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Objective: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia., Design: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443)., Setting: National population-based sample of the community-dwelling elderly., Main Outcome Measures: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status., Results: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars., Conclusion: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

Confronted with the Holocaust, I pose the question: How could the human beingas a mature person survive? Through examining the writings of one survivor, Elie Wiesel, we may discover how he pictures personal humanity conquering impersonal death. By placing his reflections in an analytical psychological structure, we may illustrate responses to threat, both healthy and unhealthy responses. At the same time, we may illumine the struggle to grapple humanly with an inhuman environment. Such a discussion may encourage reflection on our own daily dealings with stressful situations; it may also serve to guide the professional assisting in the human struggle with mortality.

The role of adenosine as a mediator of the bradycardia associated with graded global ischaemia in rat heart was examined. Hearts were perfused at 37 degrees C in the isovolumic mode with Krebs-bicarbonate medium at 12.0 ml/min/g. After equilibration, the coronary flow was reduced to 0.5, 2.5, or 5.0 ml/min/g for 20 min. Effluent was collected and assayed for adenosine and inosine by HPLC. Heart rate was measured and bipolar electrograms were obtained in severely ischaemic hearts. Basal adenosine release was 124 +/- 15 pmol/min/g. Adenosine release increased by approximately 50% in hearts perfused at 5.0 ml/min/g. In hearts perfused at 2.5 and 0.5 ml/min/g, adenosine release increased by approximately 1300 and 2300% respectively. The pattern of adenosine release at 0.5 and 2.5 ml/min/g was phasic, with adenosine release rate increasing to a maximum after about 10 min then dropping to values slightly higher than initial values. Ischaemia produced significant bradycardia and first degree AV block. Adenosine antagonism with 5 micron 8-phenyltheophylline blocked up to 25% of this bradycardia and significantly reduced the conduction delay. Adenosine release rate correlated closely with that component of heart rate slowing which was inhibited by 8-phenyltheophylline. It is concluded that adenosine released during graded global ischaemia mediates up to a quarter of the associated bradycardia. The effect of adenosine is phasic. Adenosine acts primarily to depress the sinus pacemaker. First degree AV block also occurs. These effects were only apparent at coronary flow rates below 5.0 ml/min/g.

Rat lungs were perfused by recycling Krebs-bicarbonate solution in an apparatus which allowed negative pressure ventilation of the lungs. After addition of either reduced or oxidized ascorbic acid to the perfusion fluid serial samples were taken over 60 min and assayed for ascorbic acid. At the end of perfusion, lungs were assayed for ascorbic acid. The results show that reduced ascorbic acid was taken up by the lung and concentrated in the tissue. No appreciable transport of oxidized ascorbic acid was measured.

Why formulate a philosophy statement? How may this statement influence organizational life? Answers to these questions affirm the practical utility of a philosophy within a health care facility. In addressing the first question, consideration is given to the philosophical questions by whom, to whom, and for what purpose is the organization sent. Also considered are its purpose in relating to and mode of relating to its patients. The practical place of a philosophy is illustrated through the difference between for-profit and non-profit corporations. A close analysis of organizational structure, systems, and strategies details this difference.

Only lately having recovered their bodies and feelings, Western devotees of various meditative practices are in increasing numbers striving to transcend both. Is such a turning inward healthy for individuals and our society? A full response requires both a clarifying discussion of exactly what meditation is and a review of its effects. Meditation, essentially a way of life, is marked by four stages: preparation, attention, active reception, and higher consciousness. Even though the Western traditions aim finally at union with the Infinite and Eastern traditions seek primarily an internal unity through the negation of consciousness, both describe essentially the same four stages, reached through the meditative pathways of the intellect, emotions, body, and action. Present scientific research is only beginning to provide data on the effects of meditation upon the person. To date, most research findings point out psychophysiological changes during meditation, indicating a low-stress state. Meditative experience lends support to the conclusion that successful meditation also positively affects growth by touching man's inner life source, expanding his consciousness, and revealing personal life directions.

This study examines the possibility that endogenous adenosine modulates efficiency in isovolumic perfused rat hearts stimulated with isoproterenol or norepinephrine. Efficiency in these hearts is calculated as the rate of pressure work divided by the myocardial oxygen consumption. Within 2 min of infusion of isoproterenol (50 nM), heart rate increased by 35%, the rate pressure product by 290%, oxygen consumption by 142%, and efficiency by 67%. Infusion of adenosine deaminase (2-4 IU/ml), or 8-phenyltheophylline (5 microM), into stimulated hearts augmented the increase in heart rate by 40-45%, rate-pressure product by 18-20%, and oxygen consumption by 50-55%. Efficiency was reduced by 30-35%. Adenosine release into the coronary venous effluent increased from 195 +/- 20 pmol/min/g to 2400 +/- 180 pmol/min/g after 5 min. A similar pattern of results was observed when norepinephrine (0.1 mM) was used. The results indicate that extracellular adenosine, released by catecholamine treatment, inhibits the effects of the catecholamines on rate and contractility. Consequently, adenosine reduces cardiac work (rate-pressure product), but in so doing, improves efficiency.