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Tularemia, caused by Francisella tularensis, is a potentially fatal, multisystemic disease in humans. Tularemia occurs throughout most of the Northern Hemisphere, and the number of cases is increasing in various [...]

In the trials of the present work, a double-axle trailer with a carrying capacity of 6 tons and a hydraulically effective mechanical brake were used as a tractor towed car. There is a hydraulic brake system on each axle of the agricultural trailer. In order to separate the brake system on the axles from each other, a hydraulic mechanically controlled 2/2 directional control valve was mounted on both hydraulic brake system inlets. The study was carried out at constant speed (25 km h-1), on stabilized road conditions, with 4 different braking modes and 4 different trailer loads. On stabilized ground, the braking acceleration (deceleration) of the tractor (without trailer) is 5.51 m s-2. The braking acceleration of the combination is 2.15 m s-2 under the condition that the trailer's carrying capacity was 30% more loaded and without brakes, and the braking acceleration of the combination was 3.26 m s-2 when braking on both axles (4 wheels). The deceleration of the combination was above 3.5 m s-2 under the condition of braking on both axles at the rated load of the agricultural trailer, while it was below the standard value in other braking approaches. [ABSTRACT FROM AUTHOR]

Objectives. We describe how paid and unpaid home care hours received by older unmarried Americans change in response to disability dynamics. We test whether responses to disability declines and improvements are symmetric; that is, we test whether reductions in care hours that are due to disability improvements are of similar magnitude to increases in care hours that are due to disability declines. Methods. Using a national sample of older unmarried Americans, we examine changes in total hours, paid hours, and unpaid hours of care in response to declines and improvements in personal care (activities of daily living, or ADLs) and routine care (instrumental ADLs, or IADLs) disability. We model changes in the total hours of care received in the past month and jointly model changes in unpaid and paid hours, using Tobit models. Results. Changes in the total hours of care received respond to both increases and decreases in the count of ADL limitations and appear close to symmetric. In contrast, responses to IADL disability dynamics appear to be far less symmetric: Although increases in the count of IADL limitations are met with substantial increases in the total hours of care, decreases are not met with correspondingly large declines in care. The same general pattern is found for unpaid and paid care, and for Medicaid-funded home care. Discussion. Disability and care are not static constructs in old age. Older unmarried persons experience worsening, stabilizing, and recovery of function, and their care hours change accordingly. Evaluations of home care programs must be cognizant of such dynamic realities.

This study examines the likelihood of nursing home and home health care use for childless older Americans. Four research questions are addressed: (1) Are the childless elderly at a greater risk of nursing home and home health care use? (2) Is it childlessness per se or not having children with particular characteristics that affects the likelihood of using these formal long-term care services? (3) Does having additional children beyond the first one have a significant effect on the use of these services? (4) Are the effects of childlessness different on the likelihood of nursing home and home health care use? Longitudinal data from the first (1993) and second (1995) waves of the Asset and Health Dynamics Among the Oldest Old Survey (AHEAD) and multinomial logistic regression models are used for the analyses. Separate models are developed for women and men, each controlling for a variety of demographic, socioeconomic, and health-related characteristics of sample persons. Findings indicate childlessness as an important risk factor, especially for older women's use of nursing home services. Implications of findings for planning for long-term care needs of the baby boom generation are discussed. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: KEYWORDS. Childlessness, elderly, nursing home use, home health care use, baby boom generation, AHEAD

This study investigates the effects of five state Medicaid policies on the risk of nursing home entry among a recent cohort of older persons. Longitudinal data from the first (1993) and second (1995) waves of the Asset and Health Dynamics Among the Oldest Old Survey and continuous-time hazard models are used for the analyses. Separate models are developed for women and men, each controlling for a variety of demographic, socioeconomic, and health-related characteristics of sample persons. Findings suggest that the state Medicaid policies included in the analyses do not significantly affect the risk of nursing home use among women or men and that the strongest predictors of the risk are health-related characteristics. Circumstantial evidence is presented to argue that the lack of policy effects might be due to changes in recent decades in health care policies driven by cost containment efforts.

