bluuebunny/crossref_metadata_2025 huggingface dataset:
Oakeshott, Freedom and Republicanism
Authors: Boucher David
Published: January 2005

It is contended that Michael Oakeshott resists classification in terms of conventional labels of conservative, liberal, right or left, and that it is difficult to incorporate him in discussions of modern liberal theory because his concerns are not with human rights, distributive justice or multiculturalism. It is with reference to the classical republicanism of Rome that Oakeshott's distinctive contribution to political philosophy is illuminated because of his emphasis upon authority, the rule of law and freedom as non-domination. These are the very features that Oakeshott highlights in his lectures on the ‘Political Experience’ and ‘Political Thought’ of the Romans. Oakeshott values the distinction that the Romans, but not the Greeks, made between public and private, but unlike later republicans he does not associate the public sphere exclusively with political participation and civic virtues. One may contribute just as significantly to the public concern by being a music-hall entertainer. Oakeshott is clearly differentiated from modern instrumental republicans who in his view would be rationalists obsessed with institutional design and with viewing the civil condition as an enterprise association.
A New Method for Manufacturing Cardiac Cell Sheets Using Fibrin‐Coated Dishes and Its Electrophysiological Studies by Optical Mapping
Authors: Itabashi Yuji , Miyoshi Shunichiro , Kawaguchi Haruko , Yuasa Shinsuke , Tanimoto Kojiro , Furuta Akira , Shimizu Tatsuya , Okano Teruo , Fukuda Keiichi , Ogawa Satoshi
Published: January 2005

Abstract:  We developed a novel simple method for making functional myocardial cell sheets that may be used as transplants. Polymerized human fibrin‐coated dishes were prepared with fibrinogen monomers mixed with thrombin. Neonatal rat cardiomyocytes cultured on these dishes formed myocardial cell sheets within 4 days. These cell sheets were easily dissociated intact from the polymerized fibrin layer, because the fibrin had been digested by intrinsic protease. Two overlaid myocardial cell sheets exhibited synchronized spontaneous beating and captured artificial pacing. Optical mapping confirmed that the conduction of the action potential between two partially overlaid myocardial cell sheets was established, and the action potential propagated across the junction without any delay. Transplanted three‐layered myocardial cell sheets exhibited strong spontaneous beating and showed well‐differentiated striations and an increase in cell size. This simple method of cell sheet engineering may also be applicable for various other cell types.
Cytotoxicity of Two Novel Formulations of Calcium Phosphate Cements: A Comparative In Vitro Study
Authors: Rossa Carlos , Marcantonio Elcio , Santos Luis A. , Boschi Anselmo O. , Raddi Maria Stella G.
Published: January 2005

Abstract:  The purpose was to evaluate the cytotoxicity of two novel formulations (alpha and beta) of calcium phosphate cements. Positive control, represented by a commercial hydroxyapatite cement, and negative control were included for comparative purposes. A continuous lineage of fibroblastic cells was used, and the effect of the tested materials on both cell proliferation and viability was assessed by counting cell number on hemocytometer and by the trypan blue exclusion test, respectively. Study design attempted to simulate clinical use by allowing direct and indirect contact of cells and cements. Results were analyzed by the Kruskal–Wallis test and indicated that the beta formulation was extremely cytotoxic (P < 0.001), because this material induced the greatest reduction on cell proliferation and viability. The alpha formulation behaved similarly to the positive control regarding its effect on cell proliferation and viability. Thus, it is concluded that alpha formulation has promise for further evaluation of its behavior in vivo.
In Vitro Evaluation of the Transportability of Viable Primary Human Liver Cells Originating From Discarded Donor Organs in Bioreactors
Authors: Sauer Igor M. , Schwartlander Ruth , Van der Jagt Olav , Steffen Ingo , Efimova Ekaterina , Pless Gesine , Kehr Daniel C. , Kardassis Dimitrios , Fruhauf Jan H. , Gerlach Joerg C. , Neuhaus Peter
Published: January 2005

Abstract:  Background: The use of primary human liver cells obtained from discarded donor organs is increasingly favored for cell‐based extracorporeal liver support systems. However, as cryopreservation of primary human hepatocytes causes a significant loss of metabolic activity, the transport of bioreactors with viable liver cells is required. The aim of this study was to evaluate the impact of two major potential threats to viable cells during transport: temperature changes and mechanical stress. Methods: In each experiment three hollow fiber‐based bioreactors were charged with primary human liver cells originating from the same discarded donor organ and were simultaneously kept under culture conditions for 8 days. In total, 18 bioreactors were evaluated. On the fifth day the bioreactors were exposed to hypothermia (4°C, n = 3), to hyperthermia (42°C, n = 3), or served as normothermic controls (37°C, n = 3). In a second test series bioreactors were exposed to vibration (21 Hz for 20 min, thereafter 7 Hz for 160 min, n = 3), or were operated as control cultures (n = 6). The release of hepatocyte‐specific enzymes was determined as an indicator for cell damage. Results: Hypothermic stress resulted in a significant release of transaminases and led to disturbances of the histological integrity, all indicating a high degree of cell damage. When compared with the control cultures, hyperthermia and mechanical stress in terms of vibration had no significant effect on the cells. Conclusion: The transport of hollow fiber bioreactors charged with viable primary human liver cells appears to be feasible in transport monitors for perfusion and temperature control.
Effect of Peracetic Acid Reprocessing on the Transport Characteristics of Polysulfone Hemodialyzers
Authors: Wolff Susanne H. , Zydney Andrew L.
Published: January 2005

