Home care cost-effectiveness for respiratory technology-dependent children

We evaluated home care costs and the cost-effectiveness of home care vs alternative institutional care for respiratory technology-dependent children in a Medicaid Model Waiver Program. "Cost-savings" was measured as the difference between the established Medicaid reimbursable charges to enact an individualized care plan at a long-term care institution and the actual Medicaid reimbursements for home care. Ten patients--six dependent on mechanical ventilation and four with a tracheostomy who were receiving oxygen--were included in the analysis. The mean (+/- SD) annual home care costs were $109,836 +/- $20,781 for ventilator-dependent children and $63,650 +/- $12,350 for oxygen-dependent patients with a tracheostomy, representing annual savings of approximately $79,000 per patient and $83,000 per patient, respectively. The largest portion of home care reimbursements was for nursing care, accounting for 69.0% and 59.0% of the two patient groups. The full program (50 patients) has the potential for a savings of $4 million per year.

Examining the world of the depressed: do depressed people prefer others who are depressed?

Two studies were conducted to examine the interpersonal world of the depressed person. In Study 1, depression levels and perceptions of depressed and nondepressed people and their best friend were assessed to test the hypothesis that depressed Ss have best friends who are themselves more depressed than the best friends of nondepressed Ss. The hypothesis was confirmed, suggesting that depressed persons may prefer others who also tend toward depression. To examine this possibility, in Study 2 depressed and nondepressed college students spoke with one another in either depressed-depressed, nondepressed-depressed, or nondepressed-nondepressed pairs. It was found that depressed Ss felt worse than nondepressed Ss after speaking with nondepressed targets, but not after speaking with depressed targets. There were no differences in liking or in perceived similarity between the groups. Implications for the social world of the depressed person are discussed.

Examining the world of the depressed: Do depressed people prefer others who are depressed?

Two studies were conducted to examine the interpersonal world of the depressed person. In Study 1, depression levels and perceptions of depressed and nondepressed people and their best friend were assessed to test the hypothesis that depressed Ss have best friends who are themselves more depressed than the best friends of nondepressed Ss. The hypothesis was confirmed, suggesting that depressed persons may prefer others who also tend toward depression. To examine this possibility, in Study 2 depressed and nondepressed college students spoke with one another in either depressed-depressed, nondepressed-depressed, or nondepressed-nondepressed pairs. It was found that depressed Ss felt worse than nondepressed Ss after speaking with nondepressed targets, but not after speaking with depressed targets. There were no differences in liking or in perceived similarity between the groups. Implications for the social world of the depressed person are discussed.

Evidence for terror management theory: I. The effects of mortality salience on reactions to those who violate or uphold cultural values

On the basis of terror management theory, it was hypothesized that when mortality is made salient, Ss would respond especially positively toward those who uphold cultural values and especially negatively toward those who violate cultural values. In Experiment 1, judges recommended especially harsh bonds for a prostitute when mortality was made salient. Experiment 2 replicated this finding with student Ss and demonstrated that it occurs only among Ss with relatively negative attitudes toward prostitution. Experiment 3 demonstrated that mortality salience also leads to larger reward recommendations for a hero who upheld cultural values. Experiments 4 and 5 showed that the mortality salience effect does not result from heightened self-awareness or physiological arousal. Experiment 6 replicated the punishment effect with a different mortality salience manipulation. Implications for the role of fear of death in social behavior are discussed.

Evidence for terror management theory: I. The effects of mortality salience on reactions to those who violate or uphold cultural values

On the basis of terror management theory, it was hypothesized that when mortality is made salient, Ss would respond especially positively toward those who uphold cultural values and especially negatively toward those who violate cultural values. In Experiment 1, judges recommended especially harsh bonds for a prostitute when mortality was made salient. Experiment 2 replicated this finding with student Ss and demonstrated that it occurs only among Ss with relatively negative attitudes toward prostitution. Experiment 3 demonstrated that mortality salience also leads to larger reward recommendations for a hero who upheld cultural values. Experiments 4 and 5 showed that the mortality salience effect does not result from heightened self-awareness or physiological arousal. Experiment 6 replicated the punishment effect with a different mortality salience manipulation. Implications for the role of fear of death in social behavior are discussed.

