Sample records for access-related bsi rates

  1. Bloodstream infection rates in outpatient hemodialysis facilities participating in a collaborative prevention effort: a quality improvement report.

    PubMed

    Patel, Priti R; Yi, Sarah H; Booth, Stephanie; Bren, Virginia; Downham, Gemma; Hess, Sally; Kelley, Karen; Lincoln, Mary; Morrissette, Kathy; Lindberg, Curt; Jernigan, John A; Kallen, Alexander J

    2013-08-01

    Bloodstream infections (BSIs) cause substantial morbidity in hemodialysis patients. In 2009, the US Centers for Disease Control and Prevention (CDC) sponsored a collaborative project to prevent BSIs in outpatient hemodialysis facilities. We sought to assess the impact of a set of interventions on BSI and access-related BSI rates in participating facilities using data reported to the CDC's National Healthcare Safety Network (NHSN). Quality improvement project. Patients in 17 outpatient hemodialysis facilities that volunteered to participate. Facilities reported monthly event and denominator data to NHSN, received guidance from the CDC, and implemented an evidence-based intervention package that included chlorhexidine use for catheter exit-site care, staff training and competency assessments focused on catheter care and aseptic technique, hand hygiene and vascular access care audits, and feedback of infection and adherence rates to staff. Crude and modeled BSI and access-related BSI rates. Up to 12 months of preintervention (January 2009 through December 2009) and 15 months of intervention period (January 2010 through March 2011) data from participating centers were analyzed. Segmented regression analysis was used to assess changes in BSI and access-related BSI rates during the preintervention and intervention periods. Most (65%) participating facilities were hospital based. Pooled mean BSI and access-related BSI rates were 1.09 and 0.73 events per 100 patient-months during the preintervention period and 0.89 and 0.42 events per 100 patient-months during the intervention period, respectively. Modeled rates decreased 32% (P = 0.01) for BSIs and 54% (P < 0.001) for access-related BSIs at the start of the intervention period. Participating facilities were not representative of all outpatient hemodialysis centers nationally. There was no control arm to this quality improvement project. Facilities participating in a collaborative successfully decreased their BSI and

  2. Totally implantable central venous access port infections in patients with digestive cancer: incidence and risk factors.

    PubMed

    Touré, Abdoulaye; Vanhems, Philippe; Lombard-Bohas, Catherine; Cassier, Philippe; Péré-Vergé, Denis; Souquet, Jean-Christophe; Ecochard, René; Chambrier, Cécile

    2012-12-01

    Central venous access port-related bloodstream infection (CVAP-BSI) is associated with morbidity and mortality in patients with cancer. This study examined the incidence rates and risk factors for CVAP-BSI in adult patients with digestive cancer. This prospective observational cohort study was performed from 2007 to 2011 in 2 oncology units of a university hospital. Incidence rate was expressed as number of CVAP-BSI per 1,000 catheter-days. A Cox regression model was used to identify risk factors for CVAP-BSI. A total of 315 patients were included. CVAP-BSI occurred in 41 patients (13.0%). The overall incidence rate was 0.76/1,000 catheter-days. The rate was higher in patients with esophageal cancer (1.28. P = .05) and pancreatic cancer (1.24; P = .007). Risk factors independently associated with CVAP-BSI were World Health Organization performance status between 2 and 4, catheter utilization-days in the previous month, pancreatic cancer, and parenteral nutrition. Coagulase-negative Staphylococci and enterobacteria were the main microorganisms isolated. In adult patients with digestive cancer, pancreatic cancer, cumulative catheter utilization-days, World Health Organization performance status, and parenteral nutrition were identified as independent risk factors for CVAP-BSI. Patients with any of these risk factors could be candidates for preventive strategies. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  3. Screening for emotional disorders in patients with cancer using the Brief Symptom Inventory (BSI) and the BSI-18 versus a standardized psychiatric interview (the World Health Organization Composite International Diagnostic Interview).

    PubMed

    Grassi, Luigi; Caruso, Rosangela; Mitchell, Alex J; Sabato, Silvana; Nanni, Maria Giulia

    2018-06-01

    Given the adverse consequences of psychiatric and psychosocial morbidity on the quality of life for patients with cancer, prompt detection of psychological symptoms is mandatory. The authors examined the properties and accuracy of the Brief Symptom Inventory (the 53-item version [BSI] and the 18-item version [BSI-18]) for the detection of psychiatric morbidity compared with the World Health Organization Composite International Diagnostic Interview (CIDI) for International Classification of Diseases-10th Revision psychiatric diagnoses. A convenience sample of 498 patients with newly diagnosed cancer who were recruited in cancer outpatient services participated in the CIDI interview and in BSI and BSI-18 assessments. The prevalence of psychiatric morbidity was 39.75%. When participants were classified as cases using the BSI standard case rule, agreement with the CIDI was potentially acceptable (sensitivity, 72.7%; specificity, 88.7%). In contrast, the accuracy of the BSI-18 in identifying cases was poor according to the standard case rule, with very low sensitivity (29.3%) (misclassification rate, 28.7%). By using a first alternative case-rule system (a BSI-18 global severity index [GSI] T-score ≥57), sensitivity marginally improved (45%), whereas a second alternative case-rule system (a GSI T-score ≥50) significantly increased sensitivity (77.3%). In receiver operating characteristic curve analysis, a further cutoff GSI T-score ≥48 exhibited good discrimination levels (sensitivity, 82.3%; specificity, 72.4%). There were some differences in GSI cutoff T-scores according to the International Classification of Diseases-10th Revision diagnosis and sex. The BSI appeared to have acceptable diagnostic accuracy compared with a standardized psychiatric interview. For the BSI-18, it is mandatory to use alternative case-rule systems, to identify patients with psychiatric morbidity. Cancer 2018;124:2415-26. © 2018 American Cancer Society. © 2018 American Cancer Society.

  4. Interactions Between Biogenic Silica (BSiO2) and Organic Carbon (POC) During the Recycling of Sinking Particles

    NASA Astrophysics Data System (ADS)

    Moriceau, B.; Goutx, M.; Guigue, C.; Tamburini, C.; Lee, C.; Armstrong, R. A.; Duflos, M.; Charriere, B.; Ragueneau, O.

    2006-12-01

    Despite recent progress in understanding the ocean's role in the global carbon cycle, we are not yet able to predict the response of ecosystems to climate change and feedbacks of the ocean onto atmospheric CO2. In particular, particle flux dynamics must be represented more faithfully in ocean models. We know that particulate organic carbon (POC) flux is associated with ballast minerals (BSiO2, CaCO3), but the processes controlling the interactions between carbon and ballast minerals during decomposition must be explored further. The present study aims to provide a better understanding of interactions between carbon and BSiO2 during mineralization of sinking particles. Previous studies have provided evidence that the degradation of the external membrane by bacteria increase the BSiO2 dissolution rate. Alternatively, it has been hypothesized that biogenic silica could protect carbon from degradation. To test this hypothesis, an in-vitro batch experiment using the diatom Skeletonema costatum was conducted. In this experiment, carbon degradation, bacterial growth, and BSiO2 dissolution were followed simultaneously. To identify the processes involved and the types of carbon that eventually interact with BSiO2 during mineralization, the concentrations of different lipids and amino acids were also measured. A strong increase of the degradation rate constant of the POC and PON was observed after dissolution of 40 % of initial BSiO2. This increase is associated to a peak of glycine in total amino acids and a switch between free and attached bacteria. These results suggest that carbon degradation is increased when enough of the frustule is dissolved to uncover the glycine contain inside the frustule, this amino acid may trigger an increase in the concentration of attached bacteria, which may in turn increase the degradation rate constant of organic carbon.

  5. Two feasible approaches to enhance the wear behaviors of NiCrBSi coating in atmosphere and aqueous environments

    NASA Astrophysics Data System (ADS)

    Ye, Yuwei; Wang, Chunting; Zheng, Wenru; Xiong, Wei; Wang, Yongxin; Li, Xiaogang

    2017-09-01

    NiCrBSi coating was deposited successfully on the surface of 316 stainless steel substrate by means of plasma spraying. The microstructures and mechanical property were analyzed by scanning electron microscopy, x-ray diffraction, and a Vickers hardness tester. The wear performances of the coatings sliding against the GCr15 ball under ambient air and water conditions were investigated, and two feasible approaches (tungsten carbide (WC)-doping and heat treatment) were used to improve the tribological performance. Results showed that the hardness of the NiCrBSi coating increased by 12.5% and 28.5% and the porosity decreased by 26.1% and 47.8%, respectively, after WC-doping and heat treatment. During dry friction, the friction coefficient and wear rate of the NiCrBSi coating were about 0.47 and 1.4  ×  10-5 mm3 N-1 m-1, respectively. These values were higher than those obtained on other coatings. In water conditions, all coatings showed a lower friction and wear rate than that in ambient air, which was as a result of the lubrication effect of water. Significantly, with WC-doping and heat treatment, the friction coefficients of both coatings were about 18.5% and 36.7%, respectively, lower than that of the NiCrBSi coating. Furthermore, the wear rates of both coatings were about 20% and 70%, respectively, lower than that of the NiCrBSi coating.

  6. Navy Acquisition: Development of the AN/BSY-1 Combat System

    DTIC Science & Technology

    1992-01-01

    AN/BSY-1, a computer-based combat system, is designed to detect, classify, track, and launch weapons at enemy surface, subsurface, and land targets. The Navy expects the AN/BSY-1 system to locate targets sooner than previous systems, allow operators to perform multiple tasks and address multiple targets concurrently, and reduce the time between detecting a target and launching weapons. The Navy has contracted with the International Business Machines (IBM) Corporation for 23 AN/BSY-1 systems, maintenance and operational trainers, and a software

  7. Validation of the Revised BSI-18 with Latino Migrant Day Laborers

    ERIC Educational Resources Information Center

    Negi, Nalini Junko; Iwamoto, Derek Kenji

    2014-01-01

    Objective: This study examines the factor structure of the Brief Symptom Inventory-18 (BSI-18; Derogatis, 2001) in a hard-to-reach population of mainly undocumented migrant Latino day laborers. While, the BSI-18 has been found to be a valid and reliable measure of psychological distress, cross-cultural assessments in sub-groups of Latinos are…

  8. Combination Vancomycin/Cefazolin (VAN/CFZ) for Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infections (BSI)

    PubMed Central

    Trinh, Trang D; Zasowski, Evan J; Lagnf, Abdalhamid M; Bhatia, Sahil; Dhar, Sorabh; Mynatt, Ryan; Pogue, Jason M; Rybak, Michael J

    2017-01-01

    Abstract Background VAN remains the standard for MRSA BSI but has been associated with treatment failures and resulted in prolonged BSI durations and recurrences. In vitro studies of VAN/CFZ against MRSA demonstrated synergy and prevention of VAN resistance. However, clinical use of VAN/CFZ has not been reported. The objective of this study was to compare patient outcomes treated with VAN/CFZ vs. VAN for MRSA BSI. Methods This was a retrospective, cohort, comparative-effectiveness study of hospitalized adults ≥18y with ≥1 MRSA blood culture and received VAN/CFZ combination for ≥24h or VAN alone initiated within 72h of index infection between 1/1/08 and 5/1/17. Patients who received >24h β-lactams other than CFZ, MRSA-active antibiotics other than VAN, with polymicrobial BSI, or had a second MRSA BSI episode during the study period were excluded. The primary composite failure outcome included: 30d mortality, MRSA BSI ≥7d, and 60d recurrence. Demographics were compared by Χ2, Fisher’s exact, Student’s t, or Mann–Whitney U tests. Multivariable regression models compared outcomes between the two treatment groups. Covariates with p-values ≤0.2 in bivariate analyses were included in the model. Results A total of 101 patients were included (CFZ/VAN = 41, VAN = 60). Demographics were similar except VAN patients were older (mean (±SD) age 58 (±14) v. 51 (±18) y, P = 0.04), had higher median (IQR) Charlson Comorbidity Index (3 (2-5) v. 1 (0–4), P < 0.01), APACHE II scores (13 (8-18) v. 11 (8-18), P = 0.2), and more endocarditis BSI source (37% v. 20%, P = 0.06). After accounting for BSI source, VAN/CFZ (adjusted odds ratio [aOR], 95% confidence intervals [CI], 0.33, 0.13-0.83) and low APACHE II scores (aOR 1.07, 95% CI 1–1.15) were independently associated with fewer failures. Bivariate outcomes are in table below: Variable, n (%) VAN/CFZ VAN P value Composite failure 10 (24) 31 (52) 0.006 30d mortality 3 (7.3) 5 (8.3) 1 BSI ≥7d 6 (15

  9. Psychometric properties and normative data for the Brief Symptom Inventory-18 (BSI-18) in high school and collegiate athletes

    PubMed Central

    McCrea, Michael A.; Nelson, Lindsay D.

    2016-01-01

    Objective Assessment of emotional functioning is important in sport-related concussion (SRC) management, although few standardized measures have been validated in this population, and appropriate normative data are lacking. We investigated the psychometric properties of the Brief Symptom Inventory-18 (BSI-18) in high school and collegiate athletes at risk of SRC and compiled normative data. Method Athletes (n = 2,031) completed the BSI-18 and other measures of concussion symptoms, cognition, and psychological functioning. A subset of healthy individuals was re-evaluated at approximately 7, 30, 45, and 165 days. Psychometric analyses of test–retest reliability, internal consistency reliability, and concurrent validity were performed. Given significant differences between sexes and education levels (high school or college student) on the BSI-18 Global Severity Index and all subscales, normative conversion tables were produced after stratifying by these variables. Results The BSI-18 showed good internal consistency, fair to poor test–retest reliability, and good convergent validity with other measures of emotional functioning. Conclusions These data indicate that the BSI-18 may be a valuable measure of emotional state in concussed athletes and may provide unique information beyond post-concussive symptoms for research on the role of psychological factors in SRC recovery. The limited divergent validity of the BSI-18 depression and anxiety scales implies that they tap into general distress more so than specific mood or anxiety symptoms; therefore, BSI-18 scores should be not relied upon for differential diagnosis of mood and anxiety disorders. Normative data provided can be readily applied to clinical cases with high school and collegiate athletes. PMID:26924037

  10. LiBSi2: a tetrahedral semiconductor framework from boron and silicon atoms bearing lithium atoms in the channels.

    PubMed

    Zeilinger, Michael; van Wüllen, Leo; Benson, Daryn; Kranak, Verina F; Konar, Sumit; Fässler, Thomas F; Häussermann, Ulrich

    2013-06-03

    Silicon swallows up boron: The novel open tetrahedral framework structure (OTF) of the Zintl phase LiBSi2 was made by applying high pressure to a mixture of LiB and elemental silicon. The compound represents a new topology in the B-Si net (called tum), which hosts Li atoms in the channels (see picture). LiBSi2 is the first example where B and Si atoms form an ordered common framework structure with B engaged exclusively in heteronuclear B-Si contacts.

  11. Utility of the Brief Symptom Inventory (BSI) in psychiatric outpatients with intellectual disabilities.

    PubMed

    Wieland, J; Wardenaar, K J; Fontein, E; Zitman, F G

    2012-09-01

    Diagnostics and care for people with intellectual disabilities (ID) and psychiatric disorders need to be improved. This can be done by using assessment instruments to routinely measure the nature and severity of psychiatric symptoms. Up until now, in the Netherlands, assessment measures are seldom used in the psychiatric care for this population. The objective of the present paper is to evaluate the use of the Brief Symptom Inventory (BSI), a widely used standardised questionnaire in general psychiatry, in a well-defined sample of people with borderline intellectual functioning or mild ID diagnosed with one or more psychiatric disorders. A total of 224 psychiatric outpatients with either borderline intellectual functioning or mild ID participated in this study. All participants were new patients of Kristal, Centre for Psychiatry and Intellectual Disability in the Netherlands, in the period between 1 April 2008 and 1 October 2009. All participants were assessed by a multidisciplinary team, including a certified psychiatrist. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria were applied. The mean total intelligence quotient was measured with the Wechsler Adult Intelligence Scale (WAIS-III). The BSI was administered in an assisted fashion. Utility and psychometric properties of the BSI were investigated. Internal consistency coefficients (Cronbach's alphas) were computed. Bivariate correlations between the sub-scales were computed to assess differentiation between the scales. Mean sub-scale scores were compared between different DSM-IV-TR subgroups to investigate the discriminant abilities of the scales. A confirmatory factor analysis was conducted. The results suggest that the BSI is practically useful. Internal consistencies ranged from 0.70 to 0.96 and thus are considered good to adequate. Sub-scale inter-correlations showed there is a degree of differentiation between the sub-scales. Discriminant validity was shown for the sub

  12. Luminescent properties and energy transfer in the green phosphors LaBSiO5:Tb3+, Ce3+.

    PubMed

    Wang, Zhengliang; Cheng, Ping; He, Pei; Liu, Yong; Zhou, Yayun; Zhou, Qiang

    2015-09-01

    LaBSiO5 phosphors doped with Ce(3+) and Tb(3+) were synthesized using the conventional solid-state method at 1100 °C. The phase purity and luminescent properties of these phosphors are investigated. LaBSiO5:Tb(3+) phosphors show intense green emission, and LaBSiO5 phosphors doped with Ce(3+) show blue-violet emission under UV light excitation. LaBSiO5 phosphors co-doped with Ce(3+) and Tb(3+) exhibit blue-violet and green emission under excitation by UV light. The blue-violet emission is due to the 5d-4f transition of Ce(3+) and the green emission is ascribed to the (5) D4 → (7) F5 transition of Tb(3+). The spectral overlap between the excitation band of Tb(3+) and the emission band of Ce(3+) supports the occurrence of energy transfer from Ce(3+) to Tb(3+), and the energy transfer process was investigated. Copyright © 2014 John Wiley & Sons, Ltd.

  13. Imaging electrical conductivity, permeability, and/or permittivity contrasts using the Born Scattering Inversion (BSI)

    NASA Astrophysics Data System (ADS)

    Darrh, A.; Downs, C. M.; Poppeliers, C.

    2017-12-01

    Born Scattering Inversion (BSI) of electromagnetic (EM) data is a geophysical imaging methodology for mapping weak conductivity, permeability, and/or permittivity contrasts in the subsurface. The high computational cost of full waveform inversion is reduced by adopting the First Born Approximation for scattered EM fields. This linearizes the inverse problem in terms of Born scattering amplitudes for a set of effective EM body sources within a 3D imaging volume. Estimation of scatterer amplitudes is subsequently achieved by solving the normal equations. Our present BSI numerical experiments entail Fourier transforming real-valued synthetic EM data to the frequency-domain, and minimizing the L2 residual between complex-valued observed and predicted data. We are testing the ability of BSI to resolve simple scattering models. For our initial experiments, synthetic data are acquired by three-component (3C) electric field receivers distributed on a plane above a single point electric dipole within a homogeneous and isotropic wholespace. To suppress artifacts, candidate Born scatterer locations are confined to a volume beneath the receiver array. Also, we explore two different numerical linear algebra algorithms for solving the normal equations: Damped Least Squares (DLS), and Non-Negative Least Squares (NNLS). Results from NNLS accurately recover the source location only for a large dense 3C receiver array, but fail when the array is decimated, or is restricted to horizontal component data. Using all receiver stations and all components per station, NNLS results are relatively insensitive to a sub-sampled frequency spectrum, suggesting that coarse frequency-domain sampling may be adequate for good target resolution. Results from DLS are insensitive to diminishing array density, but contain spatially oscillatory structure. DLS-generated images are consistently centered at the known point source location, despite an abundance of surrounding structure.

  14. Differences in Hispanic Access and Success Rates for Health-Related Studies in Texas Health-Related Institutions: A Multiyear, Statewide Investigation

    ERIC Educational Resources Information Center

    Cox, Shelley M.

    2013-01-01

    Purpose: The purpose of this study was to examine Hispanic student access and success in health-related degrees by examining enrollment and graduation rates over a period of 13 years. Archival data were obtained from the THECB consisting of the number of Hispanic students enrolled and number of degrees awarded in the health-related degrees at…

  15. Cigarette access and pupil smoking rates: a circular relationship?

    PubMed

    Turner, Katrina M; Gordon, Jacki; Young, Robert

    2004-12-01

    Adolescents obtain cigarettes from both commercial and social sources. While the relationship between commercial access and adolescent smoking has been researched, no one has considered in detail whether rates of peer smoking affect cigarette availability. In two relatively deprived Scottish schools that differed in their pupil smoking rates, we assess pupil access to cigarettes. 896 13 and 15 year olds were surveyed, and 25 single-sex discussion groups held with a sub-sample of the 13 year olds. Smokers in both schools obtained cigarettes from shops, food vans and other pupils. However, pupils in the 'high' smoking school perceived greater access to both commercial and social sources, and had access to an active 'peer market'. These findings suggest that variations in cigarette access may contribute to school differences in pupil smoking rates, and that the relationship between access and adolescent smoking is circular, with greater availability increasing rates, and higher rates enhancing access.

  16. Proposing an Empirically Justified Reference Threshold for Blood Culture Sampling Rates in Intensive Care Units

    PubMed Central

    Castell, Stefanie; Schwab, Frank; Geffers, Christine; Bongartz, Hannah; Brunkhorst, Frank M.; Gastmeier, Petra; Mikolajczyk, Rafael T.

    2014-01-01

    Early and appropriate blood culture sampling is recommended as a standard of care for patients with suspected bloodstream infections (BSI) but is rarely taken into account when quality indicators for BSI are evaluated. To date, sampling of about 100 to 200 blood culture sets per 1,000 patient-days is recommended as the target range for blood culture rates. However, the empirical basis of this recommendation is not clear. The aim of the current study was to analyze the association between blood culture rates and observed BSI rates and to derive a reference threshold for blood culture rates in intensive care units (ICUs). This study is based on data from 223 ICUs taking part in the German hospital infection surveillance system. We applied locally weighted regression and segmented Poisson regression to assess the association between blood culture rates and BSI rates. Below 80 to 90 blood culture sets per 1,000 patient-days, observed BSI rates increased with increasing blood culture rates, while there was no further increase above this threshold. Segmented Poisson regression located the threshold at 87 (95% confidence interval, 54 to 120) blood culture sets per 1,000 patient-days. Only one-third of the investigated ICUs displayed blood culture rates above this threshold. We provided empirical justification for a blood culture target threshold in ICUs. In the majority of the studied ICUs, blood culture sampling rates were below this threshold. This suggests that a substantial fraction of BSI cases might remain undetected; reporting observed BSI rates as a quality indicator without sufficiently high blood culture rates might be misleading. PMID:25520442

  17. Procedural and educational interventions to reduce ventilator-associated pneumonia rate and central line-associated blood stream infection rate.

    PubMed

    Kellie, Scott P; Scott, Michael J; Cavallazzi, Rodrigo; Wiemken, Tim L; Goss, Linda; Parker, Deanna; Saad, Mohamed

    2014-01-01

    Implementing best practice guidelines for ventilator-associated pneumonia (VAP) and central line-associated blood stream infection (CLA-BSI) has variable success. Our institution was concerned with high rates of VAP and CLA-BSI. This retrospective study was undertaken to see whether implementation of the below practices would reduce the rates of VAP and CLA-BSI without resorting to more expensive interventions such as subglottic endotracheal (ET) tube suctioning or silver-impregnated ET tubes. We utilized easily collectable data (standardized infection ratios [SIRs]) to rapidly assess whether interventions already in place were successful. This avoided cumbersome data collection and review. Retrospective data review calculated SIRs using National Healthcare Safety Network benchmarks. Rates and SIRs were compared using z tests with P values <.05 considered statistically significant. This data review attempted to examine the impact of education campaigns, staff meetings, in-services, physician checklist, nurse checklist, charge nurse checklist implementation, and chlorhexidine gluconate oral care addition to the VAP bundle. Additionally, central line insertion required nursing supervision, a checklist, and physician signature. The incidence rate of VAP went from 9.88 occurrences/1000 vent days in 2009 to 0 occurrences/1000 vent days in 2010 (P < .001). The CLA-BSI occurrences/1000 line days were 2.86 in 2009 and 0.97 in 2010 (P = .0187). The SIR for VAP was 4.12 in 2009 and 0 in 2010 (P < .001). For CLA-BSI, the SIR was 1.1 in 2009 and 0.37 in 2010 (P = .04). Efforts to improve physician, patient, and staff education, and checklist implementation resulted in a decrease in VAP and CLA-BSI. This study confirms the applicability of best practice guidelines and suggests a benefit to the use of checklists. We utilize a practical approach for examining the success of these changes.

  18. Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients.

    PubMed

    Patel, Priti R; Kallen, Alexander J; Arduino, Matthew J

    2010-09-01

    Infections cause significant morbidity and mortality in patients undergoing hemodialysis. Bloodstream infections (BSIs) are particularly problematic, accounting for a substantial number of hospitalizations in these patients. Hospitalizations for BSI and other vascular access infections appear to have increased dramatically in hemodialysis patients since 1993. These infections frequently are related to central venous catheter (CVC) use for dialysis access. Regional initiatives that have shown successful decreases in catheter-related BSIs in hospitalized patients have generated interest in replicating this success in outpatient hemodialysis populations. Several interventions have been effective in preventing BSIs in the hemodialysis setting. Avoiding the use of CVCs in favor of access types with lower associated BSI risk is among the most important. When CVCs are used, adherence to evidence-based catheter insertion and maintenance practices can positively influence BSI rates. In addition, facility-level surveillance to detect BSIs and stimulate examination of vascular access use and care practices is essential to a comprehensive approach to prevention. This article describes the current epidemiology of BSIs in hemodialysis patients and effective prevention strategies to decrease the incidence of these devastating infections.

  19. Drug-Related Arrest Rates and Spatial Access to Syringe Exchange Programs in New York City Health Districts: Combined Effects on the Risk of Injection-Related Infections among Injectors

    PubMed Central

    Jarlais, Don C Des; Tempalski, Barbara; Bossak, Brian H; Ross, Zev; Friedman, Samuel R

    2011-01-01

    Drug-related law enforcement activities may undermine the protective effects of syringe exchange programs (SEPs) on local injectors’ risk of injection-related infections. We explored the spatial overlap of drug-related arrest rates and access to SEPs over time (1995-2006) in New York City health districts, and used multilevel models to investigate the relationship of these two district-level exposures to the odds of injecting with an unsterile syringe. Districts with better SEP access had higher arrest rates, and arrest rates undermined SEPs’ protective relationship with unsterile injecting. Drug-related enforcement strategies targeting drug users should be de-emphasized in areas surrounding SEPs. PMID:22047790

  20. New materials and devices for preventing catheter-related infections

    PubMed Central

    2011-01-01

    Catheters are the leading source of bloodstream infections for patients in the intensive care unit (ICU). Comprehensive unit-based programs have proven to be effective in decreasing catheter-related bloodstream infections (CR-BSIs). ICU rates of CR-BSI higher than 2 per 1,000 catheter-days are no longer acceptable. The locally adapted list of preventive measures should include skin antisepsis with an alcoholic preparation, maximal barrier precautions, a strict catheter maintenance policy, and removal of unnecessary catheters. The development of new technologies capable of further decreasing the now low CR-BSI rate is a major challenge. Recently, new materials that decrease the risk of skin-to-vein bacterial migration, such as new antiseptic dressings, were extensively tested. Antimicrobial-coated catheters can prevent CR-BSI but have a theoretical risk of selecting resistant bacteria. An antimicrobial or antiseptic lock may prevent bacterial migration from the hub to the bloodstream. This review discusses the available knowledge about these new technologies. PMID:21906266

  1. Staphylococcus aureus healthcare associated bacteraemia: An indicator of catheter related infections.

    PubMed

    Bonnal, C; Birgand, G; Lolom, I; Diamantis, S; Dumortier, C; L'Heriteau, F; Armand-Lefevre, L; Lucet, J C

    2015-03-01

    Surveillance of preventable healthcare associated infections and feedback of the results to clinicians is central in the efforts to improve performance. We assessed Staphylococcus aureus healthcare associated bloodstream infection (HA-BSI) as an indicator of healthcare quality. Between 2002 and 2012, we carried out a ten-year prospective bedside surveillance of S. aureus healthcare associated bacteraemia in a 940-bed university hospital using standard definitions. Overall, 2784 HA-BSI were identified during the study period, among which 573 (18%) were due to S. aureus. Among these 573 S. aureus bacteraemias, 189 originated from intravascular catheters (32.8%) of which 84% (158/189) in patients outside intensive care units. The proportion of catheter related HA-BSI due to S. aureus was 56% (61/109) in PVC-related HA-BSI and 34% (103/301) in CVC-related HA-BSI. A sharp decrease of PVC-related HA-BSI from 20 to 7 per year was obtained during the same period. In our experience, S. aureus HA-BSI is a simple and useful indicator of catheter associated infections, and therefore of healthcare quality, especially in units not covered by other type of surveillance. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. Decreasing dialysis catheter rates by creating a multidisciplinary dialysis access program.

    PubMed

    Rosenberry, Patricia M; Niederhaus, Silke V; Schweitzer, Eugene J; Leeser, David B

    2018-03-01

    Centers for Medicare and Medicaid Services have determined that chronic dialysis units should have <12% of their patients utilizing central venous catheters for hemodialysis treatments. On the Eastern Shore of Maryland, the central venous catheter rates in the dialysis units averaged >45%. A multidisciplinary program was established with goals of decreasing catheter rates in order to decrease central line-associated bloodstream infections, decrease mortality associated with central line-associated bloodstream infection, decrease hospital days, and provide savings to the healthcare system. We collected the catheter rates within three dialysis centers served over a 5-year period. Using published data surrounding the incidence and related costs of central line-associated bloodstream infection and mortality per catheter day, the number of central line-associated bloodstream infection events, the costs, and the related mortality could be determined prior to and after the initiation of the dialysis access program. An organized dialysis access program resulted in a 82% decrease in the number of central venous catheter days which lead to a concurrent reduction in central line-associated bloodstream infection and deaths. As a result of creating an access program, central venous catheter rates decreased from an average rate of 45% to 8%. The cost savings related to the program was calculated to be over US$5 million. The decrease in the number of mortalities is estimated to be between 13 and 27 patients. We conclude that a formalized access program decreases catheter rates, central line-associated bloodstream infection, and the resultant hospitalizations, mortality, and costs. Areas with high hemodialysis catheter rates should develop access programs to better serve their patient population.

  3. Children's Access to Dental Care Affected by Reimbursement Rates, Dentist Density, and Dentist Participation in Medicaid.

    PubMed

    Chalmers, Natalia I; Compton, Robert D

    2017-10-01

    To assess the relation between Medicaid reimbursement rates and access to dental care services in the context of dentist density and dentist participation in Medicaid in each state. Data were from Early and Periodic Screening, Diagnostic, and Treatment reports for 2014, Medicaid reimbursement rate in 2013, dentist density in 2014, and dentist participation in Medicaid in 2014. We assessed patterns of mediation or moderation. Reimbursement rates and access to dental care were directly related at the state level, but no evidence indicated that higher reimbursement rates resulted in overuse of dental services for those who had access. The relation between reimbursement rates and access to care was moderated by dentist density and dentist participation in Medicaid. We estimate that more than 1.8 million additional children would have had access to dental care if reimbursement rates were higher in states with low rates. Children who access the dental care system receive care, but reimbursement may significantly affect access. States with low dentist density and low dentist participation in Medicaid may be able to improve access to dental services significantly by increasing reimbursement rates.

  4. Accessibility of Nitroxide Side Chains: Absolute Heisenberg Exchange Rates from Power Saturation EPR

    PubMed Central

    Altenbach, Christian; Froncisz, Wojciech; Hemker, Roy; Mchaourab, Hassane; Hubbell, Wayne L.

    2005-01-01

    In site-directed spin labeling, the relative solvent accessibility of spin-labeled side chains is taken to be proportional to the Heisenberg exchange rate (Wex) of the nitroxide with a paramagnetic reagent in solution. In turn, relative values of Wex are determined by continuous wave power saturation methods and expressed as a proportional and dimensionless parameter Π. In the experiments presented here, NiEDDA is characterized as a paramagnetic reagent for solvent accessibility studies, and it is shown that absolute values of Wex can be determined from Π, and that the proportionality constant relating them is independent of the paramagnetic reagent and mobility of the nitroxide. Based on absolute exchange rates, an accessibility factor is defined (0 < ρ < 1) that serves as a quantitative measure of side-chain solvent accessibility. The accessibility factors for a nitroxide side chain at 14 different sites in T4 lysozyme are shown to correlate with a structure-based accessibility parameter derived from the crystal structure of the protein. These results provide a useful means for relating crystallographic and site-directed spin labeling data, and hence comparing crystal and solution structures. PMID:15994891

  5. Does gun accessibility lead to violence-related injury?

    PubMed

    Downey, La Vonne A; Zun, Leslie S; Burke, Trena; Jefferson, Tangula

    2013-02-01

    Because of high rates of violent gun-related injuries seen in emergency department (EDs), the ED has become involved in prevention violence intervention. The purpose of the study was to determine the relation between access to guns and the risk of violence-related injuries in youth and young adults. This study was a convenience sample in an inner-city level I trauma center. A 28-item validated questionnaire consisting of a short questionnaire about guns, the New York City Youth Violence Survey, and the SAGE Baseline Survey was given to 201 subjects. Half of the subjects were victims of violence and half were seen for nonviolence-related problems. Subjects with violence-related injuries did not have a higher rate of accessibility to guns. They did, however, show a difference in their attitudes toward guns. The subjects who came into the ED with violence-related injuries believed that having a weapon was a way to avoid a fight (F = 4.68, P = 0.032). They were more likely to have grabbed or shoved someone in the last 6 months (F = 5.18, P = 0.025), punched someone in the last 6 months (F = 11.9, P = 0.011), and have been seen in the ED within the last 6 months for a injury related to being punched, attacked, or shot (F = 117, P = 0.00), as compared to those with nonviolence-related injuries. There was no difference between the two subject groups in terms of their being victims of violence and the rate of gun accessibility. There was, however, a difference in their attitudes toward guns.

  6. Local Access to Family Planning Services and Female High School Dropout Rates.

    PubMed

    Hicks-Courant, Katherine; Schwartz, Aaron L

    2016-04-01

    To assess whether geographic access to family planning services is associated with a reduced female high school dropout rate. We conducted a retrospective cross-sectional study. We merged the location of Planned Parenthood and Title X clinics with microdata from the 2012-2013 American Community Surveys. The association between female high school dropout rates and local clinic access was assessed using nearest-neighbor matching estimation. Models included various covariates to account for sociodemographic differences across communities and male high school dropout rates to account for unmeasured community characteristics affecting educational outcomes. Our sample included 284,910 16- to 22-year-old females. The presence of a Planned Parenthood clinic was associated with a decrease (4.08% compared with 4.83%; relative risk ratio 0.84, P<.001) in female high school dropout rates. This association was consistent across several model specifications. The presence of a Title X clinic was associated with a decrease (4.79% compared with 5.07%; relative risk ratio 0.94, P=.03) in female high school dropout rates, an association that did not remain significant across model specifications. Local access to Planned Parenthood is associated with lower high school dropout rates in young women.

  7. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

    PubMed Central

    Frandon, Julien; Rodiere, Mathieu; Arvieux, Catherine; Vendrell, Anne; Boussat, Bastien; Sengel, Christian; Broux, Christophe; Bricault, Ivan; Ferretti, Gilbert; Thony, Frédéric

    2015-01-01

    PURPOSE We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. METHODS Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. RESULTS The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural drainage, acute renal failures, and pancreatitis in OM and more pseudocysts in SAE. Six prognostic factors were statistically significant for one or more adverse events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. CONCLUSION Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury. PMID:26081719

  8. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

    PubMed

    Frandon, Julien; Rodiere, Mathieu; Arvieux, Catherine; Vendrell, Anne; Boussat, Bastien; Sengel, Christian; Broux, Christophe; Bricault, Ivan; Ferretti, Gilbert; Thony, Frédéric

    2015-01-01

    We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural drainage, acute renal failures, and pancreatitis in OM and more pseudocysts in SAE. Six prognostic factors were statistically significant for one or more adverse events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury.

  9. Biogeochemistry of silica in Devils Lake: Implications for diatom preservation

    USGS Publications Warehouse

    Lent, R.M.; Lyons, B.

    2001-01-01

    Diatom-salinity records from sediment cores have been used to construct climate records of saline-lake basins. In many cases, this has been done without thorough understanding of the preservation potential of the diatoms in the sediments through time. The purpose of this study was to determine the biogeochemistry of silica in Devils Lake and evaluate the potential effects of silica cycling on diatom preservation. During the period of record, 1867-1999, lake levels have fluctuated from 427 m above sea level in 1940 to 441.1 m above sea level in 1999. The biogeochemistry of silica in Devils Lake is dominated by internal cycling. During the early 1990s when lake levels were relatively high, about 94% of the biogenic silica (BSi) produced in Devils Lake was recycled in the water column before burial. About 42% of the BSi that was incorporated in bottom sediments was dissolved and diffused back into the lake, and the remaining 58% was buried. Therefore, the BSi accumulation rate was about 3% of the BSi assimilation rate. Generally, the results obtained from this study are similar to those obtained from studies of the biogeochemistry of silica in large oligotrophic lakes and the open ocean where most of the BSi produced is recycled in surface water. During the mid 1960s when lake levels were relatively low, BSi assimilation and water-column dissolution rates were much higher than when lake levels were high. The BSi assimilation rate was as much as three times higher during low lake levels. Even with the much higher BSi assimilation rate, the BSi accumulation rate was about three times lower because the BSi water-column dissolution rate was more than 99% of the BSi assimilation rate compared to 94% during high lake levels. Variations in the biogeochemistry of silica with lake level have important implications for paleolimnologic studies. Increased BSi water-column dissolution during decreasing lake levels may alter the diatom-salinity record by selectively removing the

  10. Connecting Related Rates and Differential Equations

    ERIC Educational Resources Information Center

    Brandt, Keith

    2012-01-01

    This article points out a simple connection between related rates and differential equations. The connection can be used for in-class examples or homework exercises, and it is accessible to students who are familiar with separation of variables.

  11. 76 FR 10925 - Bio-Life Labs, Inc., BSI2000, Inc., Calais Resources, Inc., EGX Funds Transfer, Inc., Great...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-28

    ... SECURITIES AND EXCHANGE COMMISSION [File No. 500-1] Bio-Life Labs, Inc., BSI2000, Inc., Calais Resources, Inc., EGX Funds Transfer, Inc., Great Western Land Recreation, Inc. (a/k/a Great Western Land and... securities of Bio-Life Labs, Inc. because it has not filed any periodic reports since the period ended March...

  12. Maintaining and sustaining the On the CUSP: stop BSI model in Hawaii.

    PubMed

    Lin, Della M; Weeks, Kristina; Holzmueller, Christine G; Pronovost, Peter J; Pham, Julius Cuong

    2013-02-01

    Hawaii joined the On the CUSP: Stop BSI national effort in the United States in 2009 (CUSP stands for Comprehensive Unit-based Safety Program). In the initial 18-month study evaluation, adult ICUs decreased central line-associated bloodstream infection (CLABSI) rates by 61%. The impact of a series of novel strategies/tools in reducing infections and sustaining the collaborative in ICUs and non-ICUs in Hawaii was assessed. This cohort collaborative consisted of 20 adult ICUs and 18 nonadult ICUs in 16 hospitals. Hawaii developed and implemented six tools between July 2010 and August 2011: a tool to investigate CLABSIs, a video to address cultural barriers, a standardized dressing change kit, a map of the cohort's journey, a 12-strategies leadership dashboard, and a geometric plot of consecutive infection-free days. The primary outcome measure was overall CLABSI rates (mean infections per 1,000 catheter-days). A comparison of baseline data from 28 ICUs with 12-quarter (36-month) postimplementation data indicated that the CLABSI rate decreased across the entire state: overall, 1.57 to 0.29 infections/1,000 catheter-days; adult ICUs, 1.49 to 0.25 infections/1,000 catheter-days; nonadult ICUs, 2.54 to 0.33 infections/1,000 catheter-days, non-ICUs (N= 14), 4.52 to 0.25 infections/1,000 catheter-days, and PICU/NICU (N = 4), 2.05 to 0.53 infections/1,000 catheter-days. Days between CLABSIs in the adult ICUs statewide increased from a median of 5 days in 2009 to 70 days in 2011. Hawaii successfully spread the program beyond adult ICUs and implemented a series of tools for maintenance and sustainment. Use of the tools shaped a culture around the continued belief that CLABSIs can be eradicated, and infections further reduced.

  13. Incidence rates of hospital-acquired urinary tract and bloodstream infections generated by automated compilation of electronically available healthcare data.

    PubMed

    Redder, J D; Leth, R A; Møller, J K

    2015-11-01

    Monitoring of hospital-acquired infection (HAI) by automated compilation of registry data may address the disadvantages of laborious, costly and potentially subjective and often random sampling of data by manual surveillance. To evaluate a system for automated monitoring of hospital-acquired urinary tract (HA-UTI) and bloodstream infections (HA-BSI) and to report incidence rates over a five-year period in a Danish hospital trust. Based primarily on electronically available data relating to microbiology results and antibiotic prescriptions, the automated monitoring of HA-UTIs and HA-BSIs was validated against data from six previous point-prevalence surveys (PPS) from 2010 to 2013 and data from a manual assessment (HA-UTI only) of one department of internal medicine from January 2010. Incidence rates (infections per 1000 bed-days) from 2010 to 2014 were calculated. Compared with the PPSs, the automated monitoring showed a sensitivity of 88% in detecting UTI in general, 78% in detecting HA-UTI, and 100% in detecting BSI in general. The monthly incidence rates varied between 4.14 and 6.61 per 1000 bed-days for HA-UTI and between 0.09 and 1.25 per 1000 bed-days for HA-BSI. Replacing PPSs with automated monitoring of HAIs may provide better and more objective data and constitute a promising foundation for individual patient risk analyses and epidemiological studies. Automated monitoring may be universally applicable in hospitals with electronic databases comprising microbiological findings, admission data, and antibiotic prescriptions. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  14. Fluctuations in Wikipedia access-rate and edit-event data

    NASA Astrophysics Data System (ADS)

    Kämpf, Mirko; Tismer, Sebastian; Kantelhardt, Jan W.; Muchnik, Lev

    2012-12-01

    Internet-based social networks often reflect extreme events in nature and society by drastic increases in user activity. We study and compare the dynamics of the two major complex processes necessary for information spread via the online encyclopedia ‘Wikipedia’, i.e., article editing (information upload) and article access (information viewing) based on article edit-event time series and (hourly) user access-rate time series for all articles. Daily and weekly activity patterns occur in addition to fluctuations and bursting activity. The bursts (i.e., significant increases in activity for an extended period of time) are characterized by a power-law distribution of durations of increases and decreases. For describing the recurrence and clustering of bursts we investigate the statistics of the return intervals between them. We find stretched exponential distributions of return intervals in access-rate time series, while edit-event time series yield simple exponential distributions. To characterize the fluctuation behavior we apply detrended fluctuation analysis (DFA), finding that most article access-rate time series are characterized by strong long-term correlations with fluctuation exponents α≈0.9. The results indicate significant differences in the dynamics of information upload and access and help in understanding the complex process of collecting, processing, validating, and distributing information in self-organized social networks.

  15. International Nosocomial Infection Control Consortium Findings of Device-Associated Infections Rate in an Intensive Care Unit of a Lebanese University Hospital

    PubMed Central

    Kanj, SS; Kanafani, ZA; Sidani, N; Alamuddin, L; Zahreddine, N; Rosenthal, VD

    2012-01-01

    Objectives: To determine the rates of device-associated healthcare-associated infections (DA-HAI), microbiological profile, bacterial resistance, length of stay (LOS), excess mortality and hand hygiene compliance in one intensive care unit (ICU) of a hospital member of the International Infection Control Consortium (INICC) in Beirut, Lebanon. Materials and Methods: An open label, prospective cohort, active DA-HAI surveillance study was conducted on adults admitted to a tertiary-care ICU in Lebanon from November 2007 to March 2010. The protocol and methodology implemented were developed by INICC. Data collection was performed in the participating ICUs. Data uploading and analyses were conducted at INICC headquarters on proprietary software. DA-HAI rates were recorded by applying the definitions of the National Healthcare Safety Network (NHSN) at the US Centers for Disease Control and Prevention (CDC). We analyzed the DA-HAI, mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI) rates, microorganism profile, excess LOS, excess mortality, and hand hygiene compliance. Results: A total of 666 patients hospitalized for 5,506 days acquired 65 DA-HAIs, an overall rate of 9.8% [(95% confidence interval (CI) 7.6–12.3], and 11.8 (95% CI 9.1–15.0) DA-HAIs per 1000 ICU-days. The CLA-BSI rate was 5.2 (95% CI 2.8–8.7) per 1000 catheter-days; the VAP rate was 8.1 (95% CI 5.5–11.7) per 1000 ventilator-days; and the CAUTI rate was 4.1 (95% CI 2.6–6.2) per 1000 catheter-days. LOS of patients was 7.3 days for those without DA-HAI, 13.8 days for those with CLA-BSI, 18.8 days for those with VAP. Excess mortality was 40.9% [relative risk (RR) 3.14; P 0.004] for CLA-BSI. Mortality of VAP and CAUTI was not significantly different from patients without DA-HAI. Escherichia coli was the most common isolated microorganism. Overall hand hygiene compliance was 84.9% (95% CI 82

  16. Factorial Invariance of the Brief Symptom Inventory-18 (BSI-18) for Adults of Mexican Descent across Nativity Status, Language Format, and Gender

    ERIC Educational Resources Information Center

    Torres, Lucas; Miller, Matthew J.; Moore, Kelly M.

    2013-01-01

    The cultural equivalence of psychological outcome measures remains a major area of investigation. The current study sought to test the factor structure and factorial invariance of the Brief Symptom Inventory-18 (BSI-18) with a sample of adult individuals of Mexican descent (N = 923) across nativity status (U.S.- vs. foreign-born), language format…

  17. The Effect of Community Uninsurance Rates on Access to Health Care

    PubMed Central

    Sabik, Lindsay M

    2012-01-01

    Objective To investigate the effect of local uninsurance rates on access to health care for the uninsured and insured and improve on recent studies by controlling for time-invariant differences across markets. Data Sources Individual-level data from the 1996 and 2003 Community Tracking Study, and market-level data from other sources, including the Area Resource File and the Bureau of Primary Healthcare. Study Design Market-level fixed effects models estimate the effect of changes in uninsurance rates within markets on access to care, measured by whether individuals report forgoing necessary care. Instrumental variables models are also estimated. Principal Findings Increases in the rate of uninsurance are associated with poorer access to necessary care among the uninsured. In contrast with recent evidence, increases in uninsurance had no effect on access to care among the insured. Instrumental variables results are similar, although not statistically significant. Conclusions Changes in rates of insurance coverage are likely to affect access to care for both previously and continuously uninsured. In contrast with earlier studies, there is no evidence of spillover effects on the insured, suggesting that such policy changes may have little effect on access for those who are already insured. PMID:22172046

  18. Reducing haemodialysis access infection rates.

    PubMed

    Dorman, Amanda; Dainton, Marissa

    Infections are the second most common cause of vascular access loss in the long-term haemodialysis patient, and recent years have seen an increase in healthcare-associated infections (HCAIs) associated with vascular access (Suhail, 2009). There have been a number of drivers including publication guidelines (Department of Health, 2006; 2007) and local protocols providing evidence-based recommendations that, when implemented, can reduce the risk of these infections. In England, the selection of bloodstream infections caused by methicillin resistant staphylococcus aureus (MRSA) as a significant clinical outcome has led to a vast amount of work in this area. Root cause analysis of individual infections (by the clinical teams when these occur) in many specialities identified areas where practice could be improved, including practice relating to vascular access within the renal setting. Manufacturers have also supported this work by focusing on developing products that are designed to reduce the likelihood of infections occurring. One product identified and used within the NHS is Chloraprep.

  19. Peripherally Inserted Central Catheter-Related Infections in a Cohort of Hospitalized Adult Patients

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bouzad, Caroline, E-mail: caroline.bouzad@gmail.com; Duron, Sandrine, E-mail: duronsandrine@yahoo.fr; Bousquet, Aurore, E-mail: aurorebousquet@yahoo.fr

    PurposeTo determine the incidence and the risks factors of peripherally inserted central catheter (PICC)-related infectious complications.Materials and MethodsMedical charts of every in-patient that underwent a PICC insertion in our hospital between January 2010 and October 2013 were reviewed. All PICC-related infections were recorded and categorized as catheter-related bloodstream infections (CR-BSI), exit-site infections, and septic thrombophlebitis.ResultsNine hundred and twenty-three PICCs were placed in 644 unique patients, mostly male (68.3 %) with a median age of 58 years. 31 (3.4 %) PICC-related infections occurred during the study period corresponding to an infection rate of 1.64 per 1000 catheter-days. We observed 27 (87.1 %) CR-BSI, corresponding tomore » a rate of 1.43 per 1000 catheter-days, 3 (9.7 %) septic thrombophlebitis, and 1 (3.2 %) exit-site infection. Multivariate logistic regression analysis showed a higher PICC-related infection rate with chemotherapy (odds ratio (OR) 7.2–confidence interval (CI) 95 % [1.77–29.5]), auto/allograft (OR 5.9–CI 95 % [1.2–29.2]), and anti-coagulant therapy (OR 2.2–95 % [1.4–12]).ConclusionChemotherapy, auto/allograft, and anti-coagulant therapy are associated with an increased risk of developing PICC-related infections.Clinical AdvanceChemotherapy, auto/allograft, and anti-coagulant therapy are important predictors of PICC-associated infections. A careful assessment of these risk factors may be important for future success in preventing PICC-related infections.« less

  20. Impact of a modified Broviac maintenance care bundle on bloodstream infections in paediatric cancer patients

    PubMed Central

    Furtwängler, Rhoikos; Laux, Carolin; Graf, Norbert; Simon, Arne

    2015-01-01

    Background: During intensive chemotherapy, bloodstream infection (BSI) represents an important complication in paediatric cancer patients. Most patients carry a long-term central venous access device (CVAD). Improved maintenance care of these vascular catheters may decrease the risk of BSI. Methods: Intervention study (adapted CVAD prevention protocol) with two observation periods (P1: 09-2009 until 05-2011; P2: 09-2011 until 05-2013); prospective surveillance of all laboratory confirmed BSIs. In P2, ready to use sterile NaCl 0.9% syringes were used for CVAD flushing and octenidine/isopropanol for the disinfection of catheter hubs and 3-way stopcocks. Results: During P1, 84 patients were included versus 81 patients during P2. There were no significant differences between the two patient populations in terms of median age, gender, underlying malignancy or disease status (first illness or relapse). Nearly all CVADs were Broviac catheters. The median duration from implantation to removal of the CVAD was 192 days (Inter-quartile-range (IQR); 110–288 days) in P1 and 191 days (IQR; 103–270 days) in P2. 28 BSI were diagnosed in 22 patients in P1 (26% of all patients experienced at least one BSI) and 15 BSI in 12 patients in P2 (15% of all patients). The corresponding results for incidence density (ID) were 0.44 (CI95 0.29–0.62) for P1 vs. 0.34 (0.19–0.53) BSI per 100 inpatient days for P2 and for incidence rate (IR) 7.76 (5.16–10.86) in P1 vs. 4.75 (2.66–7.43) BSI per 1,000 inpatient CVAD utilization days. In P1, 9 BSI were caused by CoNS vs. only 2 in P2 (IR 2.49; CI95 0.17–4.17 vs. 0.63; CI95 0.08–1.72). In P1 two BSI (7%) lead to early removal of the device. During P2 one CVAD was prematurely removed due to a Broviac-related BSI (6.7%). Conclusion: The preventive protocol investigated in this study led to a reduction of BSI in paediatric cancer patients. This result was clinically relevant but – due to insufficient power in a single centre observation

  1. Thermal analysis and vibrational spectroscopic characterization of the boro silicate mineral datolite - CaBSiO4(OH)

    NASA Astrophysics Data System (ADS)

    Frost, Ray L.; Xi, Yunfei; Scholz, Ricardo; Lima, Rosa Malena Fernandes; Horta, Laura Frota Campos; Lopez, Andres

    2013-11-01

    The objective of this work is to determine the thermal stability and vibrational spectra of datolite CaBSiO4(OH) and relate these properties to the structure of the mineral. The thermal analysis of datolite shows a mass loss of 5.83% over a 700-775 °C temperature range. This mass loss corresponds to 1 water (H2O) molecules pfu. A quantitative chemical analysis using electron probe was undertaken. The Raman spectrum of datolite is characterized by bands at 917 and 1077 cm-1 assigned to the symmetric stretching modes of BO and SiO tetrahedra. A very intense Raman band is observed at 3498 cm-1 assigned to the stretching vibration of the OH units in the structure of datolite. BOH out-of-plane vibrations are characterized by the infrared band at 782 cm-1. The vibrational spectra are based upon the structure of datolite based on sheets of four- and eight-membered rings of alternating SiO4 and BO3(OH) tetrahedra with the sheets bonded together by calcium atoms.

  2. Relative evolutionary rate inference in HyPhy with LEISR.

    PubMed

    Spielman, Stephanie J; Kosakovsky Pond, Sergei L

    2018-01-01

    We introduce LEISR (Likehood Estimation of Individual Site Rates, pronounced "laser"), a tool to infer relative evolutionary rates from protein and nucleotide data, implemented in HyPhy. LEISR is based on the popular Rate4Site (Pupko et al., 2002) approach for inferring relative site-wise evolutionary rates, primarily from protein data. We extend the original method for more general use in several key ways: (i) we increase the support for nucleotide data with additional models, (ii) we allow for datasets of arbitrary size, (iii) we support analysis of site-partitioned datasets to correct for the presence of recombination breakpoints, (iv) we produce rate estimates at all sites rather than at just a subset of sites, and (v) we implemented LEISR as MPI-enabled to support rapid, high-throughput analysis. LEISR is available in HyPhy starting with version 2.3.8, and it is accessible as an option in the HyPhy analysis menu ("Relative evolutionary rate inference"), which calls the HyPhy batchfile LEISR.bf.

  3. 47 CFR 51.911 - Access reciprocal compensation rates for competitive LECs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 3 2013-10-01 2013-10-01 false Access reciprocal compensation rates for competitive LECs. 51.911 Section 51.911 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.911 Access...

  4. 47 CFR 51.911 - Access reciprocal compensation rates for competitive LECs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 3 2012-10-01 2012-10-01 false Access reciprocal compensation rates for competitive LECs. 51.911 Section 51.911 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.911 Access...

  5. 47 CFR 51.911 - Access reciprocal compensation rates for competitive LECs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Access reciprocal compensation rates for competitive LECs. 51.911 Section 51.911 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.911 Access...

  6. In situ diagnostic methods for catheter related bloodstream infection in burns patients: A pilot study.

    PubMed

    Evans, O; Gowardman, J; Rabbolini, D; McGrail, M; Rickard, C M

    2016-03-01

    One of the most common and potentially fatal complications in critically ill burns patients is catheter related bloodstream infection (CR-BSI). Lack of in situ diagnostic techniques requires device removal if CR-BSI is suspected with 75-85% of catheters withdrawn unnecessarily. To assess the sensitivity, specificity and accuracy of two in situ diagnostic methods for CR-BSI in an adult ICU burns population: Differential Time to Positivity (DTP) and Semi-Quantitative Superficial Cultures (SQSC). Both arterial (AC) and central venous (CVC) catheters were studied. On clinicians' suspicion of CR-BSI, the CVC and AC were removed. Superficial semi-quantitative cultures were taken by removing the dressings and swabbing within a 3cm radius of the CVC and AC insertion sites, as well as inside each hub of the CVC and AC. Peripheral blood was taken for qualitative culture and the catheter tip sent for semi-quantitative culture. DTP was considered positive if culture of lumen blood became positive at least 120min before peripheral blood with an identical pathogen. Superficial and tip cultures were identified as positive if ≥15 CFUs were grown. CR-BSI was confirmed when both catheter tip culture and peripheral blood culture were positive with the same micro-organism. Sixteen patients (88% male) with an APACHE II score of 22.0 (7.3) were enrolled. The mean age was 45.7 (16.9) years with mean total burn surface area 32.9 (19.4)%. Fifty percent had airway burns. ICU stay was 19.9 (11.1) days. All 16 survived ICU discharge with a hospital survival of 93%. There were 20 episodes of CR-BSI in these 16 patients. For these 20 episodes the exposure time (line days) was 113.15. The CR-BSI rate was 15.6 per 1000 catheter days (95% CI 1.9-56.4). For diagnosis of CR-BSI in either AC and CVC, SQSC had a sensitivity of 50% [95% CI 3-97], specificity 83.3% [95% CI 67-93], PPV 14.3 [95% CI 1-58], NPV 96.8 [95% CI 81-100], accuracy of 81.6% [95%CI 65-92] and diagnostic odds ratio 5.0 [95% CI 0

  7. Access, literacy and behavioural correlates of poor self-rated oral health amongst an indigenous south Australian population.

    PubMed

    Jones, K; Parker, E J; Jamieson, L M

    2014-09-01

    To better understand the determinants of self-rated oral health within an Indigenous population by: 1, examining potential individual-level correlates of socio-demographic, health behaviours, dental care access and oral health literacy-related outcomes with self-rated oral health; and, 2, examining the relative contribution of these domains to self-rated oral health in multivariable modelling. We conducted nested logistic regression analyses on self-reported status of 'fair or poor' versus 'better' oral health using data from a convenience sample of rural dwelling Indigenous Australians (n = 468). Data were collected on background characteristics, health behaviours, access to dental care, oral health literacy-related outcome variables and REALD 30, an oral health literacy scale. Overall 37.0 % of the Indigenous adult population reported fair or poor oral health. In multivariable modelling, risk indicators for fair or poor self-rated oral health that persisted after adjusting for other covariates included being aged 38+ years (OR 2.9, 95%CI 1.9,4.6), holding a Government Health Concession card (OR 2.3, 95%CI 1.1,4.5), avoiding the dentist due to financial constraints (OR 2.3, 95%CI 1.4,3.6), not knowing how to make an emergency dental visit (OR 1.7, 95%CI 1.1,2.7) and poor understanding of the prevention of dental disease (OR 1.7, 95%CI 1.1,2.7). In this vulnerable population, risk indicators contributing to poor self-rated oral health included socio-demographic, dental care access and oral health literacy-related factors. Health behaviours were not significant.

  8. Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices.

    PubMed

    Worth, Leon J; Seymour, John F; Slavin, Monica A

    2009-07-01

    Central venous catheter (CVC)-related bloodstream infection (CR-BSI) is a significant complication in hematology patients. A range of CVC devices may be used, and risks for the development of complications are not uniform. The objectives of this study were to determine the natural history and rate of CVC-related complications and risk factors for CR-BSI and to compare device-specific complications in a hematology population. An observational cohort of patients with hematologic malignancy was prospectively studied following CVC insertion. Participants were reviewed until a CVC-related complication necessitated device removal, completion of therapy, death, or defined end-of-study date. The National Nosocomial Infection Surveillance definition for CR-BSI was used. Overall and device-specific rates of infective and noninfective complications were calculated and potential risk factors were captured. One hundred six CVCs (75 peripherally inserted central venous catheters [PICCs], 31 nontunneled CVCs) were evaluated in 66 patients, over 2,399 CVC days. Thrombosis occurred in 16 cases (15.1%), exit-site infection in two (1.9%), and CR-BSI in 18 (7.5 per 1,000 CVC days). No significant differences were found when complication rates in PICC and nontunneled devices were compared. An underlying diagnosis of acute myeloid leukemia was negatively associated with CR-BSI (odds ratio (OR) 0.14, p = 0.046), and a previous diagnosis of fungal infection was associated with infection (OR 22.82, p = 0.031). CR-BSI rates in our hematology population are comparable to prior reports. A low rate of exit-site infection and high proportion of thrombotic complications were observed. No significant differences in thrombotic or infective complications were evident when PICC and nontunneled devices were compared. PICC devices are a practical and safe option for management of hematology patients.