Abstract:  Peracetic acid is used extensively for reprocessing hemodialyzers, despite several indications that reprocessing alters the dialyzer transport characteristics. The objective of this study was to obtain quantitative data for the effects of peracetic acid reprocessing on the clearance and sieving coefficients of urea, vitamin B12, and polydisperse dextrans using Fresenius F80A polysulfone dialyzers. Reprocessing restored the urea and vitamin B12 clearance to close to their original values. However, the reprocessed dialyzers had substantially lower clearance of the larger molecular weight dextrans, which was attributed to reductions in the effective pore size caused by residual plasma proteins within the membrane. Storage in peracetic acid provided some additional removal of residual proteins, although the clearance and sieving coefficients of the larger dextrans remained well below their original values. Peracetic acid caused no degradation of the membrane polymer, in sharp contrast to results obtained with bleach reprocessing.
Longitudinal Study of Changes in Hip Bone Mineral Density in Caucasian and African‐American Women
Authors: Cauley Jane A. , Lui Li‐Yung , Stone Katie L. , Hillier Teresa A. , Zmuda Joseph M. , Hochberg Marc , Beck Thomas J. , Ensrud Kristine E.
Published: January 2005

Objectives: To determine whether changes in hip bone mineral density (BMD) differ in Caucasian and African American women.

Design: Longitudinal study of changes in hip BMD.

Setting: Four U.S. clinical centers.

Participants: Six thousand seven Caucasian (mean age 73) and 482 African‐American (mean age 75) women enrolled in the Study of Osteoporotic Fractures.

Measurements: Total hip and femoral neck BMD were measured an average of 3.5 years apart (Caucasian) and 2.0 years apart (African American). Annual absolute and percentage changes in BMD and bone mineral apparent density (BMAD) were calculated.

Results: The multivariate adjusted annual percentage change in BMD was greater in Caucasian than African‐American women at the total hip (−0.574%/y vs −0.334%/y) and femoral neck (−0.515%/y vs −0.203%/y) (both, P<.001). Similar findings were observed for BMAD. The average annualized rate of BMD loss was twice as high in women aged 75 and older as in women younger than 75 in both ethnic groups. The annual percentage loss in femoral neck BMD in nonusers versus hormone therapy users was (−0.57% vs −0.22%) in Caucasians and (−0.35% vs 0.64%) in African Americans (interaction P=.03).

Conclusion: The average rate of hip BMD loss is approximately twice as great in Caucasian as African‐American women and increases with age in both groups. The hormonal and biochemical factors that contribute to ethnic differences and the increase in bone loss with advancing age need to be identified.
Just Get Out the Door! Importance of Walking Outside the Home for Maintaining Mobility: Findings from the Women's Health and Aging Study
Authors: Simonsick Eleanor M. , Guralnik Jack M. , Volpato Stefano , Balfour Jennifer , Fried Linda P.
Published: January 2005

Objectives: To determine the association between volitional walking behavior and change in walking ability and lower extremity function over 1 year in functionally limited older women.

Design: Longitudinal cohort study.

Setting: Data were collected in participant's homes in Baltimore, Maryland.

Participants: One thousand two cognitively intact community‐resident female Medicare beneficiaries aged 65 and older enrolled in the Women's Health and Aging Study.

Measurements: Reported walking behavior and change in reported walking difficulty, usual and rapid gait speed, and lower extremity physical performance score over 1 year.

Results: Of 800 functionally limited women who could walk unassisted at baseline and were alive and contacted 1 year later, 226 (28%) walked regularly, at least eight blocks per week. These women exhibited better health and functioning than nonwalkers (e.g., lower prevalence of depressive and fatigue symptoms and cardiovascular disease and higher mean ankle‐arm index, forced expiratory volume in the first second, and gait speed). One year later, independent of initial functional status, social‐psychological and behavioral factors, and health conditions, walkers were 1.8 times (95% confidence interval=1.2–2.7; P=.002) more likely to maintain reported walking ability and showed less decline in customary walking speed (0.009 m/s vs −0.070 m/s; P=.001) and functional performance score (−0.17 vs −0.73; P=.01) than women who walked less than eight blocks.

Conclusion: The strength, consistency, and specificity of the association between walking behavior and maintenance of mobility provide strong evidence that even a small amount of regular walking can confer short‐term protection from further mobility loss in functionally limited women. The observation that most women capable of walking at least eight blocks per week were not doing so indicates the need to get more women “out the door” and to encourage those who walk a little to walk a little more.
Incidence of Cardiovascular Disease in Older Americans: The Cardiovascular Health Study
Authors: Arnold Alice M. , Psaty Bruce M. , Kuller Lewis H. , Burke Gregory L. , Manolio Teri A. , Fried Linda P. , Robbins John A. , Kronmal Richard A.
Published: January 2005

Objectives: To estimate incidence rates of major cardiovascular disease (CVD) in older Americans.

