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There is extensive literature on the significance of substance use, misuse, and abuse among the elderly in the United States. A literature review indicates a paucity of information on the nature, significance, or impacts of the lack of substance use and abuse coverage in Medicare home health. This article presents background on the topic and an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 48 home care social workers between January 2013 and May 2015 in the New York City metropolitan area. Results indicate social workers believe substance use and abuse occurs frequently among Medicare home health patients; substance use and abuse is not assessed and treated professionally in Medicare home health; the lack of coverage in Medicare home health results in exacerbation of existing patient physical and mental health conditions, which, in turn, worsen substance use and abuse conditions; the homebound requirement and lack of coverage of transportation and personal care assistants limits home care patients ability to obtain outpatient substance use and abuse treatment; and lack of home-based assessment and treatment contributes to increased home care readmissions, re-hospitalizations, and increased caregiver burden.

Objectives: Evaluate the histologic effects of grafting porcine-derived small intestinal submucosa (SIS) into the vocal fold superficial lamina propria (SLP) layer for the potential treatment of vocal fold scar, sulcus and superficial lamina propria atrophy.Methods: Small intestinal submucosa was implanted into the right vocal fold SLP of 6 mongrel dogs. The left vocal fold served as a sham surgical control. At 2, 4, and 6 weeks postoperative, bilateral vocal fold specimens were evaluated histologically.Results: At 2 and 4 weeks, respectively, SIS-implanted vocal folds demonstrated moderate and mild inflammation and acute and chronic inflammation. At 6 weeks, inflammation was minimal and chronic. The 6-week specimens showed copious amounts of newly generated hyaluronic acid (HA) within the graft. There was no reactive fibrosis at 6 weeks.Conclusions: In the canine model, SIS appears safe for SLP grafting. Inflammation is similar to that of sham surgery. Small intestinal submucosa results in newly generated HA without concomitant fibrosis. Small intestinal submucosa has potential to be used in treatment of disorders with SLP, including vocal fold scar, sulcus, and atrophy. Studies evaluating the effect of SIS implantation on vocal fold function, as well as the ultimate fate of the graft, are required.

ABSTRACT:It is often difficult or impossible to take conventional academic students into the field to observe and participate in real world ecological restoration projects. Consequently, many educators attempt to simulate these experiences by incorporating more active learning, non-lecture activities into their classes. In this paper, I share the results of, and what I have learned from, years of tinkering with a hands-on “degraded objects” activity for undergraduate students first presented in a 2004 paper by Lundholm and Larson. I have discovered that this activity is most effective when students select degraded objects that they care deeply about, bring their restored objects to class, and are free to present their work in whatever manner they think best. Although every class and every project has been unique, some common themes have emerged: 1) Restoring their objects turns out to be far more complex and interesting than the students thought it would be; 2) They demonstrate an impressive amount of perseverance, creativity, and resourcefulness; and 3) They meaningfully connect their projects to the individual components and overarching themes of the class as a whole. In conclusion, this can be a remarkably effective activity for simulating the experience of ecological restoration that simultaneously provides a concrete, achievable assignment and a holistic, open-ended challenge. It also helps the class develop a spirit of camaraderie and learn more about each other. This in turn helps us better understand, appreciate, and respect people whose values and perspectives may be radically different than our own.

Microtia represents a spectrum of maldevelopment of the external ear. Reconstructive techniques may utilize an autogenous rib cartilage framework and require 2–4 stages; alternatively, an alloplastic framework can be used and typically requires 1–2 stages. Successful reconstruction of microtia with either technique can provide a significant quality of life improvement, and both techniques are described in this article.

Abstract Contributions from the field of population biology hold promise for understanding and managing invasiveness; invasive species also offer excellent opportunities to study basic processes in population biology. Life history studies and demographic models may be valuable for examining the introduction of invasive species and identifying life history stages where management will be most effective. Evolutionary processes may be key features in determining whether invasive species establish and spread. Studies of genetic diversity and evolutionary changes should be useful for understanding the potential for colonization and establishment, geographic patterns of invasion and range expansion, lag times, and the potential for evolutionary responses to novel environments, including management practices. The consequences of biological invasions permit study of basic evolutionary processes, as invaders often evolve rapidly in response to novel abiotic and biotic conditions, and native species evolve in response to the invasion.