  9. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults.

    PubMed

    Timsit, Jean-François; Mimoz, Olivier; Mourvillier, Bruno; Souweine, Bertrand; Garrouste-Orgeas, Maïté; Alfandari, Serge; Plantefeve, Gaétan; Bronchard, Régis; Troche, Gilles; Gauzit, Remy; Antona, Marion; Canet, Emmanuel; Bohe, Julien; Lepape, Alain; Vesin, Aurélien; Arrault, Xavier; Schwebel, Carole; Adrie, Christophe; Zahar, Jean-Ralph; Ruckly, Stéphane; Tournegros, Caroline; Lucet, Jean-Christophe

    2012-12-15

    Most vascular catheter-related infections (CRIs) occur extraluminally in patients in the intensive care unit (ICU). Chlorhexidine-impregnated and strongly adherent dressings may decrease catheter colonization and CRI rates. To determine if chlorhexidine-impregnated and strongly adherent dressings decrease catheter colonization and CRI rates. In a 2:1:1 assessor-masked randomized trial in patients with vascular catheters inserted for an expected duration of 48 hours or more in 12 French ICUs, we compared chlorhexidine dressings, highly adhesive dressings, and standard dressings from May 2010 to July 2011. Coprimary endpoints were major CRI with or without catheter-related bloodstream infection (CR-BSI) with chlorhexidine versus nonchlorhexidine dressings and catheter colonization rate with highly adhesive nonchlorhexidine versus standard nonchlorhexidine dressings. Catheter-colonization, CR-BSIs, and skin reactions were secondary endpoints. A total of 1,879 patients (4,163 catheters and 34,339 catheter-days) were evaluated. With chlorhexidine dressings, the major-CRI rate was 67% lower (0.7 per 1,000 vs. 2.1 per 1,000 catheter-days; hazard ratio [HR], 0.328; 95% confidence interval [CI], 0.174-0.619; P = 0.0006) and the CR-BSI rate 60% lower (0.5 per 1,000 vs. 1.3 per 1,000 catheter-days; HR, 0.402; 95% CI, 0.186-0.868; P = 0.02) than with nonchlorhexidine dressings; decreases were noted in catheter colonization and skin colonization rates at catheter removal. The contact dermatitis rate was 1.1% with and 0.29% without chlorhexidine. Highly adhesive dressings decreased the detachment rate to 64.3% versus 71.9% (P < 0.0001) and the number of dressings per catheter to two (one to four) versus three (one to five) (P < 0.0001) but increased skin colonization (P < 0.0001) and catheter colonization (HR, 1.650; 95% CI, 1.21-2.26; P = 0.0016) without influencing CRI or CR-BSI rates. A large randomized trial demonstrated that chlorhexidine-gel-impregnated dressings decreased

  10. Effect of chlorhexidine/silver sulfadiazine-impregnated central venous catheters in an intensive care unit with a low blood stream infection rate after implementation of an educational program: a before-after trial.

    PubMed

    Schuerer, Douglas J E; Zack, Jeanne E; Thomas, James; Borecki, Ingrid B; Sona, Carrie S; Schallom, Marilyn E; Venker, Melissa; Nemeth, Jennifer L; Ward, Myrna R; Verjan, Linda; Warren, David K; Fraser, Victoria J; Mazuski, John E; Boyle, Walter A; Buchman, Timothy G; Coopersmith, Craig M

    2007-08-01

    Current guidelines recommend using antiseptic- or antibiotic-impregnated central venous catheters (CVCs) if, following a comprehensive strategy to prevent catheter-related blood stream infection (CR-BSI), infection rates remain above institutional goals based on benchmark values. The purpose of this study was to determine if chlorhexidine/silver sulfadiazine-impregnated CVCs could decrease the CR-BSI rate in an intensive care unit (ICU) with a low baseline infection rate. Pre-intervention and post-intervention observational study in a 24-bed surgical/trauma/burn ICU from October, 2002 to August, 2005. All patients requiring CVC placement after March, 2004 had a chlorhexidine/silver sulfadiazine-impregnated catheter inserted (post-intervention period). Twenty-three CR-BSIs occurred in 6,960 catheter days (3.3 per 1,000 catheter days)during the 17-month control period. After introduction of chlorhexidine/silver sulfadiazine-impregnated catheters, 16 CR-BSIs occurred in 7,732 catheter days (2.1 per 1,000 catheter days; p = 0.16). The average length of time required for an infection to become established after catheterization was similar in the two groups (8.4 vs. 8.6 days; p = 0.85). Chlorhexidine/silver sulfadiazine-impregnated catheters did not result in a statistically significant change in the microbiological profile of CR-BSIs, nor did they increase the incidence of resistant organisms. Although chlorhexidine/silver sulfadiazine-impregnated catheters are useful in specific patient populations, they did not result in a statistically significant decrease in the CR-BSI rate in this study, beyond what was achieved with education alone.

  11. A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients.

    PubMed

    Gaur, Aditya H; Bundy, David G; Werner, Eric J; Hord, Jeffrey D; Miller, Marlene R; Tang, Li; Lawlor, John P; Billett, Amy L

    2017-06-01

    OBJECTIVE To assess the burden of bloodstream infections (BSIs) among pediatric hematology-oncology (PHO) inpatients, to propose a comprehensive, all-BSI tracking approach, and to discuss how such an approach helps better inform within-center and across-center differences in CLABSI rate DESIGN Prospective cohort study SETTING US multicenter, quality-improvement, BSI prevention network PARTICIPANTS PHO centers across the United States who agreed to follow a standardized central-line-maintenance care bundle and track all BSI events and central-line days every month. METHODS Infections were categorized as CLABSI (stratified by mucosal barrier injury-related, laboratory-confirmed BSI [MBI-LCBI] versus non-MBI-LCBI) and secondary BSI, using National Healthcare Safety Network (NHSN) definitions. Single positive blood cultures (SPBCs) with NHSN defined common commensals were also tracked. RESULTS Between 2013 and 2015, 34 PHO centers reported 1,110 BSIs. Among them, 708 (63.8%) were CLABSIs, 170 (15.3%) were secondary BSIs, and 232 (20.9%) were SPBCs. Most SPBCs (75%) occurred in patients with profound neutropenia; 22% of SPBCs were viridans group streptococci. Among the CLABSIs, 51% were MBI-LCBI. Excluding SPBCs, CLABSI rates were higher (88% vs 77%) and secondary BSI rates were lower (12% vs 23%) after the NHSN updated the definition of secondary BSI (P<.001). Preliminary analyses showed across-center differences in CLABSI versus secondary BSI and between SPBC and CLABSI versus non-CLABSI rates. CONCLUSIONS Tracking all BSIs, not just CLABSIs in PHO patients, is a patient-centered, clinically relevant approach that could help better assess across-center and within-center differences in infection rates, including CLABSI. This approach enables informed decision making by healthcare providers, payors, and the public. Infect Control Hosp Epidemiol 2017;38:690-696.

  12. Generalisability and Cost-Impact of Antibiotic-Impregnated Central Venous Catheters for Reducing Risk of Bloodstream Infection in Paediatric Intensive Care Units in England.

    PubMed

    Harron, Katie; Mok, Quen; Hughes, Dyfrig; Muller-Pebody, Berit; Parslow, Roger; Ramnarayan, Padmanabhan; Gilbert, Ruth

    2016-01-01

    We determined the generalisability and cost-impact of adopting antibiotic-impregnated CVCs in all paediatric intensive care units (PICUs) in England, based on results from a large randomised controlled trial (the CATCH trial; ISRCTN34884569). BSI rates using standard CVCs were estimated through linkage of national PICU audit data (PICANet) with laboratory surveillance data. We estimated the number of BSI averted if PICUs switched from standard to antibiotic-impregnated CVCs by applying the CATCH trial rate-ratio (0.40; 95% CI 0.17,0.97) to the BSI rate using standard CVCs. The value of healthcare resources made available by averting one BSI as estimated from the trial economic analysis was £10,975; 95% CI -£2,801,£24,751. The BSI rate using standard CVCs was 4.58 (95% CI 4.42,4.74) per 1000 CVC-days in 2012. Applying the rate-ratio gave 232 BSI averted using antibiotic CVCs. The additional cost of purchasing antibiotic-impregnated compared with standard CVCs was £36 for each child, corresponding to additional costs of £317,916 for an estimated 8831 CVCs required in PICUs in 2012. Based on 2012 BSI rates, management of BSI in PICUs cost £2.5 million annually (95% uncertainty interval: -£160,986, £5,603,005). The additional cost of antibiotic CVCs would be less than the value of resources associated with managing BSI in PICUs with standard BSI rates >1.2 per 1000 CVC-days. The cost of introducing antibiotic-impregnated CVCs is less than the cost associated with managing BSIs occurring with standard CVCs. The long-term benefits of preventing BSI could mean that antibiotic CVCs are cost-effective even in PICUs with extremely low BSI rates.

  13. Improvement in Microstructure Performance of the NiCrBSi Reinforced Coating on TA15 Titanium Alloy

    NASA Astrophysics Data System (ADS)

    Peng, Li

    2012-10-01

    This work is based on the dry sliding wear of NiCrBSi reinforced coating deposited on TA15 titanium alloy using the laser cladding technique, the parameters of which were such as to provide almost crack-free coatings with minimum dilution and very low porosity. SEM results indicated that a laser clad coating with metallurgical joint to the substrate was formed. Compared with TA15 substrate, an improvement of the micro-hardness and wear resistance was observed for this composite coating. Rare earth oxide Y2O3 was beneficial in producing of the amorphous phases in laser clad coating. With addition of Y2O3, more amorphous alloys were produced, which increased the micro-hardness and wear resistance of the coating.

  14. Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access.

    PubMed

    Jablonski, Kathleen A; Guagliardo, Mark F

    2005-05-04

    BACKGROUND: The U.S. National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare. The Report is a work in progress and includes few indicators specific to children. An indicator worthy of consideration is racial/ethnic differences in the rate of bad outcomes for pediatric acute appendicitis. Bad outcomes for this condition are indicative of poor access to healthcare, which is amenable to social and healthcare policy changes. METHODS: We analyzed the KID Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children. We ran weighted logistic regression models to obtain national estimates of relative odds of rupture rate for the four groups, adjusted for developmental, biological, socioeconomic, health services and hospital factors that might influence disease outcome. RESULTS: Rupture was a much more burdensome outcome than timely surgery and rupture avoidance. Rupture cases had 97% higher hospital charges and 175% longer hospital stays than non-rupture cases on average. These burdens disproportionately affected minority children, who had 24% - 38% higher odds of appendicitis rupture than white children, adjusting for age and gender. These differences were reduced, but remained significant after adjusting for other factors. CONCLUSION: The racial/ethnic disparities in pediatric appendicitis outcome are large and are preventable with timely diagnosis and surgery for all children. Furthermore, estimating this disparity using the KID survey is a relatively straightforward process. Therefore pediatric appendicitis rupture rate is a good candidate for inclusion in the National Healthcare Disparities Report. As with most other health and healthcare disparities, efforts to reduce disparities in income, wealth and access to care will most likely improve the odds of favorable

  15. Traffic management mechanism for intranets with available-bit-rate access to the Internet

    NASA Astrophysics Data System (ADS)

    Hassan, Mahbub; Sirisena, Harsha R.; Atiquzzaman, Mohammed

    1997-10-01

    The design of a traffic management mechanism for intranets connected to the Internet via an available bit rate access- link is presented. Selection of control parameters for this mechanism for optimum performance is shown through analysis. An estimate for packet loss probability at the access- gateway is derived for random fluctuation of available bit rate of the access-link. Some implementation strategies of this mechanism in the standard intranet protocol stack are also suggested.

  16. Biomic specialization and speciation rates in ruminants (Cetartiodactyla, Mammalia): a test of the resource-use hypothesis at the global scale.

    PubMed

    Cantalapiedra, Juan L; Hernández Fernández, Manuel; Morales, Jorge

    2011-01-01

    The resource-use hypothesis proposed by E.S. Vrba predicts that specialist species have higher speciation and extinction rates than generalists because they are more susceptible to environmental changes and vicariance. In this work, we test some of the predictions derived from this hypothesis on the 197 extant and recently extinct species of Ruminantia (Cetartiodactyla, Mammalia) using the biomic specialization index (BSI) of each species, which is based on its distribution within different biomes. We ran 10000 Monte Carlo simulations of our data in order to get a null distribution of BSI values against which to contrast the observed data. Additionally, we drew on a supertree of the ruminants and a phylogenetic likelihood-based method (QuaSSE) for testing whether the degree of biomic specialization affects speciation rates in ruminant lineages. Our results are consistent with the predictions of the resource-use hypothesis, which foretells a higher speciation rate of lineages restricted to a single biome (BSI = 1) and higher frequency of specialist species in biomes that underwent high degree of contraction and fragmentation during climatic cycles. Bovids and deer present differential specialization across biomes; cervids show higher specialization in biomes with a marked hydric seasonality (tropical deciduous woodlands and schlerophyllous woodlands), while bovids present higher specialization in a greater variety of biomes. This might be the result of divergent physiological constraints as well as a different biogeographic and evolutionary history.

  17. Bloodstream Infections and Clinical Significance of Healthcare-associated Bacteremia: A Multicenter Surveillance Study in Korean Hospitals

    PubMed Central

    Son, Jun Seong; Ko, Kwan Soo; Yeom, Joon Sup; Ki, Hyun Kyun; Kim, Shin-Woo; Chang, Hyun-Ha; Ryu, Seong Yeol; Kim, Yeon-Sook; Jung, Sook-In; Shin, Sang Yop; Oh, Hee Bok; Lee, Yeong Seon; Chung, Doo Ryeon; Lee, Nam Yong; Peck, Kyong Ran

    2010-01-01

    Recent changes in healthcare systems have changed the epidemiologic paradigms in many infectious fields including bloodstream infection (BSI). We compared clinical characteristics of community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA) BSI. We performed a prospective nationwide multicenter surveillance study from 9 university hospitals in Korea. Total 1,605 blood isolates were collected from 2006 to 2007, and 1,144 isolates were considered true pathogens. HA-BSI accounted for 48.8%, CA-BSI for 33.2%, and HCA-BSI for 18.0%. HA-BSI and HCA-BSI were more likely to have severe comorbidities. Escherichia coli was the most common isolate in CA-BSI (47.1%) and HCA-BSI (27.2%). In contrast, Staphylococcus aureus (15.2%), coagulase-negative Staphylococcus (15.1%) were the common isolates in HA-BSI. The rate of appropriate empiric antimicrobial therapy was the highest in CA-BSI (89.0%) followed by HCA-BSI (76.4%), and HA-BSI (75.0%). The 30-day mortality rate was the highest in HA-BSI (23.0%) followed by HCA-BSI (18.4%), and CA-BSI (10.2%). High Pitt score and inappropriate empirical antibiotic therapy were the independent risk factors for mortality by multivariate analysis. In conclusion, the present data suggest that clinical features, outcome, and microbiologic features of causative pathogens vary by origin of BSI. Especially, HCA-BSI shows unique clinical characteristics, which should be considered a distinct category for more appropriate antibiotic treatment. PMID:20592888

  18. Relations between PTSD and distress dimensions in an Indian child/adolescent sample following the 2008 Mumbai terrorist attacks.

    PubMed

    Contractor, Ateka A; Mehta, Panna; Tiamiyu, Mojisola F; Hovey, Joseph D; Geers, Andrew L; Charak, Ruby; Tamburrino, Marijo B; Elhai, Jon D

    2014-08-01

    Posttraumatic stress disorder's (PTSD) four-factor dysphoria model has substantial empirical support (reviewed in Elhai & Palmieri, Journal of Anxiety Disorders, 25, 849-854, 2011; Yufik & Simms, Journal of Abnormal Psychology, 119, 764-776, 2010). However, debatable is whether the model's dysphoria factor adequately captures all of PTSD's emotional distress (e.g., Marshall et al., Journal of Abnormal Psychology, 119(1), 126-135, 2010), which is relevant to understanding the assessment and psychopathology of PTSD. Thus, the present study assessed the factor-level relationship between PTSD and emotional distress in 818 children/adolescents attending school in the vicinity of the 2008 Mumbai terrorist attacks. The effective sample had a mean age of 12.85 years (SD = 1.33), with the majority being male (n = 435, 53.8 %). PTSD and emotional distress were measured by the UCLA PTSD Reaction Index (PTSD-RI) and Brief Symptom Inventory-18 (BSI-18) respectively. Confirmatory factor analyses (CFA) assessed the PTSD and BSI-18 model fit; Wald tests assessed hypothesized PTSD-distress latent-level relations; and invariance testing examined PTSD-distress parameter differences using age, gender and direct exposure as moderators. There were no moderating effects for the PTSD-distress structural parameters. BSI-18's depression and somatization factors related more to PTSD's dysphoria than PTSD's avoidance factor. The results emphasize assessing for specificity and distress variance of PTSD factors on a continuum, rather than assuming dysphoria factor's complete accountability for PTSD's inherent distress. Additionally, PTSD's dysphoria factor related more to BSI-18's depression than BSI-18's anxiety/somatization factors; this may explain PTSD's comorbidity mechanism with depressive disorders.

  19. Age-Related Differences in Lexical Access Relate to Speech Recognition in Noise

    PubMed Central

    Carroll, Rebecca; Warzybok, Anna; Kollmeier, Birger; Ruigendijk, Esther

    2016-01-01

    Vocabulary size has been suggested as a useful measure of “verbal abilities” that correlates with speech recognition scores. Knowing more words is linked to better speech recognition. How vocabulary knowledge translates to general speech recognition mechanisms, how these mechanisms relate to offline speech recognition scores, and how they may be modulated by acoustical distortion or age, is less clear. Age-related differences in linguistic measures may predict age-related differences in speech recognition in noise performance. We hypothesized that speech recognition performance can be predicted by the efficiency of lexical access, which refers to the speed with which a given word can be searched and accessed relative to the size of the mental lexicon. We tested speech recognition in a clinical German sentence-in-noise test at two signal-to-noise ratios (SNRs), in 22 younger (18–35 years) and 22 older (60–78 years) listeners with normal hearing. We also assessed receptive vocabulary, lexical access time, verbal working memory, and hearing thresholds as measures of individual differences. Age group, SNR level, vocabulary size, and lexical access time were significant predictors of individual speech recognition scores, but working memory and hearing threshold were not. Interestingly, longer accessing times were correlated with better speech recognition scores. Hierarchical regression models for each subset of age group and SNR showed very similar patterns: the combination of vocabulary size and lexical access time contributed most to speech recognition performance; only for the younger group at the better SNR (yielding about 85% correct speech recognition) did vocabulary size alone predict performance. Our data suggest that successful speech recognition in noise is mainly modulated by the efficiency of lexical access. This suggests that older adults’ poorer performance in the speech recognition task may have arisen from reduced efficiency in lexical access

  20. Age-Related Differences in Lexical Access Relate to Speech Recognition in Noise.

    PubMed

    Carroll, Rebecca; Warzybok, Anna; Kollmeier, Birger; Ruigendijk, Esther

    2016-01-01

    Vocabulary size has been suggested as a useful measure of "verbal abilities" that correlates with speech recognition scores. Knowing more words is linked to better speech recognition. How vocabulary knowledge translates to general speech recognition mechanisms, how these mechanisms relate to offline speech recognition scores, and how they may be modulated by acoustical distortion or age, is less clear. Age-related differences in linguistic measures may predict age-related differences in speech recognition in noise performance. We hypothesized that speech recognition performance can be predicted by the efficiency of lexical access, which refers to the speed with which a given word can be searched and accessed relative to the size of the mental lexicon. We tested speech recognition in a clinical German sentence-in-noise test at two signal-to-noise ratios (SNRs), in 22 younger (18-35 years) and 22 older (60-78 years) listeners with normal hearing. We also assessed receptive vocabulary, lexical access time, verbal working memory, and hearing thresholds as measures of individual differences. Age group, SNR level, vocabulary size, and lexical access time were significant predictors of individual speech recognition scores, but working memory and hearing threshold were not. Interestingly, longer accessing times were correlated with better speech recognition scores. Hierarchical regression models for each subset of age group and SNR showed very similar patterns: the combination of vocabulary size and lexical access time contributed most to speech recognition performance; only for the younger group at the better SNR (yielding about 85% correct speech recognition) did vocabulary size alone predict performance. Our data suggest that successful speech recognition in noise is mainly modulated by the efficiency of lexical access. This suggests that older adults' poorer performance in the speech recognition task may have arisen from reduced efficiency in lexical access; with an

  1. A case-control study to identify risk factors for totally implantable central venous port-related bloodstream infection.

    PubMed

    Lee, Guk Jin; Hong, Sook Hee; Roh, Sang Young; Park, Sa Rah; Lee, Myung Ah; Chun, Hoo Geun; Hong, Young Seon; Kang, Jin Hyoung; Kim, Sang Il; Kim, Youn Jeong; Chun, Ho Jong; Oh, Jung Suk

    2014-07-01

    To date, the risk factors for central venous port-related bloodstream infection (CVPBSI) in solid cancer patients have not been fully elucidated. We conducted this study in order to determine the risk factors for CVP-BSI in patients with solid cancer. A total of 1,642 patients with solid cancer received an implantable central venous port for delivery of chemotherapy between October 2008 and December 2011 in a single center. CVP-BSI was diagnosed in 66 patients (4%). We selected a control group of 130 patients, who were individually matched with respect to age, sex, and catheter insertion time. CVP-BSI occurred most frequently between September and November (37.9%). The most common pathogen was gram-positive cocci (n=35, 53.0%), followed by fungus (n=14, 21.2%). Multivariate analysis identified monthly catheter-stay as a risk factor for CVP-BSI (p=0.000), however, its risk was lower in primary gastrointestinal cancer than in other cancer (p=0.002). Initial metastatic disease and long catheter-stay were statistically significant factors affecting catheter life span (p=0.005 and p=0.000). Results of multivariate analysis showed that recent transfusion was a risk factor for mortality in patients with CVP-BSI (p=0.047). In analysis of the results with respect to risk factors, prolonged catheter-stay should be avoided as much as possible. It is necessary to be cautious of CVP-BSI in metastatic solid cancer, especially non-gastrointestinal cancer. In addition, avoidance of unnecessary transfusion is essential in order to reduce the mortality of CVP-BSI. Finally, considering the fact that confounding factors may have affected the results, conduct of a well-designed prospective controlled study is warranted.

  2. Effect of the scanning speed on microstructural evolution and wear behaviors of laser cladding NiCrBSi composite coatings

    NASA Astrophysics Data System (ADS)

    Chen, J. L.; Li, J.; Song, R.; Bai, L. L.; Shao, J. Z.; Qu, C. C.

    2015-09-01

    Laser cladding composite coatings were fabricated on the surface of the Ti6Al4V substrate by fiber laser cladding the NiCrBSi alloy powder. The influences of scanning speed on the dilution rate and microstructure of the coatings were investigated in detail by X-ray diffraction (XRD), optical microscopy (OM) and scanning electron microscopy (SEM) coupled with energy dispersive spectroscopy (EDS). Combined with the analyses of microhardness and fracture toughness, the wear behaviors of the coatings obtained at different scanning speeds were revealed. Results indicated that the dilution rates of the coatings were similar (about 64.23%) with variations in scanning speed ranging from 5 mm/s to 15 mm/s. An abrupt decrease in dilution rate (37.06%) was observed at the scanning speed of 20 mm/s. Microstructural observation showed that the blocky TiB2 and the cellular dendrite TiC particles were uniformly dispersed in the TiNi-Ti2Ni dual-phase intermetallic compound matrix at scanning speeds of 5-15 mm/s. When the scanning speed was further increased to 20 mm/s, the stripe-shaped CrB, gray irregular-shaped Cr3C2 and black blocky TiC particles uniformly dispersed in the γ(Ni) matrix were synthesized in situ. The particles became finer with the increase in scanning speed. The average microhardness of the coating (1026.5 HV0.2) at the scanning speed of 20 mm/s was enhanced significantly compared with that of the other three coatings (about 886.4 HV0.2). The lowest average friction coefficient (about 0.371) was obtained at the scanning speed of 20 mm/s and was relatively stable with the change in sliding time. The lowest wear loss of the coating was also obtained at the scanning speed of 20 mm/s. Analyses of the worn surfaces showed that the coating prepared at the scanning speed of 20 mm/s was in good condition because of its excellent combination of resistance to micro-cutting and brittle debonding. Comparatively speaking, the coating produced at the scanning speed of 20 mm

  3. Eddy-current testing of fatigue degradation upon contact fatigue loading of gas powder laser clad NiCrBSi-Cr3C2 composite coating

    NASA Astrophysics Data System (ADS)

    Savrai, R. A.; Makarov, A. V.; Gorkunov, E. S.; Soboleva, N. N.; Kogan, L. Kh.; Malygina, I. Yu.; Osintseva, A. L.; Davydova, N. A.

    2017-12-01

    The possibilities of the eddy-current method for testing the fatigue degradation under contact loading of gas powder laser clad NiCrBSi-Cr3C2 composite coating with 15 wt.% of Cr3C2 additive have been investigated. It is shown that the eddy-current testing of the fatigue degradation under contact loading of the NiCrBSi-15%Cr3C2 composite coating can be performed at high excitation frequencies 72-120 kHz of the eddy-current transducer. At that, the dependences of the eddy-current instrument readings on the number of loading cycles have both downward and upward branches, with the boundary between the branches being 3×105 cycles in the given loading conditions. This is caused, on the one hand, by cracking, and, on the other hand, by cohesive spalling and compaction of the composite coating, which affect oppositely the material resistivity and, correspondingly, the eddy-current instrument readings. The downward branch can be used to monitor the processes of crack formation and growth, the upward branch - to monitor the degree of cohesive spalling, while taking into account in the testing methodology an ambiguous character of the dependences of the eddy-current instrument readings on the number of loading cycles.

  4. Bloodstream Infections in Patients With Solid Tumors

    PubMed Central

    Marín, Mar; Gudiol, Carlota; Garcia-Vidal, Carol; Ardanuy, Carmen; Carratalà, Jordi

    2014-01-01

    were the endogenous source of BSI (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.06–12.02), shock at presentation (OR, 3.63; 95% CI, 1.63–8.09), and corticosteroid therapy (OR, 3.245; 95% CI, 1.43–7.32). The independent risk factors for overall case-fatality rate were the presence of a chronic advanced cancer (OR, 35.39; 95% CI, 2.48–504.91), shock at presentation (OR, 25.84; 95% CI, 3.73–179.0), and corticosteroid therapy (OR, 6.98; 95% CI, 1.61–30.21). BSI in patients with solid tumors occurred mainly among those with hepatobiliary cancer, and cholangitis was the most frequent source; gram-negative bacilli were the most frequent causative agents. MDR organisms were relatively common, particularly in patients who had previously received antibiotics and had been hospitalized; these patients were frequently treated with inadequate empirical antibiotic therapy and had a poorer outcome. The case-fatality rate of patients with solid tumors and BSI was high and was associated with chronic advanced cancer, corticosteroid therapy, and shock at presentation. PMID:24797169

  5. Bloodstream infections in patients with solid tumors: epidemiology, antibiotic therapy, and outcomes in 528 episodes in a single cancer center.

    PubMed

    Marín, Mar; Gudiol, Carlota; Garcia-Vidal, Carol; Ardanuy, Carmen; Carratalà, Jordi

    2014-05-01

    endogenous source of BSI (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.06-12.02), shock at presentation (OR, 3.63; 95% CI, 1.63-8.09), and corticosteroid therapy (OR, 3.245; 95% CI, 1.43-7.32). The independent risk factors for overall case-fatality rate were the presence of a chronic advanced cancer (OR, 35.39; 95% CI, 2.48-504.91), shock at presentation (OR, 25.84; 95% CI, 3.73-179.0), and corticosteroid therapy (OR, 6.98; 95% CI, 1.61-30.21).BSI in patients with solid tumors occurred mainly among those with hepatobiliary cancer, and cholangitis was the most frequent source; gram-negative bacilli were the most frequent causative agents. MDR organisms were relatively common, particularly in patients who had previously received antibiotics and had been hospitalized; these patients were frequently treated with inadequate empirical antibiotic therapy and had a poorer outcome. The case-fatality rate of patients with solid tumors and BSI was high and was associated with chronic advanced cancer, corticosteroid therapy, and shock at presentation.

  6. 47 CFR 76.970 - Commercial leased access rates.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the operator in accordance with the requirement of 47 U.S.C. 532. For purposes of 47 U.S.C. 532(b)(1)(A) and (B), only those channels that must be carried pursuant to 47 U.S.C. 534 and 535 qualify as... 47 Telecommunication 4 2013-10-01 2013-10-01 false Commercial leased access rates. 76.970 Section...

  7. 47 CFR 76.970 - Commercial leased access rates.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the operator in accordance with the requirement of 47 U.S.C. 532. For purposes of 47 U.S.C. 532(b)(1)(A) and (B), only those channels that must be carried pursuant to 47 U.S.C. 534 and 535 qualify as... 47 Telecommunication 4 2012-10-01 2012-10-01 false Commercial leased access rates. 76.970 Section...

  8. 47 CFR 76.970 - Commercial leased access rates.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the operator in accordance with the requirement of 47 U.S.C. 532. For purposes of 47 U.S.C. 532(b)(1)(A) and (B), only those channels that must be carried pursuant to 47 U.S.C. 534 and 535 qualify as... 47 Telecommunication 4 2014-10-01 2014-10-01 false Commercial leased access rates. 76.970 Section...

  9. Surveillance of bloodstream infections in pediatric cancer centers – what have we learned and how do we move on?

    PubMed Central

    Simon, Arne; Furtwängler, Rhoikos; Graf, Norbert; Laws, Hans Jürgen; Voigt, Sebastian; Piening, Brar; Geffers, Christine; Agyeman, Philipp; Ammann, Roland A.

    2016-01-01

    Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI). Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients’ safety during intensive treatment. The great majority of all pediatric cancer patients (about 85%) have a long-term central venous access catheter in use (type Broviac or Port; CVAD). Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD-associated BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined. PMID:27274442

  10. Surveillance of bloodstream infections in pediatric cancer centers - what have we learned and how do we move on?

    PubMed

    Simon, Arne; Furtwängler, Rhoikos; Graf, Norbert; Laws, Hans Jürgen; Voigt, Sebastian; Piening, Brar; Geffers, Christine; Agyeman, Philipp; Ammann, Roland A

    2016-01-01

    Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI). Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients' safety during intensive treatment. The great majority of all pediatric cancer patients (about 85%) have a long-term central venous access catheter in use (type Broviac or Port; CVAD). Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD-associated BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined.

  11. Comparative examination of the microstructure and high temperature oxidation performance of NiCrBSi flame sprayed and pack cementation coatings

    NASA Astrophysics Data System (ADS)

    Chaliampalias, D.; Vourlias, G.; Pavlidou, E.; Skolianos, S.; Chrissafis, K.; Stergioudis, G.

    2009-01-01

    Coatings formed from NiCrBSi powder were deposited by thermal spray and pack cementation processes on low carbon steel. The microstructure and morphology of the coatings were studied by scanning electron microscopy (SEM) and X-ray diffraction analysis (XRD). Flame sprayed coatings exhibited high porosity and were mechanically bonded to the substrate while pack cementation coatings were more compact and chemically bonded to the substrate. The microhardness and the high temperature oxidation resistance of the coated samples were evaluated by a Vickers microhardness tester and by thermogravimetric measurements (TG), respectively. Pack cementation coatings showed higher hardness and were more protective to high temperature environments than the flame sprayed coatings.

  12. Risk factors for carbapenem-resistant K. pneumoniae bloodstream infection and predictors of mortality in Chinese paediatric patients.

    PubMed

    Zhang, Ye; Guo, Ling-Yun; Song, Wen-Qi; Wang, Yan; Dong, Fang; Liu, Gang

    2018-05-31

    Bloodstream infections (BSI) caused by carbapenem-resistant K. pneumoniae (CRKP) are associated with high rates of morbidity and mortality. Early identification of patients at highest risk is very important. The aim of this study was to describe the clinical characteristics and mortality of K. pneumoniae BSI and to identify risk factors associated with CRKP BSI among paediatric patients. From January 2011 to December 2014, a retrospective case-control study was conducted at Beijing Children's Hospital, China. Risk factors for CRKP BSI and for K. pneumoniae BSI-related death were evaluated. Patients with BSI caused by K. pneumoniae were identified from the microbiology laboratory database. Data regarding demographic, microbiological and clinical characteristics, therapy and outcome were collected from the medical records. A total of 138 patients with K. pneumoniae BSI were enrolled, including 54 patients with CRKP BSI and 84 patients with carbapenem-susceptible K. pneumoniae (CSKP) BSI. Most of the BSI (114; 82.6%) were healthcare-associated, while the rest (24; 17.4%) were community-acquired. Hematologic malignancies (odds ratio (OR):4.712, [95% CI: 2.181-10.180], P <  0.001) and previous cephalosporin administration (OR: 3.427, [95% CI: 1.513-7.766], P = 0.003) were found to be associated with the development of CRKP BSI. 28-day mortality of K. pneumoniae BSI was 8.7%. Mechanical ventilation (OR:9.502, [95% CI: 2.098-43.033], P = 0.003), septic shock (OR:6.418, [95% CI: 1.342-30.686], P = 0.020), and isolation of CRKP (OR:9.171, [95% CI: 1.546-54.416], P = 0.015) were independent risk factors for 28-day mortality of K. pneumoniae BSI. Hematologic malignancies and previous cephalosporin administration were associated with the development of CRKP BSI, while mechanical ventilation, septic shock and CRKP infection were independent mortality predictors for K. pneumoniae BSI. More attention should be paid to CRKP BSI in the paediatric population.

  13. Biogenic silicon pools in terrestrial biogeosystems and their significance for silicon cycling

    NASA Astrophysics Data System (ADS)

    Puppe, Daniel; Höhn, Axel; Kaczorek, Danuta; Ehrmann, Otto; Wanner, Manfred; Sommer, Michael

    2017-04-01

    On a global scale the biogeochemical cycles of silicon (Si) and carbon are connected by weathering processes and fluxes of dissolved Si from terrestrial to aquatic ecosystems. Various pro- and eukaryotic organisms are evolutionarily adapted to synthesize amorphous siliceous structures (biosilicification). In soils these siliceous structures can accumulate and form biogenic Si (BSi) pools, whereat it can be differentiated between phytogenic (BSi synthesized by plants), zoogenic (BSi synthesized by sponges), microbial (BSi synthesized by bacteria and fungi) and protistic (BSi synthesized by unicellular organisms) pools. Accumulation and recycling of BSi in terrestrial biogeosystems influence fluxes of dissolved Si from the continents to the oceans, thus act as a filter in the global Si cycle. As research has primarily been focused on the role of phytogenic Si pools until now there is only little information available on the other BSi pools in soils. In order to fill this knowledge gap we examined different BSi pools in soils of initial and forested terrestrial biogeosystems using modern microscopical methods (laser scanning and scanning electron microscopy). In forested biogeosystems we further analyzed abiotic (e.g. soil pH) and biotic (earthworm biomasses) influencing factors on BSi pool size, while samples of initial biogeosystems were used to analyze spatiotemporal BSi pool dynamics. We found that especially biotic interactions are important factors for protistic BSi pools (represented by testate amoebae) and that phytogenic Si pools are about several 100-times bigger than protistic (testate amoebae) Si pools (0.2-4.7 kg Si ha-1). However, annual biosilicification rates of testate amoebae (up to 80 kg Si ha-1) are comparable to or even can exceed annual silicon uptake by trees. Our studies of initial biogeosystems revealed that BSi pool sizes increased markedly within a relatively short time span (<10 years) of ecosystem development. Differences in quantities

  14. Non-Linear Response to Holocene Insolation Forcing Recorded by High-Resolution Lake Sediment Records Across Iceland

    NASA Astrophysics Data System (ADS)

    Geirsdottir, A.; Miller, G. H.; Axford, Y.

    2009-12-01

    Many Icelandic lakes have sedimentation rates in excess of 1 m ka-1 throughout the Holocene. Such high rates offer the potential for decadally resolved (or better) records of environmental change at this sensitive North Atlantic site. Abundant well-defined tephra provide a secure geochronology. The fidelity of the common climate proxies biogenic silica (BSi) and total organic carbon (TOC), was tested by comparing these proxies in three lakes with very different catchment characteristics. Hestvatn (HST, 60 m deep) in southern Iceland receives overflow from a large river originating in the glaciated highlands of central Iceland, whereas the nearby lake Vestra Gislholtsvatn (VGHV, 15 m deep) has a small, low elevation catchment without glaciers. Haukadalsvatn (HAK, 42 m deep), in northwestern Iceland, has a large, high relief catchment. The BSi record from HAK has been shown to reflect April-May temperatures, with BSi highest when spring temperatures are at their maximum. The first- and second-order trends in BSi are similar in all three lakes for most of the Holocene. This supports the contention that BSi reflects primary productivity, and is less influenced by changes in sedimentation rate. In all three lakes, BSi reaches a maximum value shortly after 8 ka, and then declines gradually toward present, reflecting a relatively late Holocene thermal maximum, potentially due to the influence of meltwater from the lingering Laurentide Ice Sheet. A steady reduction in summer insolation determines this first-order trend towards lower BSi through the middle and late Holocene. Large, abrupt departures from the overall decrease in BSi characterize all three records after 8 ka. Following each rapid BSi decrease, BSi usually exhibits a step-function change, re-equilibrating at a lower BSi value. Some of the strongest departures (ca. 6 ka, 4 to 4.5 ka and ca. 3 ka) may be related to Icelandic volcanism, but the lack of a full recovery to pre-existing values after the eruptions

  15. Temporal Trends in Enterobacter Species Bloodstream Infection: A Population-Based Study, 1998-2007

    PubMed Central

    Al-Hasan, Majdi N.; Lahr, Brian D.; Eckel-Passow, Jeanette E.; Baddour, Larry M.

    2010-01-01

    Enterobacter species are the fourth most common cause of gram-negative bloodstream infection (BSI). We examined temporal changes and seasonal variation in the incidence rate of Enterobacter spp. BSI, estimated 28-day and 1-year mortality, and determined in vitro antimicrobial resistance rates of Enterobacter spp. bloodstream isolates in Olmsted County, Minnesota, from 1/1/1998 to 12/31/2007. Multivariable Poisson regression was used to examine temporal changes and seasonal variation in incidence rate and Kaplan-Meier method to estimate 28-day and 1-year mortality. The median age of patients with Enterobacter spp. BSI was 58 years and 53% were female. The overall age- and gender-adjusted incidence rate of Enterobacter spp. BSI was 3.3/100,000 person-years (95% confidence interval [CI]: 2.3-4.4). There was a linear trend of increasing incidence rate from 0.8 (95% CI: 0-1.9) to 6.2 (95% CI: 3.0-9.3) per 100,000 person-years between 1998 and 2007 (p=0.002). There was no significant difference in the incidence rate of Enterobacter spp. BSI during the warmest four months compared to the remainder of the year (incidence rate ratio 1.06 [95% CI: 0.47-2.01]). The overall 28-day and 1-year mortality rates of Enterobacter spp. BSI were 21% (95% CI: 8-34%) and 38% (95% CI: 22-53%), respectively. Up to 13% of Enterobacter spp. bloodstream isolates were resistant to third-generation cephalosporins. To our knowledge, this is the first population-based study to describe the epidemiology and outcome of Enterobacter spp. BSI. The increase in incidence rate of Enterobacter spp. BSI over the past decade, coupled with its associated antimicrobial resistance, dictate more investigation of this syndrome. PMID:20518795

  16. 47 CFR 51.909 - Transition of rate-of-return carrier access charges.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... charges. 51.909 Section 51.909 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.909 Transition of...; and (2) Cap, in accordance with § 51.505(b)(2), the rates for rate all elements in its intrastate...

  17. 47 CFR 51.909 - Transition of rate-of-return carrier access charges.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... charges. 51.909 Section 51.909 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.909 Transition of...; and (2) Cap, in accordance with § 51.505(b)(2), the rates for rate all elements in its intrastate...

  18. 47 CFR 51.909 - Transition of rate-of-return carrier access charges.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... charges. 51.909 Section 51.909 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.909 Transition of...; and (2) Cap, in accordance with § 51.505(b)(2), the rates for rate all elements in its intrastate...

  19. The influence of preburial insect access on the decomposition rate.

    PubMed

    Bachmann, Jutta; Simmons, Tal

    2010-07-01

    This study compared total body score (TBS) in buried remains (35 cm depth) with and without insect access prior to burial. Sixty rabbit carcasses were exhumed at 50 accumulated degree day (ADD) intervals. Weight loss, TBS, intra-abdominal decomposition, carcass/soil interface temperature, and below-carcass soil pH were recorded and analyzed. Results showed significant differences (p < 0.001) in decomposition rates between carcasses with and without insect access prior to burial. An approximately 30% enhanced decomposition rate with insects was observed. TBS was the most valid tool in postmortem interval (PMI) estimation. All other variables showed only weak relationships to decomposition stages, adding little value to PMI estimation. Although progress in estimating the PMI for surface remains has been made, no previous studies have accomplished this for buried remains. This study builds a framework to which further comparable studies can contribute, to produce predictive models for PMI estimation in buried human remains.

  20. Income-Related Inequalities in Access to Dental Care Services in Japan.

    PubMed

    Nishide, Akemi; Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira

    2017-05-12

    Background : This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods : The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results : Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions : There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.

  1. Pediatric Vascular Access Peripheral IV Algorithm Success Rate.

    PubMed

    Hartman, Jane H; Baker, John; Bena, James F; Morrison, Shannon L; Albert, Nancy M

    Determine if the pediatric peripheral vascular access algorithm (PPVAA) led to differences in first-attempt and overall peripheral intravenous (PIV) success, staff attempting PIV access per episode and overall attempts and first PIV attempt success by provider. A two-cohort pre-/post-implementation comparative design involved pediatric nurses and patients. The PPVAA included four components: a patient comfort plan, PIV grading score, nurses' self-assessed IV access capability and nurse decision to stop-the-line. Two sample t-test or Wilcoxon rank sum test and Pearson's chi-square test were used to evaluate differences between groups and measures. Healthcare providers (N=96) attempted 721 PIV insertions (pre-PPVAA, n=419 and post-PPVAA, n=302). Of 78 nurse providers, mean (SD) age was 37.4 (11.0) years and 20.0% self-assessed PIV capability as expert. Of children, mean age was 8.3 (7.0) years. Post-PPVAA, first-attempt (p=0.86) and overall (p=0.21) success did not change, though fewer staff were needed per episode to initiate PIV; p=0.017. Overall rate of success after one attempt in the post-PPVAA period compared to pre-PPVAA was reduced (p=0.002), reflecting greater awareness to stop-the-line. Compared to pre-PPVAA, advanced practice nurses and non-clinician providers were more likely to achieve success on first attempt. The PPVAA did not increase first-attempt or overall PIV success; however, it decreased overall IV attempts and the number of staff attempting access per episode. The multi-component PPVAA provided a guide for nurses during PIV and assisted decision making to stop attempts in difficult cases. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. A High-Resolution Biogenic Silica Record From Lake Titicaca, Peru-Bolivia: South American Millennial-Scale Climate Variability From 18-60 Kya

    NASA Astrophysics Data System (ADS)

    Ekdahl, E. J.; Fritz, S. C.; Stevens, L. R.; Baker, P. A.; Seltzer, G. O.

    2004-12-01

    Sediments recovered from a deep basin in Lake Titicaca, Peru-Boliva, were analyzed for biogenic silica (BSi) content by extraction of freeze dried sediments in 1% sodium carbonate. Sediments were dated using an age model developed from multiple 14C dates on bulk sediments. The BSi record shows distinct fluctuations in concentration and accumulation rate from 18 to 60 kya. Multi-taper method spectral analysis reveals a significant millennial-scale component to these fluctuations centered at 1370 years. High BSi accumulation rates correlate with enhanced benthic diatom preservation, suggesting that the BSi record is related to variations in lake water level. Modern-day Lake Titicaca lake level and precipitation are strongly related to northern equatorial Atlantic sea surface temperatures, with cooler SSTs related to wetter conditions. Subsequently, the spectral behavior of the GRIP ice core δ 18O record was investigated in order to estimate coherency and linkages between North Atlantic and tropical South American climate. GRIP data exhibit a significant 1370-year spectral peak which comprises approximately 26% of the total variability in the record. Despite a high degree of coherency between millennial-scale periodicities in Lake Titicaca BSi and GRIP δ 18O records, the Lake Titicaca silica record does not show longer term cooling cycles characteristic of D-O cycles found in the GRIP record. Rather, the Lake Titicaca record is highly periodic and more similar in nature to several Antarctic climate proxy records. These results suggest that while South American tropical climate varies in phase with North Atlantic climate, additional forcing mechanisms are manifest in the region which may include tropical Pacific and Southern Ocean variability.

  3. Distributed Fair Auto Rate Medium Access Control for IEEE 802.11 Based WLANs

    NASA Astrophysics Data System (ADS)

    Zhu, Yanfeng; Niu, Zhisheng

    Much research has shown that a carefully designed auto rate medium access control can utilize the underlying physical multi-rate capability to exploit the time-variation of the channel. In this paper, we develop a simple analytical model to elucidate the rule that maximizes the throughput of RTS/CTS based multi-rate wireless local area networks. Based on the discovered rule, we propose two distributed fair auto rate medium access control schemes called FARM and FARM+ from the view-point of throughput fairness and time-share fairness, respectively. With the proposed schemes, after receiving a RTS frame, the receiver selectively returns the CTS frame to inform the transmitter the maximum feasible rate probed by the signal-to-noise ratio of the received RTS frame. The key feature of the proposed schemes is that they are capable of maintaining throughput/time-share fairness in asymmetric situation where the distribution of SNR varies with stations. Extensive simulation results show that the proposed schemes outperform the existing throughput/time-share fair auto rate schemes in time-varying channel conditions.

  4. Systems and methods for locating and imaging proppant in an induced fracture

    DOEpatents

    Aldridge, David F.; Bartel, Lewis C.

    2016-02-02

    Born Scattering Inversion (BSI) systems and methods are disclosed. A BSI system may be incorporated in a well system for accessing natural gas, oil and geothermal reserves in a geologic formation beneath the surface of the Earth. The BSI system may be used to generate a three-dimensional image of a proppant-filled hydraulically-induced fracture in the geologic formation. The BSI system may include computing equipment and sensors for measuring electromagnetic fields in the vicinity of the fracture before and after the fracture is generated, adjusting the parameters of a first Born approximation model of a scattered component of the surface electromagnetic fields using the measured electromagnetic fields, and generating the image of the proppant-filled fracture using the adjusted parameters.

  5. Web access and dissemination of Andalusian coastal erosion rates: viewers and standard/filtered map services.

    NASA Astrophysics Data System (ADS)

    Álvarez Francoso, Jose; Prieto Campos, Antonio; Ojeda Zujar, Jose; Guisado-Pintado, Emilia; Pérez Alcántara, Juan Pedro

    2017-04-01

    The accessibility to environmental information via web viewers using map services (OGC or proprietary services) has become more frequent since newly information sources (ortophotos, LIDAR, GPS) are of great detailed and thus generate a great volume of data which barely can be disseminated using either analogue (paper maps) or digital (pdf) formats. Moreover, governments and public institutions are concerned about the need of facilitates provision to research results and improve communication about natural hazards to citizens and stakeholders. This information ultimately, if adequately disseminated, it's crucial in decision making processes, risk management approaches and could help to increase social awareness related to environmental issues (particularly climate change impacts). To overcome this issue, two strategies for wide dissemination and communication of the results achieved in the calculation of beach erosion for the 640 km length of the Andalusian coast (South Spain) using web viewer technology are presented. Each of them are oriented to different end users and thus based on different methodologies. Erosion rates has been calculated at 50m intervals for different periods (1956-1977-2001-2011) as part of a National Research Project based on the spasialisation and web-access of coastal vulnerability indicators for Andalusian region. The 1st proposal generates WMS services (following OGC standards) that are made available by Geoserver, using a geoviewer client developed through Leaflet. This viewer is designed to be used by the general public (citizens, politics, etc) by combining a set of tools that give access to related documents (pdfs), visualisation tools (panoramio pictures, geo-localisation with GPS) are which are displayed within an user-friendly interface. Further, the use of WMS services (implemented on Geoserver) provides a detailed semiology (arrows and proportional symbols, using alongshore coastaline buffers to represent data) which not only

  6. Grazers: biocatalysts of terrestrial silica cycling

    PubMed Central

    Vandevenne, Floor Ina; Barão, Ana Lúcia; Schoelynck, Jonas; Smis, Adriaan; Ryken, Nick; Van Damme, Stefan; Meire, Patrick; Struyf, Eric

    2013-01-01

    Silica is well known for its role as inducible defence mechanism countering herbivore attack, mainly through precipitation of opaline, biogenic silica (BSi) bodies (phytoliths) in plant epidermal tissues. Even though grazing strongly interacts with other element cycles, its impact on terrestrial silica cycling has never been thoroughly considered. Here, BSi content of ingested grass, hay and faeces of large herbivores was quantified by performing multiple chemical extraction procedures for BSi, allowing the assessment of chemical reactivity. Dissolution experiments with grass and faeces were carried out to measure direct availability of BSi for dissolution. Average BSi and readily soluble silica numbers were higher in faeces as compared with grass or hay, and differences between herbivores could be related to distinct digestive strategies. Reactivity and dissolvability of BSi increases after digestion, mainly due to degradation of organic matrices, resulting in higher silica turnover rates and mobilization potential from terrestrial to aquatic ecosystems in non-grazed versus grazed pasture systems (2 versus 20 kg Si ha−1 y−1). Our results suggest a crucial yet currently unexplored role of herbivores in determining silica export from land to ocean, where its availability is linked to eutrophication events and carbon sequestration through C–Si diatom interactions. PMID:24107532

  7. Blacks' Death Rate Due to Circulatory Diseases Is Positively Related to Whites' Explicit Racial Bias.

    PubMed

    Leitner, Jordan B; Hehman, Eric; Ayduk, Ozlem; Mendoza-Denton, Rodolfo

    2016-10-01

    Perceptions of racial bias have been linked to poorer circulatory health among Blacks compared with Whites. However, little is known about whether Whites' actual racial bias contributes to this racial disparity in health. We compiled racial-bias data from 1,391,632 Whites and examined whether racial bias in a given county predicted Black-White disparities in circulatory-disease risk (access to health care, diagnosis of a circulatory disease; Study 1) and circulatory-disease-related death rate (Study 2) in the same county. Results revealed that in counties where Whites reported greater racial bias, Blacks (but not Whites) reported decreased access to health care (Study 1). Furthermore, in counties where Whites reported greater racial bias, both Blacks and Whites showed increased death rates due to circulatory diseases, but this relationship was stronger for Blacks than for Whites (Study 2). These results indicate that racial disparities in risk of circulatory disease and in circulatory-disease-related death rate are more pronounced in communities where Whites harbor more explicit racial bias.

  8. Geographic Disparities in Access to Agencies Providing Income-Related Social Services.

    PubMed

    Bauer, Scott R; Monuteaux, Michael C; Fleegler, Eric W

    2015-10-01

    Geographic location is an important factor in understanding disparities in access to health-care and social services. The objective of this cross-sectional study is to evaluate disparities in the geographic distribution of income-related social service agencies relative to populations in need within Boston. Agency locations were obtained from a comprehensive database of social services in Boston. Geographic information systems mapped the spatial relationship of the agencies to the population using point density estimation and was compared to census population data. A multivariate logistic regression was conducted to evaluate factors associated with categories of income-related agency density. Median agency density within census block groups ranged from 0 to 8 agencies per square mile per 100 population below the federal poverty level (FPL). Thirty percent (n = 31,810) of persons living below the FPL have no access to income-related social services within 0.5 miles, and 77 % of persons living below FPL (n = 83,022) have access to 2 or fewer agencies. 27.0 % of Blacks, 30.1 % of Hispanics, and 41.0 % of non-Hispanic Whites with incomes below FPL have zero access. In conclusion, some neighborhoods in Boston with a high concentration of low-income populations have limited access to income-related social service agencies.

  9. Bloodstream infections in patients with solid tumors

    PubMed Central

    Gudiol, Carlota; Aguado, José María; Carratalà, Jordi

    2016-01-01

    ABSTRACT Little information is currently available regarding bloodstream infection (BSI) in patients with solid tumors who, for a variety of reasons, are particularly predisposed to develop this condition. In this review we focus on the incidence, epidemiology, clinical features, etiology, antimicrobial resistance, and outcomes of BSI of adult cancer patients with solid tumors. Most episodes of BSI occur in non-neutropenic patients, in whom the site of primary or metastatic tumor often serves as the portal of entry. The urinary tract and the abdomen are the most frequent sources of infection, and cholangitis is the most common recurrent source of BSI. Gram-negative bacilli are becoming the leading cause of BSI in patients with solid tumors, and the rate of multidrug resistance is increasingly being recognized. The case-fatality rate in patients with solid tumors and BSI is high, especially among those with comorbidities, advanced neoplasms, corticosteroid therapy, and shock at presentation. PMID:26787095

  10. The Relationship Between Geographic Access to Plastic Surgeons and Breast Reconstruction Rates Among Women Undergoing Mastectomy for Cancer.

    PubMed

    Bauder, Andrew R; Gross, Cary P; Killelea, Brigid K; Butler, Paris D; Kovach, Stephen J; Fox, Justin P

    2017-03-01

    Despite a national health care policy requiring payers to cover breast reconstruction, rates of postmastectomy reconstruction are low, particularly among minority populations. We conducted this study to determine if geographic access to a plastic surgeon impacts breast reconstruction rates. Using 2010 inpatient and ambulatory surgery data from 10 states, we identified adult women who underwent mastectomy for breast cancer. Data were aggregated to the health service area (HSA) level and hierarchical generalized linear models were used to risk-standardize breast reconstruction rates (RSRR) across HSAs. The relationship between an HSA's RSRR and plastic surgeon density (surgeons/100,000 population) was quantified using correlation coefficients. The final cohort included 22,997 patients across 134 HSAs. There was substantial variation in plastic surgeon density (median, 1.4 surgeons/100,000; interquartile range, [0.0-2.6]/100,000) and the use of breast reconstruction (median RSRR, 43.0%; interquartile range, [29.9%-62.8%]) across HSAs. Higher plastic surgeon density was positively correlated with breast reconstruction rates (correlation coefficient = 0.66, P < 0.001) and inversely related to time between mastectomy and reconstruction (correlation coefficient = -0.19, P < 0.001). Non-white and publicly insured women were least likely to undergo breast reconstruction overall. Among privately insured patients, racial disparities were noted in high surgeon density areas (white = 79.0% vs. non-white = 63.3%; P < 0.001) but not in low surgeon density areas (34.4% vs 36.5%; P = 0.70). The lack of geographic access to a plastic surgeon serves as a barrier to breast reconstruction and may compound disparities in care associated with race and insurance status. Future efforts to improve equitable access should consider strategies to ensure access to appropriate clinical expertise.

  11. Pressures on safety net access: the level of managed care penetration and uninsurance rate in a community.

    PubMed

    Cunningham, P J

    1999-04-01

    To examine the effects of managed care penetration and the uninsurance rate in an area on access to care of low-income uninsured persons and to compare differences in access between low-income insured and uninsured persons across these different market areas. Primarily the Community Tracking Study household survey. Other market-level data were obtained from the Community Tracking Study physician survey, American Hospital Association annual survey of hospitals, Area Resource File, HCFA Administrative Data, Bureau of Primary Care data on Community Health Centers. Individuals are grouped based on the level of managed care penetration and uninsurance rate in the site where they reside. Measures of managed care include overall managed care penetration in the site, and the level of Medicaid managed care penetration in the state. Uninsurance rate is defined as the percentage of people uninsured in the site. Measures of access include the percentage with a usual source of care, percentage with any ambulatory care use, and percentage of persons who reported unmet medical care needs. Estimates are adjusted to control for other confounding factors, including both individual and market-level characteristics. A survey, primarily telephoned, of households concentrated in 60 sites, defined as metropolitan statistical areas and nonmetropolitan areas. Access to care for low-income uninsured persons is lower in states with high Medicaid managed care penetration, compared to uninsured persons in states with low Medicaid managed care penetration. Access to care for low-income uninsured persons is also lower in areas with high uninsurance rates. The "access gap" (differences in access between insured and uninsured persons) is also larger in areas with high Medicaid managed care penetration and areas with high uninsurance rates. Efforts to achieve cost savings under managed care may result in financial pressures that limit cross-subsidization of care to the medically indigent

  12. Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience

    PubMed Central

    Jabbour, Gaby; Al-Hassani, Ammar; El-Menyar, Ayman; Abdelrahman, Husham; Peralta, Ruben; Ellabib, Mohamed; Al-Jogol, Hisham; Asim, Mohammad; Al-Thani, Hassan

    2017-01-01

    Background Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. Material/Methods A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients. Results A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I–III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury. Conclusions Most BSI patients had grade I–III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for

  13. Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience.

    PubMed

    Jabbour, Gaby; Al-Hassani, Ammar; El-Menyar, Ayman; Abdelrahman, Husham; Peralta, Ruben; Ellabib, Mohammed; Al-Jogol, Hisham; Asim, Mohammed; Al-Thani, Hassan

    2017-07-12

    BACKGROUND Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. MATERIAL AND METHODS A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients. RESULTS A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I-III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury. CONCLUSIONS Most BSI patients had grade I-III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for

  14. Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis: A Multicenter Cohort Study.

    PubMed

    De Soyza, Anthony; McDonnell, Melissa J; Goeminne, Pieter C; Aliberti, Stefano; Lonni, Sara; Davison, John; Dupont, Lieven J; Fardon, Thomas C; Rutherford, Robert M; Hill, Adam T; Chalmers, James D

    2017-06-01

    This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI). Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and "other" BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded. A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%). Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality. Copyright © 2017 American College of Chest Physicians. All rights reserved.

  15. Hospital admissions and emergency department presentations for dental conditions indicate access to hospital, rather than poor access to dental health care in the community.

    PubMed

    Yap, Matthew; Kok, Mei-Ruu; Nanda, Soniya; Vickery, Alistair; Whyatt, David

    2018-03-01

    High rates of dental-related potentially preventable hospitalisations are thought to reflect poor access to non-hospital dental services. The association between accessibility (geographic and financial) to non-hospital dentists and potentially preventable hospitalisations was examined in Western Australia. Areas with persistently high rates of dental-related potentially preventable hospitalisations and emergency department (ED) presentations were mapped. Statistical models examined factors associated with these events. Persistently high rates of dental-related potentially preventable hospitalisations were clustered in metropolitan areas that were socioeconomically advantaged and had more dentists per capita (RR 1.06, 95% CI 1.04-1.08) after adjusting for age, sex, socioeconomics, and Aboriginality. Persistently high rates of ED presentations were clustered in socioeconomically disadvantaged areas near metropolitan EDs and with fewer dentists per capita (RR 0.91, 0.88-0.94). A positive association between dental-related potentially preventable hospitalisations and poor (financial or geographic) access to dentists was not found. Rather, rates of such events were positively associated with socioeconomic advantage, plus greater access to hospitals and non-hospital dental services. Furthermore, ED presentations for dental conditions are inappropriate indicators of poor access to non-hospital dental services because of their relationship with hospital proximity. Health service planners and policymakers should pursue alternative indicators of dental service accessibility.