Design: Longitudinal cohort study using prospectively collected data on cardiovascular events.

Setting: Four U.S. communities in the Cardiovascular Health Study (CHS).

Participants: Five thousand eight hundred eighty‐eight participants in CHS, aged 65 or older at enrollment, including 3,393 women (581 African American) and 2,495 men (343 African American).

Measurements: At semiannual contacts, participants reported any occurrence of clinical CVD. Medical records were obtained and adjudicated to confirm diagnosis of CVD.

Results: During 10 years of follow‐up, incidence of coronary heart disease (CHD) per 1,000 person‐years was 39.6 (95% confidence interval (CI)=36.4–43.1) in men and 22.3 (95% CI=20.4–24.2) in women. Cumulative event rates for CHD and myocardial infarction for women aged 75 and older at baseline were similar to those for men aged 65 to 74. The overall incidence of stroke was similar for men and women (14.7 (95% CI=13.0–16.6) and 13.7 (95% CI=12.4–15.1) per 1,000 person‐years, respectively), but the risk of stroke increased with age more rapidly in women, resulting in a greater cumulative event rate for stroke in women than in men aged 75 and older. The incidence of congestive heart failure increased 9% with each year of age over 65 and was greater than 6% per year in Caucasian men and women aged 85 and older at baseline. Rates were similar in African Americans and Caucasians.

Conclusion: The occurrence of new CVD in older Americans is high, indicating that preventive efforts need to be maintained into older ages.
Relationship Between Plasma Lipids and All‐Cause Mortality in Nondemented Elderly
Authors: Schupf Nicole , Costa Rosann , Luchsinger Jose , Tang Ming‐Xin , Lee Joseph H. , Mayeux Richard
Published: January 2005

Objectives: To investigate the relationship between plasma lipids and risk of death from all causes in nondemented elderly.

Design: Prospective cohort study.

Settin: Community‐based sample of Medicare recipients, aged 65 years and older, residing in northern Manhattan.

Participants: Two thousand two hundred seventy‐seven nondemented elderly, aged 65 to 98; 672 (29.5%) white/non‐Hispanic, 699 (30.7%) black/non‐Hispanic, 876 (38.5%) Hispanic, and 30 (1.3%) other.

Measurements: Anthropometric measures: fasting plasma total cholesterol, triglyceride, high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol (LDL‐C), and non‐HDL‐C, body mass index, and apolipoprotein E (APOE) genotype. Clinical measures: neuropsychological, neurological, medical, and functional assessments; medical history of diabetes mellitus, heart disease, hypertension, stroke, and treatment with lipid‐lowering drugs. Vital status measure: National Death Index date of death. Survival methods were used to examine the relationship between plasma lipids and subsequent mortality in younger and older nondemented elderly, adjusting for potential confounders.

Results: Nondemented elderly with levels of total cholesterol, non‐HDL‐C, and LDL‐C in the lowest quartile were approximately twice as likely to die as those in the highest quartile (rate ratio (RR)=1.8, 95% confidence interval (CI)=1.3–2.4). These results did not vary when analyses were adjusted for body mass index, APOE genotype, diabetes mellitus, heart disease, hypertension, stroke, diagnosis of cancer, current smoking status, or demographic variables. The association between lipid levels and risk of death was attenuated when subjects with less than 1 year of follow‐up were excluded (RR=1.4, 95% CI=1.0–2.1). The relationship between total cholesterol, non‐HDL‐C, HDL‐C, and triglycerides and risk of death did not differ for older (≥75) and younger participants (>75), whereas the relationship between LDL‐C and risk of death was stronger in younger than older participants (RR=2.4, 95% CI=1.2–4.9 vs RR=1.6, 95% CI=1.02–2.6, respectively). Overall, women had higher mean lipid levels than men and lower mortality risk, but the risk of death was comparable for men and women with comparable low lipid levels.

Conclusion: Low cholesterol level is a robust predictor of mortality in the nondemented elderly and may be a surrogate of frailty or subclinical disease. More research is needed to understand these associations.
Potentially Inappropriate Medication Use by Elderly Persons in U.S. Health Maintenance Organizations, 2000–2001
Authors: Simon Steven R. , Chan K. Arnold , Soumerai Stephen B. , Wagner Anita K. , Andrade Susan E. , Feldstein Adrianne C. , Lafata Jennifer Elston , Davis Robert L. , Gurwitz Jerry H.
Published: January 2005

Objectives: To determine rates of potentially inappropriate medication use in elderly persons in managed care plans in the United States in 2000–2001.

Design: Cross‐sectional study using automated medication‐dispensing data.

Setting: Ten geographically distributed health maintenance organizations (HMOs).

Participants. One hundred fifty‐seven thousand five hundred seventeen members aged 65 years and older enrolled in one of the HMOs.

Measurements: Prevalence of use of 33 potentially inappropriate medications from January 1, 2000 through June 30, 2001.