Distal mouse chromosome 16 (MMU16) shares conserved linkage with human chromosome 21 (HSA21), trisomy for which causes Down syndrome (DS). A 4.5-Mb physical map extending from Cbr1to Tmprss2on MMU16 provides a minimal tiling path of P1 artificial chromosomes (PACs) for comparative mapping and genomic sequencing. Thirty-four expressed sequences were positioned on the mouse map, including 19 that were not physically mapped previously. This region of the mouse:human comparative map shows a high degree of evolutionary conservation of gene order and content, which differs only by insertion of one gene (in mouse) and a small inversion involving two adjacent genes. “Low-pass” (2.2×) mouse sequence from a portion of the contig was ordered and oriented along 510 kb of finished HSA21 sequence. In combination with 68 kb of unique PAC end sequence, the comparison provided confirmation of genes predicted by comparative mapping, indicated gene predictions that are likely to be incorrect, and identified three candidate genes in mouse and human that were not observed in the initial HSA21 sequence annotation. This comparative map and sequence derived from it are powerful tools for identifying genes and regulatory regions, information that will in turn provide insights into the genetic mechanisms by which trisomy 21 results in DS.

The human alpha-synuclein gene (SNCA) encodes a presynaptic nerve terminal protein that was originally identified as a precursor of the non-beta-amyloid component of Alzheimer's disease plaques. More recently, mutations in SNCA have been identified in some cases of familial Parkinson's disease, presenting numerous new areas of investigation for this important disease. Molecular studies would benefit from detailed information about the long-range sequence context of SNCA. To that end, we have established the complete genomic sequence of the chromosomal regions containing the human and mouse alpha-synuclein genes, with the objective of using the resulting sequence information to identify conserved regions of biological importance through comparative sequence analysis. These efforts have yielded approximately 146 and approximately 119 kb of high-accuracy human and mouse genomic sequence, respectively, revealing the precise genetic architecture of the alpha-synuclein gene in both species. A simple repeat element upstream of SNCA/Snca has been identified and shown to be necessary for normal expression in transient transfection assays using a luciferase reporter construct. Together, these studies provide valuable data that should facilitate more detailed analysis of this medically important gene.

Distal mouse Chromosome 16 (Chr. 16) includes a region of conserved linkage with human Chromosome 21 (Chr. 21). Mouse models of Down syndrome based on trisomy of distal Chr. 16 have several phenotypes similar to those seen in human patients and have proven useful for correlating dosage imbalance of specific genes with specific developmental anomalies. The degree to which such findings can be related to Down syndrome depends on how well the conserved synteny is maintained. Twenty-four genes have been mapped in both species and there are no discordancies, but the region could carry hundreds of genes. Comparative sequence represents the ultimate comparative map and will aid in identification of genes and their regulatory sequences. A physical map of the distal 4.5 Mb of Chr. 16 has been assembled as an essential step toward a map of sequence-ready templates. The map consists of 51 YACs and 15 BACs and includes 18 transcripts, 9 of which are mapped for the first time in mouse, and 3 of which are, for the first time, described in either species. YAC fragmentation was used to precisely localize the 49 markers on the map. Comparison of this physical map with that of the corresponding region on Chr. 21 shows conservation not only of gene order but of size in the 3 Mb from Cbr1 to Ets2; distal to Ets2, the human map is expanded.

Right ventricular myocardial infarction, long unrecognized because of inadequate diagnostic methods and unwarranted assumptions regarding the dispensability of the right ventricle, is now known to occur in 30% to 40% of patients with inferior infarction and is clearly associated with anterior left ventricular infarction as well as inferior infarction. Right ventricular systolic and diastolic dysfunction, exacerbated by pericardial restraint and concomitant left ventricular dysfunction, accounts for the cardiogenic shock and dramatic preload dependence frequently encountered. Right ventricular infarction may be suspected by clinical examination and can be confirmed using well-defined electrocardiographic, radionuclide, echocardiographic, and hemodynamic criteria. Once diagnosed, right ventricular infarction requires specific medical management, including the careful use of volume expansion and inotropic therapy. Mechanical and surgical interventions are of potential value in treating hemodynamic disturbances and characteristic complications. With appropriate management, patients with right ventricular infarction may enjoy a favorable prognosis.

The relation of degree of regional wall motion abnormality by equilibrium radionuclide angiocardiography to the presence and mural extent of regional necrosis or scar at autopsy was evaluated in 23 autopsy patients who had a history of myocardial infarction and had equilibrium radionuclide angiocardiography within 40 days of death. Of the 228 regions evaluated by equilibrium radionuclide angiocardiography, 135 had abnormal regional wall motion and 102 (76%) of these 135 regions had evidence of myocardial infarction at autopsy. The overall sensitivity, specificity and predictive values of regional wall motion abnormality for regional necrosis or scar were 69, 59 and 76%, respectively.

