One picture is worth at least a million neurons

How many neurons participate in the representation of a single visual image? Answering this question is critical for constraining biologically inspired models of object recognition, which vary greatly in their assumptions from few "grandmother cells" to numerous neurons in widely distributed networks. Functional imaging techniques, such as fMRI, provide an opportunity to explore this issue, since they allow the simultaneous detection of the entire neuronal population responding to each stimulus. Several studies have shown that fMRI BOLD signal is approximately proportional to neuronal activity. However, since it provides an indirect measure of this activity, obtaining a realistic estimate of the number of activated neurons requires several intervening steps. Here, we used the extensive knowledge of primate V1 to yield a conservative estimate of the ratio between hemodynamic response and neuronal firing. This ratio was then used, in addition to several cautious assumptions, to assess the number of neurons responding to a single-object image in the entire visual cortex and particularly in object-related areas. Our results show that at least a million neurons in object-related cortex and about two hundred million neurons in the entire visual cortex are involved in the representation of a single-object image.     

Getting by at home. Community-based long-term care of Latino elders.

Although evidence suggests that the morbidity and mortality of Latino elders (of any Hispanic ancestry) are similar to those of non-Latino whites, Latinos have higher rates of disability. Little is known about influences on the use of in-home health services designed to assist disabled Latino elders. We examine the effects of various cultural and structural factors on the use of visiting nurse, home health aide, and homemaker services. Data are from the Commonwealth Fund Commission''s 1988 national survey of 2,299 Latinos aged 65 and older. Mexican-American elders are less likely than the average Latino to use in-home health services despite similar levels of need. Structural factors including insurance status are important reasons, but acculturation is not pertinent. Physicians should not assume that Latino families are taking care of their disabled elders simply because of a cultural preference. They should provide information and advice on the use of in-home health services when an older Latino patient is physically disabled.     

Problems of care in a private nursing home.

To assess problems of care in a private nursing home an observational study was carried out over two months, during which a research nurse worked as a member of the staff in a home caring for 25 patients aged 62-90. During the second month a consultant physician visited the home weekly to hold case conferences and assess each patient''s functional ability and drug regimen. Various problems in medical, nursing, and bureaucratic matters were identified--for example, staff failed to understand the appropriate response to various medical symptoms; no clear policy existed for managing pressure sores; and one patient''s anticoagulant state could not be assessed when industrial action meant that transport to take him to hospital was not available--and several changes in drug treatments were recommended. The problems that were identified were mainly due to poor communication between the home and general practitioners and hospitals and to the lack of guidance policy on common issues that arise in long term care. Such a policy could be produced by health authority staff, general practitioners, and representatives of nursing homes.     

Effect of chronic home care on admission to institutions providing long-term care.

Home care programs are operating throughout Ontario. In October 1975 pilot-test chronic home care (CHC) programs were added in three areas. Whether the Kingston CHC program prevented or delayed admission to an institution providing long-term care was studied in the 218 patients admitted to the program up to mid-March 1976. Forms were completed for all 218 patients admitted, for the 109 still in the program 6 months later, and for the 131 who had left the program by August 1976. Of the 218 patients 20% had applied for admission to an institution providing long-term care before applying for CHC, and another 22% had seriously considered applying to such an institution. The CHC staff judged that 61% would have needed institutional care without CHC. Only 12% of the 218 patients left the CHC program to enter an institution, only 1 of the 48 patients discharged to self-care at home was considering a move to an institution, and only 2 receiving CHC for 6 months applied to an institution during that time. CHC therefore seems to delay greatly admission to an institution providing long-term care for a substantial group of patients.     

Enabling more dying people to remain at home.

When it comes to dying there is no place like home. Since earliest times most cultures have accepted that dying people should remain at home. But this was never possible for all. Some were destined to die in accidents, on battlefields, by execution, and from catastrophic illness, maybe many miles away. Nevertheless, with few exceptions people could expect to die in their own beds and in the bosom of their families. In Europe from the Middle Ages until a century ago there was a simplicity about dying. Aware that the end was approaching, people would take to their sickbeds and preside over the ritual. The family, including children, friends, and neighbours would congregate. The ceremony was public and doctors often complained about overcrowding. Death was not regarded as a frightening event and was accepted as an inevitable and integral part of life. Dramatic changes in attitudes to death have taken place since the mid-nineteenth century. The natural acceptance of a biological reality has been lost and people are now unable to come to terms with their own mortality. One consequence is that death has become institutionalised. This paper seeks to answer five questions. These refer to where people die, where they would choose to die, where they spend their last year of life, the reasons for admission for terminal care, and whether more dying people could remain at home. Discussion is restricted to adults in the United Kingdom. References are mostly from the past decade.     

