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1.
OBJECTIVE: To evaluate what nursing home medical directors actually do, what they and other nursing home personnel believe would be desirable to do, and what problems and deficiencies are perceived. DESIGN: Mail survey with follow-up telephone interview when necessary. SETTING: Forty-five nursing facilities in upstate New York. PARTICIPANTS: The medical directors, administrators, and directors of nursing of the 45 facilities. MEASUREMENTS: Inventory of what medical directors reported as to their actual activities and time spent, and of what they, the administrators, and the directors of nursing felt should be their responsibilities and activities under ideal circumstances. RESULTS: For part-time medical directors, self-reported time spent on medical directorship activities averaged 12 hours per month; of all directors, 45% spent 8 hours or less per month. Proportion of time spent on various specific activities varied widely. There was general agreement that substantially more time should be spent, in particular, on evaluating and addressing problems of adequacy and quality of care, communicating with attending physicians about problems, and assisting with inservice training programs. CONCLUSIONS: To fill the role adequately, more time should be spent by many part-time medical directors, which will require greater financial commitment by facilities and reimbursement systems. Efforts need to made to better coordinate the expectations of medical directors and facility staff. 相似文献
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3.
Tsukada T. Hashimoto Y. Sakata K. Okada H. Ishibashi K. 《Solid-State Circuits, IEEE Journal of》2005,40(1):67-79
A decoupling circuit using an operational amplifier is proposed to suppress substrate crosstalk in mixed-signal system-on-chip (SoC) devices. It overcomes the parasitic inductance problem of on-chip capacitor decoupling. The effect of the proposed decoupling circuit is not limited by parasitic fine impedance. A 0.13-/spl mu/m CMOS test chip showed that substrate noise at frequencies from 40 MHz to 1 GHz was incrementally suppressed by sequentially activating three of the proposed circuits in parallel. The power dissipation of each circuit was 3.3 mW at a 1.0-V power supply. The test chip measurement showed that the proposed decoupling reduced crosstalk by 31% at 200 MHz, whereas it was reduced by 4.4% with capacitor decoupling. This 7:1 ratio, or 17 dB, corresponds to the gain of the opamp. Design of the opamp and its feedback loop for active decoupling is simple, making the opamp useful for SoC applications. 相似文献
4.
I Ezaki M Shingu M Hashimoto T Isayama J Tohmatsu H Kanda M Nobunaga T Watanabe 《Canadian Metallurgical Quarterly》1994,21(11):2005-2010
OBJECTIVE: To better understand the immunoglobulin variable (V) region repertoire of rheumatoid factors (RF). METHODS: We characterized the heavy (H) and light (L) chain gene segments utilized in a monospecific IgG RF secreting hybridoma (AEE111F) which were derived from a patient with rheumatoid arthritis (RA). The hybridoma was established by fusion of a mouse myeloma cell line with bone marrow derived mononuclear cells from a patient with RA. First strand complementary DNA (cDNA) was generated and used for a polymerase chain reaction amplification of the H and L chain V domains. The amplified V domains were sequenced and compared with an extensive database of germline and cDNA V gene segments. RESULTS: The VH sequence was found to be 96% homologous to a previously described fetal VH3 cDNA (60P2). The VL sequence was also highly homologous to the previously described V lambda II gene (96%) derived from a patient with systemic lupus erythematosus which correlated with an 8.12 idiotype (Id), and to an antibacterial antibody against the Haemophilus influenzae type b capsular polysaccharide (94.7%). CONCLUSION: The overlap among this RF VL gene and the 2 reported V lambda sequences of antibodies that expressed anti-DNA related Id and an environmental pathogen specificity suggests that a part of the IgG RF isolated from patients with RA may thus be derived from the physiological natural antibody repertoire during an abnormal immune response and then develop high affinity, monospecific RF by the selection of an antigen driven mechanism. 相似文献
5.
