The significance of long-term care in health reform

The American Association of Homes and Services for the Aging, long-term care institutions, and housing providers applaud the proposed state entitlement program in the President's plan, because it is consistent with the belief that individuals should have autonomy and should be able to live as independently as possible for as long as possible. The author presents a convincing argument that elderly and disabled people prefer home and community-based care delivered at home or in home-like settings (aging in place) over the far more expensive nursing facility care, which is now perceived as care of the "last resort."     

Behavior genetic investigation of the relationship between spontaneous locomotor activity and the acquisition of morphine self-administration behavior

There is a significant degree of individual variability in response to drugs of abuse. A goal of behavior genetic studies has been to determine the extent to which observed heterogeneity in drug use can be attributed to genetic and environmental factors and to identify the neurobiological factors involved in vulnerability. Recent hypotheses regarding the predictive value of spontaneous locomotor activity in the acquisition of drug-reinforced behavior are amenable to testing using a behavior genetics approach. Genetic differences in locomotor response to a novel environment were determined in naive and catheterized Lewis, F344, NBR and ACI rats. Operant drug-reinforced behavior was examined in a 23h access paradigm in which each lever press by a rat produced a 1mg/kg injection of morphine with a 30s timeout period (FR 1:TO 30"). Acquisition (7 days), extinction (6 days) and reacquisition (7 days) of morphine self-administration behavior was investigated in all four inbred strains. Large genetic differences in the rate of acquisition and extinction of morphine self-administration were found. Lewis rats responded at high rates beginning in the first two days, whereas F344 rats initially responded at low rates and responding increased gradually over seven days. NBR and ACI rats responded at intermediate levels. When vehicle was substituted for drug there was a significant effect of genotype on the rate of extinction; F344 and ACI increased responding to greater than 175% of drug-response levels, whereas the Lewis response rate decreased gradually and NBR response rate decreased immediately during the first several days. When drug was available again, rates of reacquisition did not differ from original acquisition rates. Drug maintained significantly greater amounts of behavior than vehicle in the Lewis, F344 and NBR rats and was thus shown to serve as a positive reinforcer in these three strains under these conditions. There was a significant genetic correlation among strains between drug intake during the first five days of acquisition and spontaneous locomotor response to a novel environment in catheterized rats. Only the ACI rats showed a significant within-strain correlation. The positive relationship between rate of acquisition of self-administration behavior and locomotor activity suggests that these two traits are influenced by common or closely linked genes. To this end, the neurobiological substrates that mediate spontaneous locomotor behavior under these environmental conditions may act, in part, as a template for determining the neurobiological substrates that mediate the relative rate of acquisition of morphine-taking behavior under these conditions.     

First transmission electron micrograph of continuous mitotic spindle fibers between polar area and chromosome ends

Congenital and/or nevoid skin disorders following the lines of Blaschko may have a delayed onset after birth. They have to be differentiated from acquired dermatoses exhibiting the same linear pattern. In common dermatoses, such as psoriasis or lichen planus, lesions in a blaschkolinear distribution most often occur together with scattered lesions, but occasionally they may be isolated. Less common self-limited dermatoses such as lichen striatus and adult blaschkitis always present in a blaschkolinear fashion. In these diseases, or some other conditions occasionally distributed along these lines (chronic graft versus host reaction, fixed drug eruption, lupus erythematosus, atopic dermatitis, etc.), the cause of the disease may lead to the unmasking of tolerance to an abnormal keratinocyte clone that remained hidden in these lines. In addition to epithelial cells, other cells may be involved in the occurrence of acquired blaschkolinear dermatoses. In linear atrophoderma and linear fibromatosis, the histogenesis seems to involve hypothetic dermal clones. The extension of an acquired dermatosis on a preexisting linear nevoid disorder is an argument in favor of an early embryonic somatic mutation of a skin cell line.     

Evaluation of oculokinetic perimetry

BACKGROUND AND METHOD: Oculokinetic perimetry (OKP) was performed on 98 patients (187 eyes) using the Damato 26-point glaucoma screening chart. Results were compared with those obtained from a 24-2 full threshold test on a Humphrey Field Analyser (HFA). RESULTS: In its ability to detect pathology in individual eyes, OKP had a sensitivity of 75.0% and a specificity of 71.4%. To detect glaucoma, OKP demonstrated a sensitivity of 86.0% and a specificity of 56.1%. The number of OKP defects detected increased with increasing HFA mean defect and corrected pattern standard deviation. Whereas moderate and severe field defects were almost always detected, smaller and shallower glaucoma defects were often missed. CONCLUSION: The fall in sensitivity and specificity of the OKP chart in identifying milder glaucomatous field defects diminishes its value as a screening test. However, its introduction into wider use in the community may increase awareness of glaucoma amongst general practitioners and members of the public, and help to detect previously undiagnosed glaucoma with moderate to severe damage. A normal OKP finding does not exclude the presence of early glaucoma. Combined with ophthalmoscopy, OKP may improve glaucoma detection rates amongst non-ophthalmologists.