Depression and interpersonal attraction: the role of perceived similarity

We hypothesized that depressed individuals are generally viewed as dissimilar and that this perceived dissimilarity contributes to negative reactions to the depressed. In addition, we hypothesized that if perceived similarity affects liking of depressed individuals, then nondepressed subjects should prefer nondepressed targets, but depressed subjects should not share this preference. To test these hypotheses, depressed and nondepressed subjects received information about two targets, both either depressed or nondepressed, one attitudinally dissimilar and one attitudinally similar. They were then asked to fill out an attraction measure and an interest in meeting measure for each target. The results clearly supported the primary hypotheses, demonstrating that nondepressed subjects preferred nondepressed targets and perceived them as more similar than depressed targets, and that this preference for nondepressed targets is not shared by depressed subjects. Tests of supplementary hypotheses also confirmed that depressed subjects perceive their best friends as being more depressed and more dissimilar than do nondepressed subjects. The implications of these findings for the social world of the depressed were discussed.

Depression and interpersonal attraction: The role of perceived similarity

We hypothesized that depressed individuals are generally viewed as dissimilar and that this perceived dissimilarity contributes to negative reactions to the depressed. In addition, we hypothesized that if perceived similarity affects liking of depressed individuals, then nondepressed subjects should prefer nondepressed targets, but depressed subjects should not share this preference. To test these hypotheses, depressed and nondepressed subjects received information about two targets, both either depressed or nondepressed, one attitudinally dissimilar and one attitudinally similar. They were then asked to fill out an attraction measure and an interest in meeting measure for each target. The results clearly supported the primary hypotheses, demonstrating that nondepressed subjects preferred nondepressed targets and perceived them as more similar than depressed targets, and that this preference for nondepressed targets is not shared by depressed subjects. Tests of supplementary hypotheses also confirmed that depressed subjects perceive their best friends as being more depressed and more dissimilar than do nondepressed subjects. The implications of these findings for the social world of the depressed were discussed.

Atypical rotavirus from South African neonates. Brief report

Rotaviruses displaying an RNA profile different from other human rotaviruses were detected in stools from six healthy neonates. These viruses shared the common group A antigen, unlike most other atypical human rotavirus electropherotypes described to date.

Characterization of rotaviruses and subgroup F adenoviruses from acute summer gastroenteritis in South Africa

Six hundred and sixteen specimens were collected from black children hospitalised with acute gastroenteritis during the summer and autumn of 1982-1983 (October to May). Eighty-five children (13.8%) shed rotavirus and at least 40 (6.5%) shed adenovirus (Ad) type 40 or 41 belonging to subgroup F. The highest monthly prevalence of shedding subgroup F adenoviruses (10.1%) coincided with a peak in admissions in midsummer, whereas the highest monthly prevalence of shedding rotaviruses (41.9%) coincided with a peak in admissions in autumn. There were at least five genome types of rotavirus, at least three genome types of Ad40, and at least five genome types of Ad41 circulating in the Johannesburg-Soweto area during the study period. The high rate of rotavirus shedding in autumn could not be attributed to an upsurge in infections by any particular rotavirus strain.

Concepts of the asylum in the care of the mentally ill

The author explores the initial intent of the asylum, a reform designed to ensure humane care of the mentally ill, drawing especially on Samuel Tuke's account of the York Retreat. He presents key concepts of the asylum related to codes of conduct, management of restraint, and social amenities from the perspective of Tuke and other reformers, and challenges some interpretations of the early asylums made by Michel Foucault.