  16. Knowledge of HIV-related disabilities and challenges in accessing care: Qualitative research from Zimbabwe

    PubMed Central

    Zuurmond, Maria; Ferrand, Rashida; Kuper, Hannah

    2017-01-01

    Introduction While the rapid expansion in antiretroviral therapy access in low and middle income countries has resulted in dramatic declines in mortality rates, many people living with HIV face new or worsening experiences of disability. As nearly 1 in 20 adults are living with HIV in sub-Saharan Africa–many of whom are likely to develop disabling sequelae from long-term infection, co-morbidities and side effects of their treatment–understanding the availability and accessibility of services to address HIV-related disabilities is of vital importance. The aim of this study thus is to explore knowledge of HIV-related disabilities amongst stakeholders working in the fields of HIV and disability and factors impacting uptake and provision of interventions for preventing, treating or managing HIV-related disabilities. Methods In-depth, semi-structured interviews were conducted with ten stakeholders based in Harare, Zimbabwe, who were working in the fields of either disability or HIV. Stakeholders were identified through a priori stakeholder analysis. Thematic Analysis, complemented by constant comparison as described in Grounded Theory, was used to analyse findings. Results All key informants reported some level of knowledge of HIV-related disability, mostly from observations made in their line of work. However, they reported no interventions or policies were in place specifically to address HIV-related disability. While referrals between HIV and rehabilitation providers were not uncommon, no formal mechanisms had been established for collaborating on prevention, identification and management. Additional barriers to accessing and providing services to address HIV-related disabilities included: the availability of resources, including trained professionals, supplies and equipment in both the HIV and rehabilitation sectors; lack of disability-inclusive adaptations, particularly in HIV services; heavy centralization of available services in urban areas, without

  17. A Needs Assessment of Health Issues Related to Maternal Mortality Rates in Afghanistan: A Pilot Study.

    PubMed

    Naim, Ali; Feldman, Robert; Sawyer, Robin

    2015-01-01

    Maternal death rates in Afghanistan were among the highest in the world during the reign of the Taliban. Although these figures have improved, current rates are still alarming. The aim of this pilot study was to develop a needs assessment of the major health issues related to the high maternal mortality rates in Afghanistan. In-depth interviews were conducted with managerial midwives, clinical midwives, and mothers. Results of the interviews indicate that the improvement in the maternal mortality rate may be attributed to the increase in the involvement of midwives in the birthing process. However, barriers to decreasing maternal mortality still exist. These include transportation, access to care, and sociocultural factors such as the influence of the husband and mother-in-law in preventing access to midwives. Therefore, any programs to decrease maternal mortality need to address infrastructure issues (making health care more accessible) and sociocultural factors (including husbands and mother-in-laws in maternal health education). However, it should be noted that these findings are based on a small pilot study to help develop a larger scale need assessment. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  18. Medical adhesive-related skin injuries associated with vascular access.

    PubMed

    Hitchcock, Jan; Savine, Louise

    2017-04-27

    Establishing vascular access and preventing infection, both at insertion and during ongoing care is generally the top priority; the maintenance of optimal skin integrity is often a distant secondary consideration. Skin can react to different types of dressings or adhesives, or problems can arise relating to the securement of lines or the development of sensitivities to cleaning solutions. Clearly, these scenarios are not limited to the securement of vascular access devices; however, a patient with a long-term vascular access device may not have other options for vascular access, which makes this a very important and yet largely unrecognised area. A review of the limited literature that existed up to March 2015 showed it was typically concerned with skin tears connected with dressings and removal, and contact irritant dermatitis. The tissue viability team and vascular access team reviewed the current products associated with a typical vascular access dressing to ensure it was fit for purpose and where at all possible had good scientific literature for validation. The team worked proactively to recognise those patients at risk with the early identification of potential medical adhesive-related skin injuries (MARSI). To facilitate this an algorithm was developed that offers a step-by-step approach, clearly outlining what to do to prevent MARSI and its treatment should it develop. These reactions can result from other factors than the dressing alone, and an increase in these kinds of skin reaction in patients who are on chemotherapy regimens is being explored further. Through the implementation of an algorithm, education for both staff and patients and collaborative working between vascular access and tissue viability teams, a reduction in these phenomena has been seen despite an increasing number of at-risk patients.

  19. Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods.

    PubMed

    Choi, Sung W; Chang, Lawrence; Hanauer, David A; Shaffer-Hartman, Jacqueline; Teitelbaum, Daniel; Lewis, Ian; Blackwood, Alex; Akcasu, Nur; Steel, Janell; Christensen, Joy; Niedner, Matthew F

    2013-02-01

    Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs. CLA-BSI rates were analyzed within a single-institution's PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit's safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes. The pre-intervention CLA-BSI incidence was 2.92 per 1,000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1,000-PD (P < 0.004). Early on, blood and marrow transplant (BMT) patients had a threefold higher CLA-BSI rate compared to non-BMT patients (P < 0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention. By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained. Copyright © 2012 Wiley Periodicals, Inc.

  20. Concurrent epidemics of skin and soft tissue infection and bloodstream infection due to community-associated methicillin-resistant Staphylococcus aureus.

    PubMed

    Tattevin, Pierre; Schwartz, Brian S; Graber, Christopher J; Volinski, Joann; Bhukhen, Akta; Bhukhen, Arti; Mai, Thuy T; Vo, Nhung H; Dang, Denise N; Phan, Tiffany HaiVan; Basuino, Li; Perdreau-Remington, Françoise; Chambers, Henry F; Diep, Binh An

    2012-09-01

    Since its emergence in 2000, epidemic spread of the methicillin-resistant Staphylococcus aureus (MRSA) clone USA300 has led to a high burden of skin and soft tissue infections (SSTIs) in the United States, yet its impact on MRSA bloodstream infections (BSIs) is poorly characterized. To assess clonality of the MRSA isolates causing SSTI and BSI during the epidemic period, a stratified, random sample of 1350 unique infection isolates (from a total of 7252) recovered at the Community Health Network of San Francisco from 2000 to 2008 were selected for genotyping. Risk factors and outcomes for 549 BSI cases caused by the USA300 epidemic clone and non-USA300 MRSA clones were assessed by retrospective review of patient medical records. From 2000 to 2008, secular trends of USA300 SSTI and USA300 BSI were strongly correlated (Pearson r = 0.953). USA300 accounted for 55% (304/549) of BSIs as it was the predominant MRSA clone that caused community-associated (115/160), healthcare-associated community-onset (125/207), and hospital-onset (64/182) BSIs. Length of hospitalization after BSI diagnosis and mortality rates for USA300 and non-USA300 were similar. Two independent risk factors for USA300 BSI were identified: concurrent SSTI (adjusted relative risk, 1.4 [95% confidence interval {CI}, 1.2-1.6]) and anti-MRSA antimicrobial use in the preceding 30 days (0.7 [95% CI, .6-.8]). Isolates from concurrent SSTI were indistinguishable genotypically from the USA300 isolates that caused BSI. USA300 SSTIs serve as a source for BSI. Strategies to control the USA300 SSTI epidemic may lessen the severity of the concurrent USA300 BSI epidemic.

  1. Access-related complications - an analysis of 6023 consecutive laparoscopic hernia repairs.

    PubMed

    2001-01-01

    In order to investigate incidence rates and types of access-related complications that may occur during laparoscopic hernioplasty, we carried out a systematic analysis of our collected results. The aim was to identify risk factors and to develop useful modifications of the surgical technique and the instrumentation used. Since we first introduced laparoscopic hernioplasty in our clinic, we have carried out standardised, prospective documentation of relevant data from all consecutive operations in an electronic database. We performed a systematic analysis of access-related complications and their possible influencing factors, taking into special account the type of instruments used, port-site and prior intra-abdominal operations. Between April 1993 and March 2000, 4857 consecutive patients received a total of 6023 laparoscopic hernia repairs. In 510 patients three-edged, sharp trocars were used and in 4347 patients conical obturators were used to insert the port. The incidence of access-related complications was 0.9% (44/4857) in the total collection (incision hernias 0.5%, bleeding from abdominal-wall vessels 0.2%, bowel injury 0.06%, wound infections 0.06%). Injuries to intra-abdominal or retroperitoneal vessels were not observed. A differentiated analysis of the various trocar types, taking into consideration the number of inserted ports, showed that for incisions outside the linea alba the incidence of bleeding from abdominal-wall vessels was 12 times higher (0.7%, 7/1020 versus 0.06%, 5/8694). The incidence of incision hernias increased significantly (1.2%, 12/1020 versus 0.02%, 2/8694; p = 0.03) when three-edged trocars were used, as opposed to conical obturators. Our results demonstrate that, outside the linea alba, three-edged trocars should no longer be used for portinsertion. The results of our differentiated analysis of laparoscopic hernia repairs, taking into account the type of obturator, the port-site and number of ports inserted, also can be applied

  2. Supramolecular self-assembly on the B-Si(111)-(√3x√3) R30° surface: From single molecules to multicomponent networks

    NASA Astrophysics Data System (ADS)

    Makoudi, Younes; Jeannoutot, Judicaël; Palmino, Frank; Chérioux, Frédéric; Copie, Guillaume; Krzeminski, Christophe; Cleri, Fabrizio; Grandidier, Bruno

    2017-09-01

    Understanding the physical and chemical processes in which local interactions lead to ordered structures is of particular relevance to the realization of supramolecular architectures on surfaces. While spectacular patterns have been demonstrated on metal surfaces, there have been fewer studies of the spontaneous organization of supramolecular networks on semiconductor surfaces, where the formation of covalent bonds between organics and adatoms usually hamper the diffusion of molecules and their subsequent interactions with each other. However, the saturation of the dangling bonds at a semiconductor surface is known to make them inert and offers a unique way for the engineering of molecular patterns on these surfaces. This review describes the physicochemical properties of the passivated B-Si(111)-(√3x√3) R30° surface, that enable the self-assembly of molecules into a rich variety of extended and regular structures on silicon. Particular attention is given to computational methods based on multi-scale simulations that allow to rationalize the relative contribution of the dispersion forces involved in the self-assembled networks observed with scanning tunneling microscopy. A summary of state of the art studies, where a fine tuning of the molecular network topology has been achieved, sheds light on new frontiers for exploiting the construction of supramolecular structures on semiconductor surfaces.

  3. Anxiety and depression in adult outpatients with bronchiectasis: Associations with disease severity and health-related quality of life.

    PubMed

    Gao, Yong-Hua; Guan, Wei-Jie; Zhu, Ya-Nan; Chen, Rong-Chang; Zhang, Guo-Jun

    2018-04-01

    Anxiety and depression might frequently affect bronchiectasis patients, but data in Chinese patients, including their association with disease severity assessed with Bronchiectasis Severity Index (BSI) and FACED score, are limited. To investigate the rate, risk factors, association with disease severity and impact of anxiety and depression on health-related quality of life (HRQoL) in adult outpatients with steady-state bronchiectasis. This cross-sectional study included 163 outpatients (102 females; mean age, 45.8 years) and 80 healthy subjects (47 females; mean age, 47.1 years). Demographic, clinical indices, radiology, spirometry, aetiology, sputum bacteriology, Hospital Anxiety and Depression Scales (HADS), Pittsburgh Sleep Quality Index (PSQI) and St. George's Respiratory Questionnaire (SGRQ) were assessed. Patients with steady-state bronchiectasis had a higher rate of depression (HADS-depression >7) (30.1% vs 10.0%, P = .001) and anxiety (HADS-anxiety >7; 39.9% vs 6.3%, P < .001) compared with healthy subjects. Notably, no significant differences in the rate of anxiety and depression were found across different disease severity, assessed with BSI and FACED score (all P > .05). In multivariate model, factors associated with anxiety included younger age (OR = 1.05), education below college graduate (OR = 4.55) and sleep disturbance (PSQI ≥ 6; OR = 2.95); whereas sleep disturbance was the sole factor associated with depression (OR = 5.98). Patients with either depression or anxiety had more markedly impaired HRQoL affecting most domains than those without. Anxiety and depression are common in bronchiectasis and can negatively affect HRQoL, but not related to disease severity. Prompt assessment and treatment of these mental disorders, regardless of bronchiectasis severity, are advocated and might improve HRQoL. © 2017 John Wiley & Sons Ltd.

  4. Quantifying Bone–relevant Activity and its Relation to Bone Strength in Girls

    PubMed Central

    Farr, Joshua N.; Lee, Vinson R.; Blew, Robert M.; Lohman, Timothy G.; Going, Scott B.

    2011-01-01

    Physical activity (PA) is critical for maximizing bone development during growth. However, there is no consensus on how well existing PA measurement tools predict bone strength. PURPOSE Compare four methods of quantifying physical activity (PA) (pedometer, 3-day physical activity recall (3DPAR), bone-specific physical activity questionnaire (BPAQ), and past year physical activity questionnaire (PYPAQ)), in young girls and evaluate their ability to predict indices of bone strength. METHODS 329 girls aged 8–13 years completed a pedometer assessment, the 3DPAR, the BPAQ, and a modified PYPAQ. Peripheral quantitative computed tomography (pQCT) was used to assess bone strength index (BSI) at metaphyseal (4% distal femur and tibia) sites and strength-strain index (SSI) at diaphyseal (femur = 20%, tibia = 66%) sites of the non-dominant leg. Correlations and hierarchical multiple regression were used to assess relationships among PA measures and indices of bone strength. RESULTS After adjustment for maturity, correlations between PA measures and indices of bone strength were positive, although low (r = 0.01–0.20). Regression models that included covariates (maturity, body mass, leg length, and ethnicity) and PA variables showed that PYPAQ score was significantly (P < 0.05) associated with BSI and SSI at all sites and explained more variance in BSI and SSI than any other PA measure. Pedometer steps were significantly (P < 0.05) associated with metaphyseal femur and tibia BSI and 3DPAR score was significantly (P < 0.05) associated with metaphyseal femur BSI. BPAQ score was not significantly (P > 0.05) associated with BSI or SSI at any sites. CONCLUSION A modified PYPAQ that accounts for the duration, frequency, and load of PA predicted indices of bone strength better than other PA measures. PMID:20631644

  5. Risk for Health Care-Associated Bloodstream Infections in Pediatric Oncology Patients With Various Malignancies.

    PubMed

    Thurman, Cara B; Abbott, Maura; Liu, Jinfang; Larson, Elaine

    This was a retrospective cohort study to identify the rates, predictors, and outcomes of health care-associated bloodstream infections (HA-BSI) among children with solid tumors, lymphoma, lymphoid leukemia, and myeloid leukemia. The study population included 4500 children ≤18 years old at a pediatric hospital in New York City from 2006 to 2014. A total of 147 HA-BSI cases were identified; using multivariable logistic regression modeling, children with a hematologic diagnosis (lymphoma, lymphoid leukemia, myeloid leukemia) were at greater risk for HA-BSI than those with a solid tumor diagnosis (all P values <.0001). The odds of mortality for patients with HA-BSI were 6.98 (95% confidence interval 3.02-16.10) times that of those without HA-BSI. Although malignancy type was identified as risk factor for HA-BSI, there was no significant difference in overall mortality from HA-BSI by tumor type ( P = .51).

  6. Predicting Graduation Rates at 4-Year Broad Access Institutions Using a Bayesian Modeling Approach

    ERIC Educational Resources Information Center

    Crisp, Gloria; Doran, Erin; Salis Reyes, Nicole A.

    2018-01-01

    This study models graduation rates at 4-year broad access institutions (BAIs). We examine the student body, structural-demographic, and financial characteristics that best predict 6-year graduation rates across two time periods (2008-2009 and 2014-2015). A Bayesian model averaging approach is utilized to account for uncertainty in variable…

  7. Concordance between European and US case definitions of healthcare-associated infections

    PubMed Central

    2012-01-01

    Background Surveillance of healthcare-associated infections (HAI) is a valuable measure to decrease infection rates. Across Europe, inter-country comparisons of HAI rates seem limited because some countries use US definitions from the US Centers for Disease Control and Prevention (CDC/NHSN) while other countries use European definitions from the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE) project. In this study, we analyzed the concordance between US and European definitions of HAI. Methods An international working group of experts from seven European countries was set up to identify differences between US and European definitions and then conduct surveillance using both sets of definitions during a three-month period (March 1st -May 31st, 2010). Concordance between case definitions was estimated with Cohen’s kappa statistic (κ). Results Differences in HAI definitions were found for bloodstream infection (BSI), pneumonia (PN), urinary tract infection (UTI) and the two key terms “intensive care unit (ICU)-acquired infection” and “mechanical ventilation”. Concordance was analyzed for these definitions and key terms with the exception of UTI. Surveillance was performed in 47 ICUs and 6,506 patients were assessed. One hundred and eighty PN and 123 BSI cases were identified. When all PN cases were considered, concordance for PN was κ = 0.99 [CI 95%: 0.98-1.00]. When PN cases were divided into subgroups, concordance was κ = 0.90 (CI 95%: 0.86-0.94) for clinically defined PN and κ = 0.72 (CI 95%: 0.63-0.82) for microbiologically defined PN. Concordance for BSI was κ = 0.73 [CI 95%: 0.66-0.80]. However, BSI cases secondary to another infection site (42% of all BSI cases) are excluded when using US definitions and concordance for BSI was κ = 1.00 when only primary BSI cases, i.e. Europe-defined BSI with ”catheter” or “unknown” origin and US-defined laboratory-confirmed BSI (LCBI), were

  8. Energy and Environment Guide to Action - Chapter 7.4: Customer Rates and Data Access

    EPA Pesticide Factsheets

    Provides recommendations for designing, implementing, and evaluating utility rates and providing data access to support energy efficiency, CHP, and clean energy goals. State examples are included for reference.

  9. Suicide Rates and State Laws Regulating Access and Exposure to Handguns

    PubMed Central

    Anestis, Joye C.

    2015-01-01

    Objectives. Using previous research, we examined the impact of 4 handgun laws (waiting periods, universal background checks, gun locks, and open carrying regulations) on suicide rates. Methods. We used publicly available databases to collect information on statewide laws, suicide rates, and demographic characteristics for 2013. Results. Each law was associated with significantly lower firearm suicide rates and the proportion of suicides resulting from firearms. In addition, each law, except for that which required a waiting period, was associated with a lower overall suicide rate. Follow-up analyses showed a significant indirect effect on overall suicide rates through the proportion of suicides by firearms, indicating that the reduced overall suicide rate was attributable to fewer suicide attempts, fewer handguns in the home, suicide attempts using less lethal means, or a combination of these factors. States that implemented any of these laws saw a decreased suicide rate in subsequent years, whereas the only state that repealed 1 of these laws saw an increased suicide rate. Conclusions. Our results were supportive of a potentially vital role in suicide prevention for state legislation that limits access and exposure to handguns. PMID:26270305

  10. Catheter-related bloodstream infection.

    PubMed

    Goede, Matthew R; Coopersmith, Craig M

    2009-04-01

    Catheter-related bloodstream infections (CR-BSIs) are a common, frequently preventable complication of central venous catheterization. CR-BSIs can be prevented by strict attention to insertion and maintenance of central venous catheters and removing unneeded catheters as soon as possible. Antiseptic- or antibiotic-impregnated catheters are also an effective tool to prevent infections. The diagnosis of CR-BSI is made largely based on culture results. CR-BSIs should always be treated with antibiotics, and except in rare circumstances the infected catheter needs to be removed.

  11. Clinic access and teenage birth rates: Racial/ethnic and spatial disparities in Houston, TX.

    PubMed

    Wisniewski, Megan M; O'Connell, Heather A

    2018-03-01

    Teenage motherhood is a pressing issue in the United States, and one that is disproportionately affecting racial/ethnic minorities. In this research, we examine the relationship between the distance to the nearest reproductive health clinic and teenage birth rates across all zip codes in Houston, Texas. Our primary data come from the Texas Department of State Health Services. We use spatial regression analysis techniques to examine the link between clinic proximity and local teenage birth rates for all females aged 15 to 19, and separately by maternal race/ethnicity. We find, overall, limited support for a connection between clinic distance and local teenage birth rates. However, clinics seem to matter most for explaining non-Hispanic white teenage birth rates, particularly in high-poverty zip codes. The racial/ethnic and economic variation in the importance of clinic distance suggests tailoring clinic outreach to more effectively serve a wider range of teenage populations. We argue social accessibility should be considered in addition to geographic accessibility in order for clinics to help prevent teenage pregnancy. Copyright © 2018. Published by Elsevier Ltd.

  12. Astronomical pacing of the global silica cycle recorded in Mesozoic bedded cherts

    NASA Astrophysics Data System (ADS)

    Ikeda, Masayuki; Tada, Ryuji; Ozaki, Kazumi

    2017-06-01

    The global silica cycle is an important component of the long-term climate system, yet its controlling factors are largely uncertain due to poorly constrained proxy records. Here we present a ~70 Myr-long record of early Mesozoic biogenic silica (BSi) flux from radiolarian chert in Japan. Average low-mid-latitude BSi burial flux in the superocean Panthalassa is ~90% of that of the modern global ocean and relative amplitude varied by ~20-50% over the 100 kyr to 30 Myr orbital cycles during the early Mesozoic. We hypothesize that BSi in chert was a major sink for oceanic dissolved silica (DSi), with fluctuations proportional to DSi input from chemical weathering on timescales longer than the residence time of DSi (<~100 Kyr). Chemical weathering rates estimated by the GEOCARBSULFvolc model support these hypotheses, excluding the volcanism-driven oceanic anoxic events of the Early-Middle Triassic and Toarcian that exceed model limits. We propose that the Mega monsoon of the supercontinent Pangea nonlinearly amplified the orbitally paced chemical weathering that drove BSi burial during the early Mesozoic greenhouse world.

  13. Higher HTLV-1c proviral loads are associated with blood stream infections in an Indigenous Australian population.

    PubMed

    Einsiedel, Lloyd; Cassar, Olivier; Spelman, Tim; Joseph, Sheela; Gessain, Antoine

    2016-05-01

    An association between blood stream infections (BSI) and HTLV-1 seropositivity in Indigenous Australians might result from HTLV-1 mediated inflammation and parasite coinfections that provide portals of entry for bacteria. To determine whether BSI risk increases with HTLV-1c proviral load (PVL) and to identify the pathogens responsible in the context of HTLV-1 related conditions. Indigenous adults admitted to Alice Springs Hospital, central Australia, were recruited as cases or controls according to whether they had a BSI. Clinical data were extracted from case notes and the hospital pathology database. HTLV-1 serology and PVL assays were then performed and risk factors for BSI were determined for HTLV-1 infected subjects. Risk factors were compared between 44 cases and 30 controls who were HTLV-1 Western blot positive. In a multivariable model, high HTLV-1c PVL was predictive of BSI during the study period (OR, 9.10; 95% CI, 2.40-34.4). Median (IQR) HTLV-1c PVL (copies per 100 PBL) was 39-fold higher for patients recording any BSI (0.116 (0.009, 0.277)) relative to those who had no BSI (0.003 (0.000, 0.067))(p=0.0007). Mean (SD) PVL for subjects with no BSI (n=27), 1 BSI (n=37) and ≥2 BSI (n=10) during the study period were 0.120 (0.301), 0.271 (0.622) and 0.500 (0.654) copies per 100 PBL, respectively (p=0.0007). Five BSI were associated with possible complications of HTLV-1; strongyloidiasis (3), infective dermatitis (1), HTLV-1 associated bronchiectasis (1). Higher HTLV-1c PVL predicts BSI risk; however; most BSI were not associated with recognised complications of HTLV-1 infection. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  14. Do parent protective responses mediate the relation between parent distress and child functional disability among children with chronic pain?

    PubMed

    Sieberg, Christine B; Williams, Sara; Simons, Laura E

    2011-10-01

    To examine whether protective parent responses mediate the relation between parent distress and child functioning. At a pain clinic evaluation, 157 families participated. Parents completed measures of global distress (BSI-18), distress in the context of their child's pain (BAP-PIQ), and protective responses to their child's pain. Children completed measures of functional disability and pain. BAP-PIQ subscales were significantly associated with child functional disability, whereas BSI subscales were unrelated. Protective parent responses partially mediated the relation between parent distress and child functional disability for depression, anxiety, and catastrophizing. However, parent protective behavior fully mediated the relationship between parent helplessness and child functional disability, indicating that feelings of parent helplessness did not uniquely contribute to child functional disability. Discussion Results suggest that when treating youth with chronic pain, parental distress in the context of children's pain needs to be addressed.

  15. Human rights responsibilities of pharmaceutical companies in relation to access to medicines.

    PubMed

    Lee, Joo-Young; Hunt, Paul

    2012-01-01

    Although access to medicines is a vital feature of the right to the highest attainable standard of health ("right to health"), almost two billion people lack access to essential medicines, leading to immense avoidable suffering. While the human rights responsibility to provide access to medicines lies mainly with States, pharmaceutical companies also have human rights responsibilities in relation to access to medicines. This article provides an introduction to these responsibilities. It briefly outlines the new UN Guiding Principles on Business and Human Rights and places the human rights responsibilities of pharmaceutical companies in this context. The authors draw from the work of the first UN Special Rapporteur on the right to the highest attainable standard of health, in particular the Human Rights Guidelines for Pharmaceutical Companies in Relation to Access to Medicines that he presented to the UN General Assembly in 2008, and his UN report on GlaxoSmithKline (GSK). While the Guiding Principles on Business and Human Rights are general human rights standards applicable to all business entities, the Human Rights Guidelines for Pharmaceutical Companies consider the specific human rights responsibilities of one sector (pharmaceutical companies) in relation to one area of activity (access to medicines). The article signals the human rights responsibilities of all pharmaceutical companies, with particular attention to patent-holding pharmaceutical companies. Adopting a right-to-health "lens," the article discusses GSK and accountability. The authors argue that human rights should shape pharmaceutical companies' policies, and provide standards in relation to which pharmaceutical companies could, and should, be held accountable. They conclude that it is now crucial to devise independent, accessible, transparent, and effective mechanisms to monitor pharmaceutical companies and hold them publicly accountable for their human rights responsibilities. © 2012 American

  16. Labeling and Rating Systems: Greater Access or Censorship?

    ERIC Educational Resources Information Center

    Martin, Ann M.

    2015-01-01

    This article asks the question: How well versed are school librarians on issues related to labeling and rating systems? As school librarians continue to design and implement resource location schemes to assist patrons, they must recognize the difference between using labels to create interest in books or implementing labeling and rating systems…

  17. An energy-efficient rate adaptive media access protocol (RA-MAC) for long-lived sensor networks.

    PubMed

    Hu, Wen; Chen, Quanjun; Corke, Peter; O'Rourke, Damien

    2010-01-01

    We introduce an energy-efficient Rate Adaptive Media Access Control (RA-MAC) algorithm for long-lived Wireless Sensor Networks (WSNs). Previous research shows that the dynamic and lossy nature of wireless communications is one of the major challenges to reliable data delivery in WSNs. RA-MAC achieves high link reliability in such situations by dynamically trading off data rate for channel gain. The extra gain that can be achieved reduces the packet loss rate which contributes to reduced energy expenditure through a reduced numbers of retransmissions. We achieve this at the expense of raw bit rate which generally far exceeds the application's link requirement. To minimize communication energy consumption, RA-MAC selects the optimal data rate based on the estimated link quality at each data rate and an analytical model of the energy consumption. Our model shows how the selected data rate depends on different channel conditions in order to minimize energy consumption. We have implemented RA-MAC in TinyOS for an off-the-shelf sensor platform (the TinyNode) on top of a state-of-the-art WSN Media Access Control Protocol, SCP-MAC, and evaluated its performance by comparing our implementation with the original SCP-MAC using both simulation and experiment.

  18. Effect of psychosocial stressors on patients with Crohn's disease: threatening life experiences and family relations.

    PubMed

    Slonim-Nevo, Vered; Sarid, Orly; Friger, Michael; Schwartz, Doron; Chernin, Elena; Shahar, Ilana; Sergienko, Ruslan; Vardi, Hillel; Rosenthal, Alexander; Mushkalo, Alexander; Dizengof, Vitaly; Ben-Yakov, Gil; Abu-Freha, Naim; Munteanu, Daniella; Gaspar, Nava; Eidelman, Leslie; Segal, Arik; Fich, Alexander; Greenberg, Dan; Odes, Shmuel

    2016-09-01

    Threatening life experiences and adverse family relations are major psychosocial stressors affecting mental and physical health in chronic illnesses, but their influence in Crohn's disease (CD) is unclear. We assessed whether these stressors would predict the psychological and medical condition of CD patients. Consecutive adult CD patients completed a series of instruments including demography, Patient Harvey-Bradshaw Index (P-HBI), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), short-form survey instrument (SF-36), brief symptom inventory (BSI), family assessment device (FAD), and list of threatening life experiences (LTE). Associations of FAD and LTE with P-HBI, SIBDQ, SF-36, and BSI were examined by multiple linear and quantile regression analyses. The cohort included 391 patients, mean age 38.38±13.95 years, 59.6% women, with intermediate economic status. The median scores were as follows: P-HBI 4 (2-8), FAD 1.67 (1.3-2.1), LTE 1 (0-3), SF-36 physical health 43.75 (33.7-51.0), SF-36 mental health 42.99 (34.1-51.9), and BSI-Global Severity Index 0.81 (0.4-1.4). The SIBDQ was 47.27±13.9. LTE was associated with increased P-HBI in all quantiles and FAD in the 50% quantile. FAD and LTE were associated with reduced SIBDQ (P<0.001). Higher LTE was associated with lower SF-36 physical and mental health (P<0.001); FAD was associated with reduced mental health (P<0.001). FAD and LTE were associated positively with GSI in all quantiles; age was associated negatively. CD patients with more threatening life experiences and adverse family relations were less healthy both physically and mentally. Physicians offering patients sociopsychological therapy should relate to threatening life experiences and family relations.

  19. An Intersectional Perspective on Access to HIV-Related Healthcare for Transgender Women

    PubMed Central

    Lacombe-Duncan, Ashley

    2016-01-01

    Abstract Transgender women experience decreased access to HIV-related healthcare relative to cisgender people, in part due to pervasive transphobia in healthcare. This perspective describes intersectionality as a salient theoretical approach to understanding this disparity, moving beyond transphobia to explore how intersecting systems of oppression, including cisnormativity, sexism/transmisogyny, classism, racism, and HIV-related, gender nonconformity, substance use, and sex work stigma influence HIV-related healthcare access for transgender women living with HIV. This perspective concludes with a discussion of how intersectionality-informed studies can be enhanced through studying underexplored intersections and bringing attention to women's resiliency and empowerment. PMID:29159304

  20. A carrier sensed multiple access protocol for high data base rate ring networks

    NASA Technical Reports Server (NTRS)

    Foudriat, E. C.; Maly, Kurt J.; Overstreet, C. Michael; Khanna, S.; Paterra, Frank

    1990-01-01

    The results of the study of a simple but effective media access protocol for high data rate networks are presented. The protocol is based on the fact that at high data rates networks can contain multiple messages simultaneously over their span, and that in a ring, nodes used to detect the presence of a message arriving from the immediate upstream neighbor. When an incoming signal is detected, the node must either abort or truncate a message it is presently sending. Thus, the protocol with local carrier sensing and multiple access is designated CSMA/RN. The performance of CSMA/RN with TTattempt and truncate is studied using analytic and simulation models. Three performance factors, wait or access time, service time and response or end-to-end travel time are presented. The service time is basically a function of the network rate, it changes by a factor of 1 between no load and full load. Wait time, which is zero for no load, remains small for load factors up to 70 percent of full load. Response time, which adds travel time while on the network to wait and service time, is mainly a function of network length, especially for longer distance networks. Simulation results are shown for CSMA/RN where messages are removed at the destination. A wide range of local and metropolitan area network parameters including variations in message size, network length, and node count are studied. Finally, a scaling factor based upon the ratio of message to network length demonstrates that the results, and hence, the CSMA/RN protocol, are applicable to wide area networks.

  1. The intraosseous have it: A prospective observational study of vascular access success rates in patients in extremis using video review.

    PubMed

    Chreiman, Kristen M; Dumas, Ryan P; Seamon, Mark J; Kim, Patrick K; Reilly, Patrick M; Kaplan, Lewis J; Christie, Jason D; Holena, Daniel N

    2018-04-01

    Quick and successful vascular access in injured patients arriving in extremis is crucial to enable early resuscitation and rapid OR transport for definitive repair. We hypothesized that intraosseous (IO) access would be faster and have higher success rates than peripheral intravenous (PIV) or central venous catheters (CVCs). High-definition video recordings of resuscitations for all patients undergoing emergency department thoracotomy from April 2016 to July 2017 were reviewed as part of a quality improvement initiative. Demographics, mechanism of injury, access type, access location, start and stop time, and success of each vascular access attempt were recorded. Times to completion for access types (PIV, IO, CVC) were compared using Kruskal-Wallis test adjusted for multiple comparisons, while categorical outcomes, such as success rates by access type, were compared using χ test or Fisher's exact test. Study patients had a median age of 30 years (interquartile range [IQR], 25-38 years), 92% were male, 92% were African American, and 93% sustained penetrating trauma. A total of 145 access attempts in 38 patients occurred (median, 3.8; SD, 1.4 attempts per patient). There was no difference between duration of PIV and IO attempts (0.63; IQR, 0.35-0.96 vs. 0.39 IQR, 0.13-0.65 minutes, adjusted p = 0.03), but both PIV and IO were faster than CVC attempts (3.2; IQR, 1.72-5.23 minutes; adjusted p < 0.001 for both comparisons). Intraosseous lines had higher success rates than PIVs or CVCs (95% vs. 42% vs. 46%, p < 0.001). Access attempts using IO are as fast as PIV attempts but are more than twice as likely to be successful. Attempts at CVC access in patients in extremis have high rates of failure and take a median of over 3 minutes. While IO access may not completely supplant PIVs and CVCs, IO access should be considered as a first-line therapy for trauma patients in extremis. Therapeutic, level III.

  2. Improving access to emergency contraception under the Scottish Sexual Health Strategy: can rates of unintended pregnancy be reduced?

    PubMed

    McGowan, James G

    2013-09-01

    Unintended pregnancy is a global sexual health problem. Outcomes of unintended pregnancy include unwanted childbirth and abortion, which may be associated with negative physical and psychosocial health implications for women. In Scotland, the Scottish Sexual Health Strategy has the stated goal of improving the sexual health of the people of Scotland. One aim of the Strategy is to reduce rates of unintended pregnancy and one policy designed to achieve this is 'widening access to emergency contraception'. This paper examines the success of this policy with reference to the implicit link it makes between expanding access to emergency contraception and increasing its effective use, aiming thereby to reduce rates of unintended pregnancy. Since there is evidence that previous policies and strategies expanding access to emergency contraception have failed to reduce such rates, alternative approaches to achieve a reduction in unintended pregnancies are discussed.

  3. Using Baidu Search Index to Predict Dengue Outbreak in China

    NASA Astrophysics Data System (ADS)

    Liu, Kangkang; Wang, Tao; Yang, Zhicong; Huang, Xiaodong; Milinovich, Gabriel J.; Lu, Yi; Jing, Qinlong; Xia, Yao; Zhao, Zhengyang; Yang, Yang; Tong, Shilu; Hu, Wenbiao; Lu, Jiahai

    2016-12-01

    This study identified the possible threshold to predict dengue fever (DF) outbreaks using Baidu Search Index (BSI). Time-series classification and regression tree models based on BSI were used to develop a predictive model for DF outbreak in Guangzhou and Zhongshan, China. In the regression tree models, the mean autochthonous DF incidence rate increased approximately 30-fold in Guangzhou when the weekly BSI for DF at the lagged moving average of 1-3 weeks was more than 382. When the weekly BSI for DF at the lagged moving average of 1-5 weeks was more than 91.8, there was approximately 9-fold increase of the mean autochthonous DF incidence rate in Zhongshan. In the classification tree models, the results showed that when the weekly BSI for DF at the lagged moving average of 1-3 weeks was more than 99.3, there was 89.28% chance of DF outbreak in Guangzhou, while, in Zhongshan, when the weekly BSI for DF at the lagged moving average of 1-5 weeks was more than 68.1, the chance of DF outbreak rose up to 100%. The study indicated that less cost internet-based surveillance systems can be the valuable complement to traditional DF surveillance in China.

  4. Feedback Functions, Optimization, and the Relation of Response Rate to Reinforcer Rate

    ERIC Educational Resources Information Center

    Soto, Paul L.; McDowell, Jack J.; Dallery, Jesse

    2006-01-01

    The present experiment arranged a series of inverted U-shaped feedback functions relating reinforcer rate to response rate to test whether responding was consistent with an optimization account or with a one-to-one relation of response rate to reinforcer rate such as linear system theory's rate equation or Herrnstein's hyperbola. Reinforcer rate…

  5. Cilostazol May Improve Maturation Rates and Durability of Vascular Access for Hemodialysis.

    PubMed

    Russell, Todd E; Kasper, Gregory C; Seiwert, Andrew J; Comerota, Anthony J; Lurie, Fedor

    2017-04-01

    Cilostazol is effective in controlling pathophysiological pathways similar or identical to those involved in nonmaturation and failure of the arteriovenous access. This case-control study examined whether cilostazol would improve maturation rates and durability of vascular access for hemodialysis. The treatment group included 33 patients who received cilostazol for ≥30 days prior to creation of a dialysis access and continued with cilostazol therapy for ≥60 days after surgery. The matched (gender, age, race, diabetes, and the year of surgery) control group included 116 patients who underwent the same procedure but did not receive cilostazol prior to and at least 3 months after surgery. Primary outcomes were maturation and, for those that matured, time of functioning access, defined as the time from the first use to irreparable failure of the access. Secondary outcomes were time to maturation, complications, and time to first complication. Study group patients were 3.8 times more likely to experience fistula maturation compared to the controls (88% vs 66%, RR = 3.8, 95% confidence interval: 1.3-11.6, P = .016). Fewer patients in the study group had complications (76% vs 92%, P = .025), and the time from construction of the fistula to the first complication was longer (345.6 ± 441 days vs 198.3 ± 185.0 days, P = .025). Time to maturation was similar in both groups (119.3 ± 62.9 days vs 100.2 ± 61.7 days, P = .2). However, once matured, time to failure was significantly longer in the treatment group (903.7 ± 543.6 vs 381.6 ± 317.2 days, P = .001). Multivariate analysis confirmed that the likelihood of maturation was significantly higher in the treatment group patients. These results suggest that dialysis access patients may benefit from preoperative and postoperative cilostazol therapy. If confirmed by a randomized trial, this treatment will have a major beneficial impact on patients dependent on a well-functioning access for their hemodialysis.

  6. Trauma center variation in splenic artery embolization and spleen salvage: a multicenter analysis.

    PubMed

    Banerjee, Aman; Duane, Therese M; Wilson, Sean P; Haney, Starre; O'Neill, Patrick J; Evans, Heather L; Como, John J; Claridge, Jeffrey A

    2013-07-01

    This study aimed to evaluate if variation in management of blunt splenic injury (BSI) among Level I trauma centers is associated with different outcomes related to the use of splenic artery embolization (SAE). All adult patients admitted for BSI from 2008 to 2010 at 4 Level I trauma centers were reviewed. Use of SAE was determined, and outcomes of spleen salvage and nonoperative management (NOM) failure were evaluated. A priori, a 10% SAE rate was used to group centers into high- or low-use groups. There were 1,275 BSI patients. There were intercenter differences in age, injury severity, and grade of spleen injury (Spleen Injury Scale [SIS]). Mortality was similar by center; however, BSI treatment varied significantly by center. Overall, SAE use was highest at center A compared with B, C, and D (19%, 11%, 1%, and 4%, respectively; p < 0.01). High SAE use centers had significantly higher spleen salvage rates and fewer NOM failures. Differences in the use of SAE (25% vs. 2%, p < 0.01) and salvage rate (67% vs. 56%, p = 0.03) were most dramatic between high- and low-use SAE centers for Grade 3 and 4 injured spleens. In patients who received initial NOM, multivariate logistic regression analysis showed that SAE was an independent predictor of spleen salvage (odds ratio, 5; 95% confidence interval, 1.8-13.5; p < 0.01) as were lower age, lower SIS, and Injury Severity Score (ISS). Patients treated at high SAE use centers were more likely to leave the hospital with their spleen in situ (odds ratio, 3; 95% confidence interval, 1.7-6.3; p < 0.01). Significant practice variation exists in the use of SAE in treating BSI at Level I trauma centers. Centers with higher rates of SAE use have higher spleen salvage and less NOM failure. SAE was shown to be an independent predictor of spleen salvage. Therapeutic study, level IV.

  7. College Access Marketing

    ERIC Educational Resources Information Center

    Tremblay, Christopher W.

    2011-01-01

    College Access Marketing (CAM) is a relatively new phenomenon that seeks to positively influence the college-going rate. This report defines CAM, describes CAM examples, and discusses how CAM seeks to counter barriers to college. It explores four main elements of CAM: information, marketing, advocacy, and social mobilization. Further, it…

  8. Drug-related stigma and access to care among people who inject drugs in Vietnam.

    PubMed

    Lan, Chiao-Wen; Lin, Chunqing; Thanh, Duong Cong; Li, Li

    2018-03-01

    There are considerable challenges faced by people with a history of injecting drug use (PWID) in Vietnam, including drug-related stigma and lack of access to healthcare. Seeking and utilising healthcare, as well as harm reduction programs for PWID, are often hampered by drug-related stigma. This study aimed to examine the impacts of drug-related stigma on access to care and utilisation of harm reduction programs among PWID in Vietnam. A cross-sectional study was conducted in two provinces in Vietnam, Phú Thọ and Vinh Phúc. The study participants completed the survey by using Audio Computer-Assisted Self-Interview between late 2014 and early 2015. Linear multiple regression models and logistic regression models were used to assess the relationship among drug-related stigma, access to care and utilisation of harm reduction programs, including methadone maintenance treatment (MMT) and needle exchange programs (NEP). A total of 900 PWID participated in this study. Drug-related stigma was significantly associated with lower level of access to care, but not with utilisation of MMT or NEP. Older age was positively associated with higher levels of access to care. Levels of education were positively correlated with access to care, as well as utilisation of MMT and NEP. This study underscores the need for future interventions to reduce drug-related stigma in society and in health-care settings to improve PWID's utilisation of care services. Special attention should be paid to younger PWID and those with lower levels of education. © 2017 Australasian Professional Society on Alcohol and other Drugs.

  9. Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study.

    PubMed

    Beck-Sague, C M; Azimi, P; Fonseca, S N; Baltimore, R S; Powell, D A; Bland, L A; Arduino, M J; McAllister, S K; Huberman, R S; Sinkowitz, R L

    1994-12-01

    For identification of risk factors for bloodstream infection (BSI) among neonatal intensive care unit patients, prospective 6-month studies in three neonatal intensive care units were conducted. BSI was diagnosed in 42 of 376 (11.2%) enrolled infants. Pathogens included coagulase-negative staphylococci, Candida sp., Group B streptococci and Gram-negative species. Patients with BSIs were more likely to die during their neonatal intensive care unit stay than were patients who did not acquire BSIs (6 of 42 vs. 11 of 334, P = 0.007). BSI rate was highest in infants with birth weight < 1500 g (relative risk (RR) = 6.8, P < 0.001), those treated with H-2 blockers (RR = 4.2, P < 0.001) or theophylline (RR = 2.8, P < 0.001) and those with admission diagnoses referable to the respiratory tract (RR = 3.7, P < 0.001). Infants who developed BSI were more severely ill on admission than other infants (median physiologic stability index 13 vs. 10 (P < 0.001) and were of lower gestational age (28 vs. 35 weeks, P < 0.001). In logistic regression analysis, risk of BSI was independently associated only with very low birth weight, respiratory admission diagnoses and receipt of H-2 blockers. Risk of isolation of a pathogen from blood culture was independently associated with Broviac, umbilical vein or peripheral venous catheterization > 10, 7 or 3 days, respectively, at one insertion site. Rate of isolation of a pathogen was higher (9 of 59 (15%)) within 48 hours of a measurable serum interleukin 6 concentration than an interleukin 6 level of 0 pg/ml (10 of 159 (6%), P = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Modelling high data rate communication network access protocol

    NASA Technical Reports Server (NTRS)

    Khanna, S.; Foudriat, E. C.; Paterra, Frank; Maly, Kurt J.; Overstreet, C. Michael

    1990-01-01

    Modeling of high data rate communication systems is different from the low data rate systems. Three simulations were built during the development phase of Carrier Sensed Multiple Access/Ring Network (CSMA/RN) modeling. The first was a model using SIMCRIPT based upon the determination and processing of each event at each node. The second simulation was developed in C based upon isolating the distinct object that can be identified as the ring, the message, the node, and the set of critical events. The third model further identified the basic network functionality by creating a single object, the node which includes the set of critical events which occur at the node. The ring structure is implicit in the node structure. This model was also built in C. Each model is discussed and their features compared. It should be stated that the language used was mainly selected by the model developer because of his past familiarity. Further the models were not built with the intent to compare either structure or language but because the complexity of the problem and initial results contained obvious errors, so alternative models were built to isolate, determine, and correct programming and modeling errors. The CSMA/RN protocol is discussed in sufficient detail to understand modeling complexities. Each model is described along with its features and problems. The models are compared and concluding observations and remarks are presented.

  11. Astronomical pacing of the global silica cycle recorded in Mesozoic bedded cherts

    PubMed Central

    Ikeda, Masayuki; Tada, Ryuji; Ozaki, Kazumi

    2017-01-01

    The global silica cycle is an important component of the long-term climate system, yet its controlling factors are largely uncertain due to poorly constrained proxy records. Here we present a ∼70 Myr-long record of early Mesozoic biogenic silica (BSi) flux from radiolarian chert in Japan. Average low-mid-latitude BSi burial flux in the superocean Panthalassa is ∼90% of that of the modern global ocean and relative amplitude varied by ∼20–50% over the 100 kyr to 30 Myr orbital cycles during the early Mesozoic. We hypothesize that BSi in chert was a major sink for oceanic dissolved silica (DSi), with fluctuations proportional to DSi input from chemical weathering on timescales longer than the residence time of DSi (<∼100 Kyr). Chemical weathering rates estimated by the GEOCARBSULFvolc model support these hypotheses, excluding the volcanism-driven oceanic anoxic events of the Early-Middle Triassic and Toarcian that exceed model limits. We propose that the Mega monsoon of the supercontinent Pangea nonlinearly amplified the orbitally paced chemical weathering that drove BSi burial during the early Mesozoic greenhouse world. PMID:28589958

  12. Astronomical pacing of the global silica cycle recorded in Mesozoic bedded cherts.

    PubMed

    Ikeda, Masayuki; Tada, Ryuji; Ozaki, Kazumi

    2017-06-07

    The global silica cycle is an important component of the long-term climate system, yet its controlling factors are largely uncertain due to poorly constrained proxy records. Here we present a ∼70 Myr-long record of early Mesozoic biogenic silica (BSi) flux from radiolarian chert in Japan. Average low-mid-latitude BSi burial flux in the superocean Panthalassa is ∼90% of that of the modern global ocean and relative amplitude varied by ∼20-50% over the 100 kyr to 30 Myr orbital cycles during the early Mesozoic. We hypothesize that BSi in chert was a major sink for oceanic dissolved silica (DSi), with fluctuations proportional to DSi input from chemical weathering on timescales longer than the residence time of DSi (<∼100 Kyr). Chemical weathering rates estimated by the GEOCARBSULFvolc model support these hypotheses, excluding the volcanism-driven oceanic anoxic events of the Early-Middle Triassic and Toarcian that exceed model limits. We propose that the Mega monsoon of the supercontinent Pangea nonlinearly amplified the orbitally paced chemical weathering that drove BSi burial during the early Mesozoic greenhouse world.

  13. Beyond Access: An Analysis of the Influence of the E-Rate Program in Bridging the Digital Divide in American Schools

    ERIC Educational Resources Information Center

    Park, Euna; Sinha, Hansa; Chong, Jing

    2007-01-01

    E-Rate is a U.S. federal funding program for providing discounts for telecommunications, Internet access and internal networking costs for schools and libraries to ensure access equity across poor and rich, rural, urban and suburban areas, and highly served and underserved areas. This paper examines the impact of the E-Rate program on social…

  14. Elementary School Computer Access, Socioeconomic Status, Ethnicity, and Grade 5 Student Achievement

    ERIC Educational Resources Information Center

    Barrett, Julie Ann

    2013-01-01

    Purpose: The purpose of this study was to describe the current school computer access rates of elementary school students and to determine the extent to which school computer access relates to academic achievement among Grade 5 students in the state of Texas. Specifically, the relationship of school computer access to student passing rates on the…

  15. Biomic Specialization and Speciation Rates in Ruminants (Cetartiodactyla, Mammalia): A Test of the Resource-Use Hypothesis at the Global Scale

    PubMed Central

    Cantalapiedra, Juan L.; Hernández Fernández, Manuel; Morales, Jorge

    2011-01-01

    The resource-use hypothesis proposed by E.S. Vrba predicts that specialist species have higher speciation and extinction rates than generalists because they are more susceptible to environmental changes and vicariance. In this work, we test some of the predictions derived from this hypothesis on the 197 extant and recently extinct species of Ruminantia (Cetartiodactyla, Mammalia) using the biomic specialization index (BSI) of each species, which is based on its distribution within different biomes. We ran 10000 Monte Carlo simulations of our data in order to get a null distribution of BSI values against which to contrast the observed data. Additionally, we drew on a supertree of the ruminants and a phylogenetic likelihood-based method (QuaSSE) for testing whether the degree of biomic specialization affects speciation rates in ruminant lineages. Our results are consistent with the predictions of the resource-use hypothesis, which foretells a higher speciation rate of lineages restricted to a single biome (BSI = 1) and higher frequency of specialist species in biomes that underwent high degree of contraction and fragmentation during climatic cycles. Bovids and deer present differential specialization across biomes; cervids show higher specialization in biomes with a marked hydric seasonality (tropical deciduous woodlands and schlerophyllous woodlands), while bovids present higher specialization in a greater variety of biomes. This might be the result of divergent physiological constraints as well as a different biogeographic and evolutionary history. PMID:22174888

  16. Values, inter-attitudinal structure, and attitude change: value accessibility can increase a related attitude's resistance to change.

    PubMed

    Blankenship, Kevin L; Wegener, Duane T; Murray, Renee A

    2015-12-01

    Accessibility is one of the most basic structural properties of an attitude and an important factor to consider in attitude strength. Despite its importance, relatively little work has examined the role of attitude accessibility in an inter-attitudinal context, particularly as it relates to the strength of related attitudes in the network. The present research examines accessibility as a property of one attitude (toward an abstract goal or end-state, that is, a value) that might influence the strength of a different but related attitude (toward a social policy conceptually related to the value). In Study 1, a highly accessible evaluative component of a value increased resistance to change of attitudes and behavioral intentions toward a social policy related to that value. Similarly, a manipulation of value accessibility (Studies 2 and 3) led to increased resistance of attitudes and behavioral intentions toward a social policy related to that value. Implications for the role of accessibility in inter-attitudinal strength are discussed. © 2015 by the Society for Personality and Social Psychology, Inc.

  17. An Investigation on a Crystalline-Silicon Solar Cell with Black Silicon Layer at the Rear.

    PubMed

    Zhou, Zhi-Quan; Hu, Fei; Zhou, Wen-Jie; Chen, Hong-Yan; Ma, Lei; Zhang, Chi; Lu, Ming

    2017-12-15

    Crystalline-Si (c-Si) solar cell with black Si (b-Si) layer at the rear was studied in order to develop c-Si solar cell with sub-band gap photovoltaic response. The b-Si was made by chemical etching. The c-Si solar cell with b-Si at the rear was found to perform far better than that of similar structure but with no b-Si at the rear, with the efficiency being increased relatively by 27.7%. This finding was interesting as b-Si had a large specific surface area, which could cause high surface recombination and degradation of solar cell performance. A graded band gap was found to form at the rear of the c-Si solar cell with b-Si layer at the rear. This graded band gap tended to expel free electrons away from the rear, thus reducing the probability of electron-hole recombination at b-Si and improving the performance of c-Si solar cell.

  18. Geographic approaches to quantifying the risk environment: a focus on syringe exchange program site access and drug-related law enforcement activities

    PubMed Central

    Cooper, Hannah LF; Bossak, Brian; Tempalski, Barbara; Des Jarlais, Don C.; Friedman, Samuel R.

    2009-01-01

    The concept of the “risk environment” – defined as the “space … [where] factors exogenous to the individual interact to increase the chances of HIV transmission” – draws together the disciplines of public health and geography. Researchers have increasingly turned to geographic methods to quantify dimensions of the risk environment that are both structural and spatial (e.g., local poverty rates). The scientific power of the intersection between public health and geography, however, has yet to be fully mined. In particular, research on the risk environment has rarely applied geographic methods to create neighbourhood-based measures of syringe exchange programs (SEPs) or of drug-related law enforcement activities, despite the fact that these interventions are widely conceptualized as structural and spatial in nature and are two of the most well-established dimensions of the risk environment. To strengthen research on the risk environment, this paper presents a way of using geographic methods to create neighbourhood-based measures of (1) access to SEP sites and (2) exposure to drug-related arrests, and then applies these methods to one setting (New York City). NYC-based results identified substantial cross-neighbourhood variation in SEP site access and in exposure to drug-related arrest rates (even within the subset of neighbourhoods nominally experiencing the same drug-related police strategy). These geographic measures – grounded as they are in conceptualizations of SEPs and drug-related law enforcement strategies – can help develop new arenas of inquiry regarding the impact of these two dimensions of the risk environment on injectors’ health, including exploring whether and how neighbourhood-level access to SEP sites and exposure to drug-related arrests shape a range of outcomes among local injectors. PMID:18963907

  19. Bioproductivity in the Southern Ocean since the last Interglacial - new high-resolution biogenic opal flux records from the Scotia Sea

    NASA Astrophysics Data System (ADS)

    Sprenk, D.; Weber, M. E.; Kuhn, G.; Rosén, P.; Röhling, H.-G.

    2012-04-01

    The Southern Ocean plays an important role in transferring CO2 via wind-induced upwelling from the deep sea to the atmosphere. It is therefore one of the key areas to study climate change. Bioproductivity in the Southern Ocean is mostly influenced by the extent of sea ice, upwelling of cold nutrient- and silica-rich water, and the availability of light. Biogenic opal (BSi) is a significant nutrient in the Southern Ocean, and according to recent investigations only marginally affected by preservation changes. It can therefore be used as bioproductivity proxy. Here we present several methods to determine BSi, discuss them and put the results into context with respect to regional bioproductivity changes in Southern Ocean during the last glacial cycle. We studied deep-sea sediment core sites MD07-3133 and MD07-3134 from the central Scotia Sea with extraordinary high sedimentation rates of up to 2.1 to 1.2 m/kyr, respectively covering the last 92.5 kyr. BSi leaching according to Müller & Schneider (1993) is very time-consuming and expensive, so we measured only 253 samples from large-amplitude variation core sections. In addition, we determined BSi using non-destructive measurements of sediment colour b*, wet-bulk density, and Ti/Si count ratios. Furthermore, we provide the first attempts to estimate BSi in marine sediment using Fourier transform infrared spectroscopy (FTIRS), a cost-efficient method, which requires only 11 mg of sediment. All estimation methods capture the main BSi trends, however FTIRS seems to be the most promising one. In the central Scotia Sea, south of the modern Antarctic Polar Front, the BSi flux reflects a relatively complicated glacial-to-interglacial pattern with large-amplitude, millennial-scale fluctuations in bioproductivity. During Antarctic Isotopic Maxima, BSi fluxes were generally increased. Lowest bioproductivity occur at the Last Glacial Maximum, while upwelling of mid-depth water was reduced, atmospheric CO2 low, and sea-ice cover

  20. Frequency, risk factors, and outcomes of vancomycin-resistant Enterococcus colonization and infection in patients with newly diagnosed acute leukemia: different patterns in patients with acute myelogenous and acute lymphoblastic leukemia.

    PubMed

    Ford, Clyde D; Lopansri, Bert K; Haydoura, Souha; Snow, Greg; Dascomb, Kristin K; Asch, Julie; Bo Petersen, Finn; Burke, John P

    2015-01-01

    OBJECTIVE To determine the frequency, risk factors, and outcomes for vancomycin-resistant Enterococcus (VRE) colonization and infection in patients with newly diagnosed acute leukemia. DESIGN Retrospective clinical study with VRE molecular strain typing. SETTING A regional referral center for acute leukemia. PATIENTS Two hundred fourteen consecutive patients with newly diagnosed acute leukemia between 2006 and 2012. METHODS All patients had a culture of first stool and weekly surveillance for VRE. Clinical data were abstracted from the Intermountain Healthcare electronic data warehouse. VRE molecular typing was performed utilizing the semi-automated DiversiLab System. RESULTS The rate of VRE colonization was directly proportional to length of stay and was higher in patients with acute lymphoblastic leukemia. Risk factors associated with colonization include administration of corticosteroids (P=0.004) and carbapenems (P=0.009). Neither a colonized prior room occupant nor an increased unit colonization pressure affected colonization risk. Colonized patients with acute myelogenous leukemia had an increased risk of VRE bloodstream infection (BSI, P=0.002). Other risk factors for VRE BSI include severe neutropenia (P=0.04) and diarrhea (P=0.008). Fifty-eight percent of BSI isolates were identical or related by molecular typing. Eighty-nine percent of bloodstream isolates were identical or related to stool isolates identified by surveillance cultures. VRE BSI was associated with increased costs (P=0.0003) and possibly mortality. CONCLUSIONS VRE colonization has important consequences for patients with acute myelogenous leukemia undergoing induction therapy. For febrile neutropenic patients with acute myelogenous leukemia, use of empirical antibiotic regimens that avoid carbapenems and include VRE coverage may be helpful in decreasing the risks associated with VRE BSI.

  1. Staff-related access deficit and antenatal care coverage across the NUTS level 1 regions of Turkey.

    PubMed

    Yardim, Mahmut S

    2010-01-01

    At the heart of each health system, the workforce is central to advancing health. The World Health Organization has identified a threshold in workforce density below which high coverage of essential interventions, including those necessary to meet the health-related Millennium Development Goals (MDGs), is very unlikely. The International Labor Organization (ILO) has launched a similar indicator -staff related access deficit- using Thailand's health care professional density as a benchmark. The aim of this study is to assess the staff-related access deficit of the population across the 12 NUTS 1 level regions of Turkey. The main hypothesis is that staff-related access deficit has a correlation with and predicts the gap in antenatal care coverage (percentage of women unable to access to antenatal care) across different regions. Staff-related access deficit, as a threshold indicator, seems to have a linear relationship with the antenatal care coverage gap. The known inequalities in the distribution of the health care workforce among different regions of Turkey were put forward once more in this study using the SRA indicator. The staff-related access deficit indicator can be easily used to monitor the status of distributional inequalities of the health care workforce at different sub-national levels in the future.

  2. Injecting drug users in Scotland, 2006: Listing, number, demography, and opiate-related death-rates.

    PubMed

    King, Ruth; Bird, Sheila M; Overstall, Antony; Hay, Gordon; Hutchinson, Sharon J

    2013-06-01

    Using Bayesian capture-recapture analysis, we estimated the number of current injecting drug users (IDUs) in Scotland in 2006 from the cross-counts of 5670 IDUs listed on four data-sources: social enquiry reports (901 IDUs listed), hospital records (953), drug treatment agencies (3504), and recent Hepatitis C virus (HCV) diagnoses (827 listed as IDU-risk). Further, we accessed exact numbers of opiate-related drugs-related deaths (DRDs) in 2006 and 2007 to improve estimation of Scotland's DRD rates per 100 current IDUs. Using all four data-sources, and model-averaging of standard hierarchical log-linear models to allow for pairwise interactions between data-sources and/or demographic classifications, Scotland had an estimated 31700 IDUs in 2006 (95% credible interval: 24900-38700); but 25000 IDUs (95% CI: 20700-35000) by excluding recent HCV diagnoses whose IDU-risk can refer to past injecting. Only in the younger age-group (15-34 years) were Scotland's opiate-related DRD rates significantly lower for females than males. Older males' opiate-related DRD rate was 1.9 (1.24-2.40) per 100 current IDUs without or 1.3 (0.94-1.64) with inclusion of recent HCV diagnoses. If, indeed, Scotland had only 25000 current IDUs in 2006, with only 8200 of them aged 35+ years, the opiate-related DRD rate is higher among this older age group than has been appreciated hitherto. There is counter-balancing good news for the public health: the hitherto sharp increase in older current IDUs had stalled by 2006.