Results: In 2000–2001, 28.8% (95% confidence interval=28.6–29.1) of elderly individuals received at least one of 33 potentially inappropriate medications. This rate ranged from 23.0% to 36.5% across the 10 HMOs. Approximately 5% of elderly patients received at least one of the 11 medications classified by an expert panel as “always avoid,” 13% received at least one of the eight medications that would rarely be considered appropriate, and 17% received at least one of the 14 medications that have some indications but are often misused. Overall, rates of use of these medications were greater in women (32.4%) than in men (24.2%). At least 1% of elderly members received belladonna alkaloids (2.3%), dicyclomine (1.1%), or hyoscyamine (1.2%), each of which multiple expert panels have classified as always inappropriate in patients aged 65 years and older. Seven percent of elderly members received propoxyphene, an analgesic medication considered rarely appropriate in the elderly and a drug that has a long history of limited efficacy and potential for toxicity.

Conclusion: Recent rates of potentially inappropriate medication use by elderly HMO members were at least as great as in a 1996 national sample. This study highlights the need to understand more fully the rationale behind the continued use of these medications.
Decreasing Use of Percutaneous Endoscopic Gastrostomy Tube Feeding for Veterans with Dementia—Racial Differences Remain
Authors: Braun Ursula K. , Rabeneck Linda , McCullough Laurence B. , Urbauer Diana L. , Wray Nelda P. , Lairson David R. , Beyth Rebecca J.
Published: January 2005

Objectives: Percutaneous endoscopic gastrostomy (PEG) tube placement is a widely used method for long‐term enteral feeding of demented patients unable to take sufficient food by mouth. National time trends in PEG tube use over the last decade have not been previously reported. The objective of this study was to determine whether use of PEG tubes for patients with dementia has changed over time and by race.

Design: Retrospective cohort study.

Setting: All Veterans Affairs hospitals.

Participants: Using an administrative database of the Veterans Health Administration, all veterans with dementia and all veterans who received a PEG tube were identified between fiscal years 1990–2001.

Measurements: Proportion of PEG tube placement for dementia patients over time and by race.

Results: Four hundred thirteen thousand six hundred twenty‐seven dementia patients aged 60 and older were identified, of whom 6,464 (1.6%) received a PEG tube. Use of PEG tubes for dementia patients increased during the first half of the decade but subsequently decreased almost to baseline after peaking in 1996 (1990: 1.2%, 1996: 1.8%, 2001: 1.3%). Time trends in the use of PEG tube feeding for dementia patients varied by race. Specifically, the relative risk for PEG tube placement in African‐American dementia patients increased from 1.65 (95% confidence interval (CI)=1.25–2.17, FY 1990) to 1.97 (95% CI=1.62–2.4, FY 2001).

Conclusion: Although the overall use of PEG tube feeding for dementia patients decreased over time, rates in use and changes in use over time varied significantly by race. Reasons for the differential use of this procedure should be explored.
Suboptimal Prescribing in Elderly Outpatients: Potentially Harmful Drug‐Drug and Drug‐Disease Combinations
Authors: Zhan Chunliu , Correa‐de‐Araujo Rosaly , Bierman Arlene S. , Sangl Judy , Miller Marlene R. , Wickizer Stephen W. , Stryer Daniel
Published: January 2005

Objectives: To assess the prevalence and correlates of potentially harmful drug‐drug combinations and drug‐disease combinations prescribed for elderly patients at outpatient settings.

Design: Retrospective analysis of the 1995–2000 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS).

Setting: Physician offices and hospital outpatient departments.

Participants: Outpatient visits by patients aged 65 and older in the NAMCS and NHAMCS (n=70,203).

Measurements: Incidences of six drug‐drug combinations and 50 drug‐disease combinations that can place elderly patients at risk for adverse events according to expert consensus panels.

Results: Overall, 0.74% (95% confidence interval (CI)=0.65–0.83) of visits with two or more prescriptions had at least one inappropriate drug‐drug combination, and 2.58% (95% CI=2.44–2.72) of visits with at least one prescription had one or more inappropriate drug‐disease combinations. Of visits with a prescription of warfarin, 6.60% (95% CI=5.46–7.74) were prescribed a drug with potentially harmful interaction. Of patients with benign prostatic hypertrophy, 4.06% (95% CI=3.06–5.06) had at least one of six drugs that should be avoided. The number of drugs prescribed is most predictive of inappropriate drug‐drug and drug‐disease combinations.

Conclusion: Potentially harmful drug‐drug and drug‐disease combinations occur in various degrees in outpatient care in the elderly population. Targeting combinations such as those involving warfarin that are high in prevalence and potential harm offers a practical approach to improving prescribing and patient safety.
Prompting Primary Providers to Increase Community Exercise Referrals for Older Adults: A Randomized Trial
Authors: Ackermann Ronald T. , Deyo Richard A. , LoGerfo James P.
Published: January 2005

Objectives: To determine whether a clinic‐based physical activity promotion intervention can lead to more community‐based exercise referrals by providers and higher exercise motivation in patients.

Design: Cluster randomized, controlled trial.

Setting: Seattle Veterans Affairs General Internal Medicine Clinic.

Participants: Thirty‐one physicians and nurse practitioners were randomized to a physical activity counseling intervention or control condition (counseling about tobacco cessation). Three hundred thirty‐six patients aged 50 and older and visiting a study provider were enrolled.

Intervention: Intervention providers were trained to offer referrals to community exercise programs for patients who reported before their clinic visit that they were “contemplative” about regular exercise.

Measurements: Process measures of health behavior assessment and provider advice, exercise stage‐of‐change, proportion of participants reporting regular physical activity.

