Biomedical subjects
Publications and source records attributed to G Atkinson.
Between 1965 and 1982, hospital costs per admission rose by some 690%. Factors that contributed to this inflationary trend and that caused payers to take drastic action are analyzed. The actions taken in the past and current proposals to control the rate of increase are reviewed. It is predicted that payment systems for other providers such as physicians and nursing homes will change in similar ways.
In this paper I argue for several related theses: first, that the distinction between killing and letting die, as it is drawn by ordinary persons in ordinary contexts, is more complex than is generally understood; second, that the key feature of this complexity lies in the presence of a hidden normative component in what appears to be a straightforwardly descriptive distinction; and, third, that this complexity renders the killing/letting die distinction an inadequate and hazardous guide for moral reasoning.
Histamine may be released from rat peritoneal mast cells by compound 48/80 and peptide 401 in the presence and absence of extracellular calcium. The process is non-cytolytic and requires an intact cell metabolism. The release produced under both conditions is inhibited by disodium cromoglycate, theophylline, dibutyryl cyclic AMP and (at high concentrations) quercetin. The efficacy of the drugs in the absence of extracellular calcium cannot be explained in terms of their postulated effect on the calcium-gating mechanism operative in anaphylactic secretion. Alternative modes of action of the compounds are thus considered.
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In this paper, we establish relationships between hospital cost per case and the independent variables; case mix complexity, case mix severity, factor input prices, and hospital characteristics. Two hundred and sixteen thousand discharges from Maryland's acute general hospitals are grouped into 383 Diagnostic Related Groups which are used to compute an information theoretic measure of case mix complexity. Multiple linear regression equations are developed which predict up to 88% of the variance of between-hospital cost per case. The most highly significant predictors of cost per case are complexity, patient age, proportion of high risk patients, average length of stay, and nonphysician salary levels. Two distinct groups of hospitals, metropolitan and rural, are defined and models are developed for each. We discuss the implications of these findings for the identification and regulation of unexpectedly high cost hospitals and for prospective cost per case reimbursement.
1 Extracellular calcium ions have a dual effect on the release of histamine from rat peritoneal mast cells treated with compound 48/80 and peptide 401. The release is either potentiated or inhibited according to the relative concentrations of ion and inducer.2 Strontium similarly potentiates the release produced by optimal concentrations of inducer but higher concentrations are required than in the case of calcium. Strontium is markedly less inhibitory than calcium.3 Mast cells may be depleted of intracellular calcium by incubation for short periods with the chelating agent, ethylenediamine tetraacetic acid (EDTA). They thereby become unresponsive to compound 48/80 and peptide 401 unless calcium is reintroduced into the incubation medium. Strontium and barium, but not magnesium, will substitute for calcium in this system. Barium additionally produces a marked release of histamine even in the absence of inducer. Pretreatment with the ionophore A23187 similarly inhibits the subsequent response to peptide 401 in divalent cation-free medium. This inhibition is reversed on the reintroduction of calcium.4 Compound 48/80 and peptide 401 release histamine from mast cells incubated in isotonic sucrose in the complete absence of added metal ions. However, the corrected release under these conditions is potentiated by both mono and divalent cations.5 On the basis of these results, the possible mechanism of action of the basic releasing agents and their usefulness as models for studying histamine secretion is discussed.
1 Rapid intravenous injection of 3-methylindole (3-MI) was shown to induce an anaphylactoid-like reaction in calves. 2 This was suggested by the reduction in response to a repeat dose of 3-MI, by the reduction of effects in the presence of antagonists to the putative mediators of anaphylaxis in cattle and by the production of signs similar to those seen in experimentally induced bovine anaphylaxis. 3 The plasma half-life of 3-MI was short (14.4 min) and, since absorption of 3-MI from the rumen is known to be slow, the extent of formation of 3-MI from L-tryptophan in the rumen would have to be substantial if 3-MI is to be considered the causative agent of 'fog fever', an acute respiratory distress syndrome seen in cattle.
Coe and Sarbin's claim that a single role skill dimension accounts for individual differences in hypnotizability is not supported by an empirical analysis. We suggest that current measures of hypnotic susceptibility are not only factorially complex but contain a sizable nonhypnotic variance component. Implications for the assessment of "true" hypnotic susceptibility are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We discuss the practical and clinical considerations encountered when planning a Phase IIa trial in chronic obstructive pulmonary disease (COPD). Various adaptive strategies for reducing the cost of the trial and the statistical implications of these are explored. Use of the EAST software to evaluate the properties of the study designs with one or more interim analyses for futility, efficacy or either is described. We emphasize the rationale for choosing between alternative designs and the relationship between the clinical and statistical considerations.