  3. A comparison of small-area hospitalisation rates, estimated morbidity and hospital access.

    PubMed

    Shulman, H; Birkin, M; Clarke, G P

    2015-11-01

    Published data on hospitalisation rates tend to reveal marked spatial variations within a city or region. Such variations may simply reflect corresponding variations in need at the small-area level. However, they might also be a consequence of poorer accessibility to medical facilities for certain communities within the region. To help answer this question it is important to compare these variable hospitalisation rates with small-area estimates of need. This paper first maps hospitalisation rates at the small-area level across the region of Yorkshire in the UK to show the spatial variations present. Then the Health Survey of England is used to explore the characteristics of persons with heart disease, using chi-square and logistic regression analysis. Using the most significant variables from this analysis the authors build a spatial microsimulation model of morbidity for heart disease for the Yorkshire region. We then compare these estimates of need with the patterns of hospitalisation rates seen across the region. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  4. Health care institutional charges associated with ambulatory bloodstream infections in pediatric oncology and stem cell transplant patients.

    PubMed

    Wong Quiles, Chris I; Gottsch, Stephanie; Thakrar, Usha; Fraile, Belen; Billett, Amy L

    2017-02-01

    The impact of ambulatory bloodstream infections (Amb-BSIs) in pediatric oncology and stem cell transplant (PO/SCT) patients is poorly understood, although a large portion of their treatment increasingly occurs in this setting. This study aimed to understand the economic impact and length of stay (LOS) associated with these infections. Charges and LOS were retrospectively collected and analyzed for Amb-BSI events leading to a hospital admission between 2012 and 2013 in a tertiary, university-affiliated hospital. Events were grouped as BSI-MIXED when hospitalizations with care unrelated to the infection-extended LOS by more than 24 hr or as BSI-PURE for all others. Billing codes were used to group charges and main drivers were analyzed. Seventy-four BSI events were identified in 61 patients. Sixty-nine percent met definition for central line-associated BSI (CLABSI). Median total charge and LOS for an Amb-BSI were $40,852 (interquartile range [IQR] $44,091) and 7 days (IQR 6), respectively. Median charges for BSI-PURE group (N = 62) were $36,611 (IQR $34,785) and $89,935 (IQR $153,263) in the BSI-MIXED (N = 12) group. Median LOS was 6 (IQR 5) days in the BSI-PURE group and 15 (IQR 24) in the BSI-MIXED. Room, pharmacy, and procedure charges accounted for more than 70% of total charges in all groups. Amb-BSIs in PO/SCT patients result in significant healthcare charges and unplanned extended hospital admissions. This analysis suggests that efforts aiming at reducing rates of infections could result in substantial system savings, validating the need for increased efforts to prevent Amb-BSIs. © 2016 Wiley Periodicals, Inc.

  5. Spatial access to restaurants and grocery stores in relation to frequency of home cooking.

    PubMed

    Pinho, Maria Gabriela M; Mackenbach, Joreintje D; Charreire, Hélène; Oppert, Jean-Michel; Bárdos, Helga; Rutter, Harry; Compernolle, Sofie; Beulens, Joline W J; Brug, Johannes; Lakerveld, Jeroen

    2018-01-16

    Little is known about the relation between the neighbourhood food environment and home cooking. We explored the independent and combined associations between residential neighbourhood spatial access to restaurants and grocery stores with home cooking in European adults. Data of 5076 participants of the SPOTLIGHT study were collected across five European countries in 2014. Food retailers were classified into grocery stores (supermarkets and local food shops) and restaurants (full-service restaurants, fast food and take-away restaurants, café/bars). We used multinomial logistic regression models to test the associations between tertiles of spatial access to restaurants and spatial to access grocery stores and the outcome 'frequency of home cooking' categorized into 0-3; 4-5; and 6-7 days/week. Additive interaction analysis was used to test the combined association between access to grocery stores and to restaurants with home cooking. Mean age was 52.3 years; most participants were women (55.5%) and completed higher education (53.8%). Residents with highest access to restaurants had a reduced likelihood of home cooking 6-7 days/week (vs. 0-3 days/week) (relative risk ratio (RRR) 0.42; 95%CI = 0.23-0.76) when compared with lowest access to restaurants. No association was found for spatial access to grocery stores. Additive interaction analysis showed that individuals with medium access to grocery stores and highest access to restaurants had the lowest likelihood (RRR = 0.29, 95%CI = 0.10-0.84) of cooking 6-7 days/week when compared to individuals with lowest access to restaurants and highest access to grocery stores. Greater neighbourhood spatial access to restaurants was associated with lower frequency of home cooking, largely independent of access to grocery stores.

  6. Infection and hemodialysis access: an updated review.

    PubMed

    Gupta, Vineet; Yassin, Mohamed H

    2013-06-01

    The incidence of end-stage renal disease (ESRD) has almost doubled over past 2 decades. Despite decreasing overall hospital admission rates for ESRD population, the rate of infection-related hospitalizations has steadily increased. Infection remains the second most common cause of mortality in this patient population. Specifically, in the hemodialysis (HD) patients, the vascular access related infections are the most common identifiable source of infection. This concise review provides an update on the bacteremia related to vascular access primarily the catheters (Catheter Related Blood Stream Infection- CRBSI) in HD patients emphasizing on the determinants ranging from the epidemiology to pathogenesis, risk factors, cost implications and prevention. Staphylococcus aureus, coagulase negative Staphylococci, and Enterococci are the most common causative microorganisms implicated in CRBSI. The pathogenesis of CRBSI includes organism entry into the blood stream followed by adherence to catheter, colonization and biofilm formation. Vascular access type, catheter position, and prior bacteremic episodes are strongly associated with blood stream infection. Preventive measures should be multidisciplinary in nature and should include avoidance of central venous catheters, best practices for catheter care, surveillance, antimicrobial catheter lock solutions, and use of antibiotic impregnated catheters.

  7. An Evaluation of the Brief Symptom Inventory-18 Using Item Response Theory: Which Items Are Most Strongly Related to Psychological Distress?

    ERIC Educational Resources Information Center

    Meijer, Rob R.; de Vries, Rivka M.; van Bruggen, Vincent

    2011-01-01

    The psychometric structure of the Brief Symptom Inventory-18 (BSI-18; Derogatis, 2001) was investigated using Mokken scaling and parametric item response theory. Data of 487 outpatients, 266 students, and 207 prisoners were analyzed. Results of the Mokken analysis indicated that the BSI-18 formed a strong Mokken scale for outpatients and…

  8. 45 CFR 156.255 - Rating variations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.255 Rating variations. (a) Rating areas. A QHP issuer...

  9. 45 CFR 156.255 - Rating variations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.255 Rating variations. (a) Rating areas. A QHP issuer...

  10. 45 CFR 156.255 - Rating variations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.255 Rating variations. (a) Rating areas. A QHP issuer...

  11. Blunt splenic trauma: Assessment, management and outcomes.

    PubMed

    El-Matbouly, Moamena; Jabbour, Gaby; El-Menyar, Ayman; Peralta, Ruben; Abdelrahman, Husham; Zarour, Ahmad; Al-Hassani, Ammar; Al-Thani, Hassan

    2016-02-01

    The approach for diagnosis and management of blunt splenic injury (BSI) has been considerably shifted towards non-operative management (NOM). We aimed to review the current practice for the evaluation, diagnosis and management of BSI. A traditional narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines. We used the keywords "Traumatic Splenic injury", "Blunt splenic trauma", "management" between December 1954 and November 2014. Most of the current guidelines support the NOM or minimally approaches in hemodynamically stable patients. Improvement in the diagnostic modalities guide the surgeons to decide the timely management pathway Though, there is an increasing shift from operative management (OM) to NOM of BSI; NOM of high grade injury is associated with a greater rate of failure, prolonged hospital stay, risk of delayed hemorrhage and transfusion-associated infections. Some cases with high grade BSI could be successfully treated conservatively, if clinically feasible, while some patients with lower grade injury might end-up with delayed splenic rupture. Therefore, the selection of treatment modalities for BSI should be governed by patient clinical presentation, surgeon's experience in addition to radiographic findings. About one-fourth of the blunt abdominal trauma accounted for BSI. A high index of clinical suspicion along with radiological diagnosis helps to identify and characterize splenic injuries with high accuracy and is useful for timely decision-making to choose between OM or NOM. Careful selection of NOM is associated with high success rate with a lower rate of morbidity and mortality. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  12. Intensive care unit-acquired blood stream infections: a 5-year retrospective analysis of a single tertiary care hospital in Korea.

    PubMed

    Lim, S J; Choi, J Y; Lee, S J; Cho, Y J; Jeong, Y Y; Kim, H C; Lee, J D; Hwang, Y S

    2014-10-01

    Bloodstream infections (BSIs) are serious complications with high mortality and morbidity in patients with critical illness. This study was conducted to analyze the clinical and microbiological characteristics as well as outcomes in patients with intensive care unit (ICU)-acquired BSIs. Data from 1,545 patients admitted to the ICU were retrospectively collected from January 2005 to December 2010. ICU-acquired BSI was defined as a positive blood culture for a clinically significant bacterial or fungal pathogen obtained >72 h after admission to the ICU. Data on clinical and demographic characteristics, comorbid illness, causes of infections, causative pathogens, and clinical outcomes were analyzed. Among the 1,545 ICU patients analyzed, 129 ICU-acquired BSIs occurred in 124 patients. Catheter-related BSIs (CR-BSIs) and ventilator-associated pneumonia (VAP) were the most common causes (29.4 and 20.9%, respectively). The most common isolates were Staphylococcus aureus in 35 (25.7%) and Candida species in 32 (24.8%) cases. Ninety-eight patients died (overall hospital mortality rate, 75.9%). ICU-acquired BSI-related mortality occurred in 23 (63.8%) and 7 (19.4%) of the VAP and CR-BSIs cases, respectively. The most commonly isolated microorganisms from these fatalities were S. aureus (12, 25.7%) and Acinetobacter species (12, 25.7%). In 99 ICU-acquired BSI cases, patients did not receive adequate empirical antimicrobial treatment at the onset of BSIs, whereas the patients in 30 cases did. ICU-acquired BSIs may be associated with high mortality in patients with critical illness. Meticulous infection control and adequate treatment may reduce ICU-acquired BSI-related mortality.

  13. Boron depth profiles and residual damage following rapid thermal annealing of low-temperature BSi molecular ion implantation in silicon

    NASA Astrophysics Data System (ADS)

    Liang, J. H.; Wang, S. C.

    2007-08-01

    The influence of substrate temperature on both the implantation and post-annealing characteristics of molecular-ion-implanted 5 × 1014 cm-2 77 keV BSi in silicon was investigated in terms of boron depth profiles and damage microstructures. The substrate temperatures under investigation consisted of room temperature (RT) and liquid nitrogen temperature (LT). Post-annealing treatments were performed using rapid thermal annealing (RTA) at 1050 °C for 25 s. Boron depth profiles and damage microstructures in both the as-implanted and as-annealed specimens were determined using secondary ion mass spectrometry (SIMS) and transmission electron microscopy (TEM), respectively. The as-implanted results revealed that, compared to the RT specimen, the LT specimen yields a shallower boron depth profile with a reduced tail into the bulk. An amorphous layer containing a smooth amorphous-to-crystalline (a/c) interface is evident in the LT specimen while just the opposite is true in the as-implanted RT one. The as-annealed results illustrated that the extension of the boron depth profile into the bulk via transient-enhanced diffusion (TED) in the LT specimen is less than it is in the RT one. Only residual defects are visible in the LT specimen while two clear bands of dislocation loops appear in the RT one.

  14. Access to Care Under Physician Payment Reform: A Physician-Based Analysis

    PubMed Central

    Meadow, Ann

    1995-01-01

    This article reports physician-based measures of access to care during the 3 years surrounding the 1989 physician payment reforms. Analysis was facilitated by a new system of physician identifiers in Medicare claims. Access measures include caseload per physician and related measures of the demographic composition of physicians' clientele, the proportion of physicians performing surgical and other procedures, and the assignment rate. The caseload and assignment measures were stable or improving over time, suggesting that reforms did not harm access. Procedure performance rates tended to decline between 1992 and 1993, but reductions were inversely related to the estimated fee changes, and several may be explainable by other factors. PMID:10172615

  15. Evaluation of accessible mineral surface areas for improved prediction of mineral reaction rates in porous media

    NASA Astrophysics Data System (ADS)

    Beckingham, Lauren E.; Steefel, Carl I.; Swift, Alexander M.; Voltolini, Marco; Yang, Li; Anovitz, Lawrence M.; Sheets, Julia M.; Cole, David R.; Kneafsey, Timothy J.; Mitnick, Elizabeth H.; Zhang, Shuo; Landrot, Gautier; Ajo-Franklin, Jonathan B.; DePaolo, Donald J.; Mito, Saeko; Xue, Ziqiu

    2017-05-01

    The rates of mineral dissolution reactions in porous media are difficult to predict, in part because of a lack of understanding of mineral reactive surface area in natural porous media. Common estimates of mineral reactive surface area used in reactive transport models for porous media are typically ad hoc and often based on average grain size, increased to account for surface roughness or decreased by several orders of magnitude to account for reduced surface reactivity of field as opposed to laboratory samples. In this study, accessible mineral surface areas are determined for a sample from the reservoir formation at the Nagaoka pilot CO2 injection site (Japan) using a multi-scale image analysis based on synchrotron X-ray microCT, SEM QEMSCAN, XRD, SANS, and FIB-SEM. This analysis not only accounts for accessibility of mineral surfaces to macro-pores, but also accessibility through connected micro-pores in smectite, the most abundant clay mineral in this sample. While the imaging analysis reveals that most of the micro- and macro-pores are well connected, some pore regions are unconnected and thus inaccessible to fluid flow and diffusion. To evaluate whether mineral accessible surface area accurately reflects reactive surface area a flow-through core experiment is performed and modeled at the continuum scale. The core experiment is performed under conditions replicating the pilot site and the evolution of effluent solutes in the aqueous phase is tracked. Various reactive surface area models are evaluated for their ability to capture the observed effluent chemistry, beginning with parameter values determined as a best fit to a disaggregated sediment experiment (Beckingham et al., 2016) described previously. Simulations that assume that all mineral surfaces are accessible (as in the disaggregated sediment experiment) over-predict the observed mineral reaction rates, suggesting that a reduction of RSA by a factor of 10-20 is required to match the core flood

  16. Vascular access for home haemodialysis.

    PubMed

    Al Shakarchi, Julien; Day, C; Inston, N

    2018-03-01

    Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. Our cohort consisted of 74 patients. On initiation of home haemodialysis, 62 individuals were using an arteriovenous fistula as vascular access, while the remaining were on a tunnelled dialysis catheter. Of the 12 patients who started on a tunnelled dialysis catheter, 5 were subsequently converted to either an arteriovenous fistula ( n = 4) or an arteriovenous graft ( n = 1). During the period of home haemodialysis use, four arteriovenous fistula failed or thrombosed with patients continuing on home haemodialysis using an arteriovenous graft ( n = 3) or a tunnelled dialysis catheter ( n = 1). To maintain uninterrupted home haemodialysis, interventional rates were 0.32 per arteriovenous fistula/arteriovenous graft access-year and 0.4 per tunnelled dialysis catheter access-year. Hospital admission rates for patients on home haemodialysis were 0.33 per patient-year. Our study has shown that home haemodialysis can be safely and independently performed at home within a closely managed home haemodialysis programme. The authors also advocate the use of arteriovenous fistulas for this cohort of patients due to both low complication and intervention rates.

  17. Hemodialysis Access Usage Patterns in the Incident Dialysis Year and Associated Catheter-Related Complications

    PubMed Central

    Xue, Hui; Ix, Joachim H.; Wang, Weiling; Brunelli, Steven M.; Lazarus, Michael; Hakim, Raymond; Lacson, Eduardo

    2012-01-01

    Background Hemodialysis(HD) access is considered a critical and actionable determinant of morbidity, with a growing literature suggesting that initial HD access type is an important marker of long term outcomes. Accordingly, we examined HD access during the incident dialysis period, focusing on infection risk and successful fistula creation over the first dialysis year. Study Design Longitudinal cohort Setting & Participants All United States adults admitted to Fresenius Medical Care North America facilities within 15 days of first maintenance dialysis session between January 1 and December 31, 2007. Predictor Vascular access type at HD initiation Outcomes Vascular access type at 90 days and at the end of the first year on HD, bloodstream infection within the first year by access type, and catheter complication rate. Results Amongst the 25,003 incident dialysis patients studied, 19,622(78.5%) initiated dialysis with a catheter, 4,151(16.6%) with a fistula, and 1,230(4.9%) with a graft. At 90 days, 14,105(69.7%) had a catheter, 4432(21.9%) patients had a fistula, and 1705(8.4%) had a graft. Functioning fistulas and grafts at dialysis initiation had first year failure rates of 10% and 15%, respectively. Grafts were seldom replaced by fistulas (3%), while 7,064 (47.6%) of all patients who initiated with a catheter alone still had only a catheter at 1 year. Overall, 3,327 (13.3%) patients had at least one positive blood culture during follow-up, with the risk being similar between fistula and graft groups, but approximately 3-fold higher in patients with a catheter (p<0.001 for either comparison). Nearly one in three catheters (32.5%) will require TPA use by median time of 41 days, with 59% requiring more than one TPA administration. Limitations Potential underestimation of bacteremia because follow-up blood culture results did not include samples sent to local laboratories. Conclusions Among a large and representative population of incident US dialysis patients

  18. Comorbidities and the risk of mortality in patients with bronchiectasis: an international multicentre cohort study.

    PubMed

    McDonnell, Melissa J; Aliberti, Stefano; Goeminne, Pieter C; Restrepo, Marcos I; Finch, Simon; Pesci, Alberto; Dupont, Lieven J; Fardon, Thomas C; Wilson, Robert; Loebinger, Michael R; Skrbic, Dusan; Obradovic, Dusanka; De Soyza, Anthony; Ward, Chris; Laffey, John G; Rutherford, Robert M; Chalmers, James D

    2016-12-01

    Patients with bronchiectasis often have concurrent comorbidities, but the nature, prevalence, and impact of these comorbidities on disease severity and outcome are poorly understood. We aimed to investigate comorbidities in patients with bronchiectasis and establish their prognostic value on disease severity and mortality rate. An international multicentre cohort analysis of outpatients with bronchiectasis from four European centres followed up for 5 years was done for score derivation. Eligible patients were those with bronchiectasis confirmed by high-resolution CT and a compatible clinical history. Comorbidity diagnoses were based on standardised definitions and were obtained from full review of paper and electronic medical records, prescriptions, and investigator definitions. Weibull parametric survival analysis was used to model the prediction of the 5 year mortality rate to construct the Bronchiectasis Aetiology Comorbidity Index (BACI). We tested the BACI as a predictor of outcomes and explored whether the BACI added further prognostic information when used alongside the Bronchiectasis Severity Index (BSI). The BACI was validated in two independent international cohorts from the UK and Serbia. Between June 1, 2006, and Nov 22, 2013, 1340 patients with bronchiectasis were screened and 986 patients were analysed. Patients had a median of four comorbidities (IQR 2-6; range 0-20). 13 comorbidities independently predicting mortality rate were integrated into the BACI. The overall hazard ratio for death conferred by a one-point increase in the BACI was 1·18 (95% CI 1·14-1·23; p<0·0001). The BACI predicted 5 year mortality rate, hospital admissions, exacerbations, and health-related quality of life across all BSI risk strata (p<0·0001 for mortality and hospital admissions, p=0·03 for exacerbations, p=0·0008 for quality of life). When used in conjunction with the BSI, the combined model was superior to either model alone (p=0·01 for combined vs BACI; p=0·008

  19. The influence of speech rate and accent on access and use of semantic information.

    PubMed

    Sajin, Stanislav M; Connine, Cynthia M

    2017-04-01

    Circumstances in which the speech input is presented in sub-optimal conditions generally lead to processing costs affecting spoken word recognition. The current study indicates that some processing demands imposed by listening to difficult speech can be mitigated by feedback from semantic knowledge. A set of lexical decision experiments examined how foreign accented speech and word duration impact access to semantic knowledge in spoken word recognition. Results indicate that when listeners process accented speech, the reliance on semantic information increases. Speech rate was not observed to influence semantic access, except in the setting in which unusually slow accented speech was presented. These findings support interactive activation models of spoken word recognition in which attention is modulated based on speech demands.

  20. Neighborhood Alcohol Outlet Density and Rates of Child Abuse and Neglect: Moderating Effects of Access to Substance Abuse Services

    PubMed Central

    Morton, Cory M.; Simmel, Cassandra; Peterson, N. Andrew

    2014-01-01

    This study investigates the relationship between concentrations of on- and off-premises alcohol outlets and rates of child abuse and neglect. Additionally, the study seeks to locate protective features of a neighborhood's built environment by investigating the potentially moderating role that access to substance abuse treatment and prevention services plays in the relationship between alcohol outlet density and child maltreatment. Using a cross-sectional design, this ecological study utilized data from 163 census tracts in Bergen County, New Jersey, on reports of child abuse and neglect, alcohol outlets, substance abuse treatment and prevention facilities, and the United States Census to investigate the linkages between socioeconomic structure, alcohol availability, and access to substance abuse service facilities on rates of child abuse and neglect. Findings indicate areas with a greater concentration of on-premises alcohol outlets (i.e., bars) had higher rates of child neglect, and those with easier access to substance abuse services had lower rates of neglect, controlling for neighborhood demographic and socioeconomic structure. Additionally, the relationship between on-premises alcohol outlet density and rates of child neglect was moderated by the presence of substance abuse service facilities. A greater concentration of off-premises outlets (i.e., liquor stores) was associated with lower rates of physical abuse. Findings suggest that the built environment and socioeconomic structure of neighborhoods have important consequences for child well-being. The implications for future research on the structural features of neighborhoods that are associated with child well-being are discussed. PMID:24529493

  1. Risk Factors for Bloodstream Infection After Living-donor Liver Transplantation in Children.

    PubMed

    Shoji, Kensuke; Funaki, Takanori; Kasahara, Mureo; Sakamoto, Seisuke; Fukuda, Akinari; Vaida, Florin; Ito, Kenta; Miyairi, Isao; Saitoh, Akihiko

    2015-10-01

    Postoperative bloodstream infection (BSI) is the most important determinant of recipient morbidity and mortality after liver transplantation (LT). Children who underwent LT are at the highest risk of developing BSI because of the significant surgical intervention, use of multiple devices, and administration of immunosuppressive agents. However, information regarding the risk factors for BSI in children after LT is limited. We retrospectively reviewed 210 children who underwent living-donor LT at the largest pediatric LT center in Japan. Patients' characteristics, blood culture results and clinical outcomes were extracted from electronic medical records. Univariate and multivariate analyses were performed to identify the risk factors for BSI. Among the 210 LT recipients, 53 (25%) recipients experienced 86 episodes of BSI during the observational period. The source of the BSI was identified only in 38%: catheter-related BSI (27%) peritonitis (7%), urinary tract infection (2%), pneumonia (1%) and infectious endocarditis (1%). A multivariate analysis demonstrated that body weight (P = 0.03), volume of blood loss during LT (P < 0.001) and cytomegalovirus (CMV) antigenemia positivity (P = 0.04) were independently associated with the development of BSI. The risk factors for BSI differed when we analyzed the subjects according to age (≤24 months and >24 months), blood loss and pediatric end-stage liver disease/model for end-stage liver disease versus positive CMV antigenemia. The volume of blood loss, postoperative CMV antigenemia positivity and body weight were associated with the development of BSI after LT in pediatric living-donor recipients. To identify the age-specific predictors of BSI in children who underwent LT, age-specific analyses are crucial.

  2. Prevention and control of blood stream infection using the balanced scorecard approach.

    PubMed

    Rohsiswatmo, Rinawati; Rafika, Sarah; Marsubrin, Putri M T

    2014-07-01

    to obtain formulation of an effective and efficient strategy to overcome blood stream infection (BSI). operational research design with qualitative and quantitative approach. The study was divided into two stages. Stage I was an operational research with problem solving approach using qualitative and quantitative method. Stage II was performed using quantitative method, a form of an interventional study on strategy implementation, which was previously established in stage I. The effective and efficient strategy for the prevention and control of infection in neonatal unit Cipto Mangunkusumo (CM) Hospital was established using Balanced Scorecard (BSC) approach, which involved several related processes. the BSC strategy was proven to be effective and efficient in substantially reducing BSI from 52.31°/oo to 1.36°/oo in neonates with birth weight (BW) 1000-1499 g (p=0.025), and from 29.96°/oo to 1.66°/oo in BW 1500-1999 g (p=0.05). Gram-negative bacteria still predominated as the main cause of BSI in CMH Neonatal Unit. So far, the sources of the microorganisms were thought to be from the environment of treatment unit (tap water filter and humidifying water in the incubator). Significant reduction was also found in neonatal mortality rate weighing 1000-1499 g at birth, length of stay, hospitalization costs, and improved customer satisfaction. effective and efficient infection prevention and control using BSC approach could significantly reduce the rate of BSI. This approach may be applied for adult patients in intensive care unit with a wide range of adjustment.

  3. Who's Got the Booze? The Role of Access to Alcohol in the Relations Between Social Status and Individual Use.

    PubMed

    Deutsch, Arielle R; Steinley, Douglas; Sher, Kenneth J; Slutske, Wendy S

    2017-09-01

    The findings of previous research that examined relationships between popularity and alcohol use in adolescents have been mixed, and few hypotheses have proposed mechanisms for this relationship. The current study expands on previous literature (a) by examining a possible mechanism that can explain the relation between popularity and alcohol use (home access to alcohol) and (b) by using another sociometric measure ("betweenness"), beyond popularity, that may relate more to home alcohol access. Using network-level data from adolescents in 9th-11th grades in eight schools within two in-home waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined two sociometric measures of social status: popularity (number of schoolmates who nominated participants as a friend) and betweenness (level of ties participants have to multiple social subgroups within a network). Betweenness, but not popularity, related to later alcohol use. Having home access to alcohol positively related to later alcohol use, and having friends with home access to alcohol negatively related to later alcohol use. Alcohol access was also related to later sociometric status. Friends' alcohol access negatively related to later betweenness, and personal alcohol access moderated other pathways predicting betweenness. Betweenness appears to play a unique role in the association between social status and alcohol use in adolescent social networks. This is potentially tied to specific ways in which adolescents may be able to access alcohol (through home or through friends with access at home). More research is necessary to examine the ways in which multiple sociometric statuses relate to the contexts in which adolescents access and use alcohol.

  4. Per-Capita Medicare Expenditures, Primary Care Access, Mortality Rates, and the Least Healthy Cities in America.

    PubMed

    Weeks, William B; Weinstein, James N

    2017-01-01

    To determine whether several measures of health care expenditures, access, and outcomes for the 25 recently identified "least healthy cities in America" differed from those in the rest of America. For 2004 and 2013, we obtained publicly available price-, age-, sex-, and race-adjusted hospital service area per-capita Medicare expenditures; age-, sex-, and race-adjusted Medicare mortality rates; and 2 indicators of primary care access: the proportion of enrollees having at least one ambulatory visit to a primary care clinician and the per-capita discharge rate for ambulatory care sensitive conditions. Using population weighting, we used Student t test for expenditure data and the chi-squared test for access and outcomes data to compare results of the 25 least healthy cities in aggregate to the rest of America. In both years examined, the 25 least healthy cities had substantially (about $500 per capita per year) and statistically significantly higher total per-capita Medicare Part A and Part B expenditures than the rest of America: about 4/5 of this difference was due to higher hospital and skilled nursing facility expenditures; physician expenditures were modestly lower in the 25 least healthy cities. While a greater proportion of Medicare beneficiaries in the least healthy cities had a primary care clinician both years, mortality and ambulatory care sensitive condition admission rates were substantially higher in the least healthy cities. Policymakers and health system executives should work together to determine the best asset allocation across determinants of health that maximizes value creation from a community health perspective. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Nonoperative management of blunt splenic injury in adults: there is (still) a long way to go. The results of the Bologna-Maggiore Hospital trauma center experience and development of a clinical algorithm.

    PubMed

    Tugnoli, Gregorio; Bianchi, Elisa; Biscardi, Andrea; Coniglio, Carlo; Isceri, Salvatore; Simonetti, Luigi; Gordini, Giovanni; Di Saverio, Salomone

    2015-10-01

    Non-operative management (NOM) of hemodynamically stable patients with blunt splenic injury (BSI) is the standard of care, although it is associated with a potential risk of failure. Hemodynamically unstable patients should always undergo immediate surgery and avoid unnecessary CT scans. Angioembolization might help to increase the NOM rates, as well as NOM success rates. The aim of this study was to review and critically analyze the data from BSI cases managed at the Maggiore Hospital Trauma Center during the past 5 years, with a focus on NOM, its success rates and outcomes. A further aim was to develop a proposed clinical practical algorithm for the management of BSI derived from Clinical Audit experience. During the period between January 1, 2009 and December 31, 2013 we managed 293 patients with splenic lesions at the Trauma Center of Maggiore Hospital of Bologna. The data analyzed included the demographics, clinical parameters and characteristics, diagnostic and therapeutic data, as well as the outcomes and follow-up data. A retrospective evaluation of the clinical outcomes through a clinical audit has been used to design a practical clinical algorithm. During the five-year period, 293 patients with BSI were admitted, 77 of whom underwent immediate surgical management. The majority (216) of the patients was initially managed non-operatively and 207 of these patients experienced a successful NOM, with an overall rate of successful NOM of 70 % among all BSI cases. The success rate of NOM was 95.8 % in this series. All patients presenting with stable hemodynamics underwent an immediate CT-scan; angiography with embolization was performed in 54 cases for active contrast extravasation or in cases with grade V lesions even in absence of active bleeding. Proximal embolization was preferentially used for high-grade injuries. After a critical review of the cases treated during the past 5 years during a monthly clinical audit meeting, a clinical algorithm has been

  6. Energy access and living standards: some observations on recent trends

    NASA Astrophysics Data System (ADS)

    Rao, Narasimha D.; Pachauri, Shonali

    2017-02-01

    A subset of Sustainable Development Goals pertains to improving people’s living standards at home. These include the provision of access to electricity, clean cooking energy, improved water and sanitation. We examine historical progress in energy access in relation to other living standards. We assess regional patterns in the pace of progress and relative priority accorded to these different services. Countries in sub-Saharan Africa would have to undergo unprecedented rates of improvement in energy access in order to achieve the goal of universal electrification by 2030. World over, access to clean cooking fuels and sanitation facilities consistently lag improved water and electricity access by a large margin. These two deprivations are more concentrated among poor countries, and poor people in middle income countries. They are also correlated to health risks faced disproportionately by women. However, some Asian countries have been able to achieve faster progress in electrification at lower income levels compared to industrialized countries’ earlier efforts. These examples offer hope that future efforts need not be constrained by historical rates of progress.

  7. Timely access to mental health care among women veterans.

    PubMed

    Brunner, Julian; Schweizer, C Amanda; Canelo, Ismelda A; Leung, Lucinda B; Strauss, Jennifer L; Yano, Elizabeth M

    2018-04-05

    Using survey data on (N = 419) patients at Department of Veterans Affairs (VA) clinics we analyzed women veterans' reports of timely access to VA mental health care. We evaluated problems that patients might face in obtaining care, and examined subjective ratings of VA care as a function of timely access to mental health care. We found that 59% of participants reported "always" getting an appointment for mental health care as soon as needed. In adjusted analyses, two problems were negatively associated with timely access to mental health care: (a) medical appointments that interfere with other activities, and (b) difficulty getting questions answered between visits. Average subjective ratings of VA ranged from 8.2-8.6 out of 10, and 93% of participants would recommend VA care. Subjective ratings of VA were higher among women who reported timely access to mental health care. Findings suggest that overall experience of care is associated with timely access to mental health care, and that such access may be amenable to improvements related to clinic hours or mechanisms for answering patient questions between visits. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  8. Neighborhood alcohol outlet density and rates of child abuse and neglect: moderating effects of access to substance abuse services.

    PubMed

    Morton, Cory M; Simmel, Cassandra; Peterson, N Andrew

    2014-05-01

    This study investigates the relationship between concentrations of on- and off-premises alcohol outlets and rates of child abuse and neglect. Additionally, the study seeks to locate protective features of a neighborhood's built environment by investigating the potentially moderating role that access to substance abuse treatment and prevention services plays in the relationship between alcohol outlet density and child maltreatment. Using a cross-sectional design, this ecological study utilized data from 163 census tracts in Bergen County, New Jersey, on reports of child abuse and neglect, alcohol outlets, substance abuse treatment and prevention facilities, and the United States Census to investigate the linkages between socioeconomic structure, alcohol availability, and access to substance abuse service facilities on rates of child abuse and neglect. Findings indicate areas with a greater concentration of on-premises alcohol outlets (i.e., bars) had higher rates of child neglect, and those with easier access to substance abuse services had lower rates of neglect, controlling for neighborhood demographic and socioeconomic structure. Additionally, the relationship between on-premises alcohol outlet density and rates of child neglect was moderated by the presence of substance abuse service facilities. A greater concentration of off-premises outlets (i.e., liquor stores) was associated with lower rates of physical abuse. Findings suggest that the built environment and socioeconomic structure of neighborhoods have important consequences for child well-being. The implications for future research on the structural features of neighborhoods that are associated with child well-being are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Chapter 6: Children's Environmental Access in Relation to Motor Competence, Physical Activity, and Fitness

    ERIC Educational Resources Information Center

    Erwin, Heather E.; Woods, Amelia Mays; Woods, Martha K.; Castelli, Darla M.

    2007-01-01

    The purpose of this study was to examine levels of physical activity engagement, motor competence, and physical fitness as related to child access to physical activity facilities in the home and school environments. The present investigation attempts to further efforts to examine the relationship between physical activity levels and access.…

  10. Characterising health care-associated bloodstream infections in public hospitals in Queensland, 2008-2012.

    PubMed

    Si, Damin; Runnegar, Naomi; Marquess, John; Rajmokan, Mohana; Playford, Elliott G

    2016-04-18

    To describe the epidemiology and rates of all health care-associated bloodstream infections (HA-BSIs) and of specific HA-BSI subsets in public hospitals in Queensland. Standardised HA-BSI surveillance data were collected in 23 Queensland public hospitals, 2008-2012. HA-BSIs were prospectively classified in terms of place of acquisition (inpatient, non-inpatient); focus of infection (intravascular catheter-associated, organ site focus, neutropenic sepsis, or unknown focus); and causative organisms. Inpatient HA-BSI rates (per 10,000 patient-days) were calculated. There were 8092 HA-BSIs and 9418 causative organisms reported. Inpatient HA-BSIs accounted for 79% of all cases. The focus of infection in 2792 cases (35%) was an organ site, intravascular catheters in 2755 (34%; including 2240 central line catheters), neutropenic sepsis in 1063 (13%), and unknown in 1482 (18%). Five per cent (117 of 2240) of central line-associated BSIs (CLABSIs) were attributable to intensive care units (ICUs). Eight groups of organisms provided 79% of causative agents: coagulase-negative staphylococci (18%), Staphylococcus aureus (15%), Escherichia coli (11%), Pseudomonas species (9%), Klebsiella pneumoniae/oxytoca (8%), Enterococcus species (7%), Enterobacter species (6%), and Candida species (5%). The overall inpatient HA-BSI rate was 6.0 per 10,000 patient-days. The rates for important BSI subsets included: intravascular catheter-associated BSIs, 1.9 per 10,000 patient-days; S. aureus BSIs, 1.0 per 10,000 patient-days; and methicillin-resistant S. aureus BSIs, 0.3 per 10,000 patient-days. The rate of HA-BSIs in Queensland public hospitals is lower than reported by similar studies elsewhere. About one-third of HA-BSIs are attributable to intravascular catheters, predominantly central venous lines, but the vast majority of CLABSIs are contracted outside ICUs. Different sources of HA-BSIs require different prevention strategies.

  11. Access to care for autism-related services.

    PubMed

    Thomas, Kathleen C; Ellis, Alan R; McLaurin, Carolyn; Daniels, Julie; Morrissey, Joseph P

    2007-11-01

    This paper identifies family characteristics associated with use of autism-related services. A telephone or in-person survey was completed during 2003-2005 by 383 North Carolina families with a child 11 years old or younger with ASD. Access to care is limited for racial and ethnic minority families, with low parental education, living in nonmetropolitan areas, and not following a major treatment approach. Service use is more likely when parents have higher stress. Families use a broad array of services; the mix varies with child ASD diagnosis and age group. Disparities in service use associated with race, residence and education point to the need to develop policy, practice and family-level interventions that can address barriers to services for children with ASD.

  12. Responses of a vulnerable Hispanic population in New Jersey to Hurricane Sandy: Access to care, medical needs, concerns and ecological ratings

    PubMed Central

    Burger, Joanna; Gochfeld, Michael; Pittfield, Taryn; Jeitner, Christian

    2017-01-01

    Recent increases in hurricanes led to a need to evaluate access to medical care, medical needs, and personal and community impact on vulnerable populations, particularly elderly, low income, and minority communities. This article examines access to care, interruptions in medical services, personal impact from Hurricane Sandy, and agreement with ecological statements related to storms, flooding and damages in Hispanic/Latino patients receiving health care at Federally Qualified Health Centers in New Jersey. Only 10 % of 335 Hispanic interviewees were U.S. born. Self-identified personal impact was a better indicator of effects from Sandy, health center use, and medical issues, than was a community impact rating. Respondents who gave a high personal impact rating were more likely to have evacuated, had longer power outage, were more likely to need medical care, had more trouble getting to centers, and had more medical interruptions during Sandy. A higher percentage of respondents who evacuated, needed the center, had trouble getting there, and had more “medical need” than those who did not evacuate. The greatest impacts were on respondents who were told to evacuate before the storm, but did not (46 % had “medical need”). The respondents had high agreement ratings for “storms are due to climate change”, followed by “frequent and stronger storms will come more often”, “flooding is due to sea level rise”, and “changing climate is due mainly to human activity and not natural causes”. These ratings will aid public policy makers and planners in developing resiliency strategies for vulnerable coastal communities. PMID:28644717

  13. Responses of a vulnerable Hispanic population in New Jersey to Hurricane Sandy: Access to care, medical needs, concerns, and ecological ratings.

    PubMed

    Burger, Joanna; Gochfeld, Michael; Pittfield, Taryn; Jeitner, Christian

    2017-01-01

    Recent increases in hurricanes led to a need to evaluate access to medical care, medical needs, and personal and community impact on vulnerable populations, particularly elderly, low income, and minority communities. This investigation examined (1) access to care, (2) interruptions in medical services, (3) personal impact from Hurricane Sandy, and (4) agreement with ecological statements related to storms, flooding, and damages in Hispanic/Latino patients receiving health care at Federally Qualified Health Centers in New Jersey. Only 10% of 335 Hispanic interviewees were US born. Self-identified personal impact was a better indicator of effects from Sandy, health center use, and medical issues, than community impact rating. Respondents who provided a high personal impact rating were more likely to have evacuated, had longer power outage, were more likely to need medical care, displayed more trouble getting to centers, and exhibited more medical interruptions during Sandy. A higher % respondents who evacuated, needed the center, had trouble getting there, and had more "medical need" than those who did not evacuate. The greatest impacts were on respondents who were told to evacuate before the storm, but did not (46% had "medical need"). The respondents had high agreement ratings for "storms are due to climate change," followed by "frequent and stronger storms will come more often," "flooding is due to sea level rise," and "changing climate is due mainly to human activity and not natural causes". These ratings may aid public policymakers and planners in developing resiliency strategies for vulnerable coastal communities.

  14. The magnetic properties of a magnetic detector using oxidized amorphous Co 95- xFe 5(BSi) x alloys

    NASA Astrophysics Data System (ADS)

    Ahn, S. J.; Kim, C. K.; Kim, S. J.; Choi, D. K.; O'Handley, R. C.

    2000-07-01

    A comparative oxidation study of several amorphous Co 75- xFe 5(BSi) 20+ x alloys was carried out. Reentrant magnetization behavior and field-induced anisotropy which are of a critical importance for a magnetic detector were obtained after oxidation of the amorphous Co-rich ribbons. During this oxidation, the ribbons develop surface oxides which are primarily nonmagnetic borosilicate or a combination of borosilicate and magnetic oxides such CoO or FeO. Beneath this lies a 100-1000 Å thick Co-rich magnetic alloy which may be either HCP or FCC in its crystal structure. The thickness of the Co-crystallized layer is determined by the type of the surface oxides. The oxidation products such as appear to affect the reentrant magnetization behavior of Co-rich amorphous alloys significantly. We have determined the amount of metalloids (a critical concentration of B and Si) which is necessary to form a continuous layer of the most thermodynamically stable oxide, in our case borosilicate, on the surface. We also observed that there is a good correlation between reentrant magnetization and the thickness of Co layer. The best reentrant M- H loop for the magnetic detector was obtained in ribbons with a surface borate-rich borosilicate since it ensures conditions such as (1) metalloid depletion in the substrate and (2) formation of oxygen impurity faults in Co grains that are required for strong reentrant magnetization behavior.

  15. Frequent accesses to totally implanted vascular ports in pediatric oncology patients are associated with higher infection rates.

    PubMed

    Gapany, Christophe; Tercier, Stéphane; Diezi, Manuel; Clement, Chantal; Lemay, Katy; Joseph, Jean-Marc

    2011-01-01

    Totally implanted vascular (TIVA) ports are used in children for repeated blood samples or intravenous treatments. We have recently published a prospective evaluation of surgical incidents and early complications associated with these devices. This work is the final part of the same study, assessing late complications over a follow-up of 2 yrs. From January 2006 to January 2008, children older than 1 yr of age with a diagnosis of solid or blood cell malignancy were included. Insertion technique and care of the device were standardized. Every manipulation was prospectively recorded by specialized nurses. Obstruction was documented clinically. When bacteremia was suspected, routine central and peripheral blood cultures were drawn. Forty-five consecutive patients were enrolled in the study. Mean age at the time of the procedure was 8.5 yrs. There was no catheter-related infection within the first 4 weeks post-surgery. No device had to be removed because of infection or obstruction during follow-up. Frequent accesses to the port (=3 per day over a 10-day period) were associated with an 8-fold risk of infection. Insertion and use of TIVA devices were frequently associated with complications. No device had to be removed because of infection or obstruction over the follow-up period, although no prophylactic antibiotic agent was used. Restrictive use of antibiotics may prevent opportunistic infection. Frequent access to the device was significantly associated with line infection (odds ratio=8.43). No risk factor was identified for obstruction which occurred at a rate of 5.3 per 10,000 accesses.

  16. Bait stations, hard mast, and black bear population growth in Great Smoky Mountains National Park

    USGS Publications Warehouse

    Clark, Joseph D.; van Manen, Frank T.; Pelton, Michael R.

    2005-01-01

    Bait-station surveys are used by wildlife managers as an index to American black bear (Ursus americanus) population abundance, but the relationship is not well established. Hard mast surveys are similarly used to assess annual black bear food availability which may affect mortality and natality rates. We used data collected in Great Smoky Mountains National Park (GSMNP) from 1989 to 2003 to determine whether changes in the bait-station index (ΔBSI) were associated with estimated rates of bear population growth (λ) and whether hard mast production was related to bear visitation to baits. We also evaluated whether hard mast production from previous years was related to λ. Estimates of λ were based on analysis of capture-recapture data with the Pradel temporal symmetry estimator. Using the Akaike's Information Criterion (AIC), our analysis revealed no direct relationship between ΔBSI and λ. A simulation analysis indicated that our data were adequate to detect a relationship had one existed. Model fit was marginally improved when we added total oak mast production of the previous year as an interaction term suggesting that the BSI was confounded with environmental variables. Consequently the utility of the bait-station survey as a population monitoring technique is questionable at the spatial and temporal scales we studied. Mast survey data, however, were valuable covariates of λ. Population growth for a given year was negatively related to oak mast production 4 and 5 years prior. That finding supported our hypothesis that mast failures can trigger reproductive synchrony, which may not be evident from the trapped sample until years later.

  17. Incidence and risk factors for central venous access port-related infection in Chinese cancer patients.

    PubMed

    Wang, Ting-Yao; Lee, Kuan-Der; Chen, Ping-Tsung; Chen, Min-Chi; Chen, Yi-Yang; Huang, Cih-En; Kuan, Feng-Che; Chen, Chih-Cheng; Lu, Chang Hsien

    2015-11-01

    Cytotoxic chemotherapy via central venous access ports is an important part of the standard treatment for most cancers, but it is accompanied with the risk of infections. This study aimed to analyze the incidence and risk factors for central venous access port-related infection (CPI) among Chinese patients receiving cytotoxic chemotherapy. Between January 1, 2002 and December 31, 2005 a total of 1391 cancer patients with 1449 totally implantable central venous access ports were evaluated. The log-rank test and Cox proportional hazards model were used for the analyses of risk factors. The overall CPI incidence rate was 0.21 per 1000 catheter-days. Hematological malignancies and head and neck cancer were associated with an increased risk of CPI (hazard ratio 4.00 and 4.11, respectively, both p < 0.001) and less infection-free catheter longevity (p < 0.001) compared with other cancer types. Chemotherapy in an adjuvant setting was associated with a lower risk of infection than for patients in a nonadjuvant setting (p < 0.001). The most common pathogens isolated from CPI were Pseudomonas aeruginosa and Candida. Infection remains to be a challenging issue for totally implantable central venous ports. Implementation of an insertion bundle for the prevention of central line-associated bloodstream infections is warranted, especially for those patients with hematological and head and neck cancers, as well as for patients receiving chemotherapy in the metastatic settings. Copyright © 2015. Published by Elsevier B.V.

  18. Health Benefits for Vocational Rehabilitation Consumers: Comparison of Access Rates with Workers in the General Population

    ERIC Educational Resources Information Center

    Lustig, Daniel C.; Strauser, David R.

    2010-01-01

    Access to health insurance is one of the critical aspects of securing employment for people with disabilities. This study investigated whether vocational rehabilitation consumers secured employment with an employer who offered health insurance at similar rates to workers in the general population. In general, the results show that vocational…

  19. Gender Differences in Availability, Internet Access and Rate of Usage of Computers among Distance Education Learners.

    ERIC Educational Resources Information Center

    Atan, Hanafi; Sulaiman, Fauziah; Rahman, Zuraidah Abd; Idrus, Rozhan Mohammed

    2002-01-01

    Explores the level of availability of computers, Internet accessibility, and the rate of usage of computers both at home and at the workplace between distance education learners according to gender. Results of questionnaires completed at the Universiti Sains Malaysia indicate that distance education reduces the gender gap. (Author/LRW)

  20. Are vital signs indicative for bacteremia in newborns?

    PubMed

    Yapıcıoğlu, Hacer; Özlü, Ferda; Sertdemir, Yaşar

    2015-01-01

    Neonatal systemic infection is a leading cause of morbidity and mortality both in industrialized and developing countries. The aim of this prospective study was to evaluate if vital signs had a predictive power in neonatal sepsis as an early marker. This study was designed as a matched case-control study. Vital signs were monitorized prior to infection in newborns that had healthcare-associated blood stream infection (BSI). Maximum and minimum values of the vital signs (blood pressure, heart rate, respiratory rate and temperature) of the babies at rest were recorded from the nurse observation charts five days prior to clinical sepsis and compared with vital signs of healthy, age-matched babies. Maximum mean heart rates, respiratory rates and systolic blood pressure levels of the patients in BSI group were significantly higher than the control group in the past three days prior to clinical deterioration. Monitoring vital signs closely might be helpful in a newborn infant to define a BSI. In future, a respiratory and blood pressure predictive monitoring system such as heart rate variability index may be developed for newborn patients with sepsis.

  1. [Evaluation of practices for the prevention and control of bloodstream infections in a government hospital].

    PubMed

    Jardim, Jaquelline Maria; Lacerda, Rúbia Aparecida; Soares, Naury de Jesus Danzi; Nunes, Bruna Kosar

    2013-02-01

    The aim of this study was to observe clinical procedures in order to evaluate the practices used for the control and prevention of bloodstream infections associated with short-term central venous catheters (BSI-ACVC). The study data came from 5877 assessments distributed among selected practices. The results revealed the following adherence rates among the practices selected: 91.6% for recording the indication and permanence time of the CVC, 51.5% for adhering to the care and maintenance of the dressing at the CVC insertion site and its devices, 10.7% for hand hygiene practices while performing procedures related to the CVC, and 0.0% for the practices related to the insertion of the central venous catheter (CVC). The results demonstrate the need for further elaboration of strategies that ensure sustainable compliance practices for prevention and control BSI-ACVC in the institution being assessed.

  2. Literacy disparities in patient access and health-related use of Internet and mobile technologies.

    PubMed

    Bailey, Stacy C; O'Conor, Rachel; Bojarski, Elizabeth A; Mullen, Rebecca; Patzer, Rachel E; Vicencio, Daniel; Jacobson, Kara L; Parker, Ruth M; Wolf, Michael S

    2015-12-01

    Age and race-related disparities in technology use have been well documented, but less is known about how health literacy influences technology access and use. To assess the association between patients' literacy skills and mobile phone ownership, use of text messaging, Internet access, and use of the Internet for health-related purposes. A secondary analysis utilizing data from 1077 primary care patients enrolled in two, multisite studies from 2011-2013. Patients were administered an in-person, structured interview. Patients with adequate health literacy were more likely to own a mobile phone or smartphone in comparison with patients having marginal or low literacy (mobile phone ownership: 96.8 vs. 95.2 vs. 90.1%, respectively, P < 0.001; smartphone ownership: 70.6 vs. 62.5 vs. 40.1%, P < 0.001) and to report text messaging (78.6 vs. 75.2 vs. 53.1%, P < 0.001). They were also more likely to have access to the Internet from their home (92.1 vs. 74.7 vs. 44.9%, P < 0.001) and to report using the Internet for email (93.0 vs. 75.7 vs. 38.5%, P < 0.001), browsing the web (93.9 vs. 80.2 vs. 44.5%, P < 0.001), accessing health information (86.3 vs. 75.5 vs. 40.8%, P < 0.001), and communicating with providers (54.2 vs. 29.8 vs. 13.0%, P < 0.001). Relationships remained significant in multivariable analyses controlling for relevant covariates. Results reveal that literacy-related disparities in technology access and use are widespread, with lower literate patients being less likely to own smartphones or to access and use the Internet, particularly for health reasons. Future interventions should consider these disparities and ensure that health promotion activities do not further exacerbate disparities. © 2014 John Wiley & Sons Ltd.

  3. Modified open-access scheduling for new patient evaluations at an academic chronic pain clinic increased patient access to care, but did not materially reduce their mean cancellation rate: A retrospective, observational study.

    PubMed

    Sivanesan, Eellan; Lubarsky, David A; Ranasinghe, Chaturani T; Sarantopoulos, Constantine D; Epstein, Richard H

    2017-09-01

    To determine if open-access scheduling would reduce the cancellation rate for new patient evaluations in a chronic pain clinic by at least 50%. Retrospective, observational study using electronic health records. Chronic pain clinic of an academic anesthesia department. All patients scheduled for evaluation or follow-up appointments in the chronic pain clinic between April 1, 2014, and December 31, 2015. Open-access scheduling was instituted in April 2015 with appointments offered on a date of the patient's choosing ≥1 business day after calling, with no limit on the daily number of new patients. Mean cancellation rates for new patients were compared between the 12-month baseline period prior to and for 7months after the change, following an intervening 2-month washout period. The method of batch means (by month) and the 2-sided Student t-test were used; P<0.01 required for significance. The new patient mean cancellation rate decreased from a baseline of 35.7% by 4.2% (95% confidence interval [CI] 1.4% to 6.9%; P=0.005); however, this failed to reach the 50% reduction target of 17.8%. Appointment lag time decreased by 4.7days (95% CI 2.3 to 7.0days, P<0.001) from 14.1days to 9.4days in the new patient group. More new patients were seen within 1week compared to baseline (50.6% versus 19.1%; P<0.0001). The mean number of new patient visits per month increased from 158.5 to 225.0 (P=0.0004). The cancellation rate and appointment lag times did not decrease for established patient visits, as expected because open-access scheduling was not implemented for this group. Access to care for new chronic pain patients improved with modified open-access scheduling. However, their mean cancellation rate only decreased from 35.7% to 31.5%, making this a marginally effective strategy to reduce cancellations. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Institutional Frameworks and Structural Factors Relating to Educational Access across Europe

    ERIC Educational Resources Information Center

    Biggart, Andy; Järvinen, Tero; Parreira do Amaral, Marcelo

    2015-01-01

    In this article institutional and structural factors relating to access to education are assessed. First, the macro frameworks of institutional regulation that exert influence on the educational trajectories of young Europeans are demonstrated. Based on different aspects of these frameworks and drawing from extant research, the article presents a…

  5. High data rate modem simulation for the space station multiple-access communications system

    NASA Technical Reports Server (NTRS)

    Horan, Stephen

    1987-01-01

    The communications system for the space station will require a space based multiple access component to provide communications between the space based program elements and the station. A study was undertaken to investigate two of the concerns of this multiple access system, namely, the issues related to the frequency spectrum utilization and the possibilities for higher order (than QPSK) modulation schemes for use in possible modulators and demodulators (modems). As a result of the investigation, many key questions about the frequency spectrum utilization were raised. At this point, frequency spectrum utilization is seen as an area requiring further work. Simulations were conducted using a computer aided communications system design package to provide a straw man modem structure to be used for both QPSK and 8-PSK channels.

  6. Health-related quality of life as a main determinant of access to rheumatologic care.

    PubMed

    Leon, Leticia; Jover, Juan Angel; Loza, Estibaliz; Zunzunegui, Maria Victoria; Lajas, Cristina; Vadillo, Cristina; Fontsere, Oscar; Rodriguez-Rodriguez, Luis; Martinez, Cristina; Fernandez-Gutierrez, Benjamin; Abasolo, Lydia

    2013-07-01

    To evaluate a rheumatology outpatient consultation access system for new patients. New patients seen from April 2005 to April 2006 at our rheumatology clinic (n = 4,460) were included and classified according to their appointment type: ordinary appointments (OA) to be seen within 30 days, urgent appointments (UA) and work disability appointments (WDA) to be seen within 3 days. Age, sex, diagnosis, and health-related quality of life (HRQoL) as determined by the Rosser Index were recorded. Logistic regression models were run to identify factors that contribute to each type of appointment. OA was the method of access for 1,938 new patients, while 1,194 and 1,328 patients were seen through WDA and UA appointments, respectively. Younger male patients, and those with microcrystalline arthritis, sciatica, shoulder, back, or neck pain, were more likely to use the faster access systems (UA or WDA), whereas patients with a degenerative disease were mainly seen through OA (<0.001). Subjects with poor (3.96; 95 % CI, 2.8-5.5) or very poor HRQoL (70.8; 95 % CI, 14.9-334) were strongly associated to visiting a rheumatologist through the WDA or UA access systems, respectively, compared to OA. Age, gender, diagnosis, and mainly health-related quality of life are associated with the referral pattern of access to rheumatologic outpatient care. Among new patients subjects with the worst HRQoL were more likely to access with faster methods (UA or WDA) than those with better HRQoL.

  7. Control of infectious mortality due to carbapenemase-producing Klebsiella pneumoniae in hematopoietic stem cell transplantation.

    PubMed

    Forcina, A; Baldan, R; Marasco, V; Cichero, P; Bondanza, A; Noviello, M; Piemontese, S; Soliman, C; Greco, R; Lorentino, F; Giglio, F; Messina, C; Carrabba, M; Bernardi, M; Peccatori, J; Moro, M; Biancardi, A; Nizzero, P; Scarpellini, P; Cirillo, D M; Mancini, N; Corti, C; Clementi, M; Ciceri, F

    2017-01-01

    Carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) infections are an emerging cause of death after hematopoietic stem cell transplantation (HSCT). In allogeneic transplants, mortality rate may rise up to 60%. We retrospectively evaluated 540 patients receiving a transplant from an auto- or an allogeneic source between January 2011 and October 2015. After an Institutional increase in the prevalence of KPC-Kp bloodstream infections (BSI) in June 2012, from July 2012, 366 consecutive patients received the following preventive measures: (i) weekly rectal swabs for surveillance; (ii) contact precautions in carriers (iii) early-targeted therapy in neutropenic febrile carriers. Molecular typing identified KPC-Kp clone ST512 as the main clone responsible for colonization, BSI and outbreaks. After the introduction of these preventive measures, the cumulative incidence of KPC-Kp BSI (P=0.01) and septic shocks (P=0.01) at 1 year after HSCT was significantly reduced. KPC-Kp infection-mortality dropped from 62.5% (pre-intervention) to 16.6% (post-intervention). Day 100 transplant-related mortality and KPC-Kp infection-related mortality after allogeneic HSCT were reduced from 22% to 10% (P=0.001) and from 4% to 1% (P=0.04), respectively. None of the pre-HSCT carriers was excluded from transplant. These results suggest that active surveillance, contact precautions and early-targeted therapies, may efficiently control KPC-Kp spread and related mortality even after allogeneic HSCT.

  8. Developing a Multicomponent Model of Nutritious Food Access and Related Implications for Community and Policy Practice.

    PubMed

    Freedman, Darcy A; Blake, Christine E; Liese, Angela D

    2013-01-01

    Access to nutritious foods is limited in disenfranchised communities in the United States. Policies are beginning to focus on improving nutritious food access in these contexts; yet, few theories are available to guide this work. We developed a conceptual model of nutritious food access based on the qualitative responses of food consumers in 2 different regions of the American South. Five domains (economic, service delivery, spatial-temporal, social, and personal) and related dimensions of nutritious food access were identified. The conceptual model provides practical guidance to researchers, policy makers, and practitioners working to improve nutritious food access in communities.

  9. Developing a Multicomponent Model of Nutritious Food Access and Related Implications for Community and Policy Practice

    PubMed Central

    FREEDMAN, DARCY A.; BLAKE, CHRISTINE E.; LIESE, ANGELA D.

    2014-01-01

    Access to nutritious foods is limited in disenfranchised communities in the United States. Policies are beginning to focus on improving nutritious food access in these contexts; yet, few theories are available to guide this work. We developed a conceptual model of nutritious food access based on the qualitative responses of food consumers in 2 different regions of the American South. Five domains (economic, service delivery, spatial–temporal, social, and personal) and related dimensions of nutritious food access were identified. The conceptual model provides practical guidance to researchers, policy makers, and practitioners working to improve nutritious food access in communities. PMID:24563605

  10. Psychological distress, self-harming behavior, and suicidal tendencies in adults with disorders of sex development.

    PubMed

    Schützmann, Karsten; Brinkmann, Lisa; Schacht, Melanie; Richter-Appelt, Hertha

    2009-02-01

    Evaluation of psychological distress has received relatively little attention in research on persons with disorders of sex development (DSD). Results of previous studies varied considerably, but most studies did not find increased levels of psychological distress. We conducted a pilot study based on a sample of 37 persons with diverse forms of DSD recruited via various strategies. The Brief Symptom Inventory (BSI) was used to assess self-reported psychological distress. Psychological distress varied broadly across all diagnostic subgroups. Overall, the BSI Global Severity Index indicated higher distress in the sample of persons with DSD compared to a non-clinical norm population of women, with an effect size of d = 0.67. According to predefined BSI criteria, 59% of participants were classified as a clinical case. Self-harming behavior and suicidal tendencies were also assessed and compared to a community based sample of women, including subgroups of traumatized women with a history of physical or sexual abuse. The prevalence rates of self-harming behavior and suicidal tendencies in the DSD sample exceeded the rates of the non-traumatized comparison subgroup, with rates comparable to the traumatized comparison groups of women with physical or sexual abuse. As possible explanations for the higher distress found here compared to most previous studies, differences in measures and sample recruitment are discussed. Our results suggest that adults with DSD are markedly psychologically distressed with rates of suicidal tendencies and self-harming behavior on a level comparable to non-DSD women with a history of physical or sexual abuse, but sample recruitment procedures do not permit a firm generalization.