Results: At baseline, 172 intervention patients and 164 controls were similar with respect to sex, age, comorbidity score, and exercise motivation level. Forty‐five percent of all intervention patients and 35% of controls reported receiving exercise advice (P=.07). Intervention patients who were contemplative about exercise were even more likely to receive exercise advice than contemplative controls (59% vs 38%; P=.02). After 4 months, 35% of all intervention patients reported regular exercise, compared with 28% of controls (P=.06).

Conclusion: Primary providers are more likely to offer exercise advice when informed whether patients are contemplative about exercise. Patients may be more likely to start regular exercise as a result of this advice.
The Effect of a Social Work Intervention to Enhance Advance Care Planning Documentation in the Nursing Home
Authors: Morrison R. Sean , Chichin Eileen , Carter John , Burack Orah , Lantz Melinda , Meier Diane E.
Published: January 2005

Objectives: To assess the effect of a multicomponent advance care planning intervention directed at nursing home social workers on identification and documentation of preferences for medical treatments and on patient outcomes.

Design: Controlled clinical trial.

Setting: New York City nursing home.

Participants: One hundred thirty‐nine newly admitted long‐term care residents.

Intervention: Nursing home social workers were randomized to the intervention or control groups. The intervention consisted of baseline education in advance care planning that incorporated small‐group workshops and role play/practice sessions for intervention social workers; structured advance care planning discussions with residents and their proxies at admission, after any change in clinical status, and at yearly intervals; formal structured review of residents' goals of care at preexisting regular team meetings; “flagging” of advance directives on nursing home charts; and feedback to individual healthcare providers of the congruence of care they provided and the preferences specified in the advance care planning process. Control social workers received an educational training session on New York State law regarding advance directives but no additional training or interventions. Subjects were enrolled from January 9, 2001 through May 25, 2003 and followed for 6 months after enrollment.

Measurements: Nursing home chart documentation of advance directives (healthcare proxies, living wills) and do‐not‐resuscitate orders; preferences for artificial nutrition and hydration, intravenous antibiotics, and hospitalization; and concordance of treatments received with documented preferences were compared for residents assigned to intervention and control social workers.

Results: Intervention residents were significantly more likely than residents in the control group to have their preferences regarding cardiopulmonary resuscitation (40% vs 20%, P=.005), artificial nutrition and hydration (47% vs 9%, P<.01), intravenous antibiotics (44% vs 9%, P<.01), and hospitalization (49% vs 16%, P<.01) documented in the nursing home chart. Control residents were significantly more likely than intervention residents to receive treatments discordant with their prior stated wishes. Two of 49 (5%) intervention residents received a treatment in conflict with their prior stated wishes (one hospitalization, one episode of intravenous antibiotics), compared with 17 of 96 (18%) control patients (P=.04).

Conclusion: This generalizable intervention directed at nursing home social workers significantly improved the documentation and identification of patients' wishes regarding common life‐sustaining treatments and resulted in a higher concordance between patients' prior stated wishes and treatments received.
Underrecognition of Cognitive Impairment in Assisted Living Facilities
Authors: Magsi Homa , Malloy Timothy
Published: January 2005

Objectives: To determine the prevalence of cognitive impairment (CI), dementia diagnosis and treatment, assistance with medications, and surrogate decision‐makers for residents of assisted living facilities (ALFs).

Design: Cross‐sectional study.

Setting: Seven ALFs in Omaha, Nebraska, and the surrounding area. None of the ALFs in this study were designated “Alzheimer's” or “dementia” facilities.

Participants: Four hundred seven of 455 ALF residents were solicited, and 230 consented. The average age ± standard deviation of participants was 83.3±8.3.

Measurements: ALF residents were examined using the Mini‐Mental State Examination (MMSE), and their medical charts were reviewed.

Results: Fifty‐eight percent of ALF residents had CI according to the MMSE. Of those with CI, 63% had no diagnosis of dementia, 75% were not treated for dementia, 41% with a documented diagnosis of dementia were not treated for dementia, 22% self‐administered an average of 5.4±3.4 medications daily, and 11% had surrogate decision makers.

Conclusion: More than half of ALF residents in this study had CI and a significant percentage was undiagnosed. Even when diagnosed as dementia, CI is significantly undertreated in this setting. These deficits must be addressed to promote quality of care and the need for specialized attention.
A National Study of the Location of Death for Older Persons with Dementia
Authors: Mitchell Susan L. , Teno Joan M. , Miller Susan C. , Mor Vincent
Published: January 2005

Objectives: To describe where older Americans with dementia die and to compare the state health system factors related to the location of dementia‐related deaths with those of cancer and all other conditions in this population.

Design: Cross‐sectional study.

Setting: United States in 2001.

Participants: All persons aged 65 and older who died from nontraumatic causes in the United States during 2001. The underlying cause of death, as determined by the National Center for Health Statistics from death certificate data, was used to categorize subjects into three decedent groups: dementia (n=88,523, 5.1%), cancer (n=389,754, 22.4%), and all other conditions (n=1,256,873, 72.5%).