Thirty patients with stable exertional angina undergoing percutaneous transluminal coronary angioplasty of an isolated obstructive lesion of the proximal left anterior descending artery were prospectively evaluated to investigate the relation between angina induced by balloon inflation and the quantity and severity of myocardial ischemia as determined by electrocardiographic (ECG) monitoring and by echocardiographic assessment of regional and global left ventricular wall motion. Anginal pain interviews, continuous two-dimensional echocardiographic recordings and 12 lead ECG recordings at 10 second intervals were obtained for the first two inflation sequences.

Five intersubspecific backcrosses and an intercross were used to establish a sex-averaged recombinational map spanning 56 cM across most of mouse Chromosome 16 (Chr 16). A total of 123 markers were ordered using an interval mapping approach to identify 425 recombination sites in a collection of 1154 meioses from 1155 progeny generated in the six crosses. The markers include the 10 “classic” Chr 16 reference markers, 26 additional genes or transcripts including two phenotypic markers (Pit1dwandKcnj6wv), and 87 simple sequence length polymorphisms (SSLPs). One set of monozygotic twins was detected among the 304 meioses mapped to highest resolution. The reference markers and SSLPs allow the map to be well integrated with existing maps of Chr 16. The average distance between crossover sites is less than 500 kb for most chromosomes, making this collection of recombinant chromosomes useful as a binning and ordering resource for YAC-based physical map assembly on Chr 16.

This study was designed to compare health-related quality of life (HRQOL) in patients undergoing coronary stenting or balloon angioplasty in the randomized Stent Restenosis Study. The study sample was drawn from patients at nine U.S. clinical sites of the Stent Restenosis Study, a randomized trial comparing Palmaz-Schatz coronary stent implantation with conventional balloon angioplasty. One hundred ninety-nine consecutive patients were sent surveys 6 to 18 months after enrollment and 160 (80%) were returned. The survey sent to the patients included the Medical Outcomes Study 36-Item Short-Form Health Survey, the Canadian Cardiovascular Society Classification, and the Duke Activity Status Index. Although patients who underwent stenting had less angiographic restenosis and a tendency for fewer ischemic events, there were few differences in HRQOL after a mean of 456 days after randomization. The group that underwent stenting reported significantly less bodily pain than the group that underwent angioplasty ( p = 0.02). Otherwise, there were no significant differences in generic or disease-specific measures. In a rating of their overall health, 47% of the group that underwent stenting and 45% of the group that underwent percutaneous transluminal coronary angioplasty reported very good or excellent health. In each group, 60% of the patients reported being symptom free from a cardiovascular perspective. This survey revealed no marked differences in long-term HRQOL between patients who underwent Palmaz-Schatz coronary stenting compared with those who underwent conventional angioplasty. (Am Heart J 1997;134:337-44.)

Objectives. The present study examined the association of estrogen (E2) and the inflammatory response of endothelium in coronary artery disease (CAD) by measuring circulating cellular adhesion molecules (cCAMs) in subjects with atherosclerosis.

Disorders of the heart frequently cause pulmonary dysfunction because of the close structural and functional association of the heart and lungs. The pulmonary vasculature is very commonly affected by cardiac pathology. The pulmonary vasculature is normally a low-pressure, low-resistance circuit with high compliance and tremendous vascular reserve. Although resting vascular tone is low, there are many identified mediators of pulmonary arterial tone that may help mediate pulmonary blood flow. Alveolar hypoxia is clearly a stimulus for increasing pulmonary vascular resistance although factors that mediate the response to hypoxia are not fully understood.

One hundred progeny from each of two intersubspecific mouse backcrosses were used to construct a comparative genetic map of a region of mouse chromosome 10 (MMU10) that is homologous to the distal tip of the long arm of human chromosome 21 (HSA21). The analysis included five genes and three simple sequence repeat markers, two of which flanked the HSA21-homologous cluster on either side. Analysis of 200 backcross progeny detected at least one crossover between each pair of adjacent genes and demonstrated that the proximal to distal orientation of the cluster was reversed between human and mouse. The order was determined to be Fyn-1-D10Mit20-S100b-Col6a1-Itgb2-Pfkl/D10Mit7-D10Mit11. Comparative mapping supports the order of corresponding markers on HSA21 determined using pulsed-field gel electrophoresis and radiation hybrid line data. However, sequence tagged site content mapping of human yeast artificial chromosomes (YACs) yielded conflicting data on the relative positions of human COL6A1 and S100B on HSA21. This discrepancy was resolved here by demonstrating that several key YACs used in the human contig analysis were mistyped for S100B. The murine map reported here provides a scaffold for construction of physical maps and yeast artificial chromosome contigs that will be useful in the development of mouse models for the study of Down syndrome. Copyright 1994, 1999 Academic Press

Percutaneous transluminal coronary angioplasty was first performed in a human coronary artery in 1977. In this article, we review the possible mechanisms of angioplasty, current indications for angioplasty, and complications of angioplasty including acute closure and restenosis.

