Association of symptoms of depression with diagnostic test charges among older adults

BACKGROUND: Previous studies have documented greater use of health services by depressed persons and have postulated that health care costs could be reduced overall through better recognition and treatment of depression. OBJECTIVE: To determine whether a greater burden of medical illness contributes to excess charges for diagnostic tests among older adults with symptoms of depression. DESIGN: Prospective cohort study. SETTING: A primary care group practice at an academic institution. PATIENTS: 3767 patients 60 years of age and older who completed testing on the Centers for Epidemiologic Studies Depression Scale (CES-D) during routine office visits. MEASUREMENTS: Charges for all inpatient and ambulatory diagnostic testing for 2 years, including clinical pathology, diagnostic imaging, and special procedures; number of visits to the ambulatory care center or emergency department; and number of hospitalizations. The Ambulatory Care Group case-mix approach, which is based on ambulatory diagnoses, was used as a measure of health status and expected resource consumption. RESULTS: Patients with symptoms of depression (CES-D scores > or = 16) were significantly younger (66.6 compared with 68.1 years; P < 0.001), more likely to be white (50.5% compared with 33.9%; P = 0.001), and more likely to be female (75.8% compared with 67.6%; P = 0.001) than were those without these symptoms (CES-D scores < 16). They also had more nonpsychiatric comorbid conditions, had more visits to the ambulatory care center (9.2 compared with 7.8; P < 0.001), were more likely to use the emergency department (52.3% compared with 40%; P = 0.001), were more likely to be hospitalized (22.4% compared with 17%; P = 0.002), and had greater median total diagnostic test charges for a period of 1 year ($583 compared with $387; P < 0.001). The difference in charges, most of which were clinical pathology charges (54.2%), persisted into the second year. Ambulatory Care Group assignment was independently associated with diagnostic test charges. The CES-D summary score was not independently associated with diagnostic test charges when controlling for Ambulatory Care Group assignment. CONCLUSIONS: Patients with symptoms of depression accrue greater average diagnostic test charges. However, these data suggest that such patients also have a greater burden of comorbid nonpsychiatric illness. Efforts to improve outcome and decrease cost for patients who have late-life depression must target interventions to improve the care of psychiatric and medical illness concurrently.     

Inhibition of tuberoinfundibular dopaminergic neural activity during suckling: involvement of mu and kappa opiate receptor subtypes

Previous studies have shown that mu (mu) and kappa (kappa) opioid antagonists inhibit suckling-induced prolactin release. Prolactin responses elicited by pup suckling or opioid administration are mediated, at least in part, by suppression of dopamine (DA) release from tuberoinfundibular dopaminergic (TIDA) neurons in the hypothalamus. We examined the effects of the mu opiate receptor antagonist, beta-funaltrexamine (beta-FNA), and the kappa opiate receptor antagonist, nor-binaltorphimine (nor-BNI) on the activity of TIDA neurons in lactating rats. TIDA neuronal activity was determined by measuring DOPA accumulation in the caudate putamen (CP) and median eminence (ME). The effects of opioid antagonist treatment were determined in pup-deprived (low circulating prolactin levels) or pup-suckled rats (high circulating prolactin levels). The accumulation of 5-hydroxytryptophan (5-HTP) in the medial preoptic area (MPOA), the anterior hypothalamus (AH) and the median eminence (ME) was quantified as an index of serotonergic activity in the same animals for comparative purposes. In vehicle treated rats, suckling caused a significant and selective decrease in DOPA accumulation in the ME. beta-FNA (5 micrograms, i.c.v.) pretreatment significantly increased DOPA accumulation in the ME of pup-deprived and pup-suckled rats. beta-FNA pretreatment also prevented the suckling-induced suppression of DOPA accumulation in the ME. In contrast to the actions of beta-FNA, pretreatment with nor-BNI (8 micrograms, i.c.v.) did not significantly affect the activity of the TIDA neurons in pup-deprived or pup-suckled rats. Suckling alone did not alter 5-HTP accumulation in any of the brain regions examined, and neither opioid antagonist had appreciable effects on 5-HTP accumulation. These results demonstrate that the EOP tonically inhibit the TIDA neurons in both pup-deprived and pup-suckled, post-partum female rats by acting through the mu, but not the kappa, opiate receptor subtype. Furthermore, the suckling-induced inhibition of TIDA neurons is also mediated through the EOP acting at mu, but not kappa opioid receptors.     

Adult rats stressed as neonates show exaggerated behavioral responses to both pharmacological and environmental challenges.