Objectives. This study explored whether previously reported declines in severe cognitive impairment were robust to cumulative effects of potentially confounding survey design issues. Methods. Using the 1993 Asset and Health Dynamics of the Oldest Old study (n = 7,443) and 1998 Health and Retirement Survey (HRS; n = 7,624) the proportion of persons ages 70 and older with severe cognitive impairment was calculated under various assumptions about item nonresponse, differential loss to follow-up, and the size and composition of the nursing home population. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents ratings of memory and judgment were used. Chi-square tests were adjusted to account for complex survey designs. Results. Ignoring loss to follow-up, excluding nursing home residents, and assigning a iow score to those refusing subscales yielded a statistically significant decline in severe cognitive impairment from 5.8% in 1993 to 3.8% in 1998. or an average annual decline of 6.9%. When cumulative effects of survey design issues were considered and design effects incorporated into statistical tests, statistically significant declines persisted, albeit at a reduced average annual rate, ranging from 2.5% to 6.9% per year. Discussion. Previously reported improvements in severe cognitive impairment appear to be robust to a variety of specifications. Replication with future waves of the HRS and other data is warranted.

This article investigates the patterns and correlates of currently married adult children's coresidence with their parents in Turkey using data from the 1993 Turkish Demographic and Health Survey. The authors are particularly interested in traditional patterns of coresidence (i.e., coresidence with one or both of the husband's parents) and the effect of variables measuring traditionality at the individual and contextual levels on coresidence with any parent and with the husband's parents. The results indicate that coresidence among currently married children is not the norm. However, the odds of coresidence with the husband's parents, given that a couple coresides with any parent, are very high. In addition, the authors find substantial effects of traditionality measures on coresidence, especially with the husband's parents. Continued economic development, and the social changes that accompany it, can be expected to reduce the prevalence of parent-child coresidence in Turkey.

Objectives. This study explored whether improvements in cognitive functioning occurred during the 1990s among older Americans and investigated several possible explanations for such changes. Methods. Using the 1993 Asset and Health Dynamics. of the Oldest Old study (N = 7,443) and 1998 Health and Retirement Survey (N = 7,624), this study examined aggregate changes in the proportion of the noninstitutionalized population aged 70 and older with severe cognitive impairment. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents, ratings of memory and judgment were used. Logistic regression was used to investigate potential explanations aggregate changes. Results. The percentage of older Americans with severe cognitive impairment declined from 6.1% in 1993 to 3.6% in 1998 (p [is less than] .001). The decline was statistically significant among self-respondents but not among those with proxy interviews. Improvements between 1993 and 1998 were not explained by shifts in demographic and socioeconomic factors or by changes in the prevalence of stroke, vision, or hearing impairments. Discussion. As a group, older persons, especially those well into their 80s, appear to have better cognitive functioning today than they did in the early 1990s.

Objective: Although sudden cardiac death is rare in children, an intracardiac defibrillator system is indicated in children with various types of cardiomyopathy, primary electrical diseases, and after surgical repair of congenital heart defects. The use of transvenous defibrillator lead systems is limited in pediatric patients because of a small body size and/or limited vascular access. Subcutaneous array leads combined with an abdominally placed generator can enable implantation. Method: This is a retrospective study of 13 patients who underwent subcutaneous defibrillator implantation between September 2010 and March 2015. The subcutaneous system was preferred because patients were not amenable to transvenous lead placement. Results: The median patient age was 4.1 years, and the median patient weight was 12.1 kg. Diagnoses of patients were long-QT syndrome in 6, aborted cardiac arrest with left ventricular non-compaction in 3, hypertrophic cardiomyopathy with sustained ventricular tachycardia in 3, and arrythmogenic right ventricular cardiomyopathy in 1. Revision of the subcutaneous lead was required in 5 patients 2-26 months after the implantation. Appropriate shocks were observed in three patients. Inappropriate shock and lead fractures were observed in one patient during the follow-up period. The failure of therapy was observed in one patient. There were no perioperative complications and no early or late deaths. Conclusion: Subcutaneous defibrillator systems are safe and effective in pediatric patients when the transvenous method is risky and contraindicated. Because the high growth rate in this population leads to lead failures, a close follow-up of this population is essential. [ABSTRACT FROM AUTHOR]