Measurements: Site of death was identified as the hospital, home, nursing home, or another location as recorded on the death certificate. In each state, the proportion of hospital deaths in the three decedent groups was categorized as high, medium, and low based on terciles of the national distribution. Using multivariate analyses, associations between state‐level variables and the proportion of deaths occurring in the hospital in each state were examined.

Results: The majority of dementia‐related deaths in the United States occurred in nursing homes (66.9%). In contrast, most older persons with cancer died at home (37.8%) or in the hospital (35.4%). The hospital was the most common site of death for all other conditions (52.2%). The state‐specific proportion of dementia‐related deaths occurring in hospitals varied from 5.0% to 37.0% across the nation and was in the highest tercile in 18 states. Hospital death rates related to cancer and all other conditions were in the highest tercile in 14 of these 18 states. After multivariate adjustment, states with a greater number of hospital beds per 1,000 persons and a lower percentage of decedents aged 85 and older were more likely to have a higher proportion of hospital deaths in all three decedent groups. Additionally, in the dementia cohort, states with fewer nursing home beds had a greater proportion of hospital deaths.

Conclusion: The majority of older Americans whose underlying cause of death is attributable to dementia on their death certificate die in nursing homes. State‐level factors, including the availability of hospital and nursing home beds and the age of decedents in the population, explain, in part, the wide state‐to‐state variability in the proportion of dementia‐related deaths occurring in the hospital.
Self‐Reported Goals of Older Patients with Type 2 Diabetes Mellitus
Authors: Huang Elbert S. , Gorawara‐Bhat Rita , Chin Marshall H.
Published: January 2005

Objectives: New diabetes mellitus guidelines from the American Geriatrics Society promote the individualization of treatment goals and plans for patients aged 65 and older. Communicating with older patients about such complex medical decisions presents new challenges for providers. The self‐reported healthcare goals, factors influencing these goals, and self‐care practices of older patients with diabetes mellitus were explored.

Design: Exploratory study involving semistructured interviews.

Setting: Four clinics of a midwestern, urban academic medical center.

Participants: Patients aged 65 and older with type II diabetes mellitus (N=28).

Measurements: Semistructured, one‐on‐one interviews were conducted. Interviews were audiotaped, transcribed, and evaluated for recurring themes using a grounded theory approach.

Results: The majority of patients expressed their healthcare goals in a social and functional language, in contrast to the biomedical language of risk factor control and complication prevention, even when specifically asked about goals for diabetes mellitus care. Patient's predominant healthcare goals centered on maintaining their independence and their activities of daily living (71%). Medical experiences of friends and family (50%), social comparison with peers (7%), and medical professionals (43%) shaped patients' goals. Self‐reported medication adherence and glucose monitoring was high, but more than one‐quarter of patients failed to adhere to any dietary recommendations, and one‐third failed to adhere to their exercise regimens.

Conclusion: As diabetes mellitus care recommendations for older patients grow more complex, providers could enhance their communication about such medical decisions by exploring patients' specific circumstances and reframing diabetes mellitus treatment goals in patients' own language. These may be crucial steps to developing successful individualized care plans.
Instruments for the Assessment of Pain in Older Persons with Cognitive Impairment
Authors: Stolee Paul , Hillier Loretta M. , Esbaugh Jacquelin , Bol Nancy , McKellar Laurie , Gauthier Nicole
Published: January 2005

Pain in older persons with cognitive impairment is often unrecognized and inadequately treated. A major problem associated with this undertreatment is the challenging nature of pain assessment and in particular the selection of accurate and useful assessment instruments. The purpose of this study was to review pain measurement instruments for acute and chronic pain suggested for use with cognitively impaired older persons and to summarize available evidence on their reliability and validity. A systematic search for pain instruments was conducted using several bibliographic databases, supplemented by a manual search of the bibliographies of retrieved articles and review chapters and by articles received from experts and clinicians in the field. Instruments were retained for review when the pain instrument was used or recommended for use with older persons with cognitive impairment.

Thirty‐nine instruments were reviewed; nine were excluded for various reasons. Of the remaining 30, 18 were self‐report and 12 were staff administered. There were no instruments for which all major tests of reliability or validity were reported. Reliability and validity data were basic or unavailable for many instruments. One instrument had excellent validity but no reliability data. The remaining instruments had weak or adequate reliability and validity.

The authors conclude that there is a need for further rigorous development and testing of pain instruments for use with cognitively impaired older persons. An adequate instrument would be one component of an effective program for assessment and management of pain in this population.
Creating a Teaching Geriatric Service: Ten Important Lessons
Authors: Siegler Eugenia L. , Capello Carol F.
Published: January 2005

The restructuring of The Medical Service at the Weill/Cornell campus of the New York Presbyterian Hospital, coupled with funding from the Donald W. Reynolds Foundation to strengthen physicians' training in geriatrics, enabled the creation of a geriatrics inpatient team and a 17‐bed Acute Care for Elders unit. It has also allowed a program to be designed that exposes residents to the fundamental principles of geriatric care, offers them opportunities to follow older patients in multiple venues, and provides a chance to enhance their skills and gain experience in interdisciplinary care.

