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.     

GELYMAC: a Macintosh application for calculating DNA fragment size from gel electrophoresis migration data

A program called GELYMAC takes data on the distances migrated by DNA fragments in a one-dimensional electrophoretic gel and, using a cubic-spline best-fit of marker fragment distance migrated versus molecular size, calculates the molecular sizes of the fragments. Written in the Rascal (Real-time Pascal) programming language, the program runs on the Macintosh family of microcomputers. Rapid entry of marker and experimental fragment migration data is afforded using a scroll bar system adjacent to a graphic representation of a gel. Output includes tabular listing of the data, graphic cartoons of the gel, and the fragment locations and molecular sizes for individual gel lanes, and the calibration curve used in data computations.     

Evaluating dynamic performance: The influence of salient Gestalt characteristics on performance ratings.

It is well recognized that performance changes over time. However, the effect of these changes on overall assessments of performance is largely unknown. In a laboratory experiment, we examined the influence of salient Gestalt characteristics of a dynamic performance profile on supervisory ratings. We manipulated performance trend (flat, linear-improving, linear-deteriorating, U-shaped, and ∩-shaped), performance variation (small, large), and performance mean (negative, zero, positive) within subjects and display format (graphic, tabular) between subjects. Participants received and evaluated information about the weekly performance of different employees over a simulated 26-week period. Results showed strong main effects on performance ratings of both performance mean and performance trend, as well as interactions with display format. Theoretical and practical implications of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Construction Robot Path-Planning for Earthwork Operations

In developing an intelligent mobile construction robot, a navigation system that can provide an effective and efficient path-planning algorithm is a very important element. The purpose of a path-planning method for a mobile construction robot is to find a continuous collision-free path from the initial position of the construction robot to its target position. This paper presents an improved Bug-based algorithm, called SensBug, which can produce an effective path in an unknown environment with both stationary and movable obstacles. The contributions, which make it possible to generate an effective and short path, are an improved method to select local directions, a reverse mode, and a simple leaving condition. Some emerging technologies that can be used for implementing an intelligent construction robot are introduced in this paper.     

Stream Classification System Based on Susceptibility to Algal Growth in Response to Nutrients

We developed a stream classification system that is based on stream’s susceptibility to algal growth using a two-step approach. The model portrays algal biomass as a result of stream’s response to nutrient concentrations and the response is governed by various stream factors. In the first step, a nutrient-chlorophyll a relationship was developed to characterize nutrient’s effects on algal biomass. Residuals of the relationship were attributed to stream’s susceptibility to algal growth in response to nutrients and referred to as “observed” susceptibility. In the second step, conditions of other contributing factors were used to explain the variation in the residuals and the developed relationship was used to generate “predicted” susceptibility. Existing data compiled from various monitoring projects of Illinois streams and rivers were used to illustrate the approach. Streams were classified into three (high, medium, and low) categories based on their observed and predicted susceptibility values, respectively. With the available data, the model showed a 40-50% success rate for classifying the streams based on three observed and predicted susceptibility categories. Model entropy also was calculated for selecting the best model. The results show the important role of both nutrients and other contributing factors in explaining the variation of algal biomass. The study also suggests ways to fine tune the model and improve its accuracy, which would make the presented model a more viable tool for stream classification for establishing nutrient criteria to prevent surface streams from eutrophication.     

Overly literal interpretations of speech in autism: understanding that messages arise from minds

Children with autism and children with Down's syndrome watched the following enactment. A protagonist put one item in location A and another in location B and then left the scene. Subsequently, the items were swapped the other way round. Finally, the protagonist (who remained ignorant of the swap) requested the item in A. The observing child participant was asked to judge (1) which item the protagonist wanted and (2) which item the protagonist put in A. Unlike children with Down's syndrome, those with autism made more errors in judging that the speaker wanted the item in B than in judging that the item the speaker put in A is now in B; children with autism wrongly tended to interpret utterances literally, and they did this significantly more frequently than children with Down's syndrome. We conclude that children with autism have a difficulty making nonliteral interpretations that cannot be explained as (1) a realist bias, (2) an inability to inhibit a prepotent response, and (3) a failure to keep track of the exchange of items.     

Alpha 2 mRNA of Na+K+ ATPase is increased in astroctyes of rat hippocampus after treatment with kainic acid

The Na+K+ ATPase (Na+ pump) plays a central role in regulating cation homeostasis and is thought to have an important role in cell proliferation. The multitude of subunit isoforms comprising the functional Na+K+ ATPase has raised the possibility that specific subunit isoform combinations may be involved in different cellular processes. We have investigated the involvement of the specific isoforms in neurons and glia at the site of a CNS lesion. Intracerebroventricular injection of kainic acid was used to induce neuronal cell loss and reactive gliosis in rat hippocampus and levels of Na+K+ ATPase subunit isoform mRNA levels were determined in cells of rat hippocampus using in situ hybridization. alpha 2 mRNA levels increased 35-40% in CA1 and CA3 astrocytes between 1-3 weeks after KA injection with no significant change in other subunit isoform mRNA levels. In addition alpha 3 mRNA levels in CA1 pyramidal neurons were decreased by approx. 35%. Small neurons in the CA1 and CA3 region showed no changes in mRNA levels for any of the Na+K+ ATPase subunit isoforms. These results may indicate a possible role for alpha 2 subunit isoform in the conversion of glial cells from a normal phenotype to the reactive phenotype characteristic in this model of CNS injury.