Radionuclide techniques for assessing patients with myocardial infarction have evolved from a diagnostic tool to one of quantifying functional myocardial characteristics. These techniques provide measures of regional and global function, myocardial perfusion, and the metabolic integrity of specific regions of the myocardium. These methods are able to quantify the extent of myocardial damage and provide important prognostic information for risk stratification. Newer techniques, particularly those involving metabolic imaging, are being developed to define and quantify myocardium salvaged by acute interventions, and to identify those patients requiring further intervention

Adequate analgesic therapy for patients with acute myocardial ischemic syndromes is a critical facet of patient management. By knowing the different pharmacologic properties of various narcotic drugs, a proper choice can be made matching the appropriate analgesic agent’s side effect profile with an individual patient’s hemodynamic status.

Paul Aebischer, Rolandiana Borealia. Publications de la Faculte des . Lettres de l'Universite de Lausanne XI. Lausanne, 1954. 290 pp.Chronique des ducs de Normandie par Benoit, publiee d'apres le manuscrit de Tours avec les variantes du manuscrit de Londres par Carin Fahlin. Tome II. (Bibliotheca Ekmaniana Universitatis Upsaliensis, 60.) 641 pages et 2 planches hors texte. Uppsala, Almqvist & Wiksell; Geneve, E. Droz, 1954.Le roman des Deduis, par Gace de la Buigne, edition critique par Åke Blomqvist, Karlshamn, Almqvist & Wiksell, 1952. 40:- cour, sued., 682 pages.Paul Zumthor, Histoire litteraire de la France medievale VIe—XIVe siecles. Presses universitaires de France, Paris, 1954, 339 pages.Hans-Erich Keller, Etude descriptive sur le vocabulaire de Wace. Deutsche Akademie der Wissenschaften zu Berlin, Veroffentlichungen des Instituts fur Romanische Sprachwissenschaft Nr. 7, Akademie-Verlag, Berlin, 1953. 436 pages.Knud Togeby, Mode, aspect et temps en espagnol. Det Kongelige Dan-ske Videnskabernes Selskab. Historisk-filologiske Meddelelser, bind 34, nr. 1. Ejnar Munksgaard, Kobenhavn, 1953. 136 pages.Sir Alan H. Gardiner, The Theory of Proper Names. A Controversial Essay. Second Edition. Oxford University Press. London 1954. viii + 77 pp. in-12. 8s. 6d.Knud Togeby, L'Œuvre de Maupassant. Danish Science Press Ltd., Copenhague — Presses Universitaires de France, Paris. Køenhavn, 1954, 180 pages.Leopold Zatocil: Cato a Facetus, pojednani a texty. Zu den deutschen Cato- und Facetusbearbeitungen, Untersuchungen und Texte. (Opera Universitatis Masarykianae Brunensis, Facultas Philosophica, Cislo 48) Brno 1952. 355 SS. 168 Kcs.Saint Thomas More. By E. E. Reynolds. London: Bums Oates, 1953. Pp. xv + 390. Price 25s.Sir Thomas More. By Leslie Paul. London: Faber and Faber, 1953. Pp. 222. Price 12s. 6d.The Young Shakespeare: Studies in Documentary Evidence. By E. B. Everitt. (Anglistica, ii), Copenhagen, 1954. 188 pp. + 10 plates. Dan. Kr. 27.50 (to subscribers to the series, Dan. Kr. 20).George Herbert. By Margaret Bottrall. John Murray, London 1954. 154 pp. Price 15/-.George Herbert: his Religion and Art. By Joseph H. Summers. Chatto and Windus, London 1954. 247 pp. Price 21/-.Christopher Cooper's English Teacher (1687). Edited by Bertil Sundby. (Lund Studies in English XXII. Editor: Professor Olof Arngart.) C. W. K. Gleerup, Lund. Ejnar Munksgaard, Copenhagen. 1953. cxvi + 10* + 120 + 2 pp.An Exposition of Qui Habitat and Bonum Est in English. Edited from the Manuscripts with Introduction, Notes, and Glossary by Bjorn Waixner. (Lund Studies in English XXIII. Editor: Professor Olof Arngart.) C. W. K. Gleerup, Lund; Ejnar Munksgaard, Copenhagen. 1954. lxxii + 122 pp.Goran Karlberg. The English interrogative Pronouns. A Study of their Syntactic History. (Gothenburg Studies in English. III. Editor: Frank Behre.) Stockhohn: Almqvist & Wiksell. 1954. 353 pp. Price Sw. kr. 18.