Retinal emboli in patients with mitral valve prolapse

Small fibrin-platelet emboli caused by prolapsed mitral valves may cause retinal occlusive disease with a wide range of ophthalmic manifestations, including amaurosis fugax in young people, retinal or choroidal arteriolar occlusion, and retinal neovascularization (atypical Eales' disease). Six patients with retinal occusive disease underwent extensive noninvasive cardiac and systemic tests and were found to have prolapsed mitral valves. Patients with unexplained ocular emboli should be examined by a cardiologist for possible mitral valve prolapse.

Acinous cell carcinoma of the larynx

Adenocarcinomas of the larynx are an unusual type of lesion that arise in the minor salivary glands. An acinous cell carcinoma that arose in a supraglottic minor salivary gland closely resembled an oncocytic adenocarcinoma on light microscopy; but on electron microscopy, the neoplasm clearly was serous in origin. Contrary to the behavior of most acinous cell carcinomas, but similar to the majority of laryngeal adenocarcinomas, the neoplasm herein discussed was extremely aggressive and developed widespread metastases, which led to the patient's death.

The nature and clinical features of myocardial infarction with normal coronary arteriogram

Six new cases of acute myocardial infarction with normal coronary arteriogram are presented and supplemented by 19 collected cases (group I). These are compared with 16 cases of myocardial infarction caused by occlusive coronary artery disease in a comparable population (group ii). The following significant differences between the two groups are established: patients in group I were younger (27.5 years vs 33.7 years, P less than 0.005); at least one risk factor was present in all patients in group II, but in only 40% of group I (P less than 0.0001). effort angina preceded the attack in ten patients of group II, but in none of group I (P less than 0.0001). The attack was unheralded in 24 of the 25 patients in group I, but was preceded by prodromes in 11 of 16 in group II (P less than 0.0001). Attacks of pain following myocardial infarction occurred in five patients of group 2 and II of group II) (P less than 0.001). Results are discussed in the light of the nature of myocardial infarction in group I. No support is found for the coronary spasm theory. The most likely mechanism for development of myocardial infarction in group I is thought to be a thromboembolic "accident." This accident is not necessarily related to atherosclerotic coronary disease and is presumed to be benign in nature.

Echocardiographic assessment of the level of cardiac compensation in valvular heart disease

The level of cardiac compensation in valvular disease was studied by relating echocardiographic and cardiac catheterization measurements. Three groups -- compensated, intermediately compensated, and decompensated -- were defined according to the left ventricular angiographic pattern and cardiac output. The echocardiographic ejection indices, percent left ventricular minor diameter shortening, ejection fraction, and fiber shortening rate were significantly higher than normal in compensated mitral regurgitation, lower then normal in compensated aortic stenosis, and within normal limits in compensated aortic insufficiency. In the decomposed state these indices were depressed. Intermediate compensation was best recognized by combining several echocardiographic variables into an echocardiographic score based on multivariate discriminant function analysis. Thus, the compensated volume overload states (aortic and mitral regurgitation) and pressure overload state (aortic stenosis) have separate sets of "normal" echocardiographic values; low ejection indices characterize the decompensated group, while recognition of intermediate compensation requires analysis of multiple echocardiographic variables.

Hyperosmolar nature of diabetic coma

Stupor in patients with nonketotic hyperglycemia has been ascribed to hyperosmolarity, but the cause of depressed consciousness in patients with ketoacidosis has been puzzling. In this study, blood pH, serum glucose and sodium concentrations, and serum osmolality were measured in eighty-five consecutive episodes of diabetic ketoacidosis and forty-seven of nonketotic hyperglycemia. In the acidotic patients, as in those with nonketotic hyperglycemia, stupor closely paralleled hyperosmolarity and not the severity of acidemia. Indeed, the mean elevations of serum osmolarity were almost the same in the ketotic and in the nonketotic patients who were deeply obtunded. It seems likely that depression of consciousness in patients with severely uncontrolled diabetes mellitus, if not due to a nonmetabolic disorder, such as acute stroke, is attributable to hyperosmolarity, whether or not ketoacidosis is present.