  11. Accessing Suicide-Related Information on the Internet: A Retrospective Observational Study of Search Behavior

    PubMed Central

    2013-01-01

    Background The Internet’s potential impact on suicide is of major public health interest as easy online access to pro-suicide information or specific suicide methods may increase suicide risk among vulnerable Internet users. Little is known, however, about users’ actual searching and browsing behaviors of online suicide-related information. Objective To investigate what webpages people actually clicked on after searching with suicide-related queries on a search engine and to examine what queries people used to get access to pro-suicide websites. Methods A retrospective observational study was done. We used a web search dataset released by America Online (AOL). The dataset was randomly sampled from all AOL subscribers’ web queries between March and May 2006 and generated by 657,000 service subscribers. Results We found 5526 search queries (0.026%, 5526/21,000,000) that included the keyword "suicide". The 5526 search queries included 1586 different search terms and were generated by 1625 unique subscribers (0.25%, 1625/657,000). Of these queries, 61.38% (3392/5526) were followed by users clicking on a search result. Of these 3392 queries, 1344 (39.62%) webpages were clicked on by 930 unique users but only 1314 of those webpages were accessible during the study period. Each clicked-through webpage was classified into 11 categories. The categories of the most visited webpages were: entertainment (30.13%; 396/1314), scientific information (18.31%; 240/1314), and community resources (14.53%; 191/1314). Among the 1314 accessed webpages, we could identify only two pro-suicide websites. We found that the search terms used to access these sites included “commiting suicide with a gas oven”, “hairless goat”, “pictures of murder by strangulation”, and “photo of a severe burn”. A limitation of our study is that the database may be dated and confined to mainly English webpages. Conclusions Searching or browsing suicide-related or pro-suicide webpages was

  12. Accessing suicide-related information on the internet: a retrospective observational study of search behavior.

    PubMed

    Wong, Paul Wai-Ching; Fu, King-Wa; Yau, Rickey Sai-Pong; Ma, Helen Hei-Man; Law, Yik-Wa; Chang, Shu-Sen; Yip, Paul Siu-Fai

    2013-01-11

    The Internet's potential impact on suicide is of major public health interest as easy online access to pro-suicide information or specific suicide methods may increase suicide risk among vulnerable Internet users. Little is known, however, about users' actual searching and browsing behaviors of online suicide-related information. To investigate what webpages people actually clicked on after searching with suicide-related queries on a search engine and to examine what queries people used to get access to pro-suicide websites. A retrospective observational study was done. We used a web search dataset released by America Online (AOL). The dataset was randomly sampled from all AOL subscribers' web queries between March and May 2006 and generated by 657,000 service subscribers. We found 5526 search queries (0.026%, 5526/21,000,000) that included the keyword "suicide". The 5526 search queries included 1586 different search terms and were generated by 1625 unique subscribers (0.25%, 1625/657,000). Of these queries, 61.38% (3392/5526) were followed by users clicking on a search result. Of these 3392 queries, 1344 (39.62%) webpages were clicked on by 930 unique users but only 1314 of those webpages were accessible during the study period. Each clicked-through webpage was classified into 11 categories. The categories of the most visited webpages were: entertainment (30.13%; 396/1314), scientific information (18.31%; 240/1314), and community resources (14.53%; 191/1314). Among the 1314 accessed webpages, we could identify only two pro-suicide websites. We found that the search terms used to access these sites included "commiting suicide with a gas oven", "hairless goat", "pictures of murder by strangulation", and "photo of a severe burn". A limitation of our study is that the database may be dated and confined to mainly English webpages. Searching or browsing suicide-related or pro-suicide webpages was uncommon, although a small group of users did access websites that contain

  13. Emerging commercial molecular tests for the diagnosis of bloodstream infection.

    PubMed

    Mwaigwisya, Solomon; Assiri, Rasha Assad M; O'Grady, Justin

    2015-05-01

    Bloodstream infection (BSI) by microorganisms can lead to sepsis. This condition has a high mortality rate, which rises significantly with delays in initiation of appropriate antimicrobial treatment. Current culture methods for diagnosing BSI have long turnaround times and poor clinical sensitivity. While clinicians wait for culture diagnosis, patients are treated empirically, which can result in inappropriate treatment, undesirable side effects and contribute to drug resistance development. Molecular diagnostics assays that target pathogen DNA can identify pathogens and resistance markers within hours. Early diagnosis improves antibiotic stewardship and is associated with favorable clinical outcomes. Nonetheless, limitations of current molecular diagnostic methods are substantial. This article reviews recent commercially available molecular methods that use pathogen DNA to diagnose BSI, either by testing positive blood cultures or directly testing patient blood. We critically assess these tests and their application in clinical microbiology. A view of future directions in BSI diagnosis is also provided.

  14. Measuring, Rating, Supporting, and Strengthening Open Access Scholarly Publishing in Brazil

    ERIC Educational Resources Information Center

    Neto, Silvio Carvalho; Willinsky, John; Alperin, Juan Pablo

    2016-01-01

    This study assesses the extent and nature of open access scholarly publishing in Brazil, one of the world's leaders in providing universal access to its research and scholarship. It utilizes Brazil's Qualis journal evaluation system, along with other relevant data bases to address the association between scholarly quality and open access in the…

  15. Decrease in Suicide Rates after a Change of Policy Reducing Access to Firearms in Adolescents: A Naturalistic Epidemiological Study

    ERIC Educational Resources Information Center

    Lubin, Gad; Werbeloff, Nomi; Halperin, Demian; Shmushkevitch, Mordechai; Weiser, Mark; Knobler, Haim Y.

    2010-01-01

    The use of firearms is a common means of suicide. We examined the effect of a policy change in the Israeli Defense Forces reducing adolescents' access to firearms on rates of suicide. Following the policy change, suicide rates decreased significantly by 40%. Most of this decrease was due to decrease in suicide using firearms over the weekend.…

  16. Low rates of antibiotic resistance and infectious mortality in a cohort of high-risk hematology patients: A single center, retrospective analysis of blood stream infection

    PubMed Central

    Conn, Jason R.; Catchpoole, Elizabeth M.; Runnegar, Naomi; Mapp, Sally J.

    2017-01-01

    Febrile neutropenia (FN) is a medical emergency and can represent a life-threatening complication for hematology patients treated with intensive chemotherapy regimens. In clinical practice, the diagnostic yield of blood cultures and other investigations which aim to identify a causative organism or site of infection is low. We have retrospectively examined all blood cultures collected in a “real world” cohort of patients receiving chemotherapy for acute leukemia and patients with aggressive lymphoma treated with Hyper-CVAD/MTX-cytarabine, at a single tertiary center over a five-year period. In this cohort, the 30-day mortality following confirmed blood stream infection (BSI) was 5.9%, which is lower than most reports in the recent literature. We compared the blood culture results of inpatients undergoing induction chemotherapy and outpatients presenting with fevers and found a significantly higher rate of proven BSI in the outpatient group. In all settings, gram-negative organisms were most common. The rate of resistance to first-line empiric antibiotics among pathogenic isolates was 11.6% in the whole cohort, independent of blood culture circumstances. There was a trend to higher resistance rates among inpatients undergoing induction chemotherapy compared to patients presenting to the emergency department (17.4% vs 7.5%) but this did not reach statistical significance. We also report low rates of ciprofloxacin resistance (5% of isolates), in a center where universal fluoroquinolone prophylaxis is not employed. Our low resistance and mortality rates support our current therapeutic strategies, however presence of resistant organisms across the spectrum of indications for BC collection highlights the importance of surveilling local patterns, escalating antimicrobial therapy in the deteriorating patient, and considering advanced techniques for the rapid identification of resistance in this patient population. PMID:28542412

  17. Clinical efficacy of β-lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae in haematological patients with neutropaenia: a study protocol for a retrospective observational study (BICAR)

    PubMed Central

    Gudiol, C; Royo-Cebrecos, C; Tebe, C; Abdala, E; Akova, M; Álvarez, R; Maestro-de la Calle, G; Cano, A; Cervera, C; Clemente, W T; Martín-Dávila, P; Freifeld, A; Gómez, L; Gottlieb, T; Gurguí, M; Herrera, F; Manzur, A; Maschmeyer, G; Meije, Y; Montejo, M; Peghin, M; Rodríguez-Baño, J; Ruiz-Camps, I; Sukiennik, T C; Carratalà, J

    2017-01-01

    Introduction Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population. Methods and analysis A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events. Sample size The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2. Ethics and dissemination The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group

  18. Clinical efficacy of β-lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae in haematological patients with neutropaenia: a study protocol for a retrospective observational study (BICAR).

    PubMed

    Gudiol, C; Royo-Cebrecos, C; Tebe, C; Abdala, E; Akova, M; Álvarez, R; Maestro-de la Calle, G; Cano, A; Cervera, C; Clemente, W T; Martín-Dávila, P; Freifeld, A; Gómez, L; Gottlieb, T; Gurguí, M; Herrera, F; Manzur, A; Maschmeyer, G; Meije, Y; Montejo, M; Peghin, M; Rodríguez-Baño, J; Ruiz-Camps, I; Sukiennik, T C; Carratalà, J

    2017-01-23

    Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population. A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events. The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2. The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group for Infections in Compromised Hosts (ESGICH). Published by the BMJ

  19. Medical Device-Associated Candida Infections in a Rural Tertiary Care Teaching Hospital of India.

    PubMed

    Deorukhkar, Sachin C; Saini, Santosh

    2016-01-01

    Health care associated infections (HCAIs) add incrementally to the morbidity, mortality, and cost expected of the patient's underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI), catheter-associated urinary tract infection (CA-UTI), intravascular catheter-related blood stream infections (CR-BSI), and ventilator-associated pneumonia (VAP), were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp.

  20. Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients.

    PubMed

    Trust, Marc D; Teixeira, Pedro G; Brown, Lawrence H; Ali, Sadia; Coopwood, Ben; Aydelotte, Jayson D; Brown, Carlos V R

    2018-01-01

    Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age < 65) and geriatric (age ≥ 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs. 4%, p < 0.0001). On logistic regression analysis, Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778; confidence interval, 1.769-4.363; p < 0.0001). There was no difference in mortality in geriatric patients who had successful vs. failed NOM (11% vs. 15%; p = 0.22). Independent risk factors for mortality in geriatric patients included admission hypotension, Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429; confidence interval, 0.776-2.625; p = 0.25). Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. Therapeutic, level IV.

  1. Proposed primary endpoints for use in clinical trials that compare treatment options for bloodstream infection in adults: a consensus definition.

    PubMed

    Harris, P N A; McNamara, J F; Lye, D C; Davis, J S; Bernard, L; Cheng, A C; Doi, Y; Fowler, V G; Kaye, K S; Leibovici, L; Lipman, J; Llewelyn, M J; Munoz-Price, S; Paul, M; Peleg, A Y; Rodríguez-Baño, J; Rogers, B A; Seifert, H; Thamlikitkul, V; Thwaites, G; Tong, S Y C; Turnidge, J; Utili, R; Webb, S A R; Paterson, D L

    2017-08-01

    To define standardized endpoints to aid the design of trials that compare antibiotic therapies for bloodstream infections (BSI). Prospective studies, randomized trials or registered protocols comparing antibiotic therapies for BSI, published from 2005 to 2016, were reviewed. Consensus endpoints for BSI studies were defined using a modified Delphi process. Different primary and secondary endpoints were defined for pilot (small-scale studies designed to evaluate protocol design, feasibility and implementation) and definitive trials (larger-scale studies designed to test hypotheses and influence clinical practice), as well as for Staphylococcus aureus and Gram-negative BSI. For pilot studies of S. aureus BSI, a primary outcome of success at day 7 was defined by: survival, resolution of fever, stable/improved Sequential Organ Failure Assessment (SOFA) score and clearance of blood cultures, with no microbiologically confirmed failure up to 90 days. For definitive S. aureus BSI studies, a primary outcome of success at 90 days was defined by survival and no microbiologically confirmed failure. For pilot studies of Gram-negative BSI, a primary outcome of success at day 7 was defined by: survival, resolution of fever and symptoms related to BSI source, stable or improved SOFA score and negative blood cultures. For definitive Gram-negative BSI studies, a primary outcome of survival at 90 days supported by a secondary outcome of success at day 7 (as previously defined) was agreed. These endpoints provide a framework to aid future trial design. Further work will be required to validate these endpoints with respect to patient-centred clinical outcomes. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.

  2. Access site-related complications after transradial catheterization can be reduced with smaller sheath size and statins.

    PubMed

    Honda, Tsuyoshi; Fujimoto, Kazuteru; Miyao, Yuji; Koga, Hidenobu; Hirata, Yoshihiro

    2012-09-01

    The aim of this study was to investigate the risk factors for access site-related complications after transradial coronary angiography (CAG) or percutaneous coronary intervention (PCI). Transradial PCI has been shown to reduce access site-related bleeding complications compared with procedures performed through a femoral approach. Although previous studies focused on risk factors for access site-related complications after a transfemoral approach or transfemoral and transradial approaches, it is uncertain which factors affect vascular complications after transradial catheterization. We enrolled 500 consecutive patients who underwent transradial CAG or PCI. We determined the incidence and risk factors for access site-related complications such as radial artery occlusion and bleeding complications. Age, sheath size, the dose of heparin and the frequency of PCI (vs. CAG) were significantly greater in patients with than without bleeding complications. However, body mass index (BMI) was significantly lower in patients with than without bleeding complications. Sheath size was significantly higher and the frequency of statin use was significantly lower in patients with than without radial artery occlusion. Multiple logistic analysis revealed that sheath size [odds ratio (OR) 5.5; P < 0.05] and BMI (OR 0.86; P < 0.01) were risk factors for bleeding complications; and sheath size (OR 5.2; P < 0.05) and the lack of statin pretreatment (OR 0.50; P < 0.05) were risk factors for occlusive complications. In conclusion, these findings indicate that down-sizing of the devices used in transradial procedures might attenuate access site-related complications after transradial CAG or PCI. Statin pretreatment might also be a strategy that could prevent radial artery occlusion after transradial procedures.

  3. 45 CFR 602.42 - Retention and access requirements for records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Retention and access requirements for records. 602.42 Section 602.42 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... computer usage chargeback rates or composite fringe benefit rates). (i) If submitted for negotiation. If...

  4. 45 CFR 602.42 - Retention and access requirements for records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 3 2012-10-01 2012-10-01 false Retention and access requirements for records. 602.42 Section 602.42 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... computer usage chargeback rates or composite fringe benefit rates). (i) If submitted for negotiation. If...

  5. 45 CFR 602.42 - Retention and access requirements for records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 3 2014-10-01 2014-10-01 false Retention and access requirements for records. 602.42 Section 602.42 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... computer usage chargeback rates or composite fringe benefit rates). (i) If submitted for negotiation. If...

  6. 45 CFR 602.42 - Retention and access requirements for records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false Retention and access requirements for records. 602.42 Section 602.42 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... computer usage chargeback rates or composite fringe benefit rates). (i) If submitted for negotiation. If...

  7. 45 CFR 602.42 - Retention and access requirements for records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 3 2011-10-01 2011-10-01 false Retention and access requirements for records. 602.42 Section 602.42 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE... computer usage chargeback rates or composite fringe benefit rates). (i) If submitted for negotiation. If...

  8. Peer Relations and Access to Capital in the Mathematics Classroom: A Bourdieusian Social Network Analysis

    ERIC Educational Resources Information Center

    Choudry, Sophina; Williams, Julian; Black, Laura

    2017-01-01

    The aim of this article is to explore the structure of social capital in peer networks and its relation to the unequal access of educational resources within mathematics classrooms. We hypothesise that learners can gain access to mathematics through friendship networks which provide more or less help from peers that might sustain (or curtail)…

  9. Quality of anaesthesia-related information accessed via Internet searches.

    PubMed

    Caron, S; Berton, J; Beydon, L

    2007-08-01

    We conducted a study to examine the quality and stability of information available from the Internet on four anaesthesia-related topics. In January 2006, we searched using four key words (porphyria, scleroderma, transfusion risk, and epidural analgesia risk) with five search engines (Google, HotBot, AltaVista, Excite, and Yahoo). We used a published scoring system (NetScoring) to evaluate the first 15 sites identified by each of these 20 searches. We also used a simple four-point scale to assess the first 100 sites in the Google search on one of our four topics ('epidural analgesia risk'). In November 2006, we conducted a second evaluation, using three search engines (Google, AltaVista, and Yahoo) with 14 synonyms for 'epidural analgesia risk'. The five search engines performed similarly. NetScoring scores were lower for transfusion risk (P < 0.001). One or more high-quality sites was identified consistently among the first 15 sites in each search. Quality scored using the simple scale correlated closely with medical content and design by NetScoring and with the number of references (P < 0.05). Synonyms of 'epidural analgesia risk' yielded similar results. The quality of accessed information improved somewhat over the 11 month period with Yahoo and AltaVista, but declined with Google. The Internet is a valuable tool for obtaining medical information, but the quality of websites varies between different topics. A simple rating scale may facilitate the quality scoring on individual websites. Differences in precise search terms used for a given topic did not appear to affect the quality of the information obtained.

  10. A method to implement fine-grained access control for personal health records through standard relational database queries.

    PubMed

    Sujansky, Walter V; Faus, Sam A; Stone, Ethan; Brennan, Patricia Flatley

    2010-10-01

    Online personal health records (PHRs) enable patients to access, manage, and share certain of their own health information electronically. This capability creates the need for precise access-controls mechanisms that restrict the sharing of data to that intended by the patient. The authors describe the design and implementation of an access-control mechanism for PHR repositories that is modeled on the eXtensible Access Control Markup Language (XACML) standard, but intended to reduce the cognitive and computational complexity of XACML. The authors implemented the mechanism entirely in a relational database system using ANSI-standard SQL statements. Based on a set of access-control rules encoded as relational table rows, the mechanism determines via a single SQL query whether a user who accesses patient data from a specific application is authorized to perform a requested operation on a specified data object. Testing of this query on a moderately large database has demonstrated execution times consistently below 100ms. The authors include the details of the implementation, including algorithms, examples, and a test database as Supplementary materials. Copyright © 2010 Elsevier Inc. All rights reserved.

  11. "On the Sidelines": Access to Autism-Related Services in the West Bank

    ERIC Educational Resources Information Center

    Dababnah, Sarah; Bulson, Kathleen

    2015-01-01

    We examined access to autism-related services among Palestinians (N = 24) raising children with autism spectrum disorder (ASD) in the West Bank. Using qualitative methods, we identified five primary interview themes. Poor screening, diagnostic, and psychoeducational practices were prevalent, as parents reported service providers minimized parental…

  12. Complication Rates of 3% Hypertonic Saline Infusion Through Peripheral Intravenous Access.

    PubMed

    Perez, Claudia Andira; Figueroa, Stephen A

    2017-06-01

    Hyperosmolar therapy with hypertonic saline (HTS) is a cornerstone in the management of intracranial hypertension and hyponatremia in the neurological intensive care unit. Theoretical safety concerns remain for infiltration, thrombophlebitis, tissue ischemia, and venous thrombosis associated with continuous 3% HTS administered via peripheral intravenous (pIV) catheters. It is common practice at many institutions to allow only central venous catheter infusion of 3% HTS. Hospital policy was changed to allow the administration of 3% HTS via 16- to 20-gauge pIVs to a maximum infusion rate of 50 mL/h in patients without central venous access. We prospectively monitored patients who received peripheral 3% HTS as part of a quality improvement project. We documented gauge, location, maximum infusion rate, and total hours of administration. Patients were assessed for infiltration, erythema, swelling, phlebitis, thrombosis, and line infection. There were 28 subjects across 34 peripheral lines monitored. Overall, subjects received 3% HTS for a duration between 1 and 124 hours with infusion rates of 30 to 50 mL/h. The rate of complications observed was 10.7% among all subjects. Documented complications included infiltration (n = 2), with an incidence of 6%, and thrombophlebitis (n = 1), with an incidence of 3%. There has been a long concern among healthcare providers, including nursing staff, in regard to pIV administration of prolonged 3% HTS infusion therapy. Our study indicates that peripheral administration of 3% HTS carries a low risk of minor, nonlimb, or life-threatening complications. Although central venous infusion may reduce the risk of these minor complications, it may increase the risk of more serious complications such as large vessel thrombosis, bloodstream infection, pneumothorax, and arterial injury. The concern regarding the risks of pIV administration of 3% HTS may be overstated and unfounded.

  13. 75 FR 62514 - Notice of Availability of Report on Data Access and Privacy Issues Related to Smart Grid...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-12

    ... DEPARTMENT OF ENERGY Notice of Availability of Report on Data Access and Privacy Issues Related to... report entitled, ``Data Access and Privacy Issues Related to Smart Grid Technologies.'' In this report... meeting conducted during the preparation of the report. This report responds to recommendations for DOE...

  14. Non-communicable diseases, infection and survival in a retrospective cohort of Indigenous and non-Indigenous adults in central Australia

    PubMed Central

    Einsiedel, Lloyd; Fernandes, Liselle; Joseph, Sheela; Brown, Alex; Woodman, Richard J

    2013-01-01

    Objectives We hypothesise that rising prevalence rates of non-communicable diseases (NCDs) increase infection risk and worsen outcomes among socially disadvantaged Indigenous Australians undergoing a rapid epidemiological transition. Design Available pathology, imaging and discharge morbidity codes were retrospectively reviewed for a period of 5 years prior to admission with a bloodstream infection (BSI), 1 January 2003 to 30 June 2007. Participants 558 Indigenous and 55 non-Indigenous community residents of central Australia. Outcome measures The effects of NCDs on risk of infection and death were determined after stratifying by ethnicity. Results The mean annual BSI incidence rates were far higher among Indigenous residents (Indigenous, 937/100 000; non-Indigenous, 64/100 000 person-years; IRR=14.6; 95% CI 14.61 to 14.65, p<0.001). Indigenous patients were also more likely to have previous bacterial infections (68.7% vs 34.6%; respectively, p<0.001), diabetes (44.3% vs 20%; p<0.001), harmful alcohol consumption (37% vs 12.7%; p<0.001) and other communicable diseases (human T-lymphotropic virus type 1, 45.2%; strongyloidiasis, 36.1%; hepatitis B virus, 12.9%). Among Indigenous patients, diabetes increased the odds of current Staphylococcus aureus BSI (OR=1.6, 95% CI 1.0 to 2.5) and prior skin infections (adjusted OR=2.1, 95% CI 1.4 to 3.3). Harmful alcohol consumption increased the odds of current Streptococcus pneumoniae BSI (OR=1.57, 95% CI 1.02 to 2.40) and of previous BSI (OR=1.7, 95% CI 1.1 to 2.5), skin infection (OR=1.7, 95% CI 1.1 to 2.6) or pneumonia (OR=4.3, 95% CI 2.8 to 6.7). Twenty-six per cent of Indigenous patients died at a mean (SD) age of 47±15 years. Complications of diabetes and harmful alcohol consumption predicted 28-day mortality (non-rheumatic heart disease, HR=2.9; 95% CI 1.4 to 6.2; chronic renal failure, HR=2.6, 95%CI 1.0 to 6.5; chronic liver disease, HR=3.3, 95% CI 1.6 to 6.7). Conclusions In a socially disadvantaged

  15. Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study

    PubMed Central

    Fujita, Misuzu; Hata, Akira

    2016-01-01

    The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0–74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40–59-year-old men and 60–69-year-old women, and in duration of hospitalization among 40–59 and 60–69-year-olds of both sexes and 70–74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts. PMID:26978270

  16. The microbiological profile and presence of bloodstream infection influence mortality rates in necrotizing fasciitis

    PubMed Central

    2011-01-01

    Introduction Necrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate. We carried out a microbiological characterization of the causative pathogens. We investigated the correlation of mortality in NF with bloodstream infection and with the presence of co-morbidities. Methods In this retrospective study, we analyzed 323 patients who presented with necrotizing fasciitis at two different institutions. Bloodstream infection (BSI) was defined as a positive blood culture result. The patients were categorized as survivors and non-survivors. Eleven clinically important variables which were statistically significant by univariate analysis were selected for multivariate regression analysis and a stepwise logistic regression model was developed to determine the association between BSI and mortality. Results Univariate logistic regression analysis showed that patients with hypotension, heart disease, liver disease, presence of Vibrio spp. in wound cultures, presence of fungus in wound cultures, and presence of Streptococcus group A, Aeromonas spp. or Vibrio spp. in blood cultures, had a significantly higher risk of in-hospital mortality. Our multivariate logistic regression analysis showed a higher risk of mortality in patients with pre-existing conditions like hypotension, heart disease, and liver disease. Multivariate logistic regression analysis also showed that presence of Vibrio spp in wound cultures, and presence of Streptococcus Group A in blood cultures were associated with a high risk of mortality while debridement > = 3 was associated with improved survival. Conclusions Mortality in patients with necrotizing fasciitis was significantly associated with the presence of Vibrio in wound cultures and Streptococcus group A in blood cultures. PMID:21693053

  17. Vascular access cannulation in hemodialysis patients - a survey of current practice and its relation to dialysis dose.

    PubMed

    Gauly, Adelheid; Parisotto, Maria Teresa; Skinder, Aleksandra; Schoder, Volker; Furlan, Andreja; Schuh, Erika; Marcelli, Daniele

    2011-01-01

    The appropriate use of vascular access is of fundamental importance in the treatment of hemodialysis (HD) patients. This survey entailed collecting data on current practice of vascular access cannulation to assess its relation to dialysis dose. This international, multicenter, observational, cross-sectional survey was performed in 171 dialysis centers of the European dialysis network of Fresenius Medical Care in Europe and South Africa during April 2009. Practice patterns of vascular access cannulations were documented by means of a 24-item questionnaire. Dialysis dose from the documented hemodialysis treatments was derived from the clinical database EuCliD®. In total, 10,807 cannulations in hemodialysis patients with either arteriovenous fistula (91%) or arteriovenous graft (9%) were documented. For the puncture, the area technique was applied most frequently using 15G and 16G needles. Blood flow rates were mostly between 300 and 400 mL/min and adjusted to the needle size used. In two-thirds of cases the arterial needle was placed first, mostly in an antegrade direction, with an average distance to the venous needle of 7.0±3.7 cm. More than two-thirds of the cannulations were performed by nurses with more than 5 years of experience in dialysis. A logistic regression model revealed a significantly higher odds ratio to attain Kt/V = 1.2 for retrograde placement of the arterial needle, and for using needles with bigger diameter. This survey covered a broad number of countries and centers and provides information on current practice of vascular access cannulation, their effect on dialysis dose, and serves as feedback to the dialysis centers for their quality management process.

  18. Prevalence of common mental disorders among Dutch medical students and related use and need of mental health care: a cross-sectional study.

    PubMed

    Gaspersz, Roxanne; Frings-Dresen, Monique H W; Sluiter, Judith K

    2012-02-15

    The purpose of the study was to assess common mental disorders and the related use and need for mental health care among clinically not yet active and clinically active medical students. All medical students (n=2266) at one Dutch medical university were approached. Students from study years 1-4 were defined as clinically not yet active and students from study years 5 and 6 as clinically active. An electronic survey was used to detect common mental disorders depression (BSI-DEP), anxiety (BSI-ANG), stress (4DSQ) and post-traumatic stress disorder (IES). The use of mental health services in the past 3 months and the need for mental health services were asked for. The prevalence of common mental disorders, the use and need for mental health services and differences between groups were calculated. The response rate was 52%: 814 clinically not yet active and 316 clinically active students. The prevalence of common mental disorders among clinically not yet active and clinically active students was 54% and 48%, respectively. The use of mental health services was 14% in clinically not yet active and 12% in clinically active students with common mental disorders (n.s.). The need for mental health services by clinically not yet active and clinically active students was 52% and 46%, respectively (n.s.). The prevalence of probable common mental disorders are higher among clinically not yet active than among clinically active students. The need of mental health services exceeds use, but is the same in the two groups of students.

  19. Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sidhu, Arshdeep; Tan, Kong T.; Noel-Lamy, Maxime

    2016-10-15

    PurposeTo study if <30 % residual stenosis post angioplasty (PTA) correlates with primary access circuit patency, and if any variables predict technical success.Materials and MethodsA prospective observational study was performed between January 2009 and December 2012, wherein 76 patients underwent 154 PTA events in 56 prosthetic grafts (AVG) and 98 autogenous fistulas (AVF). Data collected included patient age, gender, lesion location and laterality, access type and location, number of prior interventions, and transonic flow rates pre- and postintervention. Impact of technical outcome on access patency was assessed. Univariate logistic regression was used to assess the impact of variables on technical success withmore » significant factors assessed with a multiple variable model.ResultsTechnical success rates of PTA in AVFs and AVGs were 79.6 and 76.7 %, respectively. Technical failures of PTA were associated with an increased risk of patency loss among circuits with AVFs (p < 0.05), but not with AVGs (p = 0.7). In AVFs, primary access patency rates between technical successes and failures at three and 6 months were 74.4 versus 61.9 % (p = 0.3) and 53.8 versus 23.8 % (p < 0.05), respectively. In AVGs, primary access patency rates between technical successes and failures at three and six months were 72.1 versus 53.9 % (p = 0.5) and 33.6 versus 38.5 % (p = 0.8), respectively. Transonic flow rates did not significantly differ among technically successful or failed outcomes at one or three months.ConclusionTechnical failures of PTA had a significant impact on access patency among AVFs with a trend toward poorer access patency within AVGs.« less

  20. Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

    PubMed

    Sidhu, Arshdeep; Tan, Kong T; Noel-Lamy, Maxime; Simons, Martin E; Rajan, Dheeraj K

    2016-10-01

    To study if <30 % residual stenosis post angioplasty (PTA) correlates with primary access circuit patency, and if any variables predict technical success. A prospective observational study was performed between January 2009 and December 2012, wherein 76 patients underwent 154 PTA events in 56 prosthetic grafts (AVG) and 98 autogenous fistulas (AVF). Data collected included patient age, gender, lesion location and laterality, access type and location, number of prior interventions, and transonic flow rates pre- and postintervention. Impact of technical outcome on access patency was assessed. Univariate logistic regression was used to assess the impact of variables on technical success with significant factors assessed with a multiple variable model. Technical success rates of PTA in AVFs and AVGs were 79.6 and 76.7 %, respectively. Technical failures of PTA were associated with an increased risk of patency loss among circuits with AVFs (p < 0.05), but not with AVGs (p = 0.7). In AVFs, primary access patency rates between technical successes and failures at three and 6 months were 74.4 versus 61.9 % (p = 0.3) and 53.8 versus 23.8 % (p < 0.05), respectively. In AVGs, primary access patency rates between technical successes and failures at three and six months were 72.1 versus 53.9 % (p = 0.5) and 33.6 versus 38.5 % (p = 0.8), respectively. Transonic flow rates did not significantly differ among technically successful or failed outcomes at one or three months. Technical failures of PTA had a significant impact on access patency among AVFs with a trend toward poorer access patency within AVGs.

  1. Pharmacy Accessibility and Cost-Related Underuse of Prescription Medications in Low-Income Black and Hispanic Urban Communities

    PubMed Central

    Qato, Dima Mazen; Wilder, Jocelyn; Zenk, Shannon; Davis, Andrew; Makelarski, Jennifer; Lindau, Stacy Tessler

    2016-01-01

    Background Policy efforts to reduce the cost of prescription medications in the U.S. have failed to reduce disparities in cost-related underuse. Little is known about the relationships between pharmacy accessibility, utilization and cost-related underuse of prescription medications among residents of low-income minority communities. Objectives To examine the association between pharmacy accessibility, utilization and cost-related underuse of prescription medications among residents of predominantly low-income, Black and Hispanic urban communities. Methods Data from a population-based probability sample of adults 35 years and older residing on the South Side of Chicago in 2012–13 were linked with geocoded information on the type and location of primary and nearest pharmacy. Multivariable regression models were used to examine associations between pharmacy accessibility, utilization of, and travel distance to, primary pharmacy and cost-related underuse overall and by pharmacy type. Results One-third of South Side residents primarily filled their prescriptions at the pharmacy nearest to their home. Among those who did not use mail order, median distance traveled from home to the primary pharmacy was 1.2 miles. Residents whose primary pharmacy was at a community health center or clinic where they usually received care traveled the furthest but were least likely to report cost-related underuse of their prescription medications. Conclusions Most residents of minority communities on Chicago’s South Side were not using pharmacies closest to their home to obtain their prescription medications. Efforts to improve access to prescription medications in these communities should focus on improving the accessibility of affordable pharmacies at site of care. PMID:28153704

  2. A comparison of Frequency Domain Multiple Access (FDMA) and Time Domain Multiple Access (TDMA) approaches to satellite service for low data rate Earth stations

    NASA Technical Reports Server (NTRS)

    Stevens, G.

    1983-01-01

    A technological and economic assessment is made of providing low data rate service to small earth stations by satellite at Ka-band. Various Frequency Domain Multiple Access (FDMA) and Time Domain Multiple Access (TDMA) scenarios are examined and compared on the basis of cost to the end user. Very small stations (1 to 2 meters in diameter) are found not to be viable alternatives to available terrestrial services. However, medium size (3 to 5 meters) earth stations appear to be very competitive if a minimum throughput of about 1.5 Mbs is maintained. This constrains the use of such terminals to large users and shared use by smaller users. No advantage was found to the use of FDMA. TDMA had a slight advantage from a total system viewpoint and a very significant advantage in the space segment (about 1/3 the required payload weight for an equivalent capacity).

  3. Relations Between Parent Psychopathology, Family Functioning, and Adolescent Problems In Substance-Abusing Families: Disaggregating the Effects of Parent Gender

    PubMed Central

    Burstein, Marcy; Stanger, Catherine; Dumenci, Levent

    2015-01-01

    The present study: (1) examined relations between parent psychopathology and adolescent internalizing problems, externalizing problems, and substance use in substanceabusing families; and (2) tested family functioning problems as mediators of these relations. Structural equation modeling was used to estimate the independent effects of parent psychopathology and family functioning problems by parent gender. Participants included 242 parents in treatment for substance abuse and/or dependence and 59 of their coparents (16.9% in treatment for substance-abuse/dependence) from middle income households (SES: M = 4.7; SD = 2.1). Ratings were obtained for 325 adolescents (48% female; 27.8% non-Caucasian) between the ages of 10 and 18 years (M = 13.5 years; SD = 2.5 years). Parent psychopathology, family functioning problems, and adolescent problems were assessed with parent and coparent ratings on the Symptom Checklist (SCL-90)/Brief Symptom Inventory (BSI), the Family Relationship Measure, and the Child Behavior Checklist, respectively. Results indicated that maternal psychopathology was directly related to adolescent internalizing problems and substance use, but maternal perceptions of family functioning problems failed to mediate relations between maternal psychopathology and adolescent problems. By contrast, paternal perceptions of family functioning problems uniquely mediated relations between paternal psychopathology and adolescent externalizing problems. Findings underscore the importance of examining how mothers and fathers may differentially impact adolescent problems in substance-abusing families. PMID:22392413

  4. Risk factors for contrast-induced nephropathy and their association with mortality in patients with blunt splenic injuries.

    PubMed

    Hsieh, Ting-Min; Tsai, Tzu-Hsien; Liu, Yueh-Wei; Hsieh, Ching-Hua

    2016-11-01

    Although angioembolization increases the success rate of non-operative management in patients with blunt splenic injuries (BSI), the issue of contrast-induced nephropathy (CIN) due to serial administration of contrast medium remains unclear. We aimed to examine the risk factors of CIN and their clinical effect on mortality in patients with BSI. We retrospectively studied the complete data on 377 trauma patients with BSI who survived more than 48 h between July 2003 and June 2015. CIN was defined as the relative (≥25%) or absolute (≥0.5 mg/dL) increase in serum creatinine within 48 h after contrast administration. A multivariate logistic regression analysis was conducted to identify the independent predictors of CIN and mortality. CIN was independently associated with body mass index (BMI) ≥ 30 kg/m 2 (odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.20-8.76), injury severity score (ISS) ≥ 25 (OR: 6.08, 95% CI: 2.76-13.53), and 24-h hemoglobin (Hb) < 10 g/dL (OR: 3.16, 95% CI: 1.46-6.81). CIN (OR: 19.04, 95% CI: 6.15-58.94) and diabetes (OR: 3.43, 95% CI: 1.04-11.26) were also identified as independent predictors for mortality. In this study, we found that BMI ≥ 30 kg/m 2 , ISS ≥ 25, and 24-h Hb < 10 g/dL were independent risk factors for the occurrence of CIN in patients with BSI. However, angioembolization was not identified to be an independent risk factor for CIN. In addition, CIN and diabetes mellitus were identified as independent risk factors for mortality in patients with BSI. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Health care access and poverty do not explain the higher esophageal cancer mortality in African Americans.

    PubMed

    Miller, Jordan A G; Rege, Robert V; Ko, Clifford Y; Livingston, Edward H

    2004-07-01

    Esophageal cancer mortality is increased in African Americans relative to white patients. The reasons for this are unknown but are thought to be related to inadequate access to health care secondary to a higher poverty rate in African American populations. The National Health Interview Survey database for years 1986 to 1994 were combined and linked to the National Death Index. Individuals who died from esophageal carcinoma were assessed in the combined database, thus enabling detailed analysis of their socioeconomic status, race, and health care access. Poverty was 4-fold more frequent in African Americans who died from esophageal carcinoma than whites. Despite poverty, African American patients' access to health care was good and was not statistically related to increased mortality. Although the esophageal carcinoma mortality rate is higher in African Americans than in whites, it is not clearly related to the presence of poverty or to limited health care access. The higher mortality may be related to lifestyle differences, environmental exposure, or difference in disease biology, but it is not related exclusively to socioeconomic factors.

  6. The Use of Ultrasound to Improve Axillary Vein Access and Minimize Complications during Pacemaker Implantation.

    PubMed

    Esmaiel, Abdullah; Hassan, Jeremy; Blenkhorn, Fay; Mardigyan, Vartan

    2016-05-01

    The Agency for Healthcare Research and Quality in the United States recommends the use of ultrasound (US) for central venous access to improve patient outcomes. However, in a recent publication, US is still underutilized for axillary vein access during pacemaker implantation. We sought to describe a technique for US-guided axillary vein access during pacemaker implantation and to report complication rates and success rate. Retrospective data collection included success rate and complications on all pacemaker implants by one operator since implementing the systematic use of US at our institution, from November 2012 to January 2015. For the last 59 cases, data were collected prospectively to include time of venous access and number of attempts. A total of 403 consecutive patients were included in the analysis. Two leads were implanted in 255 cases and one lead was implanted in 148 cases. The rate of successful US-guided access was 99.25%. There were no access-related complications. The average number of venipuncture attempts was 1.18 per patient. The average time to obtain venous access was 2.24 minutes including the time to apply the sterile US sleeve. The described technique has the potential to improve the success rate of axillary vein access and minimize complications during pacemaker implantation. ©2016 Wiley Periodicals, Inc.

  7. Doing the Same with Less: A Randomized, Multinational, Open-Label, Adjudicator-Blinded Trial of an Algorithm vs. Standard of Care to Determine Treatment Duration for Staphylococcal Bacteremia

    PubMed Central

    Holland, Thomas L; Boucher, Helen W; Raad, Issam; Anderson, Deverick J; Cosgrove, Sara E; Aycock, Suzanne; Baddley, John W; Chow, Shein-Chung; Chu, Vivian H; Cook, Paul P; Corey, G Ralph; Daly, Jennifer S; Hachem, Ray Y; Chaftari, Anne-Marie; Horton, James M; Jenkins, Timothy C; Gu, Jiezhun; Levine, Donald P; Miro, Jose M; Riska, Paul; Rubin, Zachary A; Rupp, Mark E; Schrank, John; Sims, Matthew; Wray, Dannah; Zervos, Marcus J; Fowler, Vance

    2017-01-01

    Abstract Background The appropriate duration of antibiotics for staphylococcal bloodstream infection (BSI) is unknown. An algorithm to identify patients with staphylococcal BSI who can be safely treated with shorter courses of therapy would improve care and reduce total antibiotic use. Methods Adult patients with staphylococcal BSI were randomized to treatment based on algorithm-based therapy (ABT) or to standard of care (SOC). Co-primary outcomes were clinical success, as determined by a blinded Adjudication Committee, and serious adverse event (SAE) rates. The prespecified secondary outcome measure was antibiotic days by treatment group, among patients without complicated BSI. Prespecified durations of therapy in ABT were: S. aureus BSI (SAB): uncomplicated: 14 days; complicated: 4–6 weeks. Coagulase-negative staphylococci BSI (CoNSB): simple (1 positive blood culture) (0–3 days), uncomplicated (>1 positive blood culture) (5 days), complicated (7–28 days). Outcomes were compared using intention-to-treat principles. The target sample size was 500 patients, to ensure 90% power for establishing noninferiority within a margin of 15%. Results Between April 2011 and March 2017, 509 adults with suspected staphylococcal BSI at 16 sites in the US and Spain were randomized to ABT (N = 255) or SOC (N = 254). There were 116 patients with SAB (23%) and 385 (76%) with CoNSB (Figure 1). Overall success rate in the ABT group was 82.0% vs. 81.5% in the SOC group, difference 0.5%, 95% CI −5.2% to 6.1%. SAEs were reported in 32.9% of ABT vs. 28.3% of SOC patients (OR 1.2, 95% CI 0.9 to 1.8). Among evaluable patients without complicated BSI, mean duration of therapy was 4.4 days in the ABT group vs. 6.4 days in the SOC group (difference −2.0 days, 95% CI −3.3 to −-0.7, P = 0.003). Among patients with uncomplicated SAB, treatment durations were similar (15.3 days in ABT vs. 16.3 days in SOC, difference −1 day, 95% CI −3.89 to 1.91, P = 0

  8. Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study

    PubMed Central

    2013-01-01

    Background Healthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area. Methods A prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006–2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression. Results 341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found. Conclusion HCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI. PMID

  9. Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study.

    PubMed

    Retamar, Pilar; López-Prieto, María Dolores; Nátera, Clara; de Cueto, Marina; Nuño, Enrique; Herrero, Marta; Fernández-Sánchez, Fernando; Muñoz, Angel; Téllez, Francisco; Becerril, Berta; García-Tapia, Ana; Carazo, Inmaculada; Moya, Raquel; Corzo, Juan E; León, Laura; Muñoz, Leopoldo; Rodríguez-Baño, Jesús; Rodríguez-López, Fernando; García, María V; Fernández-Galán, Verónica; del Arco, Alfonso; Pérez-Santos, María J; Sánchez Porto, Antonio; Torres-Tortosa, Manuel; Martín-Aspas, Andrés; Arroyo, Ascensión; García-Figueras, Carolina; Acosta, Federico; Florez, Carmen; Navas, Petra; Escobar-Lara, Trinidad

    2013-07-24

    Healthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area. A prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006-2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression. 341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found. HCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI.

  10. A synthesis of studies of access point density as a risk factor for road accidents.

    PubMed

    Elvik, Rune

    2017-10-01

    Studies of the relationship between access point density (number of access points, or driveways, per kilometre of road) and accident frequency or rate (number of accidents per unit of exposure) have consistently found that accident rate increases when access point density increases. This paper presents a formal synthesis of the findings of these studies. It was found that the addition of one access point per kilometre of road is associated with an increase of 4% in the expected number of accidents, controlling for traffic volume. Although studies consistently indicate an increase in accident rate as access point density increases, the size of the increase varies substantially between studies. In addition to reviewing studies of access point density as a risk factor, the paper discusses some issues related to formally synthesising regression coefficients by applying the inverse-variance method of meta-analysis. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. High birth rates despite easy access to contraception and abortion: a cross-sectional study.

    PubMed

    Hognert, Helena; Skjeldestad, Finn E; Gemzell-Danielsson, Kristina; Heikinheimo, Oskari; Milsom, Ian; Lidegaard, Øjvind; Lindh, Ingela

    2017-12-01

    The aim of this study was to describe and compare contraceptive use, fertility, birth, and abortion rates in the Nordic countries. National data on births, abortions, fertility rate (1975-2013), redeemed prescriptions of hormonal contraceptives and sales figures of copper intrauterine devices (2008-2013) among women 15-49 years of age in the Nordic countries were collected and analyzed. Use of hormonal contraceptives and copper intrauterine devices varied between 31 and 44%. The highest use was in Denmark (39-44%) and Sweden (40-42%). Combined hormonal contraception followed by the levonorgestrel-releasing intrauterine system were the most common methods. During 1975-2013 abortion rates decreased in Denmark (from 27/1000 women to 15/1000 women aged 15-44/1000 women) and Finland (from 20 to 10/1000 women), remained stable in Norway (≈16) and Sweden (≈20) and increased in Iceland (from 6 to 15/1000 women). Birth rates remained stable around 60/1000 women aged 15-44 in all countries except for Iceland where the birth rate decreased from 95 to 65/1000 women. Abortion rates were highest in the age group 20-24 years. In the same age group, Sweden had a lower contraceptive use (51%) compared with Denmark (59%) and Norway (56%) and a higher abortion rate 33/1000 compared with Denmark (25/1000) and Norway (27/1000). In contrast to the declining average fertility and birth rates in Europe, rates in the Nordic countries remain high and stable despite high contraceptive use and liberal access to abortion on women's request. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. Complications of the access during aortic valve implantation through transfemoral access.

    PubMed

    Alsac, Jean-Marc; Zegdi, Rachid; Blanchard, Didier; Achouh, Paul; Cholley, Bernard; Berrebi, Alain; Julia, Pierre; Fabiani, Jean-Noël

    2011-08-01

    Aortic valve implantation (AVI) is a booming therapeutic option in high-risk patients with calcific aortic stenosis. Retrograde femoral approach drawbacks include vascular complications owing to the size of the introduction system (22- and 24-F).The aim of this study was to retrospectively analyze the incidence and the treatment of vascular complications in the first 2 years of transfemoral AVI experience with the first generation of Edwards SAPIEN transcatheter heart valves. Since December 2007, AVI has been performed in 71 patients, 21 times by the transapical route and 50 times by the transfemoral route through an inguinal approach with the first generation of Edwards SAPIEN transcatheter heart valves (23 and 26 mm). The incidence and the treatment of vascular complications were evaluated as main criteria for transfemoral AVI. All the procedures could be successfully performed by a femoral route, except for three cases when the introducing device could not be fixed on the thoracic aorta because of vascular access problems. Vascular access-related complications occurred in nine patients (18%), including three iliac dissections, two aortic dissections, three femoral lesions, and one thoracic aorta rupture. These complications were treated either in a conservative way (n = 2), or in an endovascular way using a contralateral approach (n = 3), or surgically through an inguinal approach (n = 3). A traumatic rupture of the thoracic aorta resulted in the death of a female patient. In our experience, transfemoral AVI gives a satisfying technical success rate in the selected patients. The incidence of complications involving the vascular access remains an important limitation of this new technique. Although a conservative or endovascular treatment can be applied in most cases, improving the introduction devices is highly expected because it would reduce the complications rate of vascular access. Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc

  13. Relative crater production rates on planets

    NASA Technical Reports Server (NTRS)

    Hartmann, W. K.

    1977-01-01

    The relative numbers of impacts on different planets, estimated from the dynamical histories of planetesimals in specified orbits (Wetherill, 1975), are converted by a described procedure to crater production rates. Conversions are dependent on impact velocity and surface gravity. Crater retention ages can then be derived from the ratio of the crater density to the crater production rate. The data indicate that the terrestrial planets have crater production rates within a factor ten of each other. As an example, for the case of Mars, least-squares fits to crater-count data suggest an average age of 0.3 to 3 billion years for two types of channels. The age of Olympus Mons is discussed, and the effect of Tharsis volcanism on channel formation is considered.

  14. Effects of Event-Related Centrality on Concept Accessibility

    ERIC Educational Resources Information Center

    Mo, Lei; Chen, Hongmin; Li, Ying; Chen, Zhe; He, Xianyou

    2007-01-01

    In 3 experiments, we explored the accessibility of concepts of varying centrality as defined by the underlying events described in script-based passages. The accessibility of central concepts, as defined by event-relatedness, was compared to that of central concepts defined on the basis of the number of mentions in the text or based on their…

  15. Legal Factors Related to Access to Campuses of Public Colleges and Universities: An Occasional Paper.

    ERIC Educational Resources Information Center

    Lytle, Michael A.

    Legal methods and related case law that can be used by public higher education administrators to deal with intrusions by outsiders onto the campus are examined. The following legal factors related to control of campus access are addressed: risk management, police power, general trespass, school related trespass/loitering statutes, First and…

  16. Clinical features and outcomes of blunt splenic injury in children

    PubMed Central

    Yang, Kaiying; Li, Yanan; Wang, Chuan; Xiang, Bo; Chen, Siyuan; Ji, Yi

    2017-01-01

    Abstract Although the spleen is the most commonly injured intra-abdominal organ after blunt trauma, there are limited data available in China. The objectives of this study were to investigate the clinical features and determine the risk factors for operative management (OM) in children with blunt splenic injury (BSI). A review of the medical records of children diagnosed with BSI between January 2010 and September 2016 at West China Hospital of Sichuan University was performed. A total of 101 patients diagnosed with BSI were recruited, including 76 patients transferred from other hospitals. The male-to-female ratio was 2.06:1, with a mean age of 7.8 years old. The most common injury season was summer and the most common injury mechanism was road traffic accidents. Sixty-eight patients suffered multiple injuries. Thirty-four patients received blood transfusions. Two patients died from multiple organ failure or hemorrhagic shock. Significant differences were observed in the injury season, injury mechanism, injury date, and hemoglobin levels between the isolated injury group and the multiple injuries group. The overall operative rate was 29.7%. Multivariate regression analysis revealed that age, blood transfusion, and grade of injury were independent risk factors for OM. Our study provided evidence that the management of pediatric BSI was variable. The operative rate in pediatric BSI may be higher in certain patient groups. Although nonoperative management is one of the standard treatment options, our data suggest that OM is an appropriate way to treat patients who are hemodynamically unstable. PMID:29390566

  17. ATAC-Seq analysis reveals a widespread decrease of chromatin accessibility in age-related macular degeneration.

    PubMed

    Wang, Jie; Zibetti, Cristina; Shang, Peng; Sripathi, Srinivasa R; Zhang, Pingwu; Cano, Marisol; Hoang, Thanh; Xia, Shuli; Ji, Hongkai; Merbs, Shannath L; Zack, Donald J; Handa, James T; Sinha, Debasish; Blackshaw, Seth; Qian, Jiang

    2018-04-10

    Age-related macular degeneration (AMD) is a significant cause of vision loss in the elderly. The extent to which epigenetic changes regulate AMD progression is unclear. Here we globally profile chromatin accessibility using ATAC-Seq in the retina and retinal pigmented epithelium (RPE) from AMD and control patients. Global decreases in chromatin accessibility occur in the RPE with early AMD, and in the retina of advanced disease, suggesting that dysfunction in the RPE drives disease onset. Footprints of photoreceptor and RPE-specific transcription factors are enriched in differentially accessible regions (DARs). Genes associated with DARs show altered expression in AMD. Cigarette smoke treatment of RPE cells recapitulates chromatin accessibility changes seen in AMD, providing an epigenetic link between a known risk factor for AMD and AMD pathology. Finally, overexpression of HDAC11 is partially responsible for the observed reduction in chromatin accessibility, suggesting that HDAC11 may be a potential new therapeutic target for AMD.

  18. How Turkish radiology residents access information related to their profession in this social media and smartphone era.

    PubMed

    Ozutemiz, Can; Dicle, Oguz; Koremezli, Nevin

    2015-01-01

    To evaluate the frequency of mobile technology and social media usage among radiology residents and their access to professional information. A questionnaire consisting of 24 questions prepared using Google Drive was sent via e-mail to 550 radiology residents throughout the country. Of the 176 participating residents, 74 completed the survey via the internet, and 102 completed it at three different national radiology meetings. Response rates and its relationship with responses given to different questions were assessed. Hundred two male and 74 female residents participated in the survey. 141 (81.3%) residents thought that they had appropriate internet access in their department. The number of residents using a smartphone was 153 (86.9%). The android operating system (70, 45.8%) was the preferred operating system of respondants. Only 24 (15.7%) of the smartphone users thought that there were enough radiology related applications. "Radiology assistant" (18.9%), "Radiopedia" (7.8%) and "Radiographics" (7.8%) were the most utilized applications. Of the smartphone users, 87(56.9%) stated that they used cell phones in order to find radiological information, and the most used web pages were Google (165, 93.8%), Radiopaedia.org (129, 73.3%), Radiologyassistant.nl (135, 76.7%), and Pubmed (114, 64.8%). Social media usages were as follows: None (10, 5.7%), Facebook (139, 79%), Twitter (55, 31.3%), Google + (51, 29%) and YouTube (44, 25%). While smartphone usage rates among the residents were high, the use of radiology specific applications was not common. Social media usage was very common among residents.

  19. Access to health care and community social capital.

    PubMed

    Hendryx, Michael S; Ahern, Melissa M; Lovrich, Nicholas P; McCurdy, Arthur H

    2002-02-01

    To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community. The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources. The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables. Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling. Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access. The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.

  20. The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries: A systematic review and meta-analysis.

    PubMed

    Crichton, James Charles Ian; Naidoo, Kamil; Yet, Barbaros; Brundage, Susan I; Perkins, Zane

    2017-11-01

    Nonoperative management (NOM) of hemodynamically normal patients with blunt splenic injury (BSI) is the standard of care. Guidelines recommend additional splenic angioembolization (SAE) in patients with American Association for the Surgery of Trauma (AAST) Grade IV and Grade V BSI, but the role of SAE in Grade III injuries is unclear and controversial. The aim of this systematic review was to compare the safety and effectiveness of SAE as an adjunct to NOM versus NOM alone in adults with BSI. A systematic literature search (Medline, Embase, and CINAHL) was performed to identify original studies that compared outcomes in adult BSI patients treated with SAE or NOM alone. Primary outcome was failure of NOM. Secondary outcomes included morbidity, mortality, hospital length of stay, and transfusion requirements. Bayesian meta-analyses were used to calculate an absolute (risk difference) and relative (risk ratio [RR]) measure of treatment effect for each outcome. Twenty-three studies (6,684 patients) were included. For Grades I to V combined, there was no difference in NOM failure rate (SAE, 8.6% vs NOM, 7.7%; RR, 1.09 [0.80-1.51]; p = 0.28), mortality (SAE, 4.8% vs NOM, 5.8%; RR, 0.82 [0.45-1.31]; p = 0.81), hospital length of stay (11.3 vs 9.5 days; p = 0.06), or blood transfusion requirements (1.8 vs 1.7 units; p = 0.47) between patients treated with SAE and those treated with NOM alone. However, morbidity was significantly higher in patients treated with SAE (SAE, 38.1% vs NOM, 18.6%; RR, 1.83 [1.20-2.66]; p < 0.01). When stratified by grade of splenic injury, SAE significantly reduced the failure rate of NOM in patients with Grade IV and Grade V splenic injuries but had minimal effect in those with Grade I to Grade III injuries. Splenic angioembolization should be strongly considered as an adjunct to NOM in patients with AAST Grade IV and Grade V BSI but should not be routinely recommended in patients with AAST Grade I to Grade III injuries. Systematic review and

  1. Pharmacy accessibility and cost-related underuse of prescription medications in low-income Black and Hispanic urban communities.

    PubMed

    Qato, Dima Mazen; Wilder, Jocelyn; Zenk, Shannon; Davis, Andrew; Makelarski, Jennifer; Lindau, Stacy Tessler

    Policy efforts to reduce the cost of prescription medications in the US have failed to reduce disparities in cost-related underuse. Little is known about the relationships between pharmacy accessibility, utilization, and cost-related underuse of prescription medications among residents of low-income minority communities. The aim of this work was to examine the association between pharmacy accessibility, utilization, and cost-related underuse of prescription medications among residents of predominantly low-income Black and Hispanic urban communities. Data from a population-based probability sample of adults 35 years of age and older residing on the South Side of Chicago in 2012-2013 were linked with the use of geocoded information on the type and location of the primary and the nearest pharmacy. Multivariable regression models were used to examine associations between pharmacy accessibility, utilization of and travel distance to the primary pharmacy, and cost-related underuse overall and by pharmacy type. One-third of South Side residents primarily filled their prescriptions at the pharmacy nearest to their home. Among those who did not use mail order, median distance traveled from home to the primary pharmacy was 1.2 miles. Residents whose primary pharmacy was at a community health center or clinic where they usually received care traveled the farthest but were least likely to report cost-related underuse of their prescription medications. Most residents of minority communities on Chicago's South Side were not using the pharmacies closest to their home to obtain their prescription medications. Efforts to improve access to prescription medications in these communities should focus on improving the accessibility of affordable pharmacies at site of care. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  2. [Microbiological surveillance in an intensive care unit of a large Roman hospital].

    PubMed

    Franchi, Cristiana; Venditti, Mario; Rocco, Monica; Spadetta, Gustavo; Vullo, Vincenzo; Raponi, Massimiliano; Orsi, Giovanni Battista

    2002-06-01

    Infection surveillance in ICU is fundamental to monitor endemic rates, to identify outbreaks on-time in order to activate control procedures implementing a correct empirical antibiotic treatment. The data collection surveillance software CIN-20002 was established in the Teaching Hospital Umberto I ICU to monitor the following site-specific infection rates: urinary tract infections (UTI), pneumonia (PNE), blood stream infections (BSI), surgical site infections (SSI). According to CDC definitions all patients developing infection 48 hours or more after ward admission were included. Furthermore risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. Overall 279 patients (183 men and 96 women) were admitted; age 54,8 20,3 years (mean), SAPS II 44,4 17,1 (mean) and average ward stay 13,3 17,8 days. Results showed a total of 121 infection episodes (56 PNE, 51 BSI, 10 UTI e 4 SSI) in 80 patients (28,7%). Standardized infection rates associated to invasive procedures were: Urinary catheter-associated UTI rate (2.9/1000), Ventilator-associated PNE rate (20.4/1000), Vascular catheter-associated BSI rate (19.1/1000). Among the infected patients the most common microrganisms isolated were P. aeruginosa (31,8%), MRSA (14,8%), A. baumanni (12,5%) e S. maltophilia (8,5%). Considering site-specific infections: PNE (P. aeruginosa 38,3% and MRSA 18,1%), BSI (MR CNS 21,9% and P. aeruginosa 17,2%), UTI (P. aeruginosa 70,0%). The surveillance software CIN-2000 proved to be very accurate, usefull and easy to use. The results showed a high incidence of infections associated to invasive procedures and the presence of multiresistant bacteria

  3. A Laboratory Exercise with Related Rates.

    ERIC Educational Resources Information Center

    Sworder, Steven C.

    A laboratory experiment, based on a simple electric circuit that can be used to demonstrate the existence of real-world "related rates" problems, is outlined and an equation for voltage across the capacitor terminals during discharge is derived. The necessary materials, setup methods, and experimental problems are described. A student laboratory…

  4. Easiness of Legal Access to Concealed Firearm Permits and Homicide Rates in the United States.

    PubMed

    Siegel, Michael; Xuan, Ziming; Ross, Craig S; Galea, Sandro; Kalesan, Bindu; Fleegler, Eric; Goss, Kristin A

    2017-12-01

    To examine the relation of "shall-issue" laws, in which permits must be issued if requisite criteria are met; "may-issue" laws, which give law enforcement officials wide discretion over whether to issue concealed firearm carry permits or not; and homicide rates. We compared homicide rates in shall-issue and may-issue states and total, firearm, nonfirearm, handgun, and long-gun homicide rates in all 50 states during the 25-year period of 1991 to 2015. We included year and state fixed effects and numerous state-level factors in the analysis. Shall-issue laws were significantly associated with 6.5% higher total homicide rates, 8.6% higher firearm homicide rates, and 10.6% higher handgun homicide rates, but were not significantly associated with long-gun or nonfirearm homicide. Shall-issue laws are associated with significantly higher rates of total, firearm-related, and handgun-related homicide.

  5. Hemodialysis patients' satisfaction and perspectives on complications associated with vascular access related interventions: are we listening?