In creating the service, a number of mistakes were made, but a few lessons were also learned in the process. After a brief description of the program, 10 lessons that highlight the pitfalls and potential of an inpatient geriatrics teaching service are shared.
Mi Casa o Su Casa? Assessing Function and Values in the Home
Authors: Medina‐Walpole Annette , Heppard Brian , Clark Nancy S. , Markakis Kathryn , Tripler Scott , Quill Timothy
Published: January 2005

Clinical instruction for medical students traditionally occurs in hospitals and offices, whereas patients and families face many health issues in their homes. This is particularly true for frail older adults, those with chronic illness, and patients at the end of life. The authors sought to incorporate geriatrics, primary care, and palliative care into house calls for medical students by integrating a home visit experience into their ambulatory clerkship. Using a guide jointly developed by geriatrics, primary care, and palliative care faculty, students conduct three home visits with a patient from their community preceptor's practice. The first visit focused on medical diagnoses and symptoms, the second on functional assessment/geriatric syndromes, and the third on social/cultural and end‐of‐life values. Students completed a 2,000‐word write‐up, including a narrative using the “voice” of the patient. Students presented the cases in small groups facilitated by geriatric and palliative care faculty.

Eighty‐three percent of students reported positive feedback about the experience. Based on write‐ups and program evaluation, students voiced improved knowledge of functional assessment, geriatric syndromes, and progression of chronic illness. Students also poignantly expressed advantages of home visits in exploring psychosocial aspects of medicine, including affirming the humanity of medicine, understanding family systems, providing patient‐centered care, and understanding patient beliefs. Several students expressed pursuing a house calls career.

A longitudinal home visit experience for medical students can successfully enhance the geriatric, ambulatory care, and palliative care curricular content of undergraduate education and positively affect student's attitudes toward the chronically ill and homebound.
Contact Resistance Measurement and Its Effect on the Thermal Conductivity of Packed Sphere Systems
Authors: Siu W. W. M. , Lee S. H.-K.
Published: January 2005

There has been a growing interest in porous systems with a smaller length-scale modeling requirement on the order of each particle, where the existing tools tend to be inadequate. To address this, a Discrete Conduction Model was recently proposed to allow for the transient temperature calculation of 3D random packed-sphere systems for various microstructures. Since many of the motivating applications involve contacting spheres and since there has been a limited number of contact-resistance studies on spheres undergoing elastic deformation, the objective of this study is to obtain measurements of the contact resistances between metallic spheres in elastic contact, as well as to quantify their influence on the effective thermal conductivity. To accomplish this, an experiment was constructed utilizing air and interfacial resistance to replace the functions of the guard heater and vacuum chamber, and in so doing, enabled transient observations. The overall uncertainty was estimated to be ±6%, and the results were benchmarked against available data. A correlation was obtained relating the contact resistance with the contact radius, and results showed the contact resistance to have minimal transient behavior. The results also showed that the neglect of contact resistance could incur an error in the effective thermal conductivity calculation as large as 800%, and a guideline was presented under which the effect of the contact resistance may be ignored. A correlation accounting for the effect of contact resistance on the effective thermal conductivity was also presented.
Modeling Thermal Contact Resistance: A Scale Analysis Approach
Authors: Bahrami M. , Culham J. R. , Yovanovich M. M.
Published: January 2005

A compact analytical model is developed for predicting thermal contact resistance (TCR) of nonconforming rough contacts of bare solids in a vacuum. Instead of using probability relationships to model the size and number of microcontacts of Gaussian surfaces, a novel approach is taken by employing the “scale analysis method.” It is demonstrated that the geometry of heat sources on a half-space for microcontacts is justifiable for an applicable range of contact pressure. It is shown that the surface curvature and contact pressure distribution have no effect on the effective microthermal resistance. The present model allows TCR to be predicted over the entire range of nonconforming rough contacts from conforming rough to smooth Hertzian contacts. A new nondimensional parameter, i.e., ratio of the macro- over microthermal resistances, is introduced as a criterion to identify three regions of TCR. The present model is compared to collected TCR data for SS304 and showed excellent agreement. Additionally, more than 880 experimental data points, collected by many researchers, are summarized and compared to the present model, and relatively good agreement is observed. The data cover a wide range of materials, mechanical and thermophysical properties, micro- and macrocontact geometries, and similar and dissimilar metal contacts.
Anisotropic Slope Distribution and Bidirectional Reflectance of a Rough Silicon Surface
Authors: Zhu Q. Z. , Zhang Z. M.
Published: January 2005

Both one-dimensional (1D) and two-dimensional (2D) slope distributions were obtained from the surface topographic data, measured using an atomic force microscope for a rough silicon surface. The resulted slope distributions deviate significantly from the Gaussian distribution, with noticeable side peaks. The bidirectional reflectance distribution function (BRDF) of the same surface, measured with a laser scatterometer at 635 nm and 785 nm, exhibits subsidiary peaks. The measured slope distributions are implanted into a geometric optics model to predict the in-plane BRDF for different azimuthal angles. The 1D slope distribution has some success in predicting the BRDF at limited azimuthal angles, but is not applicable to other cases. On the other hand, the BRDF predicted using the 2D slope distribution matches well with the experimental results for any azimuthal angles. The method developed here may also help predict the BRDF for other rough surfaces with microstructures.
Volume Scattering of Radiation in Packed Beds of Large, Opaque Spheres
Authors: Brewster Quinn
Published: January 2005