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: Double outlet left ventricule is a very rare congenital heart anomaly with incidence lower than 1 per 200000 births characterized with arising of the great arteries entirely or predominantly from morphologic left ventricle (1,2). We report a boy diagnosed as double outlet left ventricule associated with subpulmonary ventricular septal defect which is very rarely in this combination. MATERIAL AND METHOD: Seven-year-old male had been diagnosed as double outlet right ventricle, VSD, and pulmonary hypertension. He had undergone pulmonary banding operation at the age of eight-month-old. On the last examination, he was acyanotic and had systolic murmur on the left upper sternal border. Electrocardiogram showed normal sinus rhythm. Echocardiography also revealed atrial situs solitus, atrioventricular concordance, aort positioned anterior and to the left of the pulmonary trunk (fi gure 1), subpulmonary VSD (fi gure 2) , aortic-mitral discontinuity (fi gure 3), pulmonary-mitral continuity, pulmonary artery band with a systolic gradient of 70 mmHg and poststenotic dilatation on pulmonary artery. Both arteries arose dominantly from the left ventricle on echocardiography (fi gure 2 and 4). RESULTS: The patient was suitable for double ventricle correction. CONCLUSION: Double outlet left ventricle should be considered during evaluation of congenital heart defects by echocardiography. [ABSTRACT FROM AUTHOR]

Background:  Although there are considerable amounts of data on the outcomes of pediatric patients who have undergone Fontan repair, little is known about having Fontan completed in adulthood. The study presented the midterm results of our unit's experience with the Fontan completion procedure in adult patients with functionally univentricular hearts., Methods:  Between 2014 and 2023, 16 adult patients underwent total cavopulmonary connection (TCPC) completion. Relevant information was retrospectively collected., Results:  Sixteen patients with a median age of 19 years (18-21 years) were included. Median arterial oxygen saturation was 76% (70-80.75%), and 62.5% of the patients were New York Heart Association (NYHA) Class III. The median mean pulmonary artery pressure was 14 mm Hg (9.5-14.5 mm Hg). Nine patients (56%) had heterotaxy syndrome, and the median time between the last operation and TCPC was 15.5 years (6.75-17.5 years). The median durations for bypass and cross-clamp were 160 minutes (130-201 minutes) and 120 minutes (84.5-137.5 minutes), consecutively. The postoperative course was straightforward in all. The median arterial oxygen saturation before discharge was 89.5% (85-90%), and 68.75% of the patients were NYHA Class II. Follow-up was complete for all patients with a median of 24 months. There was no early or late mortality or significant morbidity during the study period., Conclusion:  We concluded that the intra-extracardiac Fontan technique was feasible for meticulously selected adults undergoing TCPC completion, as evidenced by an acceptable mortality rate and a satisfactory midterm outcome, including improvements in their NYHA functional class. However, the long-term consequences must be monitored., Competing Interests: None declared., (Thieme. All rights reserved.)

Although radiofrequency ablation is the first line therapy in some children with supraventricular tachycardia, its application in small children is still limited. Herein, we presented a premature newborn diagnosed as multidrug-resistant permanent junctional reciprocal tachycardia, and treated by radiofrequency ablation via the jugular vein approach because of bilateral femoral vein thrombosis. We think that when there is limited vascular access, the transjugular route for radiofrequency ablation might be considered as an alternative treatment in newborns with multidrug-resistant supraventricular tachycardia.