    PubMed

    Kosa, Sarah D; Bhola, Cynthia; Lok, Charmaine E

    2016-07-12

    To understand the patient's perspective on complications associated with vascular access-related interventions. A multi-stage comprehensive questionnaire of over 150 items was administered to 140 in-center hemodialysis patients in a large, Toronto-based academic-based facility from May 1, 2011 until July 1, 2014. The questionnaire was divided into three domains: physical complications, disruption to routine, and infection. For each of the 12 prespecified vascular access interventions, there were 9 items about the associated complications. The level of bother associated with complications was measured using a 5-point Likert scale. The mean Likert value (5 = extremely bothered) for the physical complications domain was highest for grafts at 1.92, followed closely by fistulas at 1.87, and catheters at 1.56. The mean Likert value for the "disruption of routine" domain was highest for catheters at 1.44, followed by grafts at 1.37, and fistulas at 1.33. For infectious complications of all vascular access-related interventions the mean Likert value was highest at 1.76 for catheters as compared to fistulas at 1.23 and grafts at 1.22. For hemodialysis patients, the physical complications associated with needle cannulation of fistulas and grafts are a major source of dissatisfaction, while infectious complications, including catheter-related infections, are not a significant source of their concerns. Future research should focus on developing methods to effectively: (i) reduce the fear and pain associated with cannulation and (ii) educate patients about the risks associated with vascular access-related infection.

  6. 45 CFR 156.1120 - Quality rating system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Quality rating system. 156.1120 Section 156.1120 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Quality...

  7. Internet Information-Seeking and Its Relation to Support for Access to Government Records

    ERIC Educational Resources Information Center

    Cuillier, David; Piotrowski, Suzanne J.

    2009-01-01

    Public access to government records is essential for democratic self-governance, and attitudes toward that right can facilitate or hinder public policy regarding transparency. As more people use the internet for gathering information about their governments and communities, it is unknown whether such online information-seeking is related to…

  8. [A Project to Reduce the Occlusion Rate in Hemodialysis Arteriovenous Access].

    PubMed

    Huang, Jia-Ling; Jang, Jeng-Fong; Lee, Kun-Feng; Shie, Yu-Ting; Jin, Mei-Hua

    2015-06-01

    Vascular occlusions in patients frequently necessitate that duty nurses work overtime to manage related vascular problems. For patients, vascular occlusions require invasive treatments that are painful, take time to heal, and increase anxiety. Furthermore, vascular occlusions seriously influence the effectiveness of hemodialysis. This project worked to reduce the rates of occlusion from 18.6% to < 15% for hemodialysis arteriovenous grafts (AVGs) and from 5.2% to < 2.6% for arteriovenous fistulas (AVFs). This project was conducted between September 1st, 2012 and July 31th, 2013. Our approach used a retrospective study, literature review, meeting discussions, and data compilation. The four main problems identified as associated with occlusion were: (1) low blood pressure during hemodialysis; (2) successive fistula puncture sites were located too close to one another; (3) abnormal blood flow; and (4) poor moisture control. Our solutions included: 1) adjusting and creating forms; 2) adjusting related nursing procedures; and 3) organizing a related lecture for our department. The occlusion rates of AVG and AVF decreased from 18.6% to 7.4% and 5.2% to 0.9%, respectively. We significantly reduced AVG and AVF occlusion rates by using simple methods such as using a tourniquet ruler, designing big-print, illustrated patient instruction sheets on preventing low blood pressure, creating a simplified fistula puncture site series chart, creating a moisture control card, and scheduling follow-up visits for patients with abnormal blood flow at the OPD. This project provides a reference for other hemodialysis departments.

  9. Is random access memory random?

    NASA Technical Reports Server (NTRS)

    Denning, P. J.

    1986-01-01

    Most software is contructed on the assumption that the programs and data are stored in random access memory (RAM). Physical limitations on the relative speeds of processor and memory elements lead to a variety of memory organizations that match processor addressing rate with memory service rate. These include interleaved and cached memory. A very high fraction of a processor's address requests can be satified from the cache without reference to the main memory. The cache requests information from main memory in blocks that can be transferred at the full memory speed. Programmers who organize algorithms for locality can realize the highest performance from these computers.

  10. Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases.

    PubMed

    Cadier, Benjamin; Durand-Zaleski, Isabelle; Thomas, Daniel; Chevreul, Karine

    2016-01-01

    In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis. We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15-75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million. The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings.

  11. Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases

    PubMed Central

    Cadier, Benjamin; Durand-Zaleski, Isabelle; Thomas, Daniel; Chevreul, Karine

    2016-01-01

    Context In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis. Methods and Findings We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15–75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million. Conclusion The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings. PMID:26909802

  12. Editorial: Next Generation Access Networks

    NASA Astrophysics Data System (ADS)

    Ruffini, Marco; Cincotti, Gabriella; Pizzinat, Anna; Vetter, Peter

    2015-12-01

    Over the past decade we have seen an increasing number of operators deploying Fibre-to-the-home (FTTH) solutions in access networks, in order to provide home users with a much needed network access upgrade, to support higher peak rates, higher sustained rates and a better and more uniform broadband coverage of the territory.

  13. Vascular access type, health-related quality of life, and depression in hemodialysis patients: a preliminary report.

    PubMed

    Afsar, Baris; Elsurer, Rengin; Covic, Adrian; Kanbay, Mehmet

    2012-01-01

    Arteriovenous fistulas (AVF) are the vascular access of choice for hemodialysis (HD) compared with arteriovenous grafts (AVG) and central venous catheters (CVC). In spite of increasing recognition of importance of a patient's perception of health-related quality of life (HRQOL) and depression, few studies have assessed the association of vascular access type with HRQOL and depression. The purpose of our study was to examine HRQOL and depression among patients with different vascular access. Severity of symptoms of depression and HRQOL were assessed by Beck Depression Inventory (BDI) and Short Form-36 (SF-36), respectively. Vascular access was reported as one of three options; AVF, AVG, and CVC. In total, 136 patients were included; 104 had AVF, 15 had AVG, and 17 had CVC. BDI and HRQOL parameters differed among patients with different vascular access types. In post hoc analysis, BDI and HRQOL subscales were not different between patients with AVF and AVG. Patients with CVC had lower physical functioning (P:.001), role-physical limitation (P:.015), general health perception (P:.017), vitality (P:.010), social functioning (P:.004), role-emotional (P:.008), mental health (P:.001), physical component summary score (P:.017), and mental component summary score (P:.006) when compared to patients with AVF. Patients with CVC had lower physical functioning (P:.044), role-emotional (P:.044) and mental health scores (P:.04) when compared to patients with AVG. Having a CVC may negatively influence HRQOL in HD patients. Vascular access type does not seem to be related to depressed mood in HD.

  14. Access to artemisinin-based anti-malarial treatment and its related factors in rural Tanzania

    PubMed Central

    2013-01-01

    Background Artemisinin-based combination treatment (ACT) has been widely adopted as one of the main malaria control strategies. However, its promise to save thousands of lives in sub-Saharan Africa depends on how effective the use of ACT is within the routine health system. The INESS platform evaluated effective coverage of ACT in several African countries. Timely access within 24 hours to an authorized ACT outlet is one of the determinants of effective coverage and was assessed for artemether-lumefantrine (Alu), in two district health systems in rural Tanzania. Methods From October 2009 to June 2011we conducted continuous rolling household surveys in the Kilombero-Ulanga and the Rufiji Health and Demographic Surveillance Sites (HDSS). Surveys were linked to the routine HDSS update rounds. Members of randomly pre-selected households that had experienced a fever episode in the previous two weeks were eligible for a structured interview. Data on individual treatment seeking, access to treatment, timing, source of treatment and household costs per episode were collected. Data are presented on timely access from a total of 2,112 interviews in relation to demographics, seasonality, and socio economic status. Results In Kilombero-Ulanga, 41.8% (CI: 36.6–45.1) and in Rufiji 36.8% (33.7–40.1) of fever cases had access to an authorized ACT provider within 24 hours of fever onset. In neither of the HDSS site was age, sex, socio-economic status or seasonality of malaria found to be significantly correlated with timely access. Conclusion Timely access to authorized ACT providers is below 50% despite interventions intended to improve access such as social marketing and accreditation of private dispensing outlets. To improve prompt diagnosis and treatment, access remains a major bottle neck and new more innovative interventions are needed to raise effective coverage of malaria treatment in Tanzania. PMID:23651521

  15. Access and Mobilization: How Social Capital Relates to Low-Income Youth's Postsecondary Educational (PSE) Attainment

    ERIC Educational Resources Information Center

    Ashtiani, Mariam; Feliciano, Cynthia

    2018-01-01

    Youth from advantaged backgrounds have more social relationships that provide access to resources facilitating their educational success than those from low-income families. Does access to and mobilization of social capital also relate to success among the few low-income youth who "overcome the odds" and persist in higher education?…

  16. Does optimal access to dental care counteract the oral health-related quality of life social gradient?

    PubMed

    Crocombe, L A; Mahoney, G D

    2016-12-01

    The aim of this study was to determine if an oral health-related quality of life (OHRQoL) social gradient existed when Australian Defence Force (ADF) members have universal and optimal access to dental care. A nominal roll included 4089 individuals who were deployed to the Solomon Islands as part of Operation ANODE and a comparison group of 4092 ADF personnel frequency matched to the deployed group on gender, age group and service type, from which 500 deployed and 500 comparison individuals were randomly selected. The dependent variables were the OHIP-14 summary measures. Rank was used to determine socioeconomic status. The demographic variables selected were: gender and age. The response rate was 44%. Of the individual OHIP-14 items, being self-conscious, painful aching and having discomfort when eating were the most common problems. Mean OHIP-14 severity was 2.8. In bivariate analysis, there was not a significant difference in mean OHIP-14 severity (p = 0.52) or frequency of OHIP-14 impacts (p = 0.57) by military rank. There was a significant increasing OHIP-14 extent score from commissioned officer to non-commissioned officer to other ranks (0.07, 0.19, 0.40, p = 0.03). Even with optimal access to dental care, there was an OHRQoL social gradient between military ranks in the ADF. © 2016 Australian Dental Association.

  17. Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies

    PubMed Central

    Akande, Tokunbo; Shankar, Anita V.; McIntire, Katherine N.; Gounder, Celine R.; Gupta, Amita; Yang, Wei-Teng

    2014-01-01

    Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified “inductive coding” system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gender-variable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services. PMID:24900921

  18. Institutional delivery in rural India: the relative importance of accessibility and economic status.

    PubMed

    Kesterton, Amy J; Cleland, John; Sloggett, Andy; Ronsmans, Carine

    2010-06-06

    Skilled attendance at delivery is an important indicator in monitoring progress towards Millennium Development Goal 5 to reduce the maternal mortality ratio by three quarters between 1990 and 2015. In addition to professional attention, it is important that mothers deliver their babies in an appropriate setting, where life saving equipment and hygienic conditions can also help reduce the risk of complications that may cause death or illness to mother and child. Over the past decade interest has grown in examining influences on care-seeking behavior and this study investigates the determinants of place of delivery in rural India, with a particular focus on assessing the relative importance of community access and economic status. A descriptive analysis of trends in place of delivery using data from two national representative sample surveys in 1992 and 1998 is followed by a two-level (child/mother and community) random-effects logistical regression model using the second survey to investigate the determinants. In this investigation of institutional care seeking for child birth in rural India, economic status emerges as a more crucial determinant than access. Economic status is also the strongest influence on the choice between a private-for-profit or public facility amongst institutional births. Greater availability of obstetric services will not alone solve the problem of low institutional delivery rates. This is particularly true for the use of private-for-profit institutions, in which the distance to services does not have a significant adjusted effect. In the light of these findings a focus on increasing demand for existing services seems the most rational action. In particular, financial constraints need to be addressed, and results support current trials of demand side financing in India.

  19. Bloodstream infections caused by multi-drug resistant Proteus mirabilis: Epidemiology, risk factors and impact of multi-drug resistance.

    PubMed

    Korytny, Alexander; Riesenberg, Klaris; Saidel-Odes, Lisa; Schlaeffer, Fransisc; Borer, Abraham

    2016-01-01

    The prevalence of antimicrobial co-resistance among ESBL-producing Enterobactereaceae is extremely high in Israel. Multidrug-resistant Proteus mirabilis strains (MDR-PM), resistant to almost all antibiotic classes have been described. The aim was to determine the risk factors for bloodstream infections caused by MDR-PM and clinical outcomes. A retrospective case-control study. Adult patients with PM bacteremia during 7 years were identified retrospectively and their files reviewed for demographics, underlying diseases, Charlson Comorbidity Index, treatment and outcome. One hundred and eighty patients with PM-bloodstream infection (BSI) were included; 90 cases with MDR-PM and 90 controls with sensitive PM (S-PM). Compared to controls, cases more frequently were from nursing homes, had recurrent hospital admissions in the past year and received antibiotic therapy in the previous 3 months, were bedridden and suffered from peripheral vascular disease and peptic ulcer disease (p < 0.001). Two-thirds of the MDR-PM isolates were ESBL-producers vs 4.4% of S-PM isolates (p < 0.001, OR = 47.6, 95% CI = 15.9-142.6). In-hospital crude mortality rate of patients with MDR-PM BSI was 37.7% vs 23.3% in those with S-PM BSI (p = 0.0359, OR = 2, 95% CI = 1.4-3.81). PM bacteremia in elderly and functionally-dependent patients is likely to be caused by nearly pan-resistant PM strains in the institution; 51.8% of the patients received inappropriate empiric antibiotic treatment. The crude mortality rate of patients with MDR-PM BSI was significantly higher than that of patients with S-PM BSI.

  20. Evaluation of bloodstream infections, Clostridium difficile infections, and gut microbiota in pediatric oncology patients.

    PubMed

    Nycz, Bryan T; Dominguez, Samuel R; Friedman, Deborah; Hilden, Joanne M; Ir, Diana; Robertson, Charles E; Frank, Daniel N

    2018-01-01

    Bloodstream infections (BSI) and Clostridium difficile infections (CDI) in pediatric oncology/hematology/bone marrow transplant (BMT) populations are associated with significant morbidity and mortality. The objective of this study was to explore possible associations between altered microbiome composition and the occurrence of BSI and CDI in a cohort of pediatric oncology patients. Stool samples were collected from all patients admitted to the pediatric oncology floor from Oct.-Dec. 2012. Bacterial profiles from patient stools were determined by bacterial 16S rRNA gene profiling. Differences in overall microbiome composition were assessed by a permutation-based multivariate analysis of variance test, while differences in the relative abundances of specific taxa were assessed by Kruskal-Wallis tests. At admission, 9 of 42 patients (21%) were colonized with C. difficile, while 6 of 42 (14%) subsequently developed a CDI. Furthermore, 3 patients (7%) previously had a BSI and 6 patients (14%) subsequently developed a BSI. Differences in overall microbiome composition were significantly associated with disease type (p = 0.0086), chemotherapy treatment (p = 0.018), BSI following admission from any cause (p < 0.0001) or suspected gastrointestinal organisms (p = 0.00043). No differences in baseline microbiota were observed between individuals who did or did not subsequently develop C. difficile infection. Additionally, multiple bacterial groups varied significantly between subjects with post-admission BSI compared with no BSI. Our results suggest that differences in gut microbiota not only are associated with type of cancer and chemotherapy, but may also be predictive of subsequent bloodstream infection.

  1. Association between the accessibility to lethal methods and method-specific suicide rates: An ecological study in Taiwan.

    PubMed

    Lin, Jin-Jia; Lu, Tsung-Hsueh

    2006-07-01

    To examine the association between availability of lethal methods of suicide and method-specific suicide rates at the city/ county level in Taiwan. Age-adjusted and age-specific suicide rates of 23 cities/counties in Taiwan for the years 1999 to 2003 were calculated. Partial correlation coefficients were used to examine cross-sectional associations between independent variables, i.e., proportion of agricultural population and proportion of households living on the sixth floor or above, and suicide rates by different methods (poisoning by solids/liquids, jumping, and hanging) after adjusting for unemployment rates and prevalence of depression. The partial correlation coefficient was 0.77 (p < .001) for proportion of agricultural population with solids/liquids poisoning suicide rates. It was 0.73 (p < .001) for the proportion of households living on the sixth floor or above with suicide rates by jumping. Correlations between hanging suicide rates and proportion of agricultural population or between hanging suicide rates and proportion of households living on the sixth floor or above were not significant. The results showed strong positive associations between access to lethal methods and method-specific suicide rates. Controlling the availability of pesticides and fencing high buildings or installing window guards may be effective measures for suicide prevention.

  2. Impact of the introduction of an automated microbiologic system on the clinical outcomes of bloodstream infections caused by Enterobacteriaceae strains.

    PubMed

    Callefi, Luciana Azevedo; Medeiros, Eduardo Alexandrino Servolo de; Furtado, Guilherme Henrique Campos

    2013-01-01

    Enterobacteriaceae strains are a leading cause of bloodstream infections (BSI). The aim of this study is to assess differences in clinical outcomes of patients with BSI caused by Enterobacteriaceae strains before and after introduction of an automated microbiologic system by the microbiology laboratory. We conducted a retrospective cohort study aimed to evaluate the impact of the introduction of an automated microbiologic system (Phoenix(tm) automated microbiology system, Becton, Dickinson and Company (BD) - Diagnostic Systems, Sparks, MD, USA) on the outcomes of BSIs caused by Enterobacteriaceae strains. The study was undertaken at Hospital São Paulo, a 750-bed teaching hospital in São Paulo, Brazil. Patients with BSI caused by Enterobacteriaceae strains before the introduction of the automated system were compared with patients with BSI caused by the same pathogens after the introduction of the automated system with regard to treatment adequacy, clinical cure/improvement and 14- and 28-day mortality rates. We evaluated 90 and 106 patients in the non-automated and automated testing periods, respectively. The most prevalent species in both periods were Klebsiella spp. and Proteus spp. Clinical cure/improvement occurred in 70% and 67.9% in non-automated and automated period, respectively (p = 0.75). 14-day mortality rates were 22.2% and 30% (p = 0.94) and 28-day mortality rates were 24.5% and 40.5% (p = 0.12). There were no significant differences between the two testing periods with regard to treatment adequacy, clinical cure/improvement and 14- and 28-day mortality rates. Introduction of the BD Phoenix(tm) automated microbiology system did not impact the clinical outcomes of BSIs caused by Enterobacteriaceae strains in our setting.

  3. More than a feeling: Emotional cues impact the access and experience of autobiographical memories.

    PubMed

    Sheldon, Signy; Donahue, Julia

    2017-07-01

    Remembering is impacted by several factors of retrieval, including the emotional content of a memory cue. Here we tested how musical retrieval cues that differed on two dimensions of emotion-valence (positive and negative) and arousal (high and low)-impacted the following aspects of autobiographical memory recall: the response time to access a past personal event, the experience of remembering (ratings of memory vividness), the emotional content of a cued memory (ratings of event arousal and valence), and the type of event recalled (ratings of event energy, socialness, and uniqueness). We further explored how cue presentation affected autobiographical memory retrieval by administering cues of similar arousal and valence levels in a blocked fashion to one half of the tested participants, and randomly to the other half. We report three main findings. First, memories were accessed most quickly in response to musical cues that were highly arousing and positive in emotion. Second, we observed a relation between a cue and the elicited memory's emotional valence but not arousal; however, both the cue valence and arousal related to the nature of the recalled event. Specifically, high cue arousal led to lower memory vividness and uniqueness ratings, but cues with both high arousal and positive valence were associated with memories rated as more social and energetic. Finally, cue presentation impacted both how quickly and specifically memories were accessed and how cue valence affected the memory vividness ratings. The implications of these findings for views of how emotion directs the access to memories and the experience of remembering are discussed.

  4. Epidemiology and molecular typing of VRE bloodstream isolates in an Irish tertiary care hospital.

    PubMed

    Ryan, L; O'Mahony, E; Wrenn, C; FitzGerald, S; Fox, U; Boyle, B; Schaffer, K; Werner, G; Klare, I

    2015-10-01

    Ireland has the highest rate of vancomycin-resistant Enterococcus faecium (VREfm) isolated from blood of nosocomial patients in Europe, which rose from 33% (110/330) in 2007 to 45% (178/392) in 2012. No other European country had a VREfm rate from blood cultures of >25%. Our aim was to elucidate the reasons for this significantly higher rate in Ireland. The epidemiology and molecular typing of VRE from bloodstream infections (BSIs) was examined in a tertiary care referral hospital and isolates were compared with those from other tertiary care referral centres in the region. The most common source of VRE BSIs was intra-abdominal sepsis, followed by line-related infection and febrile neutropenia. Most of the isolates were positive for vanA; 52% (43/83) possessed the esp gene and 12% (10/83) possessed the hyl gene. Genotyping by SmaI macrorestriction analysis (PFGE) of isolates revealed clonal relatedness between bloodstream isolates and environmental isolates. VRE BSI isolates from two other tertiary care hospitals in the Dublin region showed relatedness by PFGE analysis. MLST revealed four STs (ST17, ST18, ST78 and ST203), all belonging to the clonal complex of hospital-associated strains. Irish VRE BSI isolates have virulence factor profiles as previously reported from Europe. Typing analysis shows the spread of individual clones within the hospital and between regional tertiary care hospitals. Apart from transmission of VRE within the hospital and transfer of colonized patients between Irish hospitals, no other explanation for the persistently high VREfm BSI rate in Ireland has been found. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  5. Rating scale for the assessment of competence in ultrasound-guided peripheral vascular access - a Delphi Consensus Study.

    PubMed

    Primdahl, Stine C; Todsen, Tobias; Clemmesen, Louise; Knudsen, Lars; Weile, Jesper

    2016-09-21

    Peripheral vascular access is vital for treatment and diagnostics of hospitalized patients. Ultrasound-guided vascular access (UGVA) is superior to the landmark technique. To ensure competence-based education, an assessment tool of UGVA competence is needed. We aimed to develop a global rating scale (RS) for assessment of UGVA competence based on opinions on the content from ultrasound experts in a modified Delphi consensus study. We included experts from anesthesiology, emergency medicine and radiology across university hospitals in Denmark. Nine elements were drafted based on existing literature and recommendations from international societies. In a multi-round survey, the experts rated the elements on a five-point Likert scale according to importance, and suggested missing elements. The final Delphi round occurred when >80% of the experts rated all elements ≥4 on the Likert scale. Sixteen experts consented to participate in the study, one withdrew consent prior to the first Delphi round, and 14 completed all three Delphi rounds. In the first Delphi round the experts excluded one element from the scale and changed the content of two elements. In the second Delphi round, the experts excluded one element from the scale. In the third Delphi round, consensus was obtained on the eight elements: preparation of utensils, ergonomics, preparation of the ultrasound device, identification of blood vessels, anatomy, hygiene, coordination of the needle, and completion of the procedure. We developed an RS for assessment of UGVA competence based on opinions of ultrasound experts through a modified Delphi consensus study.

  6. Mandatory and Location-Aware Access Control for Relational Databases

    NASA Astrophysics Data System (ADS)

    Decker, Michael

    Access control is concerned with determining which operations a particular user is allowed to perform on a particular electronic resource. For example, an access control decision could say that user Alice is allowed to perform the operation read (but not write) on the resource research report. With conventional access control this decision is based on the user's identity whereas the basic idea of Location-Aware Access Control (LAAC) is to evaluate also a user's current location when making the decision if a particular request should be granted or denied. LAAC is an interesting approach for mobile information systems because these systems are exposed to specific security threads like the loss of a device. Some data models for LAAC can be found in literature, but almost all of them are based on RBAC and none of them is designed especially for Database Management Systems (DBMS). In this paper we therefore propose a LAAC-approach for DMBS and describe a prototypical implementation of that approach that is based on database triggers.

  7. Trends in rates of acetaminophen-related adverse events in the United States

    PubMed Central

    Major, Jacqueline M.; Zhou, Esther H.; Wong, Hui-Lee; Trinidad, James P.; Pham, Tracy M.; Mehta, Hina; Ding, Yulan; Staffa, Judy A.; Iyasu, Solomon; Wang, Cunlin; Willy, Mary E.

    2017-01-01

    Purpose The goal of this study is to summarize trends in rates of adverse events attributable to acetaminophen use, including hepatotoxicity and mortality. Methods A comprehensive analysis of data from three national surveillance systems estimated rates of acetaminophen-related events identified in different settings, including calls to poison centers (2008–2012), emergency department visits (2004–2012), and inpatient hospitalizations (1998–2011). Rates of acetaminophen-related events were calculated per setting, census population, and distributed drug units. Results Rates of poison center calls with acetaminophen-related exposures decreased from 49.5/1000 calls in 2009 to 43.5/1000 calls in 2012. Rates of emergency department visits for unintentional acetaminophen-related adverse events decreased from 58.0/1000 emergency department visits for adverse drug events in 2009 to 50.2/1000 emergency department visits in 2012. Rates of hospital inpatient discharges with acetaminophen-related poisoning decreased from 119.8/100 000 hospitalizations in 2009 to 108.6/100 000 hospitalizations in 2011. After 2009, population rates of acetaminophen-related events per 1million census population decreased for poison center calls and hospitalizations, while emergency department visit rates remained stable. However, when accounting for drug sales, the rate of acetaminophen-related events (per 1 million distributed drug units) increased after 2009. Prior to 2009, the rates of acetaminophen-related hospitalizations had been slowly increasing (p-trend = 0.001). Conclusions Acetaminophen-related adverse events continue to be a public health burden. Future studies with additional time points are necessary to confirm trends and determine whether recent risk mitigation efforts had a beneficial impact on acetaminophen-related adverse events. PMID:26530380

  8. Accessing the public MIMIC-II intensive care relational database for clinical research.

    PubMed

    Scott, Daniel J; Lee, Joon; Silva, Ikaro; Park, Shinhyuk; Moody, George B; Celi, Leo A; Mark, Roger G

    2013-01-10

    The Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database is a free, public resource for intensive care research. The database was officially released in 2006, and has attracted a growing number of researchers in academia and industry. We present the two major software tools that facilitate accessing the relational database: the web-based QueryBuilder and a downloadable virtual machine (VM) image. QueryBuilder and the MIMIC-II VM have been developed successfully and are freely available to MIMIC-II users. Simple example SQL queries and the resulting data are presented. Clinical studies pertaining to acute kidney injury and prediction of fluid requirements in the intensive care unit are shown as typical examples of research performed with MIMIC-II. In addition, MIMIC-II has also provided data for annual PhysioNet/Computing in Cardiology Challenges, including the 2012 Challenge "Predicting mortality of ICU Patients". QueryBuilder is a web-based tool that provides easy access to MIMIC-II. For more computationally intensive queries, one can locally install a complete copy of MIMIC-II in a VM. Both publicly available tools provide the MIMIC-II research community with convenient querying interfaces and complement the value of the MIMIC-II relational database.

  9. Accessing the public MIMIC-II intensive care relational database for clinical research

    PubMed Central

    2013-01-01

    Background The Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database is a free, public resource for intensive care research. The database was officially released in 2006, and has attracted a growing number of researchers in academia and industry. We present the two major software tools that facilitate accessing the relational database: the web-based QueryBuilder and a downloadable virtual machine (VM) image. Results QueryBuilder and the MIMIC-II VM have been developed successfully and are freely available to MIMIC-II users. Simple example SQL queries and the resulting data are presented. Clinical studies pertaining to acute kidney injury and prediction of fluid requirements in the intensive care unit are shown as typical examples of research performed with MIMIC-II. In addition, MIMIC-II has also provided data for annual PhysioNet/Computing in Cardiology Challenges, including the 2012 Challenge “Predicting mortality of ICU Patients”. Conclusions QueryBuilder is a web-based tool that provides easy access to MIMIC-II. For more computationally intensive queries, one can locally install a complete copy of MIMIC-II in a VM. Both publicly available tools provide the MIMIC-II research community with convenient querying interfaces and complement the value of the MIMIC-II relational database. PMID:23302652

  10. When being a girl matters less: accessibility of gender-related self-knowledge in single-sex and coeducational classes and its impact on students' physics-related self-concept of ability.

    PubMed

    Kessels, Ursula; Hannover, Bettina

    2008-06-01

    Establishing or preserving single-sex schooling has been widely discussed as a way of bringing more girls into the natural sciences. We test the assumption that the beneficial effects of single-sex education on girls' self-concept of ability in masculine subjects such as physics are due to the lower accessibility of gender-related self-knowledge in single-sex classes. N=401 eighth-graders (mean age 14.0 years) from coeducational comprehensive schools. Random assignment of students to single-sex vs. coeducational physics classes throughout the eighth grade. At the end of the year, students' physics-related self-concept of ability was measured using a questionnaire. In a subsample of N=134 students, the accessibility of gender-related self-knowledge during physics classes was assessed by measuring latencies and endorsement of sex-typed trait adjectives. Girls from single-sex physics classes reported a better physics-related self-concept of ability than girls from coeducational classes, while boys' self-concept of ability did not vary according to class composition. For both boys and girls, gender-related self-knowledge was less accessible in single-sex classes than in mixed-sex classes. To the extent that girls' feminine self-knowledge was relatively less accessible than their masculine self-knowledge, their physics-related self-concept of ability improved at the end of the school year. By revealing the importance of the differential accessibility of gender-related self-knowledge in single- and mixed-sex settings, our study clarifies why single-sex schooling helps adolescents to gain a better self-concept of ability in school subjects that are considered inappropriate for their own sex.

  11. Learning Relational Policies from Electronic Health Record Access Logs

    PubMed Central

    Malin, Bradley; Nyemba, Steve; Paulett, John

    2011-01-01

    Modern healthcare organizations (HCOs) are composed of complex dynamic teams to ensure clinical operations are executed in a quick and competent manner. At the same time, the fluid nature of such environments hinders administrators' efforts to define access control policies that appropriately balance patient privacy and healthcare functions. Manual efforts to define these policies are labor-intensive and error-prone, often resulting in systems that endow certain care providers with overly broad access to patients' medical records while restricting other providers from legitimate and timely use. In this work, we propose an alternative method to generate these policies by automatically mining usage patterns from electronic health record (EHR) systems. EHR systems are increasingly being integrated into clinical environments and our approach is designed to be generalizable across HCOs, thus assisting in the design and evaluation of local access control policies. Our technique, which is grounded in data mining and social network analysis theory, extracts a statistical model of the organization from the access logs of its EHRs. In doing so, our approach enables the review of predefined policies, as well as the discovery of unknown behaviors. We evaluate our approach with five months of access logs from the Vanderbilt University Medical Center and confirm the existence of stable social structures and intuitive business operations. Additionally, we demonstrate that there is significant turnover in the interactions between users in the HCO and that policies learned at the department level afford greater stability over time. PMID:21277996

  12. A Spatial Analysis of Acute Myocardial Infarction Rates in New York State in Relation to Hospitals Along State Jurisdictional Borders.

    PubMed

    Stamm, Abigail J; Savadatti, Sanghamitra S; Kumar, Sanjaya; Hwang, Syni-An

    Patients experiencing acute myocardial infarction (AMI) are likely to visit the nearest hospital providing appropriate services since timely care is a critical determinant in the treatment and progression of AMI. We comparatively examined AMI rates in border and nonborder census tracts. The New York State (NYS) Environmental Public Health Tracking (EPHT) program, in conjunction with the Statewide Planning and Research Cooperative System, will work on developing memoranda of understanding with neighboring states to be able to more comprehensively access NYS residents' out-of-state health records. To determine whether AMI rates in the NYS border census tracts differ from AMI rates in nonborder census tracts as a preliminary exploration of the utilization of out-of-state care for acute health conditions by NYS border residents. We reviewed data on inpatient and emergency department visits in NYS with discharge dates from 2005 to 2014 retrospectively. We used the NYS EPHT tier 1 system database to locate hospitals. We geocoded all cases to NYS 2010 census tracts. We mapped differences between border and nonborder tracts and analyzed resulting spatial patterns. We computed tract-level AMI rates and differences between border and nonborder AMI rates. The age-adjusted AMI rates differed by 8.2 cases per 10 000 people (95% confidence interval, 6.94-12.60). Maps showed patterns of differences in AMI rates, especially along the NYS border with New England and other geographically closer out-of-state hospitals. AMI rates that were geographically closer to out-of-state hospitals were lower, suggesting that people residing in border census tracts are utilizing out-of-state care. Our study adds to literature on the geographical component of health care accessibility and utilization in the context of acute conditions such as AMI and lends impetus to access out-of-state health records to better understand health care facility access and utilization for NYS residents.

  13. Related Rates and the Speed of Light.

    ERIC Educational Resources Information Center

    Althoen, S. C.; Weidner, J. F.

    1985-01-01

    Standard calculus textbooks often include a related rates problem involving light cast onto a straight line by a revolving light source. Mathematical aspects to these problems (both in the solution and in the method by which that solution is obtained) are examined. (JN)

  14. Costs and length of stay associated with antimicrobial resistance in acute kidney injury patients with bloodstream infection.

    PubMed

    Vandijck, D M; Blot, S I; Decruyenaere, J M; Vanholder, R C; De Waele, J J; Lameire, N H; Claus, S; De Schuijmer, J; Dhondt, A W; Verschraegen, G; Hoste, E A

    2008-01-01

    Antimicrobial resistance negatively impacts on prognosis. Intensive care unit (ICU) patients, and particularly those with acute kidney injury (AKI), are at high risk for developing nosocomial bloodstream infections (BSI) due to multi-drug-resistant strains. Economic implications in terms of costs and length of stay (LOS) attributable to antimicrobial resistance are underevaluated. This study aimed to assess whether microbial susceptibility patterns affect costs and LOS in a well-defined cohort of ICU patients with AKI undergoing renal replacement therapy (RRT) who developed nosocomial BSI. Historical study (1995-2004) enrolling all adult RRT-dependent ICU patients with AKI and nosocomial BSI. Costs were considered as invoiced in the Belgian reimbursement system, and LOS was used as a surrogate marker for hospital resource allocation. Of the 1330 patients with AKI undergoing RRT, 92 had microbiologic evidence of nosocomial BSI (57/92, 62% due to a multi-drug-resistant microorganism). Main patient characteristics were equal in both groups. As compared to patients with antimicro-4 bial-susceptible BSI, patients with antimicrobial-resistant BSI were more likely to acquire Gram-positive infection (72.6% vs 25.5%, P<0.001). No differences were found neither in LOS (ICU before BSI, ICU, hospital before BSI, hospital, hospital after BSI, and time on RRT; all P>0.05) or hospital costs (all P>0.05) when comparing patients with antimicrobial-resistant vs antimicrobial-susceptible BSI. However, although not statistically significant, patients with BSI caused by resistant Gram-negative-, Candida-, or anaerobic bacteria incurred substantial higher costs than those without. In a cohort of ICU patients with AKI and nosocomial BSI undergoing RRT, patients with antimicrobial-resistant vs antimicrobial-susceptible Gram-positive BSI did not have longer hospital stays, or higher hospital costs. Patients with resistant "other" (i.e. Gram-negative, Candida, or anaerobic) BSI were found

  15. Genetic analysis of 430 Chinese Cynodon dactylon accessions using sequence-related amplified polymorphism markers.

    PubMed

    Huang, Chunqiong; Liu, Guodao; Bai, Changjun; Wang, Wenqiang

    2014-10-21

    Although Cynodon dactylon (C. dactylon) is widely distributed in China, information on its genetic diversity within the germplasm pool is limited. The objective of this study was to reveal the genetic variation and relationships of 430 C. dactylon accessions collected from 22 Chinese provinces using sequence-related amplified polymorphism (SRAP) markers. Fifteen primer pairs were used to amplify specific C. dactylon genomic sequences. A total of 481 SRAP fragments were generated, with fragment sizes ranging from 260-1800 base pairs (bp). Genetic similarity coefficients (GSC) among the 430 accessions averaged 0.72 and ranged from 0.53-0.96. Cluster analysis conducted by two methods, namely the unweighted pair-group method with arithmetic averages (UPGMA) and principle coordinate analysis (PCoA), separated the accessions into eight distinct groups. Our findings verify that Chinese C. dactylon germplasms have rich genetic diversity, which is an excellent basis for C. dactylon breeding for new cultivars.

  16. Genetic Analysis of 430 Chinese Cynodon dactylon Accessions Using Sequence-Related Amplified Polymorphism Markers

    PubMed Central

    Huang, Chunqiong; Liu, Guodao; Bai, Changjun; Wang, Wenqiang

    2014-01-01

    Although Cynodon dactylon (C. dactylon) is widely distributed in China, information on its genetic diversity within the germplasm pool is limited. The objective of this study was to reveal the genetic variation and relationships of 430 C. dactylon accessions collected from 22 Chinese provinces using sequence-related amplified polymorphism (SRAP) markers. Fifteen primer pairs were used to amplify specific C. dactylon genomic sequences. A total of 481 SRAP fragments were generated, with fragment sizes ranging from 260–1800 base pairs (bp). Genetic similarity coefficients (GSC) among the 430 accessions averaged 0.72 and ranged from 0.53–0.96. Cluster analysis conducted by two methods, namely the unweighted pair-group method with arithmetic averages (UPGMA) and principle coordinate analysis (PCoA), separated the accessions into eight distinct groups. Our findings verify that Chinese C. dactylon germplasms have rich genetic diversity, which is an excellent basis for C. dactylon breeding for new cultivars. PMID:25338051

  17. Accessibility to health care facilities in Montreal Island: an application of relative accessibility indicators from the perspective of senior and non-senior residents.

    PubMed

    Paez, Antonio; Mercado, Ruben G; Farber, Steven; Morency, Catherine; Roorda, Matthew

    2010-10-25

    . The combination of average trip length estimates with the spatial distribution of health care facilities indicates that despite being more mobile, suburban residents tend to have lower levels of accessibility compared to central city residents. The effect is more marked for seniors. Furthermore, the results indicate that accessibility calculated using a fixed bandwidth would produce patterns of exposure to health care facilities that would be difficult to achieve for suburban seniors given actual mobility patterns. The analysis shows large disparities in accessibility between seniors and non-seniors, between urban and suburban seniors, and between vehicle owning and non-owning seniors. This research was concerned with potential accessibility levels. Follow up research could consider the results reported here to select case studies of actual access and usage of health care facilities, and related health outcomes.

  18. [Influence of HIV related stigma on health care access].

    PubMed

    Bermúdez-Román, Viviana; Bran-Piedrahita, Lemy; Palacios-Moya, Lucía; Posada-Zapata, Isabel Cristina

    2015-01-01

    To notice the influence of the stigma surrounding HIV on the access to health services among the seropositive population of Medellín, Colombia, in 2012. A qualitative approach using Strauss' and Corbin's grounded theory. Data was collected through 13 interviews at two different moments.These interviews were transcribed and analyzed, and the data found in them was processed via axial and open coding. The myths surrounding HIV become a barrier preventing access to healthcare;this hinders timely treatment of the virus. Government policies must aim to reduce the effect that the historical discrimination against HIV has generated so that it can guarantee that infected individuals have early access to treatments for this condition as well as health promotion services.

  19. 45 CFR 156.210 - QHP rate and benefit information.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 156.210 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.210 QHP rate and benefit information...

  20. 45 CFR 156.210 - QHP rate and benefit information.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 156.210 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.210 QHP rate and benefit information...

  1. 45 CFR 156.210 - QHP rate and benefit information.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 156.210 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.210 QHP rate and benefit information...

  2. Universal accessibility of "accessible" fitness and recreational facilities for persons with mobility disabilities.

    PubMed

    Arbour-Nicitopoulos, Kelly P; Ginis, Kathleen A Martin

    2011-01-01

    This study descriptively measured the universal accessibility of "accessible" fitness and recreational facilities for Ontarians living with mobility disabilities. The physical and social environments of 44 fitness and recreational facilities that identified as "accessible" were assessed using a modified version of the AIMFREE. None of the 44 facilities were completely accessible. Mean accessibility ratings ranged between 31 and 63 out of a possible 100. Overall, recreational facilities had higher accessibility scores than fitness centers, with significant differences found on professional support and training, entrance areas, and parking lot. A modest correlation was found between the availability of fitness programming and the overall accessibility of fitness-center specific facility areas. Overall, the physical and social environments of the 44 fitness and recreational facilities assessed were limited in their accessibility for persons with mobility disabilities. Future efforts should be directed at establishing and meeting universal accessibility guidelines for Canadian physical activity facilities.

  3. When self-destructive thoughts flash through the mind: Failure to meet standards affects the accessibility of suicide-related thoughts.

    PubMed

    Chatard, Armand; Selimbegović, Leila

    2011-04-01

    When individuals realize that they fail to attain important standards or expectations, they may be motivated to escape the self, which could lead thoughts of suicide to become more accessible. Six studies examined this hypothesis, mainly derived from escape theory (Baumeister, 1990). The results indicated that whenever individuals realize that they fail to attain an important standard, they experience increased accessibility of suicide-related thoughts (Studies 1-6). In line with the idea that such effects reflect motivations to escape from negative self-awareness, they were especially pronounced when associated with high levels of self-consciousness and escapist motivations (Study 1) and with a large discrepancy between self and standards (Studies 2-4). Moreover, failure to attain standards increased suicide-thought accessibility along with the desire for an altered state of consciousness (Study 5). Finally, increases in suicide-thought accessibility after failure were associated with simultaneous increases in accessibility of general concepts related to escape (Study 6). Implications of these findings for escape and terror management theories are discussed.

  4. Efficacy of β-Lactam/β-Lactamase Inhibitor Combinations for the Treatment of Bloodstream Infection Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Hematological Patients with Neutropenia

    PubMed Central

    Royo-Cebrecos, Cristina; Abdala, Edson; Akova, Murat; Álvarez, Rocío; Maestro-de la Calle, Guillermo; Cano, Angela; Cervera, Carlos; Clemente, Wanessa T.; Martín-Dávila, Pilar; Freifeld, Alison; Gómez, Lucía; Gottlieb, Thomas; Gurguí, Mercè; Herrera, Fabián; Manzur, Adriana; Maschmeyer, Georg; Meije, Yolanda; Montejo, Miguel; Peghin, Maddalena; Rodríguez-Baño, Jesús; Ruiz-Camps, Isabel; Sukiennik, Teresa C.; Tebe, Cristian; Carratalà, Jordi

    2017-01-01

    ABSTRACT β-Lactam/β-lactamase inhibitors (BLBLIs) were compared to carbapenems in two cohorts of hematological neutropenic patients with extended-spectrum-β-lactamase (ESBL) bloodstream infection (BSI): the empirical therapy cohort (174 patients) and the definitive therapy cohort (251 patients). The 30-day case fatality rates and other secondary outcomes were similar in the two therapy groups of the two cohorts and also in the propensity-matched cohorts. BLBLIs might be carbapenem-sparing alternatives for the treatment of BSI due to ESBLs in these patients. PMID:28584145

  5. Relative growth rate in phylogenetically related deciduous and evergreen woody species.

    PubMed

    Antúnez, Isabel; Retamosa, Emilio C; Villar, Rafael

    2001-07-01

    Relative growth rate (RGR) and other growth parameters were studied in eight pairs of closely related deciduous and evergreen species (within the same genus or family). The main objective of this study was to test the association between leaf turnover rate and RGR, specific leaf area (SLA, leaf area/leaf dry weight) and other growth variables. Plants were grown for 6 months in a greenhouse under favourable water and nutrient conditions. Variation in RGR among the 16 woody species was due mainly to differences in morphological parameters such as leaf area ratio (LAR, whole plant area/whole plant dry weight) and SLA). However, temporal variation in RGR within species was due mainly to variation in net assimilation rate. When phylogeny was not taken into account, analyses showed that deciduous species grew faster than evergreens. In contrast, when phylogeny was taken into account, the data analysis showed that a faster RGR is not consistently associated with the deciduous habit (in five pairs it was, but in the other three it was not). The faster growth of the deciduous trees (in the five positive contrasts) could be explained by their higher LAR and higher SLA relative to evergreens. The lack of differences in RGR between deciduous and evergreens (in three pairs) was due to the higher leaf mass ratio (LMR, leaf dry biomass/total dry biomass) for the evergreens, which offset the higher SLA of the deciduous species, resulting in a similar LAR in both functional groups (LAR=LMR×SLA). Deciduous species had consistently higher SLA than evergreens. We suggest that SLA, more than RGR, could be an important parameter in determining adaptive advantages of deciduous and evergreen species.

  6. Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome.

    PubMed

    Dat, Vu Quoc; Vu, Hieu Ngoc; Nguyen The, Hung; Nguyen, Hoa Thi; Hoang, Long Bao; Vu Tien Viet, Dung; Bui, Chi Linh; Van Nguyen, Kinh; Nguyen, Trung Vu; Trinh, Dao Tuyet; Torre, Alessandro; van Doorn, H Rogier; Nadjm, Behzad; Wertheim, Heiman F L

    2017-07-12

    Bloodstream infections (BSIs) are associated with high morbidity and mortality worldwide. However their aetiology, antimicrobial susceptibilities and associated outcomes differ between developed and developing countries. Systematic data from Vietnam are scarce. Here we present aetiologic data on BSI in adults admitted to a large tertiary referral hospital for infectious diseases in Hanoi, Vietnam. A retrospective study was conducted at the National Hospital for Tropical Diseases between January 2011 and December 2013. Cases of BSI were determined from records in the microbiology department. Case records were obtained where possible and clinical findings, treatment and outcome were recorded. BSI were classified as community acquired if the blood sample was drawn ≤48 h after hospitalization or hospital acquired if >48 h. A total of 738 patients with BSI were included for microbiological analysis. The predominant pathogens were: Klebsiella pneumoniae (17.5%), Escherichia coli (17.3%), Staphylococcus aureus (14.9%), Stenotrophomonas maltophilia (9.6%) and Streptococcus suis (7.6%). The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 25.1% (67/267 isolates) and of methicillin-resistance in S. aureus (MRSA) 37% (40/108). Clinical data was retrieved for 477 (64.6%) patients; median age was 48 years (IQR 36-60) with 27.7% female. The overall case fatality rate was 28.9% and the highest case fatality was associated with Enterobacteriaceae BSI (34.7%) which accounted for 61.6% of all BSI fatalities. Enterobacteriaceae (predominantly K. pneumoniae and E. coli) are the most common cause of both community and hospital acquired bloodstream infections in a tertiary referral clinic in northern Vietnam.

  7. Competitive and Allelopathic Effects of Wild Rice Accessions (Oryza longistaminata) at Different Growth Stages.

    PubMed

    Shen, Shicai; Xu, Gaofeng; Clements, David Roy; Jin, Guimei; Zhang, Fudou; Tao, Dayun; Xu, Peng

    2016-01-01

    The competitive and allelopathic effects of wild rice (Oryza longistaminata) accessions on barnyard grass at different growth stages determined by days after sowing (0, 30, 60 and 90 days) were studied in greenhouse pot experiments. Wild rice accession RL159 exhibited the greatest height and tillering. The weed suppression rates of wild rice accessions OL and F1 on barnyard grass were significantly higher than for other rice accessions, with the lowest being O. sativa cultivar RD23. The highest suppression rates of OL and F1 were 80.23 and 73.96% at barnyard grass growth stages of 90 days and 60 days. At a 90 growth stage, wild rice accessions RL159 and RL169 caused 61.33 and 54.51% inhibition in barnyard grass growth, respectively. Under the same conditions, the competitive inhibition rates of OL, F1, RL159, RL169 and RL219 against barnyard grass were markedly lower than their weed suppressive effects, but were relatively similar for RD23. The allelopathic inhibition of OL and F1 on barnyard grass was significantly higher than other rice accessions. The highest allelopathic rates of OL and F1 were 60.61 and 56.87% at the 0 day growth stage. It is concluded that wild rice accessions OL and F1 exhibited the highest allelopathic activity along with moderate competitive ability against barnyard grass; wild rice accession RL159 had the highest competitive ability and moderate allelopathic activity on barnyard grass. Thus, the three wild rice accessions OL, F1 and RL159 could be used as ideal breeding materials for cultivated rice improvement.

  8. Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies.

    PubMed

    Satlin, Michael J; Cohen, Nina; Ma, Kevin C; Gedrimaite, Zivile; Soave, Rosemary; Askin, Gülce; Chen, Liang; Kreiswirth, Barry N; Walsh, Thomas J; Seo, Susan K

    2016-10-01

    To determine the prevalence, risk factors, treatments, and outcomes of bloodstream infections (BSIs) due to carbapenem-resistant Enterobacteriaceae (CRE) in adult neutropenic patients with hematologic malignancies. We reviewed all BSIs between 2008 and 2012 in this population at two New York City oncology centers. A case-control study was conducted to identify CRE BSI risk factors, using three controls of non-CRE BSIs per case. CRE caused 43 (2.2%) of 1992 BSIs overall and 4.7% of Gram-negative bacteremias. Independent risk factors for CRE BSI were prior β-lactam/β-lactamase inhibitor (adjusted odds ratio [aOR] 3.2; P = 0.03) or carbapenem (aOR 3.0; P = 0.05) use, current trimethoprim-sulfamethoxazole (aOR 24; P = 0.001) or glucocorticoid (aOR 5.4, P = 0.004) use, and having a prior CRE culture (aOR 12; P = 0.03). Patients with CRE bacteremia had a median of 52 h from culture collection until receipt of active therapy. They had a 51% BSI-related mortality rate, with a median of 4 days from bacteremia onset until death. CRE-active empirical therapy was associated with a lower 30-day mortality rate (17% vs. 59%; P = 0.08). CRE are lethal emerging causes of bacteremia in neutropenic patients. New strategies are needed to shorten the delay in administration of CRE-active agents and improve outcomes in this vulnerable population. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  9. Accessibility | NREL

    Science.gov Websites

    electronic and information technologies accessible to individuals with disabilities in accordance with Section 508 of the Rehabilitation Act (29 U.S.C. 794d), as amended in 1998. Contact us with feedback or concerns related to the accessibility of this website.

  10. Pediatric access to dermatologists: Medicaid versus private insurance.

    PubMed

    Chaudhry, Sofia B; Armbrecht, Eric S; Shin, Yoon; Matula, Sarah; Caffrey, Charles; Varade, Reena; Jones, Lisa; Siegfried, Elaine

    2013-05-01

    There is disparity in access to outpatient care for Medicaid beneficiaries. This inequity disproportionately impacts children. Access for children with skin disease may be especially limited. We sought to compare access to dermatologists for new pediatric patients insured by Medicaid versus a private plan. We surveyed 13 metropolitan markets by conducting secret-shopper scripted telephone calls to dermatology providers listed by Medicaid health plans. Paired calls, differing by insurance type, were made to each office on the same day, portraying a parent requesting a new appointment for a child with eczema. We called the offices of 723 Medicaid-listed providers. Final analysis included 471 dermatologists practicing general dermatology. Of these, an average of 44% refused a new Medicaid-insured pediatric patient. The average wait time for an appointment did not significantly vary between insurance types. Assuming that dermatologists not listed as Medicaid providers do not see Medicaid-insured children, our data indicate that pediatric Medicaid acceptance rates ranged from 6% to 64% by market, with an overall market size-weighted average acceptance rate of 19%. Relative reimbursement levels for Medicaid-insured patients did not correlate with acceptance rates. Although the most current health plan directories were used to create calling lists, these are dynamic. The sample sizes of confirmed appointments were in part limited by a lack of referral letters and/or health plan identification numbers. Only confirmed appointments were used to calculate average wait times. Access to dermatologists is limited for Medicaid-insured children with eczema. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  11. Specific detection and quantitation of bovine IgG in bioreactor derived mouse mAb preparations.

    PubMed

    Gall-Debreceni, Anna; Lazar, Jozsef; Kadas, Janos; Balogh, Attila; Ferenczi, Annamaria; Sos, Endre; Takacs, Laszlo; Kurucz, Istvan

    2016-11-01

    Monoclonal antibody and recombinant protein production benefits greatly from bovine serum as an additive. The caveat is that bovine serum IgG, co-purifies with mAbs and IgG Fc-containing fusion proteins and it presents a contaminant in the end products. In order to analytically validate the products, species specific reagents are needed that react with bovine IgG exclusively. Our attempts to find such commercially available reagents failed. Here, we report the production of species specific mAbs which recognize bovine IgG even in the presence of excess amount of mouse IgG. We present five mAbs: Bsi4028, Bsi4032, Bsi4033, Bsi4034 and Bsi4035 suitable to determine the presence of bovine IgG contamination via ELISA or immunoblotting in bioreactor derived mouse mAb preparations. To quantitate bovine IgG content we developed sensitive sandwich ELISAs capable to detect bovine IgG contaminant in the ng/ml (~10 -11 M/l) range. Finally, we show that bovine IgG is efficiently removed from bioreactor produced mouse mAb preparation via affinity depletion columns prepared with Bsi4028, Bsi4032, Bsi4033, Bsi4034, Bsi4035 mAbs. Copyright © 2016. Published by Elsevier B.V.

  12. The Role of Inhibition in Age-related Off-Topic Verbosity: Not Access but Deletion and Restraint Functions

    PubMed Central

    Yin, Shufei; Peng, Huamao

    2016-01-01

    The speech of older adults is commonly described as verbose and off-topic, which is thought to influence their social communication. This study investigated the role of inhibition in age-related off-topic verbosity (OTV). Inhibition consists of three functions: access, deletion, and restraint. The access function is responsible for preventing irrelevant information from accessing the attention center (pre-mechanism of inhibition); The deletion function is responsible for deleting previously relevant but currently irrelevant information from working memory, and the restraint function is responsible for restraining strong but inappropriate responses (post-mechanisms of inhibition). A referential communication task was used to determine whether OTV was influenced by the pre-mechanism of inhibition. A self-involved event interview task was used to investigate the effect of the post-mechanisms of inhibition on OTV. Results showed that the OTV of the elderly participants was associated with an age-related decline in the post-mechanisms of inhibition, while the OTV exhibited by young adults was most likely due to deficits in the pre-mechanism function of inhibition. This research contributed to fill gaps in the existing knowledge about the potential relationship between specific functions of inhibition and age-related OTV. PMID:27199793

  13. The Role of Inhibition in Age-related Off-Topic Verbosity: Not Access but Deletion and Restraint Functions.

    PubMed

    Yin, Shufei; Peng, Huamao

    2016-01-01

    The speech of older adults is commonly described as verbose and off-topic, which is thought to influence their social communication. This study investigated the role of inhibition in age-related off-topic verbosity (OTV). Inhibition consists of three functions: access, deletion, and restraint. The access function is responsible for preventing irrelevant information from accessing the attention center (pre-mechanism of inhibition); The deletion function is responsible for deleting previously relevant but currently irrelevant information from working memory, and the restraint function is responsible for restraining strong but inappropriate responses (post-mechanisms of inhibition). A referential communication task was used to determine whether OTV was influenced by the pre-mechanism of inhibition. A self-involved event interview task was used to investigate the effect of the post-mechanisms of inhibition on OTV. Results showed that the OTV of the elderly participants was associated with an age-related decline in the post-mechanisms of inhibition, while the OTV exhibited by young adults was most likely due to deficits in the pre-mechanism function of inhibition. This research contributed to fill gaps in the existing knowledge about the potential relationship between specific functions of inhibition and age-related OTV.

  14. An observational study of the universal use of octenidine to decrease nosocomial bloodstream infections and MDR organisms.

    PubMed

    Gastmeier, Petra; Kämpf, Klaus-Peter; Behnke, Michael; Geffers, Christine; Schwab, Frank

    2016-09-01

    To investigate the effect of universal decolonization with octenidine on the incidence of ICU-acquired bloodstream infections (BSI) and MDR organisms (MDRO). A system-wide change in practice was performed in the ICUs of a university hospital with three campuses (eight medical ICUs and nine surgical ICUs). All ICUs had a general admission screening strategy for MRSA with subsequent isolation in the 12 month baseline period, which was stopped. After a wash-in period of 1 month, decolonization of the nose with octenidine nasal gel and octenidine wash cloths was introduced. The endpoints were ICU-acquired BSI and ICU-acquired MDRO isolates from clinical cultures. Segmented regression analysis of interrupted time series was used to assess the effect of intervention. A total of 29 532 ICU patients (16 677 surgical and 12 855 medical) were included in the study. The baseline incidence density of ICU-acquired BSI was 5.1 per 1000 patient days and the baseline ICU-acquired MRSA rate was 0.97 per 1000 patient days. Whereas no significant effect on either outcome was found in surgical ICUs, we identified a significant effect on ICU-acquired BSI for the intervention in medical ICUs by means of multivariate analysis (incidence rate ratio 0.78; 95% CI 0.65-0.94). In addition, the intervention was also effective in decreasing ICU-acquired MRSA in medical ICUs (incidence rate ratio 0.58; 95% CI 0.41-0.82). No effect on ICU-acquired VRE and Gram-negative MDRO was found. System change was successful by decreasing infection rates in medical ICUs and improving the management in all ICUs. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  15. Expanding the Genotypic Spectrum of Bathing Suit Ichthyosis

    PubMed Central

    Marukian, Nareh V.; Hu, Rong-Hua; Craiglow, Brittany G.; Milstone, Leonard M.; Zhou, Jing; Theos, Amy; Kaymakcalan, Hande; Akkaya, Deniz A.; Uitto, Jouni J.; Vahidnezhad, Hassan; Youssefian, Leila; Bayliss, Susan J.; Paller, Amy S.; Boyden, Lynn M.

    2017-01-01

    Importance Bathing suit ichthyosis (BSI) is a rare congenital disorder of keratinization characterized by restriction of scale to sites of relatively higher temperature such as the trunk, with cooler areas remaining unaffected. Fewer than 40 cases have been reported in the literature. Bathing suit ichthyosis is caused by recessive, temperature-sensitive mutations in the transglutaminase-1 gene (TGM1). Clear genotype-phenotype correlations have been difficult to establish because several of the same TGM1 mutations have been reported in BSI and other forms of congenital ichthyosis. We identify novel and recurrent mutations in 16 participants with BSI. Objective To expand the genotypic spectrum of BSI, identifying novel TGM1 mutations in patients with BSI, and to use BSI genotypes to draw inferences about the temperature sensitivity of TGM1 mutations. Design, Setting, and Participants A total of 16 participants with BSI from 13 kindreds were identified from 6 academic medical centers. A detailed clinical history was obtained from each participant, including phenotypic presentation at birth and disease course. Each participant underwent targeted sequencing of TGM1. Main Outcomes and Measures Phenotypic and genotypic characteristics in these patients from birth onward. Results Of the 16 participants, 7 were male, and 9 were female (mean age, 12.6 years; range, 1-39 years). We found 1 novel TGM1 indel mutation (Ile469_Cys471delinsMetLeu) and 8 TGM1 missense mutations that to our knowledge have not been previously reported in BSI: 5 have been previously described in non–temperature-sensitive forms of congenital ichthyosis (Arg143Cys, Gly218Ser, Gly278Arg, Arg286Gln, and Ser358Arg), and 3 (Tyr374Cys, Phe495Leu, and Ser772Arg) are novel mutations. Three probands were homozygous for Arg264Trp, Arg286Gln, or Arg315Leu, indicating that these mutations are temperature sensitive. Seven of 10 probands with a compound heterozygous TGM1 genotype had a mutation at either arginine

  16. Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency.

    PubMed

    Karliner, Leah S; Pérez-Stable, Eliseo J; Gregorich, Steven E

    2017-03-01

    Twenty-five million people in the United States have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized. Federal requirements that hospitals provide language access services are very challenging to implement in the fast-paced, 24-hour hospital environment. To determine if increasing access to professional interpreters improves hospital outcomes for older patients with LEP. Natural experiment on a medicine floor of an academic hospital. Patients age 50 years or above discharged between January 15, 2007 and January 15, 2010. Dual-handset interpreter telephone at every bedside July 15, 2008 to Mar 14, 2009. Thirty-day readmission, length of stay, estimated hospital expenditures. Of 8077 discharges, 1963 were for LEP, and 6114 for English proficient patients. There was a significant decrease in observed 30-day readmission rates for the LEP group during the 8-month intervention period compared with 18 months preintervention (17.8% vs. 13.4%); at the same time English proficient readmission rates increased (16.7% vs. 19.7%); results remained significant in adjusted analyses. This improved readmission outcome for the LEP group was not maintained during the subsequent postintervention period when the telephones became less accessible. There was no significant intervention impact on length of stay in either unadjusted or adjusted analyses. After accounting for interpreter services costs, the estimated 119 readmissions averted during the intervention period were associated with estimated monthly hospital expenditure savings of $161,404. Comprehensive language access represents an important, high value service that all medical centers should provide to achieve equitable, quality healthcare for vulnerable LEP populations.