A simple model is proposed for radiative properties of close-packed large, opaque spheres that accounts for nonvanishing volume of the particles, i.e., volume scattering as opposed to point scattering. It is based on the mean-beam-length concept applied to an assembly of particles, as illustrated by Mills. The resulting particle-scattering properties differ from those of classical pseudocontinuum theory based on point scattering by the simple factor of void fraction, and reduce to the point-scattering expressions in the limit of small particle volume fraction. The volume-scattering model matches detailed Monte Carlo results for extinction obtained by Kaviany and Singh and by Coquard and Baillis, which explicitly accounted for particle volume. The present model also confirms the Monte Carlo finding that the effects of nonvanishing particle volume are felt primarily in the extinction coefficient; albedo and phase function are relatively unaffected. These findings pertain only to the geometric optics regime where dependent scattering (wave coherence effects) are negligible.
Temperature Measurement by Visible Pyrometry: Orthogonal Cutting Application
Authors: Ranc N. , Pina V. , Sutter G. , Philippon S.
Published: January 2005

The working processes of metallic materials at high strain rate like forging, stamping and machining often induce high temperatures that are difficult to quantify precisely. In this work we, developed a high-speed broad band visible pyrometer using an intensified CCD camera (spectral range: 0.4 μm–0.9 μm). The advantage of the visible pyrometry technique is to limit the temperature error due to the uncertainties on the emissivity value and to have a good spatial resolution (3.6 μm) and a large observation area. This pyrometer was validated in the case of high speed machining and more precisely in the orthogonal cutting of a low carbon steel XC18. The cutting speed varies between 22 ms−1 and 60 ms−1. The experimental device allows one to visualize the evolution of the temperature field in the chip according to the cutting speed. The maximum temperature in the chip can reach 730°C and minimal temperature which can be detected is around 550°C.
Fluid Flow and Heat Transfer in a Lid-Driven Cavity Due to an Oscillating Thin Fin: Transient Behavior
Authors: Shi Xundan , Khodadadi J. M.
Published: January 2005

A finite-volume-based computational study of transient laminar flow and heat transfer (neglecting natural convection) within a lid-driven square cavity due to an oscillating thin fin is presented. The lid moves from left to right and a thin fin positioned perpendicular to the right stationary wall oscillates in the horizontal direction. The length of the fin varies sinusoidally with its mean length and amplitude equal to 10 and 5 percent of the side of the cavity, respectively. Two Reynolds numbers of 100 and 1000 for a Pr=1 fluid were considered. For a given convection time scale tconv, fin’s oscillation periods (τ) were selected in order to cover both slow τ/tconv>1 and fast τ/tconv<1 oscillation regimes. This corresponded to a Strouhal number range of 0.005 to 0.5. The number of the cycles needed to reach the periodic state for the flow and thermal fields increases as τ/tconv decreases for both Re numbers with the thermal field attaining the periodic state later than the velocity field. The key feature of the transient evolution of the fluid flow for the case with Re=1000 with slow oscillation is the creation, lateral motion and subsequent wall impingement of a CCW rotating vortex within the lower half of the cavity. This CCW rotating vortex that has a lifetime of about 1.5τ brings about marked changes to the temperature field within a cycle. The dimensionless time for the mean Nusselt numbers to reach their maximum or minimum is independent of the frequency of the fin’s oscillation and is dependent on the distance between the oscillating fin and the respective wall, and the direction of the primary CW rotating vortex. The phase lag angle between the oscillation of the fin and the mean Nusselt number on the four walls increases as the distance between the fin and the respective wall increases.
Simulation of Pendant Droplets and Falling Films in Horizontal Tube Absorbers
Authors: Killion Jesse D. , Garimella Srinivas
Published: January 2005

Recent literature suggests that the droplets that form in horizontal-tube, falling-film absorbers play a major role in the absorption process. The performance of such absorbers is critical to the performance of many absorption heat pump systems. The simulation of droplets of aqueous Lithium Bromide pendant from horizontal tubes was performed by numerically solving the equations of motion on a fixed three-dimensional (3D) grid. The so-called volume of fluid method was used to handle the interface between the liquid and vapor phase. Results are compared with simplified axisymmetric models and with high speed video taken during flow visualization experiments. The results show that simplified axisymmetric models do not satisfactorily represent the evolution of the droplets under horizontal tubes, and that the 3D numerical model appears to accurately match the important characteristics of droplet formation, detachment, and impact observed in the experiments.
Numerical Analysis on the Impact Behavior of Molten Metal Droplets Using a Modified Splat-Quench Solidification Model
Authors: Sivakumar D. , Nishiyama H.
Published: January 2005

A simple model is formulated for the analysis of the spreading and solidification processes of a molten metal droplet impinging on a solid substrate. At the first stage, the model evaluates the diameter and the radial velocity of the spreading molten metal layer at the instant t0=D/W from the start of impact using analytical relations. Here D and W are, respectively, the diameter and the velocity of the impinging droplet. Numerical predictions on the evolution of the spreading metal layer are obtained by using a modified splat-quench solidification model with initial conditions described at the instant t0=D/W. The model predictions are compared with the experimental data available from the literature. A systematic parametric study is carried out to illustrate the model predictions at different impinging conditions.