Staff attitudes to oral health care. A comparative study of registered nurses,nursing assistants and home care aides

This study compares differences in attitude, of oral health care of nursing personnel working with dependent elderly and severely disabled patients. A questionnaire was administered to 398 personnel covering (1) personal oral health care habits. (2) experiences and attitudes in assisting oral care and (3) willingness to assist patients/residents with their daily oral hygiene. Three hundred and sixty - four persons answered the questionnaire, including 70 registered nurses, 148 nursing assistants and 146 home care aides. The study revealed that oral care assistance is viewed as more disagreeable than other nursing activities. Although registered nurses were found to have more positive attitudes toward oral care assistance than the other nursing groups, they were seldom invoked in the daily practice of oral hygiene care. The results indicate a gap between knowledge and practice in nursing personnel's attitudes toward oral health care of dependent elderly and severely disabled patients.     

Multimodal home care intervention for dependent older people “Live better at home”: Protocol of a randomized clinical trial

BackgroundThe intensity of the home care interventions for dependent older people offered in Spain may not be sufficient to help keep older people living at home, being the institutionalization in a nursing home (NH) an unavoidable consequence.ObjectiveTo evaluate the effect of intensification in home care interventions on users with grade II or III dependency, as well as training for their informal caregivers in order to delay or avoid their institutionalization in a NH.MethodsA randomized clinical trial with two parallel arms and blinded assessment will be conducted at the community level in two municipalities in Catalonia (Spain). The study will include those older people (aged 65 and over) living in the community, with degree II or III of dependency, users of the public home care unwilling to be institutionalized and with a main informal caregiver in charge, who will also participate in the study. The assessments will be performed monthly up to 15 months, when the intervention will be finished. The main outcome will be the time until the willingness for admission to a NH. Secondary variables will be composed of sociodemographic, health, psychosocial, resource use, and follow-up variables. A multivariate Cox regression model will be carried out to estimate the effectiveness of the intervention.DiscussionA multimodal home care intervention could improve the health and psychosocial status of dependent people and their informal caregivers and facilitate their permanence at home.Trial registrationNCT05567965     

Self-administration of intravenous antibiotics: an efficient,cost-effective home care program.

The effects of a home care program with 102 courses (2336 patient-days) of intravenous antibiotic therapy were evaluated. Home care nurses changed the intravenous cannula site every 3 days. The initial hospital stay averaged 11.8 days and the duration of home therapy averaged 22.9 days. The diseases treated included osteomyelitis, septic arthritis, endocarditis, cystic fibrosis and pneumonia, staphylococcal bacteremia, blastomycosis, actinomycosis and other soft tissue infections. All classes of commonly used antibiotics, including penicillins, cephalosporins, aminoglycosides and amphotericin B, were administered, alone or in combination. There were no side effects that necessitated discontinuation of home treatment or readmission to hospital. The average cost per patient-day was $58, compared with an estimated $193 for in-hospital therapy; in addition, 2336 hospital bed-days were made available. Most patients were able to resume many or all of their daily activities while receiving intravenous antibiotic therapy.     

Management of feverish children at home.

OBJECTIVES--To compare the acceptability and effects on temperature of advice to unwrap children and give paracetamol or warm sponging treatments in the management of feverish illness at home. DESIGN--A randomised, open, parallel group study using factorial design comparison of unwrapping, warm sponging plus unwrapping, paracetamol plus unwrapping, and paracetamol and warm sponging plus unwrapping. SETTING--Homes of willing families with a feverish child recruited after consulting one of 21 participating general practitioners in Southampton. SUBJECTS--52 children aged from 3 months to 5 years with axillary temperatures before treatment of > or = 37.8 degrees C and < 40 degrees C. MAIN OUTCOME MEASURES--Response to advice assessed over four hours; temperature assessed by continuous data logging from an axillary thermistor; acceptability of treatment to child and parent scored on Likert scales immediately after treatment and on return to health. RESULTS--Response to treatment advice varied; unwrapping alone had little effect on temperature. Paracetamol increased the time below 37.2 degrees C in four hours by 109 (95% confidence interval 74 to 145) minutes compared with unwrapping; warm sponging caused the fastest reduction in temperature. Parents discriminated between treatments, preferring paracetamol. CONCLUSION--Advice to give paracetamol is more effective than sponging or unwrapping in controlling temperature in children at home and is more acceptable to parents. Warm sponging has an additive effect and reduces fever more quickly than paracetamol.