  17. Detection of Anomalous Insiders in Collaborative Environments via Relational Analysis of Access Logs

    PubMed Central

    Chen, You; Malin, Bradley

    2014-01-01

    Collaborative information systems (CIS) are deployed within a diverse array of environments, ranging from the Internet to intelligence agencies to healthcare. It is increasingly the case that such systems are applied to manage sensitive information, making them targets for malicious insiders. While sophisticated security mechanisms have been developed to detect insider threats in various file systems, they are neither designed to model nor to monitor collaborative environments in which users function in dynamic teams with complex behavior. In this paper, we introduce a community-based anomaly detection system (CADS), an unsupervised learning framework to detect insider threats based on information recorded in the access logs of collaborative environments. CADS is based on the observation that typical users tend to form community structures, such that users with low a nity to such communities are indicative of anomalous and potentially illicit behavior. The model consists of two primary components: relational pattern extraction and anomaly detection. For relational pattern extraction, CADS infers community structures from CIS access logs, and subsequently derives communities, which serve as the CADS pattern core. CADS then uses a formal statistical model to measure the deviation of users from the inferred communities to predict which users are anomalies. To empirically evaluate the threat detection model, we perform an analysis with six months of access logs from a real electronic health record system in a large medical center, as well as a publicly-available dataset for replication purposes. The results illustrate that CADS can distinguish simulated anomalous users in the context of real user behavior with a high degree of certainty and with significant performance gains in comparison to several competing anomaly detection models. PMID:25485309

  18. Structural Determinants of the Closed KCa3.1 Channel Pore in Relation to Channel Gating: Results from a Substituted Cysteine Accessibility Analysis

    PubMed Central

    Klein, Hélène; Garneau, Line; Banderali, Umberto; Simoes, Manuel; Parent, Lucie; Sauvé, Rémy

    2007-01-01

    In this work we address the question of the KCa3.1 channel pore structure in the closed configuration in relation to the contribution of the C-terminal end of the S6 segments to the Ca2+-dependent gating process. Our results based on SCAM (substituted cysteine accessibility method) experiments first demonstrate that the S6 transmembrane segment of the open KCa3.1 channel contains two distinct functional domains delimited by V282 with MTSEA and MTSET binding leading to a total channel inhibition at positions V275, T278, and V282 and to a steep channel activation at positions A283 and A286. The rates of modification by MTSEA (diameter 4.6 Å) of the 275C (central cavity) and 286C residues (S6 C-terminal end) for the closed channel configuration were found to differ by less than sevenfold, whereas experiments performed with the larger MTSET reagent (diameter 5.8 Å) resulted in modification rates 103–104 faster for cysteines at 286 compared with 275. Consistent with these results, the modification rates of the cavity lining 275C residue by MTSEA, Et-Hg+, and Ag+ appeared poorly state dependent, whereas modification rates by MTSET were 103 faster for the open than the closed configuration. A SCAM analysis of the channel inner vestibule in the closed state revealed in addition that cysteine residues at 286 were accessible to MTS reagents as large as MTS-PtrEA, a result supported by the observation that binding of MTSET to cysteines at positions 283 or 286 could neither sterically nor electrostatically block the access of MTSEA to the closed channel cavity (275C). It follows that the closed KCa3.1 structure can hardly be accountable by an inverted teepee-like structure as described for KcsA, but is better represented by a narrow passage centered at V282 (equivalent to V474 in Shaker) connecting the channel central cavity to the cytosolic medium. This passage would not be however restrictive to the diffusion of small reagents such as MTSEA, Et-Hg+, and Ag+, arguing

  19. Stability of agronomic and yield related traits of Jatropha curcas accessions raised from cuttings

    NASA Astrophysics Data System (ADS)

    Mat, Nurul Hidayah Che; Yaakob, Zahira; Ratnam, Wickneswari

    2016-11-01

    Monitoring stability of agronomic and yield related traits is important for prediction of crop yields. This study was a latter study for the evaluation of 295 J. curcas individuals representing 21 accessions from eight countries at Biodiesel Research Station of Universiti Kebangsaan Malaysia, Kuala Pilah planted in December 2012. In this study, 183 J. curcas individuals were selected randomly from the population and their growth performance evaluated from December 2013 to December 2014. All the individual plants were raised from cuttings. The yield related data were recorded periodically and performance of each accession was analyzed using Statistical Analysis System (SAS) 9.4. Five traits which were number of fruits per plant (NFPP), number of fruits per inflorescence (NFPI), hundred seed weight (g) (HSW), number of seeds per plant (NSPP) and yield per plant (g) (YPP) showed significant differences among the accessions after two years of planting. Maximum values for each trait were 208 cm for plant height (PH), 31 for number of branches per plant (BPP), 115 for number of inflorescence per plant (NIPP), 582 for NFPP, 7 for NFPI, 307 for number of flowers per inflorescence (NFI), 17 for number of female flowers per inflorescence (NFFPI), 91.6 g for HSW, 1647.1 for NSPP and 927.6 g for YPP. Most of the plants which had performed well in the first year were among the best performers in the second year.

  20. Random access with adaptive packet aggregation in LTE/LTE-A.

    PubMed

    Zhou, Kaijie; Nikaein, Navid

    While random access presents a promising solution for efficient uplink channel access, the preamble collision rate can significantly increase when massive number of devices simultaneously access the channel. To address this issue and improve the reliability of the random access, an adaptive packet aggregation method is proposed. With the proposed method, a device does not trigger a random access for every single packet. Instead, it starts a random access when the number of aggregated packets reaches a given threshold. This method reduces the packet collision rate at the expense of an extra latency, which is used to accumulate multiple packets into a single transmission unit. Therefore, the tradeoff between packet loss rate and channel access latency has to be carefully selected. We use semi-Markov model to derive the packet loss rate and channel access latency as functions of packet aggregation number. Hence, the optimal amount of aggregated packets can be found, which keeps the loss rate below the desired value while minimizing the access latency. We also apply for the idea of packet aggregation for power saving, where a device aggregates as many packets as possible until the latency constraint is reached. Simulations are carried out to evaluate our methods. We find that the packet loss rate and/or power consumption are significantly reduced with the proposed method.

  1. The Effects of Drug-Prevention Messages on the Accessibility of Identity-Related Constructs

    PubMed Central

    COMELLO, MARIA LEONORA G.; SLATER, MICHAEL D.

    2011-01-01

    Recent theoretical work has posited that the self-system guides behavior via currently activated self-concepts. We adopt this framework to the study of drug-prevention messages by examining the extent to which messages can alter the accessibility of views of self and of drugs that would support non-use. Participants were exposed to one of three print-ad conditions: autonomy-themed prevention messages (treatment), health-information themed prevention messages (comparison), and informational consumer ads (control). Outcomes were reaction times to make dichotomous judgments. Relative to comparison and control ads, treatment ads were more successful at activating a self-view as a nonuser, a view that marijuana use is inconsistent with autonomy, and unwillingness to use marijuana. Post-hoc analysis revealed that the effect of ad condition on unwillingness was partially mediated by the accessibility of self-view as a nonuser. PMID:21271426

  2. The base rates and factors associated with reported access to firearms in psychiatric inpatients.

    PubMed

    Kolla, Bhanu Prakash; O'Connor, Stephen S; Lineberry, Timothy W

    2011-01-01

    The aim of this study was to define whether specific patient demographic groups, diagnoses or other factors are associated with psychiatric inpatients reporting firearms access. A retrospective medical records review study was conducted using information on access to firearms from electronic medical records for all patients 16 years and older admitted between July 2007 and May 2008 at the Mayo Clinic Psychiatric Hospital in Rochester, MN. Data were obtained only on patients providing authorization for record review. Data were analyzed using univariate and multivariate logistic regression analyses accounting for gender, diagnostic groups, comorbid substance use, history of suicide attempts and family history of suicide/suicide attempts. Seventy-four percent (1169/1580) of patients provided research authorization. The ratio of men to women was identical in both research and nonresearch authorization groups. There were 14.6% of inpatients who reported firearms access. In univariate analysis, men were more likely (P<.0001) to report access than women, and a history of previous suicide attempt(s) was associated with decreased access (P=.02). Multiple logistic regression analyses controlling for other factors found females and patients with history of previous suicide attempt(s) less likely to report access, while patients with a family history of suicide or suicide attempts reported increased firearms access. Diagnostic groups were not associated with access on univariate or multiple logistic regression analyses. Men and inpatients with a family history of suicide/suicide attempts were more likely to report firearms access. Clinicians should develop standardized systems of identification of firearms access and provide guidance on removal. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Clinical and laboratory parameter dynamics as markers of blood stream infections in pediatric oncology patients with fever and neutropenia.

    PubMed

    Hazan, Guy; Ben-Shimol, Shalom; Fruchtman, Yariv; Abu-Quider, Abed; Kapelushnik, Joseph; Moser, Asher; Falup-Pecurariu, Oana; Greenberg, David

    2014-07-01

    Identifying markers associated with blood stream infection (BSI) in children with fever and neutropenia (FN) could lead to a substantial reduction in unnecessary treatment. The aim of this study was to determine the association between clinical/laboratory parameters and BSI in pediatric oncology patients with FN. This prospective study was conducted between 2007 and 2010 at the Pediatric oncology unit. Clinical and laboratory parameters were obtained from all hospitalized FN patients. Linear regression and trends were calculated to determine the association between clinical/laboratory parameters and BSI. Of the 195 FN episodes in 73 children, BSIs were identified in 38 (19%) episodes. Gram-positive bacteria, gram-negative bacteria, and fungi caused 47%, 43%, and 10% of all BSIs, respectively. Mean fever duration was longer in the BSI group (5 d) compared with the non-BSI group (2 d, P=0.01). Mean (±SD) monocyte count at admission was lower in the BSI group compared with the non-BSI group (0.06±0.1 vs. 0.14±0.33 cells/mm, respectively, P=0.05). Mean C-reactive protein (CRP) levels at hospitalization days 5 to 8 were higher in children with BSI (P<0.001). Increment trends of monocyte and platelet levels and decrement trend of CRP levels were noted in the BSI group but not in the non-BSI group (P<0.01 for all). Prolonged fever, lower monocyte count at admission, higher CRP levels between the fifth and the eighth hospitalization days, increment trends of monocyte and platelet levels, and CRP level decrement were associated with BSI. These factors may serve as markers for BSI in pediatric oncology patients with FN.

  4. Surgical management of vascular access related aneurysms to salvage dialysis access: case report and a systematic review of the literature.

    PubMed

    Furukawa, Hiroshi

    2015-01-01

    We retrospectively evaluated the surgical outcome of revising vascular access related aneurysms (VARAs) to salvage dialysis access. Twenty-six consecutive hemodialysis patients (mean age 67.6 years, range: 32-89 years) who presented with true or false VARA and underwent surgery between January 2006 and February 2011 were enrolled in this study, and comprised 11 women and 15 men. Aneurysms were true in 21 patients and false in five; native arteriovenous fistulas (AVFs) were reported in 23, including one infected native pseudoaneurysm, and arteriovenous prosthetic grafts (AVGs) in three. The mean aneurysm diameter was 29.8 ± 8.0 mm, ranging from 18 to 50 mm. Indications of surgical intervention were local pain, rapid enlargement of the aneurysm, and AVF failure due to stenosis. Surgical revision was performed by resection of VARA and concomitant creation of a new proximal arteriovenous anastomosis in 18 patients. Two aneurysms were ruptured by blunt dissection; however, bleeding did not occur due to prior clamping of the inflow artery without hemodynamic compromise. VARA plication was performed in one case in which severe calcified VARA could not be incised. No significant complications were reported, except for delayed wound healing in three patients and minor peripheral neuropathy in five. The postoperative course was uneventful without hospital mortality in all patients with VARA. Aggressive surgical management of VARAs is likely to become an acceptable procedure to salvage dialysis access and consistently maintain AVF or AVG function.

  5. Access to Money and Relation to Women's Use of Family Planning Methods Among Young Married Women in Rural India.

    PubMed

    Reed, Elizabeth; Donta, Balaiah; Dasgupta, Anindita; Ghule, Mohan; Battala, Madhusudana; Nair, Saritha; Silverman, Jay; Jadhav, Arun; Palaye, Prajakta; Saggurti, Niranjan; Raj, Anita

    2016-06-01

    Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women's access to and decision-making power related to family planning (FP). Women's access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women's status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women's social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n = 855), crude and adjusted regression was used to assess women's access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59 %) was associated with condom and other contraceptive use (AORs ranged 1.5-1.8). These findings remained significant after adjusting for women's FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women's ability to obtain FP methods, even in contexts where social norms to support women's power in FP decision-making may not be readily adopted.

  6. Accessibility and socio-economic development of human settlements.

    PubMed

    Hasan, Samiul; Wang, Xiaoming; Khoo, Yong Bing; Foliente, Greg

    2017-01-01

    Access to facilities, services and socio-economic opportunities plays a critical role in the growth and decline of cities and human settlements. Previous attempts to explain changes in socio-economic indicators by differences in accessibility have not been convincing as countries with highly developed transport infrastructure have only seen marginal benefits of infrastructure improvements. Australia offers an ideal case for investigating the effects of accessibility on development since it is seen as home to some of the most liveable cities in the world while, at the same time, it also has some of the most isolated settlements. We investigate herein the connectivity and accessibility of all 1814 human settlements (population centers exceeding 200 persons) in Australia, and how they relate to the socio-economic characteristics of, and opportunities in, each population center. Assuming population as a proxy indicator of available opportunities, we present a simple ranking metric for a settlement using the number of population and the distance required to access all other settlements (and the corresponding opportunities therein). We find a strikingly unequal distribution of access to opportunities in Australia, with a marked prominence of opportunities in capital cities in four of the eight states. The two largest cities of Sydney and Melbourne have a dominant position across all socio-economic indicators, compared to all the other cities. In general, we observe across all the settlements that a decrease in access to opportunities is associated with relatively greater socio-economic disadvantage including increased median age and unemployment rate and decreased median household income. Our methodology can be used to better understand the potential benefits of improved accessibility based on infrastructure development, especially for remote areas and for cities and towns with many socio-economically disadvantaged population.

  7. Accessibility and socio-economic development of human settlements

    PubMed Central

    Wang, Xiaoming; Khoo, Yong Bing; Foliente, Greg

    2017-01-01

    Access to facilities, services and socio-economic opportunities plays a critical role in the growth and decline of cities and human settlements. Previous attempts to explain changes in socio-economic indicators by differences in accessibility have not been convincing as countries with highly developed transport infrastructure have only seen marginal benefits of infrastructure improvements. Australia offers an ideal case for investigating the effects of accessibility on development since it is seen as home to some of the most liveable cities in the world while, at the same time, it also has some of the most isolated settlements. We investigate herein the connectivity and accessibility of all 1814 human settlements (population centers exceeding 200 persons) in Australia, and how they relate to the socio-economic characteristics of, and opportunities in, each population center. Assuming population as a proxy indicator of available opportunities, we present a simple ranking metric for a settlement using the number of population and the distance required to access all other settlements (and the corresponding opportunities therein). We find a strikingly unequal distribution of access to opportunities in Australia, with a marked prominence of opportunities in capital cities in four of the eight states. The two largest cities of Sydney and Melbourne have a dominant position across all socio-economic indicators, compared to all the other cities. In general, we observe across all the settlements that a decrease in access to opportunities is associated with relatively greater socio-economic disadvantage including increased median age and unemployment rate and decreased median household income. Our methodology can be used to better understand the potential benefits of improved accessibility based on infrastructure development, especially for remote areas and for cities and towns with many socio-economically disadvantaged population. PMID:28636630

  8. A crossover randomized prospective pilot study evaluating a central venous catheter team in reducing catheter-related bloodstream infections in pediatric oncology patients.

    PubMed

    Secola, Rita; Azen, Colleen; Lewis, Mary Ann; Pike, Nancy; Needleman, Jack; Sposto, Richard; Doering, Lynn

    2012-01-01

    Treatment for most children with cancer includes the use of a central venous catheter (CVC). CVCs provide reliable venous access for delivery of chemotherapy and supportive care. This advantage is mitigated by an increased risk of bloodstream infections (BSIs). Despite the ubiquitous use of CVCs, few prospective studies have been conducted to address infection prevention strategies in pediatric oncology patients. Prospective, crossover pilot study of a CVC team intervention versus standard care. Two inpatient oncology units in a metropolitan children's hospital. A total of 41 patients/135 admissions for the experimental unit (EU) and 41/129 admissions for the control unit (CU). Patients received a CVC blood draw bundle procedure by a CVC registered nurse (RN) team member (experimental intervention: EU) for 6 months and by the assigned bedside RN (standard care: CU) for 6 months. Feasibility of implementing a CVC RN team; a significant difference in CVC-related BSIs between the team intervention versus standard care and risk factors associated in the development of CVC-related BSIs were determined. There were 7 CVC-related BSIs/1238 catheter days in the EU group (5.7/1000 catheter days) versus 3 CVC-related BSIs/1419 catheter days in the CU group (2.1/1000 catheter days; P = .97). Selected risk factors were not significantly associated with the development of a CVC-related BSI. A CVC team in the care of pediatric oncology patients is feasible; however, a larger cohort will be required to adequately determine the effectiveness of the team reducing CVC-related BSIs.

  9. Questioning the efficacy of 'gold' open access to published articles.

    PubMed

    Fredericks, Suzanne

    2015-07-01

    To question the efficacy of 'gold' open access to published articles. Open access is unrestricted access to academic, theoretical and research literature that is scholarly and peer-reviewed. Two models of open access exist: 'gold' and 'green'. Gold open access provides everyone with access to articles during all stages of publication, with processing charges paid by the author(s). Green open access involves placing an already published article into a repository to provide unrestricted access, with processing charges incurred by the publisher. This is a discussion paper. An exploration of the relative benefits and drawbacks of the 'gold' and 'green' open access systems. Green open access is a more economic and efficient means of granting open access to scholarly literature but a large number of researchers select gold open access journals as their first choices for manuscript submissions. This paper questions the efficacy of gold open access models and presents an examination of green open access models to encourage nurse researchers to consider this approach. In the current academic environment, with increased pressures to publish and low funding success rates, it is difficult to understand why gold open access still exists. Green open access enhances the visibility of an academic's work, as increased downloads of articles tend to lead to increased citations. Green open access is the cheaper option, as well as the most beneficial choice, for universities that want to provide unrestricted access to all literature at minimal risk.

  10. Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs.

    PubMed

    Fonjungo, Peter N; Boeras, Debrah I; Zeh, Clement; Alexander, Heather; Parekh, Bharat S; Nkengasong, John N

    2016-02-01

    Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  11. Differences and inequalities in relation to access to renal replacement therapy in the BRICS countries.

    PubMed

    Ferraz, Fábio Humberto Ribeiro Paes; Rodrigues, Cibele Isaac Saad; Gatto, Giuseppe Cesare; Sá, Natan Monsores de

    2017-07-01

    End-stage renal disease (ESRD) is an important public health problem, especially in developing countries due to the high level of economic resources needed to maintain patients in the different programs that make up renal replacement therapy (RRT). To analyze the differences and inequalities involved in access to RRT in the BRICS countries (Brazil, Russian Federation, India, China and South Africa). This is an applied, descriptive, cross-sectional, quantitative and qualitative study, with documentary analysis and a literature review. The sources of data were from national censuses and scientific publications regarding access to RRT in the BRICS countries. There is unequal access to RRT in all the BRICS countries, as well as the absence of information regarding dialysis and transplants (India), the absence of effective legislation to inhibit the trafficking of organs (India and South Africa) and the use of deceased prisoners as donors for renal transplants (China). The construction of mechanisms to promote the sharing of benefits and solidarity in the field of international cooperation in the area of renal health involves the recognition of bioethical issues related to access to RRT in the BRICS countries.

  12. Will improving access to dental care improve oral health-related quality of life?

    PubMed

    Crocombe, L A; Mahoney, G D; Spencer, A J; Waller, M

    2013-06-01

    The aim of this study was to determine if Australian Defence Force (ADF) members had better oral health-related quality of life (OHRQoL) than the general Australian population and whether the difference was due to better access to dental care. The OHRQoL, as measured by OHIP-14 summary indicators, of participants from the Defence Deployed Solomon Islands (SI) Health Study and the National Survey of Adult Oral Health 2004-06 (NSAOH) were compared. The SI sample was age/gender status-adjusted to match that of the NSAOH sample which was age/gender/regional location weighted to that of the Australian population. NSAOH respondents with good access to dental care had lower OHIP-14 summary measures [frequency of impacts 8.5% (95% CI = 5.4, 11.6), extent mean = 0.16 (0.11, 0.22), severity mean = 5.0 (4.4, 5.6)] than the total NSAOH sample [frequency 18.6 (16.6, 20.7); extent 0.52 (0.44, 0.59); severity 7.6 (7.1, 8.1)]. The NSAOH respondents with both good access to dental care and self-reported good general health did not have as low OHIP-14 summary scores as in the SI sample [frequency 2.6 (1.2, 5.4), extent 0.05 (0.01, 0.10); severity 2.6 (1.9, 3.4)]. ADF members had better OHRQoL than the general Australian population, even those with good access to dental care and self-reported good general health. © 2013 Australian Dental Association.

  13. 45 CFR 155.1020 - QHP issuer rate and benefit information.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Section 155.1020 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Certification of Qualified Health Plans § 155.1020 QHP issuer rate and benefit...

  14. Composition and variability in the export of biogenic silica in the Changjiang River and the effect of Three Gorges Reservoir.

    PubMed

    Ran, Xiangbin; Liu, Sen; Liu, Jun; Zang, Jiaye; Che, Hong; Ma, Yongxing; Wang, Yibin

    2016-11-15

    Silicon (Si) plays an essential role in biogeochemical processes, but is still poorly characterized in the river system. This study addressed the biogenic silica (BSi) composition, origin and variation in the Changjiang River, and estimated the impacts of natural processes and human activities on the river Si cycling. Our results indicate that phytoliths comprised 14%-64% of BSi, while diatoms accounted for 34%-85% of BSi. The Changjiang River transported 620Ggyr(-1) of BSi and 2100Ggyr(-1) of dissolved silicate (DSi) loadings, respectively; 55% of the BSi and 51% of the DSi fluxes are transported during the high discharge period from June to September. The Changjiang River carried phytolith BSi mostly comes from the middle and lower reaches area. The ratio of BSi/(BSi+DSi) has decreased from 0.47 before 1980 to 0.19 in 2013-2014 due to the direct retention of BSi. The BSi sedimentation in the Three Gorges Reservoir would cause a decrease of total reactive silica, but contribute to approximately 4%-16% of the DSi loading at the Jiangyin station due to its dissolution. This study demonstrates that phytoliths represent a significant contribution to the biogeochemical cycle of silica in coastal waters, and in-stream process exerts a great influence on the river Si loading and cycling. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Village poultry consumption and marketing in relation to gender, religious festivals and market access.

    PubMed

    Aklilu, H A; Almekinders, C J M; Udo, H M J; Van der Zijpp, A J

    2007-04-01

    This study aimed to examine village poultry consumption and marketing in Ethiopia in relation to gender, socio-cultural events and market access. The main objects of the research were producers, poultry markets, producer-sellers, and intermediary sellers in three locations representing different levels of market access in Tigray. About 3000 farm records were collected over a period of 12 months from 131 producers to obtain quantitative data on sales and consumption. Ninety-three semi-structured interviews with 58 producer-sellers and 35 intermediaries and 12 group discussions with these market actors were conducted to explore organization, price dynamics and socio-cultural aspects of poultry marketing. In total, 928 producer-sellers and 225 intermediaries were monitored monthly to examine participation by gender in poultry marketing. Better market access was associated with a shorter market chain and higher prices for the producers. Female-headed households had smaller poultry sales and consumption per household but sale and consumption per family member were 25% and 66% higher, respectively, than in male-headed households. While women dominated in the producer-sellers group, intermediaries were mainly men. Religious festivals periodically shifted local demand and prices of poultry. To improve the benefit of poultry keeping, poverty-stricken households may profit from better market access through better market information, infrastructure, market group formation and careful planning to match the dynamics in demand.

  16. Determinants of Outcome in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: Results From National Surveillance in Canada, 2008-2012.

    PubMed

    Simor, Andrew E; Pelude, Linda; Golding, George; Fernandes, Rachel; Bryce, Elizabeth; Frenette, Charles; Gravel, Denise; Katz, Kevin; McGeer, Allison; Mulvey, Michael R; Smith, Stephanie; Weiss, Karl

    2016-04-01

    BACKGROUND Bloodstream infection (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with considerable morbidity and mortality. OBJECTIVE To determine the incidence of MRSA BSI in Canadian hospitals and to identify variables associated with increased mortality. METHODS Prospective surveillance for MRSA BSI conducted in 53 Canadian hospitals from January 1, 2008, through December 31, 2012. Thirty-day all-cause mortality was determined, and logistic regression analysis was used to identify variables associated with mortality. RESULTS A total of 1,753 patients with MRSA BSI were identified (incidence, 0.45 per 1,000 admissions). The most common sites presumed to be the source of infection were skin/soft tissue (26.6%) and an intravascular catheter (22.0%). The most common spa types causing MRSA BSI were t002 (USA100/800; 55%) and t008 (USA300; 29%). Thirty-day all-cause mortality was 23.8%. Mortality was associated with increasing age (odds ratio, 1.03 per year [95% CI, 1.02-1.04]), the presence of pleuropulmonary infection (2.3 [1.4-3.7]), transfer to an intensive care unit (3.2 [2.1-5.0]), and failure to receive appropriate antimicrobial therapy within 24 hours of MRSA identification (3.2 [2.1-5.0]); a skin/soft-tissue source of BSI was associated with decreased mortality (0.5 [0.3-0.9]). MRSA genotype and reduced susceptibility to vancomycin were not associated with risk of death. CONCLUSIONS This study provides additional insight into the relative impact of various host and microbial factors associated with mortality in patients with MRSA BSI. The results emphasize the importance of ensuring timely receipt of appropriate antimicrobial agents to reduce the risk of an adverse outcome.

  17. Annual Plasmodium falciparum entomological inoculation rates (EIR) across Africa: literature survey, internet access and review

    PubMed Central

    Hay, Simon I.; Rogers, David J.; Toomer, Jonathan F.; Snow, Robert W.

    2011-01-01

    This paper presents the results of an extensive search of the formal and informal literature on annual Plasmodium falciparum entomological inoculation rates (EIR) across Africa from 1980 onwards. It first describes how the annual EIR data were collated, summarized, neo-referenced and staged for public access on the internet. Problems of data standardization, reporting accuracy and the subsequent publishing of information on the internet follow. The review was conducted primarily to investigate the spatial heterogeneity of malaria exposure in Africa and supports the idea of highly heterogeneous risk at the continental, regional and country levels. The implications for malaria control of the significant spatial (and seasonal) variation in exposure to infected mosquito bites are discussed. PMID:10897348

  18. Cutaneous body image dissatisfaction and suicidal ideation: mediation by interpersonal sensitivity.

    PubMed

    Gupta, Madhulika A; Gupta, Aditya K

    2013-07-01

    Cutaneous body image (CBI) dissatisfaction, feelings of social exclusion and stigmatization have been associated with increased suicidality in dermatology patients. We examined the relation between CBI dissatisfaction and suicidal ideation in a non-clinical sample, and examined the possible mediating effect of interpersonal sensitivity (IS), a symptom dimension related to self-consciousness, feelings of inferiority and social exclusion. As part of a larger study, 312 community-based participants from London, Ontario, Canada (241 women, 71 men; mean±SD age: 38.4±14.9years) rated their CBI satisfaction, measured with the Cutaneous Body Image Scale (Gupta MA et al., 2004). The Brief Symptom Inventory (BSI) (Derogatis L et al.,1982) was used to measure the constructs of suicidal ideation (4 suicide-related items from the BSI) and IS (Interpersonal Sensitivity subscale of BSI). Assessing mediation using the Baron & Kenny (1986) model, CBI satisfaction had a significant negative effect on suicidal ideation [c=-0.316, t(296)=-5.73, p<0.001] and IS [a=-0.365, t(297)=-6.76, p<0.001]; when CBI satisfaction and IS were considered together, IS had a significant positive effect on suicidal ideation (b=.690, t(295)=15.80, p<.001) while the effect of CBI satisfaction on suicidal ideation was no longer significant [c*=-.063, t(295)=-1.44, ns]. Our findings suggest an inverse relationship between CBI satisfaction and suicidal ideation, which is mediated by IS. This relationship likely falls in a continuum between non-clinical and clinical situations, with suicide risk being greater when individuals experience greater CBI dissatisfaction and social alienation. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Experimental Determination of the Effect of the Ratio of B/Al on Glass Dissolution along the Nepheline (NaAlSiO 4) – Malinkoite (NaBSiO 4) Join

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Pierce, Eric M; Reed, Lunde R; Shaw, Wendy J

    2010-03-27

    The dissolution kinetics of five glasses along the NaAlSiO 4-NaBSiO 4 join were used to evaluate how the structural variations associated with boron-aluminum substitution affect the rate of dissolution. The composition of each glass varied inversely in mol% of Al 2O 3 (5 to 25 mol%) and B 2O 3 (20 to 0 mol%) with Na 2O (25 mol%) and SiO 2 (50 mol%) making up the remaining amount, in every case Na/(Al+B) = 1.0. Single-pass flow-through experiments (SPFT) were conducted under dilute conditions as a function of solution pH (from 7.0 to 12.0) and temperature (from 23° to 90°C).more » Analysis by 27Al and 29Si MAS-NMR suggests Al (~98% [4]Al) and Si atoms (~100% [4]Si) occupy a tetrahedral coordination whereas, B atoms occupy both tetrahedral ([4]B) and trigonal ( [3]B) coordination. The distribution of [3]B fractionated between [3]B(ring) and [3]B(non-ring) moieties, with the [3]B(ring)/ [3]B(non-ring) ratio increases with the B/Al ratio. The MAS-NMR results also indicated an increase in the fraction of [4]B with an increase in the B/Al ratio. But despite the changes in the B/Al ratio and B coordination, the 29Si spectra maintain a chemical shift between -88 to -84 ppm for each glass. Unlike the 29Si spectra, the 27Al resonances shift to more positive values with an increase in the B/Al ratio which suggests mixing between the [4]Al and [3]B sites, assuming avoidance between tetrahedral trivalent cations ( [4]Al-O- [4]B avoidance). Raman spectroscopy was use to augment the results collected from MAS-NMR and demonstrated that NeB4 (glass sample with the highest B content) was glass-glass phase separated (e.g., heterogeneous glass). Results from SPFT experiments suggest a forward rate of reaction and pH power law coefficients,η, that are independent of B/Al under these neutral to alkaline test conditions for all homogeneous glasses. The temperature dependence shows an order of magnitude increase in the dissolution rate with a 67°C increase in temperature and

  20. Access to means of suicide, occupation and the risk of suicide: a national study over 12 years of coronial data.

    PubMed

    Milner, A; Witt, K; Maheen, H; LaMontagne, A D

    2017-04-04

    Availability of lethal means is a significant risk factor for suicide. This study investigated whether occupations with greater access to lethal means had higher suicide rates than those without access, and further, whether this relationship differed for females versus males. A retrospective mortality study was conducted across the Australian population over the period 2001 to 2012. Data from the Australian Bureau of Statistics, which collects Census information on occupation for the Australian population, and the National Coroners Information System, which records information on suicide deaths, were combined. Employed suicide records were coded by occupation and work-related access to lethal means. Descriptive analysis and negative binomial regression were used to assess the relationship between access to means and suicide. Persons in occupations with access to firearms, medicines or drugs, and carbon monoxide more frequently used these methods to end their lives than those without access to means. Females employed in occupations with access to means had suicide rates that were 3.02 times greater (95% CI 2.60 to 3.50, p < 0.001) than those employed in occupations without access. Males in occupations with access had suicide rates that were 1.24 times greater than those without access (95% CI 1.16 to 1.33, p < 0.001). Work-related access to means is a risk factor for suicide in the employed population, but is associated with a greater risk for females than males. The findings of this study suggest the importance of controlling access to lethal methods in occupations where these are readily available.

  1. Flow rate-pressure drop relation for deformable shallow microfluidic channels

    NASA Astrophysics Data System (ADS)

    Christov, Ivan C.; Cognet, Vincent; Shidhore, Tanmay C.; Stone, Howard A.

    2018-04-01

    Laminar flow in devices fabricated from soft materials causes deformation of the passage geometry, which affects the flow rate--pressure drop relation. For a given pressure drop, in channels with narrow rectangular cross-section, the flow rate varies as the cube of the channel height, so deformation can produce significant quantitative effects, including nonlinear dependence on the pressure drop [{Gervais, T., El-Ali, J., G\\"unther, A. \\& Jensen, K.\\ F.}\\ 2006 Flow-induced deformation of shallow microfluidic channels.\\ \\textit{Lab Chip} \\textbf{6}, 500--507]. Gervais et. al. proposed a successful model of the deformation-induced change in the flow rate by heuristically coupling a Hookean elastic response with the lubrication approximation for Stokes flow. However, their model contains a fitting parameter that must be found for each channel shape by performing an experiment. We present a perturbation approach for the flow rate--pressure drop relation in a shallow deformable microchannel using the theory of isotropic quasi-static plate bending and the Stokes equations under a lubrication approximation (specifically, the ratio of the channel's height to its width and of the channel's height to its length are both assumed small). Our result contains no free parameters and confirms Gervais et. al.'s observation that the flow rate is a quartic polynomial of the pressure drop. The derived flow rate--pressure drop relation compares favorably with experimental measurements.

  2. Simple trigonometry on computed tomography helps in planning renal access.

    PubMed

    Bilen, Cenk Yücel; Koçak, Burak; Kitirci, Gürcan; Danaci, Murat; Sarikaya, Saban

    2007-08-01

    To retrospectively assess the usefulness of the measurements on preoperative computed tomography (CT) of patients with urinary stone disease for planning the access site using vertical angulation of the C-arm. Of the patients who underwent percutaneous nephrolithotomy from November 2001 to October 2006, 41 patients with superior calix access had undergone preoperative CT. The depth of the target stone (y) and the vertical distance from that point to the first rib free slice (x) were measured on CT. The limit of the ratio of x over y was accepted as 0.58, with ratios below that indicating that infracostal access could be achieved by vertical angulation of the C-arm. We achieved an approach to the superior calix through an infracostal access in 28 patients. The preoperative trigonometric study on CT predicted 24 of them. The stone-free rate was 92.6%, and no chest-related complications developed. Simple trigonometry on CT of the patients with complex stones could help endourologists in planning renal access.

  3. Transit accessibility and labor force participation rate of at-risk groups : Dade County

    DOT National Transportation Integrated Search

    1997-06-01

    This report examines whether transit accessibility to jobs from individual traffic analysis zones has an impact on employment of different racial/ethnic groups. Demonstrations of cross-town bus routes making suburban employment more accessible have b...

  4. Persistent blood stream infection in patients supported with a continuous-flow left ventricular assist device is associated with an increased risk of cerebrovascular accidents.

    PubMed

    Trachtenberg, Barry H; Cordero-Reyes, Andrea M; Aldeiri, Molham; Alvarez, Paulino; Bhimaraj, Arvind; Ashrith, Guha; Elias, Barbara; Suarez, Erik E; Bruckner, Brian; Loebe, Matthias; Harris, Richard L; Zhang, J Yi; Torre-Amione, Guillermo; Estep, Jerry D

    2015-02-01

    Common adverse events in patients supported with Continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection (BSI) and CVA. Medical records of patients who received Heartmate II (HMII) CF-LVADs in 2008-2012 at a single center were reviewed. CVA was categorized as either hemorrhagic (HCVA) or ischemic (ICVA). BSI was divided into persistent (pBSI) and nonpersistent (non-pBSI). pBSI was defined as BSI with the same organism on repeated blood culture >72 hours from initial blood culture despite antibiotics. Univariate and multivariate analyses were performed to determine predictors. A total of 149 patients had HMII implanted; 76% were male, and the overall mean age was 55.4 ± 13 years. There were a total of 19 (13%) patients who had CVA (7 HCVA and 12 ICVA) at a median of 295 days (range 5-1,096 days) after implantation. There were a total of 28 (19%) patients with pBSI and 17 (11%) patients with non-pBSI. Patients with pBSI had a trend toward greater BMI (31 kg/m(2) vs 27 kg/m(2); P = .09), and longer duration of support (1,019 d vs 371 d; P < .001) compared with those with non-pBSI. Persistent BSI was associated with an increased risk of mortality and with all-cause CVA on multivariate analysis (odds ratio [OR] 5.97; P = .003) as well as persistent Pseudomonas aeruginosa infection (OR 4.54; P = .048). Persistent BSI is not uncommon in patients supported by CF-LVAD and is highly associated with all-cause CVA and increased all-cause mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Laparoscopic access overview: Is there a safest entry method?

    PubMed

    Bianchi, G; Martorana, E; Ghaith, A; Pirola, G M; Rani, M; Bove, P; Porpiglia, F; Manferrari, F; Micali, S

    2016-01-01

    Laparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. Laparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. The response rate was 68.33%. The total number of procedures considered was 65.636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but it's the less commonly used. The 28,2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. Laparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According with our study, optical trocar technique seems to be the safest. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Relative fluid novelty differentially alters the time course of limited-access ethanol and water intake in selectively bred high-alcohol-preferring mice.

    PubMed

    Linsenbardt, David N; Boehm, Stephen L

    2015-04-01

    The influence of previous alcohol (ethanol [EtOH])-drinking experience on increasing the rate and amount of future EtOH consumption might be a genetically regulated phenomenon critical to the development and maintenance of repeated excessive EtOH abuse. We have recently found evidence supporting this view, wherein inbred C57BL/6J (B6) mice develop progressive increases in the rate of binge EtOH consumption over repeated drinking-in-the-dark (DID) EtOH access sessions (i.e., "front loading"). The primary goal of this study was to evaluate identical parameters in high-alcohol-preferring (HAP) mice to determine whether similar temporal alterations in limited-access EtOH drinking develop in a population selected for high EtOH preference/intake under continuous (24-hour) access conditions. Using specialized volumetric drinking devices, HAP mice received 14 daily 2-hour DID EtOH or water access sessions. A subset of these mice was then given 1 day access to the opposite assigned fluid on day 15. Home cage locomotor activity was recorded concomitantly on each day of these studies. The possibility of behavioral/metabolic tolerance was evaluated on day 16 using experimenter-administered EtOH. The amount of EtOH consumed within the first 15 minutes of access increased markedly over days. However, in contrast to previous observations in B6 mice, EtOH front loading was also observed on day 15 in mice that only had previous DID experience with water. Furthermore, a decrease in the amount of water consumed within the first 15 minutes of access compared to animals given repeated water access was observed on day 15 in mice with 14 previous days of EtOH access. These data further illustrate the complexity and importance of the temporal aspects of limited-access EtOH consumption and suggest that previous procedural/fluid experience in HAP mice selectively alters the time course of EtOH and water consumption. Copyright © 2015 by the Research Society on Alcoholism.

  7. Relative Fluid Novelty Differentially Alters the Time Course of Limited-Access Ethanol and Water Intake in Selectively Bred High Alcohol Preferring Mice

    PubMed Central

    Linsenbardt, David N.; Boehm, Stephen L.

    2015-01-01

    Background The influence of previous alcohol (ethanol) drinking experience on increasing the rate and amount of future ethanol consumption might be a genetically-regulated phenomenon critical to the development and maintenance of repeated excessive ethanol abuse. We have recently found evidence supporting this view, wherein inbred C57BL/6J (B6) mice develop progressive increases in the rate of binge-ethanol consumption over repeated Drinking-in-the-Dark (DID) ethanol access sessions (i.e. ‘front-loading’). The primary goal of the present study was to evaluate identical parameters in High Alcohol Preferring (HAP) mice to determine if similar temporal alterations in limited-access ethanol drinking develop in a population selected for high ethanol preference/intake under continuous (24hr) access conditions. Methods Using specialized volumetric drinking devices, HAP mice received 14 daily 2 hour DID ethanol or water access sessions. A subset of these mice was then given one day access to the opposite assigned fluid on day 15. Home cage locomotor activity was recorded concomitantly on each day of these studies. The possibility of behavioral/metabolic tolerance was evaluated on day 16 using experimenter administered ethanol. Results The amount of ethanol consumed within the first 15 minutes of access increased markedly over days. However, in contrast to previous observations in B6 mice, ethanol front-loading was also observed on day 15 in mice that only had previous DID experience with water. Furthermore, a decrease in the amount of water consumed within the first 15 minutes of access compared to animals given repeated water access was observed on day 15 in mice with 14 previous days of ethanol access. Conclusions These data further illustrate the complexity and importance of the temporal aspects of limited-access ethanol consumption, and suggest that previous procedural/fluid experience in HAP mice selectively alters the time course of ethanol and water consumption

  8. Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients with Limited English Proficiency

    PubMed Central

    Karliner, Leah S.; Pérez-Stable, Eliseo J.; Gregorich, Steven E.

    2016-01-01

    Background Twenty-five million people in the U.S. have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized. Federal requirements that hospitals provide language access services are very challenging to implement in the fast-paced, 24-hour hospital environment. Objective Determine if increasing access to professional interpreters improves hospital outcomes for older patients with LEP Design Natural experiment on a medicine floor of an academic hospital Participants Patients age ≥50 discharged between Jan 15, 2007–Jan 15, 2010. Exposure Dual-handset interpreter telephone at every bedside July 15, 2008–Mar 14, 2009 Outcome Measures 30-day readmission, length of stay (LOS), estimated hospital expenditures Results Of 8,077 discharges, 1,963 were for LEP, and 6,114 for English-proficient (EP) patients. There was a significant decrease in observed 30-day readmission rates for the LEP group during the 8-month intervention period compared to 18 months pre-intervention (17.8% vs. 13.4%); at the same time EP readmission rates increased (16.7% vs. 19.7%); results remained significant in adjusted analyses. This improved readmission outcome for the LEP group was not maintained during the subsequent post-intervention period when the telephones became less accessible. There was no significant intervention impact on LOS in either unadjusted or adjusted analyses. After accounting for interpreter services costs, the estimated 119 readmissions averted during the intervention period were associated with estimated monthly hospital expenditure savings of $161,404. Conclusions Comprehensive language access represents an important, high value service that all medical centers should provide in order to achieve equitable, quality healthcare for vulnerable LEP populations. PMID:27579909

  9. Common MRI acquisition non-idealities significantly impact the output of the boundary shift integral method of measuring brain atrophy on serial MRI.

    PubMed

    Preboske, Gregory M; Gunter, Jeff L; Ward, Chadwick P; Jack, Clifford R

    2006-05-01

    Measuring rates of brain atrophy from serial magnetic resonance imaging (MRI) studies is an attractive way to assess disease progression in neurodegenerative disorders, particularly Alzheimer's disease (AD). A widely recognized approach is the boundary shift integral (BSI). The objective of this study was to evaluate how several common scan non-idealities affect the output of the BSI algorithm. We created three types of image non-idealities between the image volumes in a serial pair used to measure between-scan change: inconsistent image contrast between serial scans, head motion, and poor signal-to-noise (SNR). In theory the BSI volume difference measured between each pair of images should be zero and any deviation from zero should represent corruption of the BSI measurement by some non-ideality intentionally introduced into the second scan in the pair. Two different BSI measures were evaluated, whole brain and ventricle. As the severity of motion, noise, and non-congruent image contrast increased in the second scan, the calculated BSI values deviated progressively more from the expected value of zero. This study illustrates the magnitude of the error in measures of change in brain and ventricle volume across serial MRI scans that can result from commonly encountered deviations from ideal image quality. The magnitudes of some of the measurement errors seen in this study exceed the disease effect in AD shown in various publications, which range from 1% to 2.78% per year for whole brain atrophy and 5.4% to 13.8% per year for ventricle expansion (Table 1). For example, measurement error may exceed 100% if image contrast properties dramatically differ between the two scans in a measurement pair. Methods to maximize consistency of image quality over time are an essential component of any quantitative serial MRI study.

  10. Management of immunosuppressive therapy in liver transplant recipients who develop bloodstream infection.

    PubMed

    Bartoletti, Michele; Vandi, Giacomo; Furii, Francesca; Bertuzzo, Valentina; Ambretti, Simone; Tedeschi, Sara; Pascale, Renato; Cristini, Francesco; Campoli, Caterina; Morelli, Maria Cristina; Cescon, Matteo; Pinna, Antonio Daniele; Viale, Pierluigi; Giannella, Maddalena

    2018-05-29

    Data about the optimal management of immunosuppressive therapy in liver transplant (LT) recipients with bloodstream infection (BSI) are missing. We aimed to describe the management of immunosuppressive therapy at diagnosis of BSI in LT recipients and to assess its impact on 28-day mortality. We performed a single-centre retrospective study of all LT recipients diagnosed with BSI, over 10-year period. Multivariate Cox regression analysis of risk factors for all-cause 28-day mortality was adjusted for the propensity score of being managed with "any reduction" in immunosuppressive therapy at the diagnosis of BSI. We identified 209 episodes of BSI in 157 LT recipients: 107 (68%) male, median age 54 (IQR 48-63) years. "Any reduction" was made in 90 (43%) cases including: dosage reduction of ≥1 immunosuppressive drug in 31 (15%), discontinuation of ≥1 immunosuppressive drug in 28 (13%), both dosage reduction and discontinuation in 13 (6%), complete withdrawal of immunosuppressive therapy in 18 (9%) cases. All-cause 28-day mortality rate was 13.4%, varying from 22% to 7% (p=0.002) in cases with and without "any reduction". Cox regression showed septic shock (aHR 3.15, p=0.007) and "any reduction" (aHR 2.50, p=0.02) as independent risk factors for all-cause 28-day mortality, while Escherichia coli (aHR 0.38, p=0.03) and source control (aHR 0.43, p=0.04) were protective factors. The final model did not change after the introduction of the propensity score for "any reduction". Any reduction in the immunosuppressive therapy was common and was associated with worse outcome in LT recipients developing BSI. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  11. Validity of calendar day-based definitions for community-onset bloodstream infections.

    PubMed

    Laupland, Kevin B; Gregson, Daniel B; Church, Deirdre L

    2015-04-02

    Community-onset (CO) bloodstream infections (BSI) are those BSI where the blood culture is drawn <48 hours from hospital admission. However, exact times of culture draw or hospital admission are not always available. We evaluated the validity of using 2- or 3- calendar day based definitions for CO-BSI by comparing to a "gold standard" 48-hour definition. Among the population-based cohort of 14,106 episodes of BSI studied, 10,543 were classified as CO based on "gold standard" 48-hour criteria. When 2-day and 3-day definitions were applied, 10,396 and 10,707 CO-BSI episodes were ascertained, respectively. All but 147 (1.4%) true CO-BSI cases were included by using the 2-day definition. When the 3-day definition was applied, all cases of CO-BSI were identified but and additional 164 (1.5%) cases of hospital-onset HO-BSI were also included. Thus the sensitivity and specificity of the 2-day definition was 98.6% and 100% and for the 3-day definition was 100% and 98.5%, respectively. Overall, only 311 (2.2%) cases were potentially miss-classifiable using either the 2- or 3-calendar day based definitions. Use of either a 2- or 3-day definition is highly accurate for classifying CO-BSI.

  12. Bone Scan Index and Progression-free Survival Data for Progressive Metastatic Castration-resistant Prostate Cancer Patients Who Received ODM-201 in the ARADES Multicentre Study.

    PubMed

    Reza, Mariana; Jones, Robert; Aspegren, John; Massard, Christophe; Mattila, Leena; Mustonen, Mika; Wollmer, Per; Trägårdh, Elin; Bondesson, Eva; Edenbrandt, Lars; Fizazi, Karim; Bjartell, Anders

    2016-12-01

    ODM-201, a new-generation androgen receptor inhibitor, has shown clinical efficacy in prostate cancer (PCa). Quantitative methods are needed to accurately assess changes in bone as a measurement of treatment response. The Bone Scan Index (BSI) reflects the percentage of skeletal mass a given tumour affects. To evaluate the predictive value of the BSI in metastatic castration-resistant PCa (mCRPC) patients undergoing treatment with ODM-201. From a total of 134 mCRPC patients who participated in the Activity and Safety of ODM-201 in Patients with Progressive Metastatic Castration-resistant Prostate Cancer clinical trial and received ODM-201, we retrospectively selected all those patients who had bone scan image data of sufficient quality to allow for both baseline and 12-wk follow-up BSI-assessments (n=47). We used the automated EXINI bone BSI software (EXINI Diagnostics AB, Lund, Sweden) to obtain BSI data. We used the Cox proportional hazards model and Kaplan-Meier estimates to investigate the association among BSI, traditional clinical parameters, disease progression, and radiographic progression-free survival (rPFS). In the BSI assessments, at follow-up, patients who had a decrease or at most a 20% increase from BSI baseline had a significantly longer time to progression in bone (median not reached vs 23 wk, hazard ratio [HR]: 0.20; 95% confidence interval [CI], 0.07-0.58; p=0.003) and rPFS (median: 50 wk vs 14 wk; HR: 0.35; 95% CI, 0.17-0.74; p=0.006) than those who had a BSI increase >20% during treatment. The on-treatment change in BSI was significantly associated with rPFS in mCRPC patients, and an increase >20% in BSI predicted reduced rPFS. BSI for quantification of bone metastases may be a valuable complementary method for evaluation of treatment response in mCRPC patients. An increase in Bone Scan Index (BSI) was associated with shorter time to disease progression in patients treated with ODM-201. BSI may be a valuable method of complementing treatment

  13. Civil commitment law, mental health services, and US homicide rates.

    PubMed

    Segal, Steven P

    2012-09-01

    The study considers whether involuntary civil comment (ICC) statute provisions are associated with homicide rates. Do statutes based solely upon dangerousness criteria versus broader ICC-criteria-i.e. "need for treatment," "protection of health and safety," and family protection-have differential associations related to their goal of reducing the frequency of homicide? State-level data were obtained from online data bases and key-informant surveys. Ordinary-least-squares and Poisson regression were used to evaluate the association between statute characteristics, mental health system characteristics, and 2004 Homicide Rates after controlling for firearm-control-law restrictiveness and social-economic-demographic-geographic-and-political indicators historically related to homicide rate variation. Poisson and OLS models, respectively, were significant: likelihood ratio χ(2) = 108.47, df = 10; p < 0.000 and Adj. R (2) = 0.72; df = 10, 25; F = 10.21; p < 0.000. Poisson results indicate that social-economic-demographic-geographic-and-political-indicators had the strongest association with state homicide rates (p < 0.000). Lower rates were associated with: broader ICC-criteria (p ≤ 0.01), fewer inpatient-bed access problems (p ≤ 0.03), and better mental health system ratings (p ≤ 0.04). OLS results indicate that social-economic-demographic-geographic-and-political indicators accounted for 25% of homicide rate variation. Broader ICC-criteria were associated with 1.42 less homicides per 100,000. Less access to psychiatric inpatient-beds and more poorly rated mental health systems were associated with increases in the homicide rates of 1.08 and 0.26 per 100,000, respectively. While social-economic-demographic-geographic-and-political indicators show the strongest association with homicide rate variation, the results show the importance and potentially preventive utility of broader ICC criteria, increased psychiatric inpatient-bed access, and better performing mental

  14. A population-based analysis of injury-related deaths and access to trauma care in rural-remote Northwest British Columbia.

    PubMed

    Simons, Richard; Brasher, Penelope; Taulu, Tracey; Lakha, Nasira; Molnar, Nadine; Caron, Nadine; Schuurman, Nadine; Evans, David; Hameed, Morad

    2010-07-01

    Injury rates and injury mortality rates are generally higher in rural and remote communities compared with urban jurisdictions as has been shown to be the case in the rural-remote area of Northwest (NW) British Columbia (BC). The purpose of study was to identify: (1) the place and timing of death following injury in NW BC, (2) access to and quality of local trauma services, and (3) opportunities to improve trauma outcomes. Quantitative data from demographic and geographic databases, the BC Trauma Registry, Hospital discharge abstract database, and the BC Coroner's Office, along with qualitative data from chart reviews of selected major trauma cases, and interviews with front-line trauma care providers were collated and analyzed for patients sustaining injury in NW BC from April 2001 to March 2006. The majority of trauma deaths (82%) in NW BC occur prehospital. Patients arriving alive to NW hospitals have low hospital mortality (1.0%), and patients transferring from NW BC to tertiary centers have better outcomes than matched patients achieving direct entry into the tertiary center by way of geographic proximity. Access to local trauma services was compromised by: incident discovery, limited phone service (land lines/cell), incomplete 911 emergency medical services system access, geographical and climate challenges compounded by limited transportation options, airport capabilities and paramedic training level, dysfunctional hospital no-refusal policies, lack of a hospital destination policies, and lack of system leadership and coordination. Improving trauma outcomes in this rural-remote jurisdiction requires a systems approach to address root causes of delays in access to care, focusing on improved access to emergency medical services, hospital bypass and destination protocols, improved transportation options, advanced life support transfer capability, and designated, coordinated local trauma services.

  15. Associations between Motivational Orientations and Chronically Accessible Outcomes in Leisure-Time Physical Activity: Are Appearance-Related Outcomes Controlling in Nature?

    ERIC Educational Resources Information Center

    McLachlan, Sarah; Hagger, Martin S.

    2010-01-01

    This study aimed to explore relations between chronically accessible outcomes in physical activity and scaled measures of motivational orientations from a self-determination perspective. Methods from construct and attitude accessibility research and the Levesque and Pelletier (2003) study were used to identify participants' chronically accessible…

  16. The trend in mental health-related mortality rates in Australia 1916-2004: implications for policy

    PubMed Central

    2010-01-01

    Background This study determines the trend in mental health-related mortality (defined here as the aggregation of suicide and deaths coded as "mental/behavioural disorders"), and its relative numerical importance, and to argue that this has importance to policy-makers. Its results will have policy relevance because policy-makers have been predominantly concerned with cost-containment, but a re-appraisal of this issue is occurring, and the trade-off between health expenditures and valuable gains in longevity is being emphasised now. This study examines longevity gains from mental health-related interventions, or their absence, at the population level. The study sums mortality data for suicide and mental/behavioural disorders across the relevant ICD codes through time in Australia for the period 1916-2004. There are two measures applied to the mortality rates: the conventional age-standardised headcount; and the age-standardised Potential Years of Life Lost (PYLL), a measure of premature mortality. Mortality rates formed from these data are analysed via comparisons with mortality rates for All Causes, and with circulatory diseases, cancer and motor vehicle accidents, measured by both methods. Results This study finds the temporal trend in mental health-related mortality rates (which reflects the longevity of people with mental illness) has worsened through time. There are no gains. This trend contrasts with the (known) gains in longevity from All Causes, and the gains from decreases achieved in previously rising mortality rates from circulatory diseases and motor vehicle accidents. Also, PYLL calculation shows mental health-related mortality is a proportionately greater cause of death compared with applying headcount metrics. Conclusions There are several factors that could reverse this trend. First, improved access to interventions or therapies for mental disorders could decrease the mortality analysed here. Second, it is important also that new efficacious

  17. Worktime control access, need and use in relation to work-home interference, fatigue, and job motivation.

    PubMed

    Nijp, Hylco H; Beckers, Debby G J; Kompier, Michiel A J; van den Bossche, Seth N J; Geurts, Sabine A E

    2015-07-01

    Worktime control (WTC) has been suggested as a tool to reduce employees' work-home interference and fatigue and improve job motivation. The purpose of this study was twofold: (i) to examine the prevalence of employees' need for, access to, and use of WTC, as well as the incongruence between need for and access to WTC (ie, mismatch); and (ii) to examine the associations of this mismatch and the use of WTC with employees' work-home interference (WHI), fatigue and job motivation. Questionnaire data were collected among a large (N=2420) quasi-representative sample of Dutch employees. The prevalence of WTC need, access, use, and mismatch was assessed by means of descriptive statistics. Associations with employees' outcomes were assessed by analyses of covariance. The need for WTC was highly prevalent. For many employees, we observed a negative mismatch between access to and need for WTC (ie, accessrelatively high levels of WHI and fatigue, and lower job motivation. The use of WTC was also highly prevalent, but no meaningful associations were found with the outcome variables. It is relevant to examine WTC comprehensively, that is, to include measurements of employees' need for and access to WTC and assess employees' (mis)match between components of WTC. For practice, we recommend to introduce WTC on an organizational level and assess employees' need for WTC on an individual basis.

  18. Global evaluation of erosion rates in relation to tectonics

    NASA Astrophysics Data System (ADS)

    Hecht, Hagar; Oguchi, Takashi

    2017-12-01

    Understanding the mechanisms and controlling factors of erosion rates is essential in order to sufficiently comprehend bigger processes such as landscape evolution. For decades, scientists have been researching erosion rates where one of the main objectives was to find the controlling factors. A variety of parameters have been suggested ranging from climate-related, basin morphometry and the tectonic setting of an area. This study focuses on the latter. We use previously published erosion rate data obtained mainly using 10Be and sediment yield and sediment yield data published by the United States Geological Survey. We correlate these data to tectonic-related factors, i.e., distance to tectonic plate boundary, peak ground acceleration ( PGA), and fault distribution. We also examine the relationship between erosion rate and mean basin slope and find significant correlations of erosion rates with distance to tectonic plate boundary, PGA, and slope. The data are binned into high, medium, and low values of each of these parameters and grouped in all combinations. We find that groups with a combination of high PGA (> 0.2.86 g) and long distance (> 1118.69 km) or low PGA (< 0.68 g) and short distance (< 94.34 km) are almost inexistent suggesting a strong coupling between PGA and distance to tectonic plate boundary. Groups with low erosion rates include long distance and/or low PGA, and groups with high erosion rates include neither of these. These observations indicate that tectonics plays a major role in determining erosion rates, which is partly ascribable to steeper slopes produced by active crustal movements. However, our results show no apparent correlation of slope with erosion rates, pointing to problems with using mean basin-wide slope as a slope indicator because it does not represent the complex slope distribution within a basin.

  19. Italian Percutaneous EVAR (IPER) Registry: outcomes of 2381 percutaneous femoral access sites' closure for aortic stent-graft.

    PubMed

    Pratesi, G; Barbante, M; Pulli, R; Fargion, A; Dorigo, W; Bisceglie, R; Ippoliti, A; Pratesi, C

    2015-12-01

    The aim of this paper was to report outcomes of endovascular aneurysm repair with percutaneous femoral access (pEVAR) using Prostar XL and Proglide closure systems (Abbot Vascular, Santa Clara, CA, USA), from the multicenter Italian Percutaneous EVAR (IPER) registry. Consecutive patients affected by aortic pathology treated by EVAR with percutaneous access (pEVAR) between January 2010 and December 2014 at seven Italian centers were enrolled in this multicenter registry. All the operators had an experience of at least 50 percutaneous femoral access procedures. Data were prospectively collected into a dedicated online database including patient's demographics, anatomical features, intra- and postoperative outcomes. A retrospective analysis was carried out to report intraoperative and 30-day technical success and access-related complication rate. Uni- and multivariate analyses were performed to identify factors potentially associated with an increased risk of percutaneous pEVAR failure. A total of 2381 accesses were collected in 1322 patients, 1249 (94.4%) male with a mean age of 73.5±8.3 years (range 45-97). The overall technical success rate was 96.8% (2305/2381). Major intraoperative access-related complications requiring conversion to surgical cut-down were observed in 3.2% of the cases (76/2381). One-month pEVAR failure-rate was 0.25% (6/2381). Presence of femoral artery calcifications resulted to be a significant predictor of technical failure (OR: 1.69; 95% CI: 1.03-2.77; P=0.036) at multivariate analysis. No significant association was observed with sex (P=0.28), obesity (P=0.64), CFA diameter (P=0.32), level of CFA bifurcation (P=0.94) and sheath size >18 F (P=0.24). The use of Proglide was associated with a lower failure rate compared to Prostar XL (2.5% vs. 3.3%) despite not statistically significant (P=0.33). The results of the IPER registry confirm the high technical success rate of percutaneous EVAR when performed by experienced operators, even in

  20. Catch rates relative to angler party size with implications for monitoring angler success

    USGS Publications Warehouse

    Miranda, L.E.