Cell death was analyzed in neurulating mouse embryos after in vivo doses of 2-methoxyethanol (2-ME) that produce anterior neural tube defects. Characterization of 2-ME-induced cell death was performed by evaluating: (1) vital fluorochrome staining in whole embryos applying confocal laser scanning microscopy; (2) characteristics of cell debris in conventional histological sections revealed by light microscopy; and (3) Apoptag in situ immunohistochemical staining for apoptosis using light microscopy. Methods for quantification of cell death identified by these three techniques were explored using computerized image analysis. Physiological cell death in control embryos primarily occurred in the neural crest region during neural fold elevation. Embryos exposed to 2-ME had expanded areas of cell death in the neural crest and also new areas of cell death in medial regions of the anterior neural tube. Both physiological and 2-ME-induced embryonic cell death had morphological, immunohistochemical, and fluorochrome staining characteristics of apoptosis. When fluorescence data from confocal microscopic analysis of vital fluorochrome-stained embryos were analyzed, a dose-dependent increase was found in embryos exposed to 2-ME. Similar results were obtained when cell death was analyzed in either conventional histological sections or sections prepared for immunohistochemical detection of apoptosis. The cell death data obtained in this study correlate with previously observed near-term malformation rates, suggesting that a quantitative relationship exists between 2-ME-induced embryonic cell death and neural tube defects. 相似文献
6.
A case of small epithelioid hemangioendothelioma encapsulated by an egg-shaped bony shell composed of newly formed mature lamellar bone is presented. A nodule measuring 10 x 5 x 5 mm was excised from inside of the right cheek muscle of a 46-year-old man. Histopathologically, the nodule consisted mainly of round-to-short spindled epithelioid cells with round nuclei and occasional cytoplasmic vacuoles associated with some foci of osseous metaplasia. Characteristically, egg shell-like lamellar bone enclosed this lesion showing well-circumscribed appearance. The main component cells were immunohistochemically stained positive for factor VIII-related antigen, CD 34, UEA-1, and vimentin, and proved to be vascular endothelial cells. The term ossifying epithelioid hemangioendothelioma is proposed for this unique lesion. This type of epithelioid hemangioendothelioma has not been previously reported to our knowledge, and differentiation from ossifying fibromyxoid tumor of soft parts is considered to be important. 相似文献
7.
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. 相似文献
8.
Y. Miyamoto Y. Kubo N. Ono M. Hashimoto T. Takahashi I. Ito F. Arezzo P. Gimondo 《Thin solid films》1995,270(1-2):253-259
A new coil-coating pilot plant, capable of utilizing ion plating, sputtering and plasma-assisted chemical vapor deposition (PACVD) processes, independently or in series, was developed and optimum conditions for TiN, TiC, AlxOy, SiOx and Cr coating were established. This paper is mostly concerned with the results of characterization (conducted in parallel by the authors′ two institutions) of TiN films deposited by ion plating or sputtering onto type-304 stainless steel strips. In particular, the dependence of the basic properties such as chemical composition, structure, adhesion, and color on the coating process are discussed with respect to anti-corrosion, anti-wear, and decorative applications. TiN coatings with a very attractive gold coloration were obtained; they performed well in wear testing, but did not show satisfactory corrosion resistance. However, it was found that the latter can be improved significantly by depositing a SiOx, top layer by PACVD above the TiN coating. Thus the in-line dry coating processes are capable of producing highly functional steel surfaces with decorative color and high corrosion resistance. 相似文献
9.
K Iihara M Sasahara Y Saeki N Hashimoto H Kikuchi F Hazama 《Canadian Metallurgical Quarterly》1993,20(7-8):515-521
1. We characterized the endothelial cell-derived growth factors of SHRSP and Wistar Kyoto rats (WKY), respectively and found that platelet-derived growth factor (PDGF)-B chain related growth factor constituted a major portion of the mitogenic activity of the conditioned media of endothelial cells from both animals. There were no remarkable qualitative differences between the endothelial cell-derived growth factors of SHRSP and WKY. 2. Northern analysis revealed that the expression of PDGF-B chain was 2-4-fold enhanced in cultured aortic endothelial cells of SHRSP. This enhanced expression of PDGF-B chain, which may be induced under chronic hypertensive conditions, is suggested to contribute to the increase in endothelial cell-derived growth factors reported in this animal. 相似文献
10.
H Koh Y Hashimoto H Takagi K Hirota H Ishihara A Matsuki 《Canadian Metallurgical Quarterly》1993,42(2):217-224
The purpose of the study was to explore the relationship between the exposure of adolescents in the seventh and eighth grades to cigarette advertising and their being smokers. A survey questionnaire given to 602 adolescents assessed their exposure to cigarette advertising and provided measures of their smoking behavior, demographic characteristics, and some psychosocial variables. The results indicated that exposure to cigarette advertising and having friends who smoked were predictive of current smoking status. Adolescents with high exposure to cigarette advertising were significantly more likely to be smokers, according to several measures of smoking behavior, than were those with low exposure to cigarette advertising. The findings extend previous research identifying factors that may play a role in the initiation and maintenance of smoking among adolescents. 相似文献