Adult rats that were isolated from the mother and nest for 1 hr per day from Postnatal Day 2 to 9 were studied. Controls consisted of handled littermates as well as separate litters that were never handled. As adults, animals were given either a pharmacological challenge (1.0 or 2.0 mg/kg amphetamine) or an environmental challenge (restraint). Previously isolated animals demonstrated increased activity compared to controls at both drug doses. Similarly, isolated animals manifested exaggerated inhibition of activity after restraint. Previously isolated animals usually did not show differences compared to controls under baseline conditions (saline injection or no restraint). The neuroplastic changes that result from the neonatal experience are long lasting and appear when the system is challenged. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician-hospital transactions: developing a process for handling valuation-related issues

Hospitals are increasingly attempting to integrate their operations with physician constituents through the development of hospital-physician joint ventures and acquisition of physician practices. This article provides an overview of valuation-related issues that result with respect to such affiliation efforts and guidance to assist the health care financial and legal professional in resolving such issues consistent with the business objectives of the transaction parties.     

VisComplete: automating suggestions for visualization pipelines

Building visualization and analysis pipelines is a large hurdle in the adoption of visualization and workflow systems by domain scientists. In this paper, we propose techniques to help users construct pipelines by consensus--automatically suggesting completions based on a database of previously created pipelines. In particular, we compute correspondences between existing pipeline subgraphs from the database, and use these to predict sets of likely pipeline additions to a given partial pipeline. By presenting these predictions in a carefully designed interface, users can create visualizations and other data products more efficiently because they can augment their normal work patterns with the suggested completions. We present an implementation of our technique in a publicly-available, open-source scientific workflow system and demonstrate efficiency gains in real-world situations.     

Progressive volume rendering of large unstructured grids

We describe a new progressive technique that allows real-time rendering of extremely large tetrahedral meshes. Our approach uses a client-server architecture to incrementally stream portions of the mesh from a server to a client which refines the quality of the approximate rendering until it converges to a full quality rendering. The results of previous steps are re-used in each subsequent refinement, thus leading to an efficient rendering. Our novel approach keeps very little geometry on the client and works by refining a set of rendered images at each step. Our interactive representation of the dataset is efficient, light-weight, and high quality. We present a framework for the exploration of large datasets stored on a remote server with a thin client that is capable of rendering and managing full quality volume visualizations.     

Communication lessons from IT consultancies

In the corporate world, IT consultancies are unique. They provide professional services to clients, like most consultants. But unlike many consultant fields, IT consultants also commonly develop the technological tools their clients need to improve their business operations. This business model allows IT consultants to flexibly redesign business processes that achieve client objectives, because these business processes can evolve hand-in-hand with the IT tools. However, these two workloads - developing the tools and providing the professional services - often conflict within the inner workings of the IT consultancy.     

Microstructure-Based Estimation of Strength and Ductility Distributions for $$\alpha +\beta $$ Titanium Alloys

Titanium alloys are processed to develop a wide range of microstructure configurations and therefore material properties. While these properties are typically measured experimentally, a framework for property prediction could greatly enhance alloy design and manufacturing. Here a microstructure-sensitive framework is presented for the prediction of strength and ductility as well as estimates of the bounds in variability for these properties. The framework explicitly considers distributions of microstructure via new approaches for instantiation of structure in synthetic samples. The parametric evaluation strategy, including the finite element simulation package FEpX, is used to create and test virtual polycrystalline samples to evaluate the variability bounds of mechanical properties in Ti-6Al-4V. Critical parameters for the property evaluation framework are provided by measurements of single crystal properties and advanced characterization of microstructure and slip system strengths in 2D and 3D. Property distributions for yield strength and ductility are presented, along with the validation and verification steps undertaken. Comparisons between strain localization and slip activity in virtual samples and in experimental grain-scale strain measurements are also discussed.

     

高效能石英振荡器的选择

当今的网络设备必须支持数目不断增多的各种数据速率,包括10G以太网络、10G光纤信道(Fibre Channel)、SONET OC-192和相关的前向错误更正(FEC)速率.传统的时序子系统架构必须为每种频率使用一颗石英晶体或表面声波(SAW)谐振器,这会导致每个线路卡上出现许多不同的振荡器.使用多个石英振荡器或SAW谐振器可能为网络设备设计人员带来问题,包括很长的石英晶体采购交货时间、产品频率稳定性、长期老化现象、温度漂移和机械完整性.