A Multi-Part Model Approach to Examining Medicaid Payment Methods and Nursing Home Quality

The incentive to provide nursing home quality depends, in part, on whether the state Medicaid reimbursement system is prospective or retrospective in nature. This paper examines the effect of state-level Medicaid reimbursement methods on the provision of quality in the context of bed constraint regulations that may influence market tightness. A three-part estimation strategy is constructed around the idea that a change in the Medicaid reimbursement method may affect both a facility's payer mix and the provision of quality. Across a range of quality measures, this multi-part model did not show nursing home quality to be significantly higher under a retrospective reimbursement system as compared with a prospective-based system of reimbursement. This finding holds regardless of whether the analysis was isolated to those markets with the tightest supply of beds or those homes that care for predominantly Medicaid residents.     

益气养血补肾法合康力龙治疗重型再生障碍性贫血的临床研究

目的观察益气养血补肾法治疗重型再生障碍性贫血的临床疗效.方法用益气养血补肾法合康力龙治疗重型再生障碍性贫血33例,观察治疗后患者临床表现、血常规等指标的变化.结果治疗后证候学积分较疗前有显著性下降(P<0.01),在改善症状方面有效率为90.91%,临床疗效总有效率88.24%,患者的血色素从疗后第6个月开始较疗前升高(P<0.01),白细胞计数比疗前升高(P＜0.05),疗后网织红细胞计数较疗前有显著性升高(P<0.01).结论益气养血补肾法合康力龙对重型再生障碍性贫血患者有较好的临床疗效.     

Hyperprolactinemia stimulates food intake in the female rat

Lactation in the rat is marked by extreme hyperphagia. The present study examined the possibility that elevated prolactin levels contribute to this increase. It also evaluated the effects of hyperprolactinemia on brown adipose tissue and carcass composition. Virgin Osborne-Mendel rats were made hyperprolactinemic via ectopic pituitary transplants (PIT, n = 9) or were sham-operated (SHAM, n = 8). Eight lactating rats (LACT) served as additional controls. Food intake, body weight and rectal temperature were recorded daily. Eleven days postsurgery (or 11-12 days postpartum), the rats were sacrificed, and brown fat (scapular, axillary, cervical and thoracic) was excised, weighed, and assayed for GDP binding, one indicator of thermogenic capacity. Carcasses were subjected to body composition analysis. Although prior to surgery, PIT and SHAM rats weighed the same, PIT rats gained significantly more weight during the experiment than did SHAMs. Percent body fat and food intake (both total intake and intake relative to metabolic body size) were significantly elevated in the PIT rats. GDP binding in both PIT and LACT rats was significantly less than in SHAMs. This was true whether GDP binding was expressed per mg mitochondrial protein or per total amount of mitochondrial protein recovered. These data confirm that brown fat thermogenic capacity is suppressed during lactation. They also demonstrate that elevations of serum prolactin, to levels that are well within physiological limits, are capable of stimulating food intake and white fat deposition in the female rat. It is presently unclear whether these results are a direct or an indirect effect of hyperprolactinemia.     

Role of the median preoptic nucleus in the chronic hypotensive effect of losartan in sodium-replete normal rats

1. We have shown previously that the chronic hypotensive effect of the angiotensin II AT₁ receptor antagonist losartan is mediated, in part, by the subfornical organ (SFO). However, the neural pathway(s) mediating this central effect of losartan downstream from the SFO has not been completely elucidated.
2. The present study was designed to test the hypothesis that the median preoptic nucleus (MnPO) is a crucial part of the neural pathway necessary for the chronic hypotensive effect of losartan. To test this hypothesis, male Sprague-Dawley rats were subjected to either Sham or electrolytic lesion of the MnPO (MnPOx). Rats were instrumented with radiotelemetric transducers and aortic flow probes for the continuous measurement of mean arterial pressure (MAP) and heart rate and cardiac output (CO), respectively. Total peripheral resistance (TPR) was calculated as MAP/CO. After 3 days of baseline measurements, rats were infused intraperitoneally with losartan (10 mg/kg per day) via an osmotic minipump at a rate of 5 μL/min.
3. The data revealed that, by Day 9 of losartan treatment, MAP had decreased 34 ± 2 mmHg in MnPOx rats ( n  = 9), whereas the MAP of Sham-lesioned rats ( n  = 8) had only decreased 24 ± 3 mmHg. These findings were accompanied by a greater decrease in TPR in MnPOx compared with Sham rats (−0.464 vs −0.237 mmHg/mL per min, respectively), whereas CO remained unchanged throughout the study protocol.
4. These results do not support the hypothesis that an intact MnPO is necessary to mediate the full chronic hypotensive effect of losartan in normal rats. Instead, they appear to suggest that the MnPO may play an important role in buffering the profound hypotension induced by losartan.     

Anti-depressants and suicide

Suicide takes the lives of around a million people each year, most of whom suffer from depression. In recent years there has been growing controversy about whether one of the best-selling anti-depressants – selective serotonin reuptake inhibitors (SSRIs) – increases or decreases the risk of completed suicide. Randomized clinical trials are not informative in this application because of small samples and other problems. We present what we believe are the most scientifically credible estimates to date on how SSRI sales affect suicide mortality using data from 26 countries for up to 25 years. We exploit just the variation in SSRI sales that can be explained by institutional differences in how drugs are regulated, priced, and distributed, as reflected by the sales growth of new drugs more generally. We find an increase in SSRI sales of 1 pill per capita (12% of 2000 sales levels) reduces suicide by 5%.     

胡萝卜渣膳食纤维调节血脂的作用

<正>胡萝卜资源丰富,加工成胡萝卜汁和胡萝卜浆等产品时,伴随着产生大量胡萝卜残渣。本研究探讨胡萝卜渣膳食纤维调节血脂的功能,为进一步开发利用提供理论依据。     

Said Another Way: On an International Nursing License

Key words: Nursing is multidimensional, interactive, interdisciplinary, and complex. Almost anything that can be said about nursing can be said another way. Some things worth being said and heard will not follow the norms of journal presentation. A forum accommodates the emerging voice, the new format, the innovative approach. Nursing Forum, in an effort to honor the independent voice in mursing, presents here the voice who elects to enter the dialogue, but who does so "in another way."     

促炎症介质对B型滑膜细胞晚期糖基化终产物受体的调节作用

探讨促炎症介质对B型滑膜细胞晚期糖基化终产物（AGE）受体的调节作用。通过体外实验，观察TNF－α、IL-1β和AGE修饰的人血清白蛋白（AGE－HSA）对B型滑膜细胞AGE受体mRNA表达的影响，以及中和性抗TNF－α和抗IL－β抗体对AGE－GHSA调节作用的阻断能力。结果显示，滑膜B型细胞表达RACE和AGE－R3mRNA;AGE-HSA和TNF－α能以时间和剂量依赖的方式下调B型滑膜细胞RAGEmRNA的表达，上调AGE－R3mRNA的表达；IL－1β能以时间和剂量依赖的方式上调B型滑膜细胞AGE－R3mRNA的表达，而对RAGEmRNA的表达无影响；AGE－HSA对B型滑膜细胞AGE受体mRNA表达的调节作用被抗TNF－α抗体所阻断。提示促炎症介质对 滑膜细胞不同的AGE受体具有不同的调节作用。