquired as hyperechoic image without strong acoustic shadow to the end of injection. Consequently we could reduce the number of treatment sessions to almost 1 for lesions < or = 3 cm in diameter and markedly reduce total dose of injected ethanol. The detectable rate of CO2 ethanol leaked out HCC nodule was high. No serious complication occurred. There have been only 1 lesion of local recurrence and no case of intrahepatic and peritoneal dissemination for 11.5 months on average of observation after PEIT by CO2 ethanol (CO2PEIT). These findings suggest that CO2PEIT is useful method for reducing the number of treatment sessions and total dose of injected ethanol, moreover preventing complication by ethanol leakage.     

Flashover voltage characteristics of contaminated station insulators under temporary ac overvoltages in the ac system connected with a frequency converter station

According to the recent analysis results of temporary ac overvoltage in the ac system connected with a frequency converter station, large-magnitude over-voltages were confirmed to occur under some special system conditions. Most of the station insulators currently used cannot withstand such overvoltages according to an evaluation based on the data obtained earlier. The necessity of tests to be done to evaluate such performance more accurately was recognized. Both power frequency and switching impulse overvoltage flashover tests were made on contaminated insulators by the method well simulating the natural wetting condition. Switching impulse flashover voltage with the waveshape having a long wavefront time of 2 ms can be well correlated with the flashover voltage characteristics of temporary ac overvoltage. Higher flashover voltage characteristics were obtained by a clean fog test method compared with those obtained by equivalent fog test method.     

Radiative ignition mechanism of solid fuels

Transmittance of external radiation from a CO₂ laser through a boundary layer of decomposition products over a vertical sample surface is measured during the ignition period. The results indicate that there is significant absorption of the external radiation for PMMA, and a lesser but still not negligible amount, for red oak. An increase in gas phase temperature over surface temperature is observed over much of the ignition interval. Using the experimentally measured incident flux at the sample surface, surface temperature history was calculated from a model that included re-radiation and convection losses from the surface, endothermic decomposition and conduction into the material. The results confirm the significant effect of gas phase absorption on surface temperature. Steady-state-derived surface regression rate expression was used for PMMA in this model. The results raise questions about the validity of such data for the dynamic heating conditions during the ignition period. Further studies needed to understand the radiative ignition mechanism are identified.     

Ru-catalyzed anode materials for direct hydrocarbon SOFCs

A solid oxide fuel cell using a thin ceria-based electrolyte film with a Ru-catalyzed anode was directly operated on hydrocarbons, including methane, ethane, and propane, at 600 °C. The role of the Ru catalyst in the anode reaction was to promote the reforming reaction of the unreacted hydrocarbons by the produced steam and CO₂, which avoided interference from steam and CO₂ in the gas-phase diffusion of the fuels. The resulting peak power density reached 750 mW cm⁻² with dry methane, which was comparable to the peak power density of 769 mW cm⁻² with wet (2.9 vol.% H₂O) hydrogen. More important was the fact that the cell performance was maintained at a high level regardless of the change in the methane utilization from 12 to 46% but was significantly reduced by increasing the hydrogen utilization from 13 to 42%. While the anodic reaction of hydrogen was controlled by the slow gas diffusion, the anodic reaction of methane was not subject to the onset of such a gas-diffusion process.     

Solid-Phase Syntheses of Two Deacetyl-Thymosin β4 Analogues with Substitution at Position 12 and Their Effects on Impaired Blastogenic Response of T Lymphocytes of Uremic Patients

Two deacetyl-thymosin β₄ analogues containing Phe(4Br) or D-Phe(4Br) as position 12 were synthesized by the manual solid-phase method, and their immunological effects on the impaired blastogenic response of phytohemagglutinin-stimulated T lymphocytes of uremic patients with infectious diseases were studied. Bromination of the p-position of Phe¹² resulted in a marked restorative effect on the impaired blastogenic response of T lympocytes compared with that of our synthetic deacetyl-thymosin β₄ The synthetic [Phe(4Br)¹²]deacetyl-thymsin β₄ was approximately equal in potency to our synthetic [Phe(4F)¹²]deacetyl-thymosin β₄ in uremic patients, but the other analogue, [D-Phe(4Br)¹²]deacetyl-thymosin β₄, had no effect.     

Effects of nondensifying inclusions on the densification and microstructure of zinc oxide matrix composites

The densification and microstructure development of ZnO containing Zn₇Sb₂O₁₂, ZrO₂, and aggregated ZnO were investigated to elucidate the effect of nondensifying inclusions on the sintering of ceramic/ceramic composites. The inclusion retarded the densification, and the degree of retardation was found to depend on the chemical species of inclusion; Zn₇Sb₂O₁₂ had the largest effect, followed by ZrO₂ and then aggregated ZnO last. The experimental results for aggregated ZnO was explained by the theory which predicts the generation of backstresses. The backstresses give a less significant effect on the densification. For Zn₇Sb₂O₁₂ and ZrO₂, the microstructure of the matrix varied with distance from an inclusion particle; much porosity was observed in the region surrounding the inclusion. Circumferential voids, which are responsible for the suppression of densification, form during the initial stage of sintering. Inclusion particles generate an anchoring effect which retards the densification of the matrix immediately surrounding the inclusion particle during the intermediate stage.Supported by the Inamori Foundation.     

Development of 170 GHz/500 kW gyrotron

A development of 170GHz/500kW level gyrotron was carried out as R&D work of ITER. The oscillation mode is TE_31,8. In a short pulse experiment, the maximum power of 750kW was achieved at 85kV/40A. The efficiency was 22%. In the depressed collector operation, 500kW/36%/50ms was obtained. The maximum efficiency of 40% was obtained at P_RF=470kW whereas the power decrease by the electron trapping was observed. Pulse extension was done up to 10s at P_RF=170kW with the depressed collector operation. The power was limited by the temperature increase of the output window.     

High performance liquid chromatographic separation of stereoisomeric bile acids as their UV-sensitive esters

High performance liquid chromatographic separation of a series of mono-, di- and trihydroxylated 5β-cholanic acids which differ only in position and configuration of hydroxyl groups at positions C-3, C-7 and/or C-12, is reported. The C-24 free acids were derivatized to four different classes of UV-sensitive esters, i.e.,p-bromophenacyl (BP),m-methoxyphenacyl (MP), 4-nitrophthalimidemethyl (NPM) and 9-anthrylmethyl (AM) esters, and chromatographed on two, variants of C₁₈ reversed-phase columns (Nova-Pak C₁₈ and Zorbax ODS) with methanol-water systems as mobile phase. Separation efficiency and elution order of some isomeric pairs were influenced by both the structure of the C-24 ester groups and the nature of the columns used. Excellent chromatographic properties were found for those derivatives, particularly for the NPM esters.