The immediate effects of ingesting melatonin in the daytime include decreased alertness and body temperature. To date, no researcher has examined whether daytime ingestion of melatonin leads to impairments in variables relevant to short-term (<10 min) athletic performance. Twelve physically active participants (mean +/- s age = 25.2 +/- 5.0 years, body mass = 81.4 +/- 12.1 kg and chronotype = 33.8 +/- 6.3 units) ingested 5 mg of melatonin or placebo at 11:45 hours in a double-blind experiment. At 13:00 and 17:00 hours, subjective alertness was measured, together with intra-aural temperature, reaction time (two-, four- and eight-choice), short-term memory recall and grip strength. Performance, ratings of perceived exertion (RPE) and heart rate were also recorded during a 4-km cycling time trial. At 13:00 hours, the mean +/- s intra-aural temperature was 0.49 +/- 0.79 degrees C lower after ingestion of melatonin than after placebo (p = 0.015), but this difference was not apparent at 17:00 hours. At both 13:00 and 17:00 hours, melatonin reduced (p < 0.05) alertness, short-term memory and exercise heart rate by 1.5 +/- 1.8 units, 1 +/- 1 digits and 6 +/- 9 beats.min(-1), respectively (mean +/- s). Eight-choice reaction time was also slower at both times of day after ingesting melatonin. Melatonin did not influence time trial performance or RPE (p > 0.05). The effects of 5 mg of melatonin seem more pronounced for mental rather than physical components of short-term athletic performance, although the cardiovascular responses to exercise are affected. Some effects of melatonin were apparent 5 h after ingestion when the hypothermic effects of melatonin had dissipated.
This study compared circadian rhythms in physiological, subjective, and performance measures between groups exhibiting different levels of habitual physical activity. Fourteen male subjects, aged 19-29 years, were assigned to a physically active (group I, n = 7) or a physically inactive (group II, n = 7) group on the basis of leisure-time physical activity. Rectal temperature, oral temperature, resting pulse rate, subjective arousal and sleepiness were measured at 02:00, 06:00, 10:00, 14:00, 18:00 and 22:00 in a counter-balanced sequence for each subject. Whole-body flexibility, back and leg strength, grip strength (right and left), flight time in a vertical jump, PWC150, and self-chosen work-rate were also recorded at each time point. At least 8h separated each test session. Subjects avoided exercise 48h prior to, and during the experiment. Data were subjected to the group cosinor method. Group I evidenced 1.5-2.5 times greater rhythm amplitudes than Group II for oral temperature, subjective arousal, sleepiness, flexibility, left and right grip strength, submaximal heart rate, and self-chosen work-rate (p < 0.05). Oral temperature and arousal for Group I were lower than Group II only at 06:00. Early morning troughs in most of the performance measures were significantly greater for Group I (p < 0.05). The groups did not differ with respect to phasing of the rhythms (p < 0.05). These results confirm with physical performance measures that rhythm amplitudes are higher for physically fit subjects. This could be attributed to greater early-morning troughs in the measures for active individuals. Since the subjects were sedentary immediately prior to testing, it is plausible that these findings are training effects of physical activity.
In recent years hospital uncompensated care has been declining in the seven states studied here: California, Florida, Washington, Connecticut, Maryland, New Jersey, and New York. We document these declines and compare trends in uncompensated care in safety-net and other hospitals between the early 1980s and the early to mid-1990s. We discuss state responses to deal with the declines in hospital uncompensated care and their likely impact on the observed trends.
Variables associated with physical activity show circadian rhythms in resting subjects; these rhythms have both exogenous (due to the individual's lifestyle and environment) and endogenous (due to the "body clock") components. During exercise, many of the rhythms persist, even though some show decreasing amplitude with increasing severity of exercise. Whilst the value of physical fitness is not disputed (for elite athletes, for individuals who just want to be physically fit, or for patients undertaking physical rehabilitation regimens), there are certain times of the day when special care is needed. These times are soon after waking--when there is the possibility of an increased risk of cardiovascular morbidity and damage to the spine--and late in the day--when there is an increased risk of respiratory difficulties. Since physical exercise is inextricably linked with thermoregulation, there are special considerations to bear in mind when exercise takes place in cold or hot environments. Further, due to the effects of the body clock, exercise and activity during night work and after time-zone transitions presents problems peculiar to these circumstances. In addition, the menstrual cycle affects physical performance, and these circatrigintan rhythms interact with the circadian ones. Bearing in mind these factors, advice that is based upon knowledge of circadian and circatrigintan rhythms can be given to all those contemplating physical activity. Chronobiologically, there is advantage in undertaking physical activity programmes towards the middle of the waking day and not at times when a sleep or nap has just been taken.