    2005-01-01

    Angler catch rates often are used to monitor angler success, assess the need for additional management actions, and evaluate the effectiveness of management practices. Potential linkages between catch rate and angler party size were examined to assess how party size might affect the use of catch rate as an index of angler success in recreational fisheries. Data representing 22,355 completed interviews conducted at access points in lakes and reservoirs throughout Mississippi during 1987-2003 were analyzed. Total party catch was not proportional to total party effort; thus, catch rate decreased as party size increased. Depending on the taxa targeted, the average catch rate per angler decreased 40-50% between parties of one and parties of two, although subsequent decreases were less substantial. Because party size accounted for a considerable portion of the variability in catch rate over time and space, failure to remove this variability weakens the manager's ability to detect differences or changes in catch rates. Therefore, the use of catch rates to monitor fisheries may be inappropriate unless party size is taken into account. Party size may influence the angler's ability to catch fish through a variety of processes, including partitioning a limited number of catchable fish among members of a party and party composition. When catch rates are used to estimate total catch rather than to index angler success, party size is not a concern.

  1. Urbanization and Access Inequality to Collective Consumption Goods & Services related to Sanitation & Solid Waste in the cities of Sao Paulo State, Brazil

    NASA Astrophysics Data System (ADS)

    Roig, C. D. A.; Feitosa, F. D. F.; Monteiro, A. M. V.

    2016-12-01

    Cities are mainly a product of collective consumption and there is a pressing need to expand and deepen the discussion about the quality of access to collective goods and services in the urban world: the availability of electricity and potable water and its interrelation with the lack of solid waste management and wastewater treatment leading to pollution of water sources.This study attempts to measure urban stratification through access conditions to collective goods in the metropolitan regions of Sao Paulo State (SPS) by contributing with a research method that incorporates collective consumption as a core component of the population-environment relationship. The use of spatial analysis allows the examination of the structure and distribution of accessibility to sanitation services and basic urban infrastructure.The water stress situation in SPS is dramatic. The average water loss within these distribution systems is 34,3% and a 39% average sewage treatment rate of all wastewater generated. The SPS also imports 60,6% of electricity from other states that use mostly hydroelectric power which imposes greater pressure on the country's water resources. The energy and water crisis has harmed a number of essential rights related mostly to resource access and service continuity as suburban residents of poor municipalities are the ones most affected by disruptions.SPS is the most populous state of Brazil and this region of study is responsible for 75% of total State population with 83% of State GDP. There has been a major increase in water use conflicts such as power generation, urban water supply (including the Rio de Janeiro water demand) and the dilution of urban sewage and solid waste disposal. These collective consumption access problems demonstrate the urgent need for better integrated metropolitan management of natural resources and the urban commons.

  2. Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit

    PubMed Central

    Neill, Sara; Haithcock, Sarah; Smith, P. Brian; Goldberg, Ronald; Bidegain, Margarita; Tanaka, David; Carriker, Charlene; Ericson, Jessica E.

    2015-01-01

    Purpose Reduction of bloodstream infections (BSI) has emerged as an important patient safety goal. Implementation of central line insertion bundles, standardized line care protocols, and health care provider education programs have reduced BSI in neonatal intensive care units (NICUs) around the country. The ability of large tertiary care centers to decrease nosocomial infections, including BSI, has been demonstrated. However, long-term BSI reductions in infants are not well documented. We sought to demonstrate that a low incidence of BSI can be maintained over time in a tertiary care NICU. Subjects 6,790 infants admitted to a large, tertiary care NICU between 2005 and 2013. Design Retrospective intervention study. Methods A staged, multifaceted infection prevention plan was implemented beginning in October 2007 under nursing leadership. The incidence of BSI was determined annually for 2005-2013. Results Baseline BSI incidence for infants admitted to the NICU was 5.15 and 6.08 episodes per 1,000 infant-days in 2005 and 2006, respectively. After protocol implementation, the incidence of BSI decreased to 2.14/1,000 infant-days and 2.44/1,000 infant-days in 2008 and 2009, respectively. Yearly incidence remained low over the next 4 years and decreased even further to 0.20-0.45 infections/1,000 infant days. This represents a 92% decrease in BSI over a period of >5 years. Conclusions Implementation of a nursing-led comprehensive infection control initiative can effectively produce and maintain a reduction in the incidence of BSI in infants at a large tertiary care NICU. What this study adds Long term reductions in neonatal BSI are possible with implementation of a multidisciplinary team approach and strong nursing leadership. PMID:25915573

  3. Are HPV vaccination services accessible to high-risk communities? A spatial analysis of HPV-associated cancer and Chlamydia rates and safety-net clinics.

    PubMed

    Tsui, Jennifer; Rodriguez, Hector P; Gee, Gilbert C; Escobedo, Loraine A; Kominski, Gerald F; Bastani, Roshan

    2013-12-01

    While HPV vaccines can greatly benefit adolescents and young women from high-risk areas, little is known about whether safety-net immunization services are geographically accessible to communities at greatest risk for HPV-associated diseases. We explore the spatial relationship between areas with high HPV risk and proximity to safety-net clinics from an ecologic perspective. We used cancer registry data and Chlamydia surveillance data to identify neighborhoods within Los Angeles County with high risk for HPV-associated cancers. We examined proximity to safety-net clinics among neighborhoods with the highest risk. Proximity was measured as the shortest distance between each neighborhood center and the nearest clinic and having a clinic within 3 miles of each neighborhood center. The average 5-year non-age-adjusted rates were 1,940 cases per 100,000 for Chlamydia and 60 per 100,000 for HPV-associated cancers. A large majority, 349 of 386 neighborhoods with high HPV-associated cancer rates and 532 of 537 neighborhoods with high Chlamydia rates, had a clinic within 3 miles of the neighborhood center. Clinics were more likely to be located within close proximity to high-risk neighborhoods in the inner city. High-risk neighborhoods outside of this urban core area were less likely to be near accessible clinics. The majority of high-risk neighborhoods were geographically near safety-net clinics with HPV vaccination services. Due to low rates of vaccination, these findings suggest that while services are geographically accessible, additional efforts are needed to improve uptake. Programs aimed to increase awareness about the vaccine and to link underserved groups to vaccination services are warranted.

  4. Are HPV vaccination services accessible to high-risk communities?: A spatial analysis of HPV-associated cancer and Chlamydia rates and safety-net clinics

    PubMed Central

    Tsui, Jennifer; Rodriguez, Hector P.; Gee, Gilbert C.; Escobedo, Loraine A.; Kominski, Gerald F.; Bastani, Roshan

    2013-01-01

    Purpose While HPV vaccines can greatly benefit adolescents and young women from high-risk areas, little is known about whether safety-net immunization services are geographically accessible to communities at greatest risk for HPV-associated diseases. We explore the spatial relationship between areas with high HPV risk and proximity to safety-net clinics from an ecologic perspective. Methods We used cancer registry data and Chlamydia surveillance data to identify neighborhoods within Los Angeles County with high risk for HPV-associated cancers. We examined proximity to safety-net clinics among neighborhoods with the highest risk. Proximity was measured as the shortest distance between each neighborhood center and the nearest clinic and having a clinic within 3 miles of each neighborhood center. Results The average 5-year non-age-adjusted rates were 1,940 cases per 100,000 for Chlamydia and 60 per 100,000 for HPV-associated cancers. A large majority, 349 of 386 neighborhoods with high HPV-associated cancer rates and 532 of 537 neighborhoods with high Chlamydia rates had a clinic within 3 miles of the neighborhood center. Clinics were more likely to be located within close proximity to high-risk neighborhoods in the inner city. High-risk neighborhoods outside of this urban core area were less likely to be near accessible clinics. Conclusions The majority of high-risk neighborhoods were geographically near safety-net clinics with HPV vaccination services. Due to low rates of vaccination, these findings suggest that while services are geographically accessible, additional efforts are needed to improve uptake. Programs aimed to increase awareness about the vaccine and to link underserved groups to vaccination services are warranted. PMID:24043448

  5. The Borderline Syndrome Index: a validation study using the personality assessment schedule.

    PubMed

    Marlowe, M J; O'Neill-Byrne, K; Lowe-Ponsford, F; Watson, J P

    1996-01-01

    This study examines the validity and screening properties of the Borderline Syndrome Index--BSI (developed in the USA) for categories of the Personality Assessment Schedule--PAS (developed in the UK). Patients were recruited by case control sampling. Chance corrected agreement between instruments and screening properties of the BSI were calculated. The BSI proved a moderately sensitive but non-specific screen. Questionnaire scores were highly correlated with symptom measures. The results do not support the validity of the BSI or its use as a screening instrument. BSI scores may be distorted by current symptoms.

  6. Magnet-related injury rates in children: a single hospital experience.

    PubMed

    Agbo, Chioma; Lee, Lois; Chiang, Vincent; Landscahft, Assaf; Kimia, Tomer; Monuteaux, Michael C; Kimia, Amir A

    2013-07-01

    The ingestion of multiple magnets simultaneously or the placement of magnets in both nares can lead to serious injury resulting from the attraction of the magnets across the tissues. The impact of mandatory standards for toys containing magnets has not been thoroughly investigated. The aim of the present study was to describe the emergency department (ED) visit rate for magnet-related injuries. We performed a retrospective study of children evaluated for magnet-related injuries from 1995 to 2012 in an urban tertiary care pediatric ED. We identified cases using a computerized text-search methodology followed by manual chart review. We included children evaluated for magnet ingestion or impaction in the ears, nose, vagina, or rectum. We assessed the type and number of magnets as well as management and required interventions. A Poisson regression model was used to analyze rates of injury over time. We identified 112 cases of magnet injuries. The median patient age was 6 years (IQR 3.5, 10), and 54% were male. Compared to before 2006, the rate for all magnet-related injuries in 2007-2012 (incidence rate ratio 3.44; 95% confidence interval 2.3-5.11) as well as multiple magnet-related injuries (incidence rate ratio 7.54; 95% confidence interval 3.51-16.19) increased. Swallowed magnets accounted for 86% of the injuries. Thirteen patients had endoscopy performed for magnet removal (12%), and 4 (4%) had a surgical intervention. Magnets from toys account for the majority of the injuries. The number of ED visits for magnet-related injuries in children may be rising and are underreported, with an increase in the proportion of multiple magnets involvement. In our case series, mandatory standard for toys had no mitigating effect.

  7. Prognostic determinants of community-acquired bloodstream infection in type 2 diabetic patients in ED.

    PubMed

    Yo, Chia-Hung; Lee, Meng-Tse Gabriel; Gi, Weng-Tein; Chang, Shy-Shin; Tsai, Kuang-Chau; Chen, Shyr-Chyr; Lee, Chien-Chang

    2014-12-01

    The objective of the study is to describe the epidemiology and outcome of community-acquired bloodstream infection (BSI) in type 2 diabetic patients in emergency department (ED). All patients admitted to the ED of the university hospital from June 2010 to June 2011 with a history of type 2 diabetes mellitus and microbiologically documented BSI were retrospectively enrolled. Demographic characteristics, Charlson comorbidity index, antibiotic therapy, clinical severity, microbiological etiology, and diabetes-related complications were recorded in a standardized form. The major outcome measure was 30-day survival. χ2 Or Student t test was used for univariate analysis, and Cox proportional hazards models were used for multivariate analysis. Among 250 enrolled emergency patients with BSI, the overall 30-day mortality rate was 15.5%. Twenty-seven patients (10.7%) developed diabetic ketoacidosis (DKA), and 22 patients (8.8%) developed hyperosmolar hyperglycemic state. On univariate analysis, DKA rather than hyperosmolar hyperglycemic state was associated with adverse outcome. Other risk factors include higher mean glycated hemoglobin level, presence of underlying malignancy, long-term use of steroids, lower respiratory tract infection, and higher Charlson scores. Multivariate analysis identified 3 independent risk factors for early mortality when severity, comorbidity, age, and sex were under control: DKA (hazard ratio, 3.89; 95% confidence interval, 1.6-8.9), inappropriate antibiotics (2.25, 1.05-4.82), and chronic use of steroid (3.89, 1.1-13.2). In type 2 diabetic patients with BSI, a substantial proportion of patients developed DKA. This condition was probably underrecognized by clinicians and constituted an independent risk factor for short-term mortality. Other identified risk factors are potentially correctable and may allow preventive efforts to individuals at greatest potential benefit. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Ranging behavior relates to welfare indicators pre- and post-range access in commercial free-range broilers.

    PubMed

    Taylor, Peta S; Hemsworth, Paul H; Groves, Peter J; Gebhardt-Henrich, Sabine G; Rault, Jean-Loup

    2018-06-01

    Little is known about the effect of accessing an outdoor range on chicken welfare. We tracked individual ranging behavior of 538 mixed-sex Ross 308 chickens on a commercial farm across 4 flocks in winter and summer. Before range access, at 17 to 19 d of age, and post-range access, at 30 to 33 and 42 to 46 d of age in winter and summer flocks respectively, welfare indicators were measured on chickens (pre-range: winter N = 292; summer N = 280; post-range: winter N = 131; summer N = 140), including weight, gait score, dermatitis and plumage condition. Post-ranging autopsies were performed (winter: N = 170; summer: N = 60) to assess breast burn, leg health, and ascites. Fewer chickens accessed the range in winter flocks (32.5%) than summer flocks (82.1%). Few relationships between welfare and ranging were identified in winter, likely due to minimal ranging and the earlier age of post-ranging data collection compared to summer flocks. In summer flocks prior to range access, chickens that accessed the range weighed 4.9% less (P = 0.03) than chickens that did not access the range. Pre-ranging weight, gait score, and overall plumage cover predicted the amount of range use by ranging chickens in summer flocks (P < 0.01), but it explained less than 5% of the variation, suggesting other factors are associated with ranging behavior. In summer flocks post-range access, ranging chickens weighed 12.8% less than non-ranging chickens (P < 0.001). More range visits were associated with lower weight (P < 0.01), improved gait scores (P = 0.02), greater breast plumage cover (P = 0.02), lower ascites index (P = 0.01), and less pericardial fluid (P = 0.04). More time spent on the range was associated with lower weight (P < 0.01) and better gait scores (P < 0.01). These results suggest that accessing an outdoor range in summer is partly related to changes in broiler chicken welfare. Further investigations are required to determine causation.

  9. Nutrition therapy cost analysis in the US: pre-mixed multi-chamber bag vs compounded parenteral nutrition.

    PubMed

    Turpin, Robin S; Canada, Todd; Liu, Frank Xiaoqing; Mercaldi, Catherine J; Pontes-Arruda, Alessandro; Wischmeyer, Paul

    2011-09-01

    Bloodstream infections (BSI) occur in up to 350 000 inpatient admissions each year in the US, with BSI rates among patients receiving parenteral nutrition (PN) varying from 1.3% to 39%. BSI-attributable costs were estimated to approximate $US12 000 per episode in 2000. While previous studies have compared the cost of different PN preparation methods, this analysis evaluates both the direct costs of PN and the treatment costs for BSI associated with different PN delivery methods to determine whether compounded or manufactured pre-mixed PN has lower overall costs. The purpose of this study was to compare costs in the US associated with compounded PN versus pre-mixed multi-chamber bag (MCB) PN based on underlying infection risk. Using claims information from the Premier Perspective™ database, multivariate logistic regression was used to estimate the risk of infection. A total of 44 358 hospitalized patients aged ≥18 years who received PN between 1 January 2005 and 31 December 2007 were included in the analyses. A total of 3256 patients received MCB PN and 41 102 received compounded PN. The PN-associated costs and length of stay were analysed using multivariate ordinary least squares regression models constructed to measure the impact of infectious events on total hospital costs after controlling for baseline and clinical patient characteristics. There were 7.3 additional hospital days attributable to BSI. After adjustment for baseline variables, the probability of developing a BSI was 30% higher in patients receiving compounded PN than in those receiving MCB PN (16.1% vs 11.3%; odds ratio = 1.56; 95% CI 1.37, 1.79; p < 0.0001), demonstrating 2172 potentially avoidable infections. The observed daily mean PN acquisition cost for patients receiving MCB PN was $US164 (including all additives and fees) compared with $US239 for patients receiving compounded PN (all differences p < 0.001). With a mean cost attributable to BSI of $US16 141, the total

  10. A Long-term Study of the Association between the Relative Poverty Rate and Suicide Rate in Japan.

    PubMed

    Inoue, Ken; Fujita, Yasuyuki; Takeshita, Haruo; Abe, Shuntaro; Fujihara, Junko; Ezoe, Satoko; Sampei, Mari; Miyaoka, Tsuyoshi; Horiguchi, Jun; Okazaki, Yuji; Fukunaga, Tatsushige

    2016-01-01

    The annual number of suicides in Japan totaled around 23,000 in 1997 and abruptly increased to around 31,000 in 1998. This figure has remained high since then. This abrupt increase in the number of suicides was primarily due to an increase in suicides occasioned by economic concerns. The association between various economic factors and suicide must be studied in detail and over the long term in order to ascertain the association between economic concerns and suicide. This study examined the relative poverty rate and the suicide rate in Japan over 30 years and discussed the association between those two rates. The results suggest that the relative poverty rate may be associated with the suicide rate for both sexes. This association is true for men in particular. The organizations and professionals involved in implementing suicide prevention measures should be cognizant of the current findings and consider formulating additional specific measures. © 2015 American Academy of Forensic Sciences.

  11. Access to Money and Relation to Women’s Use of Family Planning Methods among Young Married Women in Rural India

    PubMed Central

    Reed, Elizabeth; Donta, Balaiah; Dasgupta, Anindita; Ghule, Mohan; Battala, Madhusudana; Nair, Saritha; Silverman, Jay; Jadhav, Arun; Palaye, Prajakta; Saggurti, Niranjan; Raj, Anita

    2016-01-01

    Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women’s access to and decision-making power related to family planning (FP). Women’s access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women’s status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women’s social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n=855), crude and adjusted regression was used to assess women’s access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59%) was associated with condom and other contraceptive use (AORs ranged: 1.5 – 1.8). These findings remained significant after adjusting for women’s FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women’s ability to obtain FP methods, even in contexts where social norms to support women’s power in FP decision-making may not be readily adopted. PMID:26971270

  12. A simple, effective media access protocol system for integrated, high data rate networks

    NASA Technical Reports Server (NTRS)

    Foudriat, E. C.; Maly, K.; Overstreet, C. M.; Khanna, S.; Zhang, L.

    1992-01-01

    The operation and performance of a dual media access protocol for integrated, gigabit networks are described. Unlike other dual protocols, each protocol supports a different class of traffic. The Carrier Sensed Multiple Access-Ring Network (CSMA/RN) protocol and the Circulating Reservation Packet (CRP) protocol support asynchronous and synchronous traffic, respectively. The two protocols operate with minimal impact upon each other. Performance information demonstrates that they support a complete range of integrated traffic loads, do not require call setup/termination or a special node for synchronous traffic control, and provide effective pre-use and recovery. The CRP also provides guaranteed access and fairness control for the asynchronous system. The paper demonstrates that the CSMA-CRP system fulfills many of the requirements for gigabit LAN-MAN networks most effectively and simply. To accomplish this, CSMA-CRP features are compared against similar ring and bus systems, such as Cambridge Fast Ring, Metaring, Cyclic Reservation Multiple Access, and Distributed Dual Queue Data Bus (DQDB).

  13. Access to mental health care among women Veterans: is VA meeting women's needs?

    PubMed

    Kimerling, Rachel; Pavao, Joanne; Greene, Liberty; Karpenko, Julie; Rodriguez, Allison; Saweikis, Meghan; Washington, Donna L

    2015-04-01

    Patient-centered access to mental health describes the fit between patient needs and resources of the system. To date, little data are available to guide implementation of services to women veterans, an underrepresented minority within Department of Veteran Affairs (VA) health care. The current study examines access to mental health care among women veterans, and identifies gender-related indicators of perceived access to mental health care. A population-based sample of 6287 women veterans using VA primary care services participated in a survey of past year perceived need for mental health care, mental health utilization, and gender-related mental health care experiences. Subjective rating of how well mental health care met their needs was used as an indicator of perceived access. Half of all women reported perceived mental health need; 84.3% of those women received care. Nearly all mental health users (90.9%) used VA services, although only about half (48.8%) reported that their mental health care met their needs completely or very well. Gender related experiences (availability of female providers, women-only treatment settings, women-only treatment groups, and gender-related comfort) were each associated with 2-fold increased odds of perceived access, and associations remained after adjusting for ease of getting care. Women VA users demonstrate very good objective access to mental health services. Desire for, and access to specialized mental health services for women varies across the population and are important aspects of shared decision making in referral and treatment planning for women using VA primary care.

  14. Upper limb grafts for hemodialysis access.

    PubMed

    Shemesh, David; Goldin, Ilya; Verstandig, Anthony; Berelowitz, Daniel; Zaghal, Ibrahim; Olsha, Oded

    2015-01-01

    Arteriovenous (AV) grafts are required for hemodialysis access when options for native fistulas have been fully exhausted, where they continue to play an important role in hemodialysis patients, offering a better alternative to central vein catheters. When planning autogenous accesses using Doppler ultrasound, adequate arterial inflow and venous outflow must be consciously preserved for future access creation with grafts. Efforts to improve graft patency include changing graft configuration, graft biology and hemodynamics. Industry offers early cannulation grafts to reduce central catheter use and a bioengineered graft is undergoing clinical studies. Although the outcome of AV grafts is inferior to fistulas, grafts can provide long-term hemodialysis access that is a better alternative to central venous catheters. AV grafts have significant drawbacks, mainly poor patency, infection and cost but also have some advantages: early maturation, ease of creation and needling and widespread availability. The outcome of AV graft surgery is variable from center to center. The primary patency rate for AV grafts is 58% at 6 months and the secondary patency rate is 76% at 6 months and 55% at 18 months. There are centers of excellence that report a 1 year secondary patency rate of up to 91%. In this review of the use of AV grafts for hemodialysis access in the upper extremities, technical issues involved in planning the access and performing the surgery in its different configurations are discussed and the role of surveillance and maintenance with their attendant surgical and radiological interventions is described.

  15. The burden of rheumatoid arthritis and access to treatment: determinants of access.

    PubMed

    Lundqvist, J; Kastäng, F; Kobelt, G; Jönsson, B

    2008-01-01

    As part of the study "The Burden of Rheumatoid Arthritis (RA) and Patient Access to Treatment", this paper reviews the impact on access to RA drugs of the approval processes, pricing and funding decisions and times to market (access) in different countries. In addition, an overview of health technology assessments (HTA) and the economic literature related to RA treatments is provided. The time from approval to market access ranged from immediate to over 500 days in the countries included in the study. A total of 55 HTA reports were identified, 40 of them in the period between 2002 and 2006; 29 were performed by European HTA agencies, 14 in Canada and 7 in the United States. A total of 239 economic evaluations related to RA were identified in a specialized health economic database (HEED).

  16. Heart Rate Variability in Sleep-Related Migraine without Aura

    PubMed Central

    Vollono, Catello; Gnoni, Valentina; Testani, Elisa; Dittoni, Serena; Losurdo, Anna; Colicchio, Salvatore; Di Blasi, Chiara; Mazza, Salvatore; Farina, Benedetto; Della Marca, Giacomo

    2013-01-01

    Objectives: This is an observational study aimed to investigate the activity of autonomic nervous system during sleep in patients with sleep-related migraine. Methods: Eight consecutive migraineurs without aura were enrolled (6 women and 2 men), aged 30 to 62 years (mean 48.1 ± 9.3 years). Inclusion criteria were: high frequency of attacks (> 5 per month) and occurrence of more than 75% of the attacks during sleep causing an awakening. Patients were compared with a control group of 55 healthy subjects (23 men and 32 women, mean age 54.2 ± 13.0 years), and with a further control group of 8 age- and gender-matched healthy controls. Patient and controls underwent polysomnography and heart rate variability analysis. Results: A significant reduction of the LF/HF ratio during N2 and N3 sleep stages was observed in migraineurs compared with controls. No differences in sleep macrostructure were observed; cyclic alternating pattern (CAP) time and CAP rate were lower in migraineurs than in controls. Conclusions: These findings indicate a peculiar modification of the autonomic balance during sleep in sleep-related migraine. The reduction of LF/HF ratio in NREM sleep was observed in controls, but it was quantitatively much more evident in migraineurs. Changes in LF/HF could be consequent to an autonomic unbalance which could manifest selectively (or alternatively become more evident) during sleep. These findings, together with the reduction in CAP rate, could be an expression of reduced arousability during sleep in patients with sleep-related migraine. The simultaneous involvement of the autonomic, arousal, and pain systems might suggest involvement of the hypothalamic pathways. Citation: Vollono C; Gnoni V; Testani E; Dittoni S; Losurdo A; Colicchio S; Di Blasi C; Mazza S; Farina B; Della Marca G. Heart rate variability in sleep-related migraine without aura. J Clin Sleep Med 2013;9(7):707-714. PMID:23853566

  17. Prevalence and incidence of mental health problems among Dutch medical students and the study-related and personal risk factors: a longitudinal study.

    PubMed

    Borst, Jorien M; Frings-Dresen, Monique H W; Sluiter, Judith K

    2016-11-01

    A high prevalence of mental health problems (i.e. depression and/or anxiety) has been found in medical students in comparison with the general population. Therefore, the objective was first to study the prevalence and 1-year incidence of symptoms of depression, anxiety and any mental health problems among Dutch medical students and, second, to study which study-related and personal factors present a risk of these mental health problems. A 1-year prospective longitudinal study was performed among medical students of two medical faculties in the Netherlands (n=951). Health problems and study-related and personal factors were measured with an online questionnaire. Mental health problems were assessed by depression and/or anxiety symptoms (BSI-DEP and BSI-ANG). Univariate and multivariate hierarchical logistic regression analyses were performed to examine which of the study-related and personal factors predict mental health problems. At follow-up, 36%, 28% and 48% of the medical students reported symptoms of depression, anxiety and mental health problems, respectively. The incidence between 2010 and 2011 for depression was 20%, 17% for anxiety and 25% for mental health problems. Students who are worried about their own health during medical education are at an increased risk of future mental health problems (OR 2.0 [1.3-2.9], p=0.00). Excessive drinking behavior is a protective factor in this study (OR 0.7 [0.5-0.9], p=0.02). This study shows that only two out of nine factors are significantly associated with mental health problems among Dutch medical students, one risk factor and one protective factor.

  18. Land use change affects biogenic silica pool distribution in a subtropical soil toposequence

    NASA Astrophysics Data System (ADS)

    Unzué-Belmonte, Dácil; Ameijeiras-Mariño, Yolanda; Opfergelt, Sophie; Cornelis, Jean-Thomas; Barão, Lúcia; Minella, Jean; Meire, Patrick; Struyf, Eric

    2017-07-01

    Land use change (deforestation) has several negative consequences for the soil system. It is known to increase erosion rates, which affect the distribution of elements in soils. In this context, the crucial nutrient Si has received little attention, especially in a tropical context. Therefore, we studied the effect of land conversion and erosion intensity on the biogenic silica pools in a subtropical soil in the south of Brazil. Biogenic silica (BSi) was determined using a novel alkaline continuous extraction where Si / Al ratios of the fractions extracted are used to distinguish BSi and other soluble fractions: Si / Al > 5 for the biogenic AlkExSi (alkaline-extractable Si) and Si / Al < 5 for the non-biogenic AlkExSi. Our study shows that deforestation can rapidly (< 50 years) deplete the biogenic AlkExSi pool in soils depending on the slope of the study site (10-53 %), with faster depletion in steeper sites. We show that higher erosion in steeper sites implies increased accumulation of biogenic Si in deposition zones near the bottom of the slope, where rapid burial can cause removal of BSi from biologically active zones. Our study highlights the interaction of erosion strength and land use for BSi redistribution and depletion in a soil toposequence, with implications for basin-scale Si cycling.

  19. Interpersonal relations between health care workers and young clients: barriers to accessing sexual and reproductive health care.

    PubMed

    Alli, Farzana; Maharaj, Pranitha; Vawda, Mohammed Yacoob

    2013-02-01

    Interpersonal relations between health care providers and young clients have long being cited as an important element for improving client up take of services, satisfaction and overall health outcomes. In an era of HIV and AIDS this forms a critical determinant to young people accessing sexual and reproductive health care. This study explores to what extent interpersonal relations form a barrier to young peoples access to and satisfaction of health services. The study draws on data from 200 client exit interviews and four in-depth interviews conducted with university students and university health care staff in Kwazulu-Natal, South Africa. While young people are aware of the importance of utilising STI, HIV and family planning services they experienced barriers in their relationship with providers. This served as a deterrent to their use of the health facility. Adequate training in interpersonal relations for youth-friendly service provision is essential in helping overcome communication problems and enabling providers to interact with young clients at a more personal level.

  20. Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study

    PubMed Central

    Metzger, Marie; Labeeuw, Michel; Ayav, Carole; Jacquelinet, Christian; Massy, Ziad A.; Stengel, Bénédicte

    2017-01-01

    Determinants of nonfunctional arteriovenous (AV) access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter. We estimated crude and adjusted odds ratio (OR) with 95% confidence intervals (CI) of nonfunctional versus functional AV access associated with case-mix, facility characteristics, and timing of AV access creation. Analyses were stratified by dialysis start condition (planned or as an emergency) and comorbidity profile. Overall, 18% patients had nonfunctional AV access at hemodialysis initiation. In the group with planned dialysis start, female gender (OR 1.43, 95% CI 1.32–1.56), diabetes (OR 1.28, 95% CI 1.15–1.44), and a higher number of cardiovascular comorbidities (OR 1.27, 95% CI 1.09–1.49, and 1.31, 1.05–1.64, for 3 and >3 cardiovascular comorbidities versus none, respectively) were independent predictors of nonfunctional AV access. A higher percentage of AV access creation at the region level was associated with a lower rate of nonfunctional AV access (OR 0.98, 95% CI 0.98–0.99 per 1% increase). The odds of nonfunctional AV access decreased as time from creation to hemodialysis initiation increased up to 3 months in nondiabetic patients with fewer than 2 cardiovascular comorbidities and 6 months in patients with diabetes or 2 or more such comorbidities. In conclusion, both patient characteristics and clinical practices may play a role in successful AV access use at hemodialysis initiation. Adjusting the timing of AV access creation to patients’ comorbidity profiles may improve functional AV access rates. PMID:28749967

  1. Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study.

    PubMed

    Alencar de Pinho, Natalia; Coscas, Raphael; Metzger, Marie; Labeeuw, Michel; Ayav, Carole; Jacquelinet, Christian; Massy, Ziad A; Stengel, Bénédicte

    2017-01-01

    Determinants of nonfunctional arteriovenous (AV) access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter. We estimated crude and adjusted odds ratio (OR) with 95% confidence intervals (CI) of nonfunctional versus functional AV access associated with case-mix, facility characteristics, and timing of AV access creation. Analyses were stratified by dialysis start condition (planned or as an emergency) and comorbidity profile. Overall, 18% patients had nonfunctional AV access at hemodialysis initiation. In the group with planned dialysis start, female gender (OR 1.43, 95% CI 1.32-1.56), diabetes (OR 1.28, 95% CI 1.15-1.44), and a higher number of cardiovascular comorbidities (OR 1.27, 95% CI 1.09-1.49, and 1.31, 1.05-1.64, for 3 and >3 cardiovascular comorbidities versus none, respectively) were independent predictors of nonfunctional AV access. A higher percentage of AV access creation at the region level was associated with a lower rate of nonfunctional AV access (OR 0.98, 95% CI 0.98-0.99 per 1% increase). The odds of nonfunctional AV access decreased as time from creation to hemodialysis initiation increased up to 3 months in nondiabetic patients with fewer than 2 cardiovascular comorbidities and 6 months in patients with diabetes or 2 or more such comorbidities. In conclusion, both patient characteristics and clinical practices may play a role in successful AV access use at hemodialysis initiation. Adjusting the timing of AV access creation to patients' comorbidity profiles may improve functional AV access rates.

  2. Black silicon: fabrication methods, properties and solar energy applications

    DOE PAGES

    Liu, Xiaogang; Coxon, Paul R.; Peters, Marius; ...

    2014-08-04

    Black silicon (BSi) represents a very active research area in renewable energy materials. The rise of BSi as a focus of study for its fundamental properties and potentially lucrative practical applications is shown by several recent results ranging from solar cells and light-emitting devices to antibacterial coatings and gas-sensors. Here in this article, the common BSi fabrication techniques are first reviewed, including electrochemical HF etching, stain etching, metal-assisted chemical etching, reactive ion etching, laser irradiation and the molten salt Fray-Farthing-Chen-Cambridge (FFC-Cambridge) process. The utilization of BSi as an anti-reflection coating in solar cells is then critically examined and appraised, basedmore » upon strategies towards higher efficiency renewable solar energy modules. Methods of incorporating BSi in advanced solar cell architectures and the production of ultra-thin and flexible BSi wafers are also surveyed. Particular attention is given to routes leading to passivated BSi surfaces, which are essential for improving the electrical properties of any devices incorporating BSi, with a special focus on atomic layer deposition of Al 2O 3. Finally, three potential research directions worth exploring for practical solar cell applications are highlighted, namely, encapsulation effects, the development of micro-nano dual-scale BSi, and the incorporation of BSi into thin solar cells. It is intended that this paper will serve as a useful introduction to this novel material and its properties, and provide a general overview of recent progress in research currently being undertaken for renewable energy applications.« less

  3. SIPP ACCESS: Information Tools Improve Access to National Longitudinal Panel Surveys.

    ERIC Educational Resources Information Center

    Robbin, Alice; David, Martin

    1988-01-01

    A computer-based, integrated information system incorporating data and information about the data, SIPP ACCESS systematically links technologies of laser disk, mainframe computer, microcomputer, and electronic networks, and applies relational technology to provide access to information about complex statistical data collections. Examples are given…

  4. The effect of alkaline pretreatment methods on cellulose structure and accessibility

    DOE PAGES

    Bali, Garima; Meng, Xianzhi; Deneff, Jacob I.; ...

    2014-11-24

    The effects of different alkaline pretreatments on cellulose structural features and accessibility are compared and correlated with the enzymatic hydrolysis of Populus. The pretreatments are shown to modify polysaccharides and lignin content to enhance the accessibility for cellulase enzymes. The highest increase in the cellulose accessibility was observed in dilute sodium hydroxide, followed by methods using ammonia soaking and lime (Ca(OH) 2). The biggest increase of cellulose accessibility occurs during the first 10 min of pretreatment, with further increases at a slower rate as severity increases. Low temperature ammonia soaking at longer residence times dissolved a major portion of hemicellulosemore » and exhibited higher cellulose accessibility than high temperature soaking. Moreover, the most significant reduction of degree of polymerization (DP) occurred for dilute sodium hydroxide (NaOH) and ammonia pretreated Populus samples. The study thus identifies important cellulose structural features and relevant parameters related to biomass recalcitrance.« less

  5. Vascular access choice in incident hemodialysis patients: a decision analysis.

    PubMed

    Drew, David A; Lok, Charmaine E; Cohen, Joshua T; Wagner, Martin; Tangri, Navdeep; Weiner, Daniel E

    2015-01-01

    Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 70% of United States dialysis patients. A decision tree model was constructed to reflect progression from hemodialysis initiation. Patients were classified into one of three vascular access choices: maintain CVC, attempt fistula, or attempt graft. We explicitly modeled probabilities of primary and secondary patency for each access type, with success modified by age, sex, and diabetes. Access-specific mortality was incorporated using preexisting cohort data, including terms for age, sex, and diabetes. Costs were ascertained from the 2010 USRDS report and Medicare for procedure costs. An AV fistula attempt strategy was found to be superior to AV grafts and CVCs in regard to mortality and cost for the majority of patient characteristic combinations, especially younger men without diabetes. Women with diabetes and elderly men with diabetes had similar outcomes, regardless of access type. Overall, the advantages of an AV fistula attempt strategy lessened considerably among older patients, particularly women with diabetes, reflecting the effect of lower AV fistula success rates and lower life expectancy. These results suggest that vascular access-related outcomes may be optimized by considering individual patient characteristics. Copyright © 2015 by the American Society of Nephrology.

  6. Silicon dynamics in the Oder estuary, Baltic Sea

    NASA Astrophysics Data System (ADS)

    Pastuszak, Marianna; Conley, Daniel J.; Humborg, Christoph; Witek, Zbigniew; Sitek, Stanisław

    2008-10-01

    Studies on dissolved silicate (DSi) and biogenic silica (BSi) dynamics were carried out in the Oder estuary, Baltic Sea in 2000-2005. The Oder estuary proved to be an important component of the Oder River-Baltic Sea continuum where very intensive seasonal DSi uptake during spring and autumn, but also BSi regeneration during summer take place. Owing to the regeneration process annual DSi patterns in the river and the estuary distinctly differed; the annual patterns of DSi in the estuary showed two maxima and two minima in contrast to one maximum- and one minimum-pattern in the Oder River. DSi concentrations in the river and in the estuary were highest in winter (200-250 μmol dm - 3 ) and lowest (often less than 1 μmol dm - 3 ) in spring, concomitant with diatom growth; such low values are known to be limiting for new diatom growth. Secondary DSi summer peaks at the estuary exit exceeded 100 μmol dm - 3 , and these maxima were followed by autumn minima coinciding with the autumn diatom bloom. Seasonal peaks in BSi concentrations (ca. 100 μmol dm - 3 ) occurred during the spring diatom bloom in the Oder River. Mass balance calculations of DSi and BSi showed that DSi + BSi import to the estuary over a two year period was 103.2 kt and that can be compared with the DSi export of 98.5 kt. The difference between these numbers gives room for ca. 2.5 kt BSi to be annually exported to the Baltic Sea. Sediment cores studies point to BSi annual accumulation on the level of 2.5 kt BSi. BSi import to the estuary is on the level of ca. 10.5 kt, thus ca. 5 kt of BSi is annually converted into the DSi, increasing the pool of DSi that leaves the system. BSi concentrations being ca. 2 times higher at the estuary entrance than at its exit remain in a good agreement with the DSi and BSi budgeting presented in the paper.

  7. Prevention of central venous catheter-related bloodstream infections using non-technologic strategies.

    PubMed

    Gnass, Silvia Acosta; Barboza, Luisa; Bilicich, Dafne; Angeloro, Pablo; Treiyer, Walter; Grenóvero, Silvia; Basualdo, Juan

    2004-08-01

    To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them. This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from April 1997 to December 2001. The medical-surgical ICU of a tertiary-care, university-affiliated hospital in Argentina. We studied all patients admitted to the ICU using non-impregnated CVCs. Maximal sterile barrier precautions (ie, use of cap, mask, sterile gown, sterile gloves, and large sterile drape), strict handwashing, preparation of the patients' skin with antiseptic solutions, insertion and management of catheters by trained personnel, and continuing quality improvement programs aimed at appropriate insertion and maintenance of catheters were employed. During the study period, 2,525 patients were admitted to the ICU. Eight hundred sixty-eight patients had 1,037 CVCs inserted. The number of CVC-related bloodstream infections (BSIs), acquired in the ICU, was 2.7 per 1,000 CVC-days (13 nosocomial CVC-related BSIs during 4,770 days of CVC use). Microorganisms isolated included methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), coagulase-negative methicillin-resistant Staphylococcus (n = 2), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 1), and Enterobacter cloacae (n = 1). A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters. The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU.

  8. Rating the Accessibility of Library Tutorials from Leading Research Universities

    ERIC Educational Resources Information Center

    Clossen, Amanda; Proces, Paul

    2017-01-01

    Video and Web-based tutorials created by libraries from 71 public universities designated by the Carnegie Classification as having the Highest Research Activity (R1) were reviewed for accessibility and usability by disabled people. The results of this review indicate that a large portion of library tutorial content meets neither the minimum legal…

  9. Unique characteristics of community-onset healthcare- associated bloodstream infections: a multi-centre prospective surveillance study of bloodstream infections in Japan.

    PubMed

    Takeshita, N; Kawamura, I; Kurai, H; Araoka, H; Yoneyama, A; Fujita, T; Ainoda, Y; Hase, R; Hosokawa, N; Shimanuki, H; Sekiya, N; Ohmagari, N

    2017-05-01

    Analysis of bloodstream infections (BSIs) is valuable for their diagnosis, treatment and prevention. However, limited data are available in Japan. To investigate the characteristics of patients with bacteraemia in Japan. This study was conducted in five hospitals from October 2012 to September 2013. Clinical, demographic, microbiological and outcome data for all blood-culture-positive cases were analysed. In total, 3206 cases of BSI were analysed: 551 community-onset healthcare-associated (CHA)-BSIs, 1891 hospital-acquired (HA)-BSIs and 764 community-acquired (CA)-BSIs. The seven- and 30-day mortality rates were higher in patients with CHA- and HA-BSIs than in patients with CA-BSIs. The odds ratios (ORs) for seven-day mortality were 2.56 [95% confidence interval (CI) 1.48-4.41] and 2.63 (95% CI 1.64-4.19) for CHA- and HA-BSIs, respectively. The ORs for 30-day mortality were 2.41 (95% CI 1.63-3.57) and 3.31 (95% CI 2.39-4.59) for CHA- and HA-BSIs, respectively. There were 499 cases (15.2%) of central-line-associated BSI and 163 cases (5.0%) of peripheral-line-associated BSI. Major pathogens included coagulase-negative staphylococci (N = 736, 23.0%), Escherichia coli (N = 581, 18.1%), Staphylococcus aureus (N = 294, 9.2%) and Klebsiella pneumoniae (N = 263, 8.2%). E. coli exhibited a higher 30-day mortality rate among patients with HA-BSIs (22.3%) compared with patients with CHA-BSIs (12.3%) and CA-BSIs (3.4%). K. pneumoniae exhibited higher 30-day mortality rates in patients with HA-BSIs (22.0%) and CHA-BSIs (22.7%) compared with patients with CA-BSIs (7.8%). CHA- and HA-BSIs had higher mortality rates than CA-BSIs. The prognoses of E. coli- and K. pneumonia-related BSIs differed according to the category of bacteraemia. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  10. Relationship between household access to food and malnutrition in eastern and southern Africa.

    PubMed

    Mwadime, R K; Baldwin, S L

    1994-09-01

    This review paper gives an overview of the relationship between household access to food and malnutrition using national level data in the Eastern and Southern Africa Region. The overall prevalence of malnutrition amongst the under-five population have not changed significantly over the decade and, in some cases, have deteriorated. The situation of household access to food differs between economies and production systems, but most households (average of 80%) in the region do not have access to adequate food. A preliminary analysis of the determinants of malnutrition at country level pointed to the importance of: financial access to food (an indicator of household access to food) and; access to safe water (an indicator of household healthy environment), as the most significant variables predicting rates of malnutrition. Several areas for action by governments in the region and for further study within the subject of household access to food are delineated. These are: more clear determination of the relative contribution of household access to food, to the nutritional status of women and children and, improved analysis of indicators of household access to food.

  11. International Policies on Sharing Genomic Research Results with Relatives: Approaches to Balancing Privacy with Access.

    PubMed

    Branum, Rebecca; Wolf, Susan M

    2015-01-01

    Returning genetic research results to relatives raises complex issues. In order to inform the U.S. debate, this paper analyzes international law and policies governing the sharing of genetic research results with relatives and identifies key themes and lessons. The laws and policies from other countries demonstrate a range of approaches to balancing individual privacy and autonomy with family access for health benefit, offering important lessons for further development of approaches in the United States. © 2015 American Society of Law, Medicine & Ethics, Inc.

  12. Do Better-rated Navigators Improve Patient Satisfaction with Cancer-Related Care?

    PubMed Central

    Jean-Pierre, Pascal; Winters, Paul C.; Clark, Jack A.; Warren-Mears, Victoria; Wells, Kristen J.; Post, Douglas M.; LaVerda, Nancy; Van Duyn, Mary Ann; Fiscella, Kevin

    2013-01-01

    Background Patient navigation has emerged as a promising strategy for addressing racial-ethnic and socioeconomic disparities in cancer-related care. However, little is known about the impact of patients’ perception of the quality of navigation on patient outcomes. We examined the impact of better-rated navigators on patients’ satisfaction with cancer related care. Methods The sample included 1,593 adults (85.8% with abnormal cancer screening and 14.2% with confirmed cancer diagnosis) who received patient navigation. We defined better-rated navigators as those scoring above the first quartile of mean scores on the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) scale. We defined patient satisfaction based on scores above or below the median of the Patient Satisfaction with Cancer-Related Care scale (PSCC). We controlled for patient and site characteristics using backward selection logistic regression analyses. Results Among patients with abnormal screening, having a better-rated navigator was associated with higher score on the PSCC (p<0.05). After controlling for other bivariate predictors of satisfaction (e.g., age, race, income, and household size), navigation by better-rated navigators was associated with a greater likelihood of having higher patient satisfaction (Odds Ratio [OR]: 1.38, 95% Confidence Interval [CI]: 1.05-1.82). Similar findings between better-rated navigators and score on the PSCC were found for participants with diagnosed cancer (OR: 3.06, 95% CI: 1.56-6.0). Conclusions Patients navigated by better-rated navigators reported higher satisfaction with their cancer-related care. PMID:23807598

  13. Surveillance of US Death Rates from Chronic Diseases Related to Excessive Alcohol Use.

    PubMed

    Polednak, Anthony P

    2016-01-01

    To assess the utility of multiple-cause (MC) death records for surveillance of US mortality rates from chronic causes related to excessive alcohol use. The Alcohol-Related Disease Impact (ARDI) resource produced estimates of the population 'alcohol attributable fraction' (AAF) due to excessive drinking for each alcohol-related (AAF > 0%) cause of death, and used AAFs to estimate numbers of alcohol-related deaths from alcohol-related underlying causes (UC) in adults age 20-64 and 65+ years in 2006-2010. For surveillance, this study used MC death file to identify individual deaths (2006-2010) with an 'alcohol-induced' cause (AAF = 100%) anywhere on the certificate, and to obtain US rates of premature death (ages 15-64 and 65-74 years) for 1999-2012. Using the selected MC records, numbers of deaths from alcohol-related chronic UC (2006-2010) were 81% of ARDI estimates for age 20-64, but only 40% for 65+ years. The MC records identified substantial numbers of deaths from causes (e.g. certain infectious diseases) not included as alcohol-related in ARDI, but included in surveillance of premature death rates for chronic UC. Also, premature death rates for chronic alcohol-induced causes using only the UC (as in routine mortality statistics) were only about half the rates based on MC; all rates increased in recent years but some reached statistical significance only by using MC. Using MC records underestimated total US deaths from alcohol-related chronic causes as the UC, but enhanced surveillance of rates for premature deaths involving chronic causes that may be related to excessive alcohol use. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

  14. Assessment method of accessibility conditions: how to make public buildings accessible?

    PubMed

    Andrade, Isabela Fernandes; Ely, e Vera Helena Moro Bins

    2012-01-01

    The enforcement of accessibility today has faced several difficulties, such as intervention in historic buildings that now house public services and cultural activities, such as town halls, museums and theaters and should allow access, on equal terms to all people. The paper presents the application of a method for evaluating the spatial accessibility conditions and their results. For this, we sought to support the theoretical foundation about the main issue involved and legislation. From the method used--guided walks--it was possible to identify the main barriers to accessibility in historic buildings. From the identified barriers, possible solutions are presented according to the four components of accessibility: spatial orientation, displacement, use and communication. It is hoped also that the knowledge gained in this research contributes to an improvement of accessibility legislation in relation to the listed items.

  15. Optical monitoring of neuronal activity at high frame rate with a digital random-access multiphoton (RAMP) microscope.

    PubMed

    Otsu, Yo; Bormuth, Volker; Wong, Jerome; Mathieu, Benjamin; Dugué, Guillaume P; Feltz, Anne; Dieudonné, Stéphane

    2008-08-30

    Two-photon microscopy offers the promise of monitoring brain activity at multiple locations within intact tissue. However, serial sampling of voxels has been difficult to reconcile with millisecond timescales characteristic of neuronal activity. This is due to the conflicting constraints of scanning speed and signal amplitude. The recent use of acousto-optic deflector scanning to implement random-access multiphoton microscopy (RAMP) potentially allows to preserve long illumination dwell times while sampling multiple points-of-interest at high rates. However, the real-life abilities of RAMP microscopy regarding sensitivity and phototoxicity issues, which have so far impeded prolonged optical recordings at high frame rates, have not been assessed. Here, we describe the design, implementation and characterisation of an optimised RAMP microscope. We demonstrate the application of the microscope by monitoring calcium transients in Purkinje cells and cortical pyramidal cell dendrites and spines. We quantify the illumination constraints imposed by phototoxicity and show that stable continuous high-rate recordings can be obtained. During these recordings the fluorescence signal is large enough to detect spikes with a temporal resolution limited only by the calcium dye dynamics, improving upon previous techniques by at least an order of magnitude.

  16. Is Clostridium difficile infection a risk factor for subsequent bloodstream infection?

    PubMed

    Ulrich, Robert J; Santhosh, Kavitha; Mogle, Jill A; Young, Vincent B; Rao, Krishna

    2017-12-01

    Clostridium difficile infection (CDI) is a common nosocomial diarrheal illness increasingly associated with mortality in United States. The underlying factors and mechanisms behind the recent increases in morbidity from CDI have not been fully elucidated. Murine models suggest a mucosal barrier breakdown leads to bacterial translocation and subsequent bloodstream infection (BSI). This study tests the hypothesis that CDI is associated with subsequent BSI in humans. We conducted a retrospective cohort study on 1132 inpatients hospitalized >72 h with available stool test results for toxigenic C. difficile. The primary outcome was BSI following CDI. Secondary outcomes included 30-day mortality, colectomy, readmission, and ICU admission. Unadjusted and adjusted logistic regression models were developed. CDI occurred in 570 of 1132 patients (50.4%). BSI occurred in 86 (7.6%) patients. Enterococcus (14%) and Klebsiella (14%) species were the most common organisms. Patients with BSI had higher comorbidity scores and were more likely to be male, on immunosuppression, critically ill, and have a central venous catheter in place. Of the patients with BSI, 36 (42%) had CDI. CDI was not associated with subsequent BSI (OR 0.69; 95% CI 0.44-1.08; P = 0.103) in unadjusted analysis. In multivariable modeling, CDI appeared protective against subsequent BSI (OR 0.57; 95% CI 0.34-0.96; P = 0.036). Interaction modeling suggests a complicated relationship among CDI, BSI, antibiotic exposure, and central venous catheter use. In this cohort of inpatients that underwent testing for CDI, CDI was not a risk factor for developing subsequent BSI. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Effects of network node consolidation in optical access and aggregation networks on costs and power consumption

    NASA Astrophysics Data System (ADS)

    Lange, Christoph; Hülsermann, Ralf; Kosiankowski, Dirk; Geilhardt, Frank; Gladisch, Andreas

    2010-01-01

    The increasing demand for higher bit rates in access networks requires fiber deployment closer to the subscriber resulting in fiber-to-the-home (FTTH) access networks. Besides higher access bit rates optical access network infrastructure and related technologies enable the network operator to establish larger service areas resulting in a simplified network structure with a lower number of network nodes. By changing the network structure network operators want to benefit from a changed network cost structure by decreasing in short and mid term the upfront investments for network equipment due to concentration effects as well as by reducing the energy costs due to a higher energy efficiency of large network sites housing a high amount of network equipment. In long term also savings in operational expenditures (OpEx) due to the closing of central office (CO) sites are expected. In this paper different architectures for optical access networks basing on state-of-the-art technology are analyzed with respect to network installation costs and power consumption in the context of access node consolidation. Network planning and dimensioning results are calculated for a realistic network scenario of Germany. All node consolidation scenarios are compared against a gigabit capable passive optical network (GPON) based FTTH access network operated from the conventional CO sites. The results show that a moderate reduction of the number of access nodes may be beneficial since in that case the capital expenditures (CapEx) do not rise extraordinarily and savings in OpEx related to the access nodes are expected. The total power consumption does not change significantly with decreasing number of access nodes but clustering effects enable a more energyefficient network operation and optimized power purchase order quantities leading to benefits in energy costs.

  18. Mid-Holocene Strengthening of the Bering Strait Inflow to the Arctic and its Linkage With the North Atlantic Subpolar Gyre Circulation

    NASA Astrophysics Data System (ADS)

    Yamamoto, M.; Nam, S. I.; Polyak, L.; Kobayashi, D.; Suzuki, K.; Irino, T.; Shimada, K.

    2017-12-01

    The Bering Strait inflow (BSI) is an important element of the Arctic Ocean circulation system. We report records of the chlorite/illite ratios in three sediment cores from the northern Chukchi Sea providing insights into the long-term dynamics of the BSI during the Holocene. The BSI approximation by the chlorite/illite record, despite a considerable geographic variability, consistently shows intensified flow from the Bering Sea to the Arctic during the middle Holocene, which is attributed primarily to the effect of higher atmospheric pressure over the Aleutian Basin. The intensified BSI was associated with decrease in sea-ice concentrations and increase in marine production, as indicated by biomarker concentrations, suggesting a major influence of the BSI on sea-ice and biological conditions in the Chukchi Sea. Multi-century to millennial fluctuations, presumably controlled by solar activity, were also identified. This middle Holocene strengthening of the BSI was coeval with intense subpolar gyre circulation in the North Atlantic. We propose that the BSI is linked with the North Atlantic circulation via an atmospheric teleconnection between the Aleutian and Icelandic Lows.

  19. Pregnant women's use of information and communications technologies to access pregnancy-related health information in South Australia.

    PubMed

    Rodger, D; Skuse, A; Wilmore, M; Humphreys, S; Dalton, J; Flabouris, M; Clifton, V L

    2013-01-01

    This paper examines how pregnant women living in South Australia use information and communication technologies (ICTs), principally Internet and mobile phones, to access pregnancy-related information. It draws on 35 semistructured interviews conducted as part of the 'Health-e Baby' project, a qualitative study designed to assess the information needs and ICT preferences of pregnant women cared for at a South Australian metropolitan teaching hospital. Our research shows that although ICTs offer exciting possibilities for health promotion and the potential for new forms of communication, networking and connection, we cannot assume the effectiveness of communicating through such channels, despite near universal levels of ICT access. In turn, this highlights that if e-mediated health promotion is to be effective, health promoters and practitioners need to better understand ICT access, usage and content preferences of their clients.

  20. Tuning negative differential resistance in single-atomic layer boron-silicon sheets

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Zhou, Ming-Yue; Liu, Chun-Sheng, E-mail: csliu@njupt.edu.cn, E-mail: yanxh@njupt.edu.cn; Key Laboratory of Radio Frequency and Micro-Nano Electronics of Jiangsu Province, Nanjing 210023, Jiangsu

    2015-03-21

    Using density functional theory and nonequilibrium Green's function formalism for quantum transport calculation, we have quantified the ballistic transport properties along different directions in two-dimensional boron-silicon (B-Si) compounds, as well as the current response to bias voltage. The conductance of the most B-Si devices is higher than the conductance of one-atom-thick boron and silicene. Furthermore, the negative differential resistance phenomenon can be found at certain B-Si stoichiometric composition, and it occurs at various bias voltages. Also, the peak-to-valley ratio is sensitive to the B-Si composition and dependent of the direction considered for B-Si monolayers. The present findings could be helpfulmore » for applications of the single-atomic layer B-Si sheets in the field of semiconductor devices or low-dimensional electronic devices.« less

  1. Dual-mode ultraflow access networks: a hybrid solution for the access bottleneck

    NASA Astrophysics Data System (ADS)

    Kazovsky, Leonid G.; Shen, Thomas Shunrong; Dhaini, Ahmad R.; Yin, Shuang; De Leenheer, Marc; Detwiler, Benjamin A.

    2013-12-01

    Optical Flow Switching (OFS) is a promising solution for large Internet data transfers. In this paper, we introduce UltraFlow Access, a novel optical access network architecture that offers dual-mode service to its end-users: IP and OFS. With UltraFlow Access, we design and implement a new dual-mode control plane and a new dual-mode network stack to ensure efficient connection setup and reliable and optimal data transmission. We study the impact of the UltraFlow system's design on the network throughput. Our experimental results show that with an optimized system design, near optimal (around 10 Gb/s) OFS data throughput can be attained when the line rate is 10Gb/s.

  2. Nonoperative management of splenic injury in combat: 2002-2012.

    PubMed

    Mitchell, Thomas A; Wallum, Timothy E; Becker, Tyson E; Aden, James K; Bailey, Jeffrey A; Blackbourne, Lorne H; White, Christopher E

    2015-03-01

    Selective nonoperative management of combat-related blunt splenic injury (BSI) is controversial. We evaluated the impact of the November 2008 blunt abdominal trauma clinical practice guideline that permitted selective nonoperative management of some patients with radiological suggestion of hemoperitoneum on implementation of nonoperative management (NOM) of splenic injury in austere environments. Retrospective evaluation of patients with splenic injuries from November 2002 through January 2012 in Iraq and Afghanistan was performed. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes identified patients as laparotomy with splenectomy, or NOM. Delayed operative management had no operative intervention at earlier North American Treaty Organization (NATO) medical treatment facilities (MTFs), and had a definitive intervention at a latter NATO MTFs. Intra-abdominal complications and overall mortality were juxtaposed. A total of 433 patients had splenic injuries from 2002 to 2012. Initial NOM of BSI from 2002 to 2008 compared to 2009-2012 was 44.1% and 47.2%, respectively (p=0.75). Delayed operative management and NOM completion had intra-abdominal complication and mortality rates of 38.1% and 9.1% (p<0.01), and 6.3% and 8.1% (p=0.77). Despite high-energy explosive injuries, NATO Role II MTFs radiological constraints and limited medical resources, hemodynamically normal patients with BSI and low abdominal abbreviated injury scores underwent NOM in austere environments. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  3. Are Competitive Materialism and Female Employment Related to International Homicide Rate?

    PubMed

    Chon, Don Soo

    2017-04-01

    The institutional anomie theory is a proposal that states competitive materialism, an intense cultural pressure for economic success at any costs, and increased female employment may be related to a high homicide rate. The current work tested this proposition by utilizing homicide data collected from 45 developed and developing countries. Regression results did not support the proposition. Competitive materialism and female employment were not significantly related to the cross-national variation of homicide rates.

  4. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  5. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  6. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  7. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  8. 24 CFR 1000.554 - Which agencies have right of access to the recipient's records relating to activities carried out...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring, Oversight and Accountability § 1000.554 Which agencies have right of access to the recipient's records relating to activities carried out under NAHASDA... to the recipient's records relating to activities carried out under NAHASDA? 1000.554 Section 1000...

  9. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions.

    PubMed

    Reynders, A; Kerkhof, A J F M; Molenberghs, G; Van Audenhove, C

    2014-02-01

    Accessibility and availability of mental health care services are necessary but not sufficient for people to seek help for psychological problems. Attitudes and stigma related to help seeking also determine help seeking intentions. The aim of this study is to investigate how cross-national differences in attitudes and stigma within the general population are related to professional and informal help seeking intentions in low and high suicide rate regions. By means of a postal structured questionnaire, data of 2999 Dutch and Flemish respondents between 18 and 65 years were gathered. Attitudes toward help seeking, perceived stigma, self-stigma, shame and intention to seek help were assessed. People in the Netherlands, where suicide rates are low, have more positive attitudes toward help seeking and experience less self stigma and shame compared to the people in Flanders, where suicide rates are relatively high. These attitudinal factors predicted professional as well as informal help seeking intentions. Perceived stigma was negatively associated with informal help seeking. Shame was positively associated with higher intention to use psychotropic drugs and perceived stigma was negatively associated with the intention to seek help from a psychotherapist in Flanders but not in the Netherlands. Help seeking for psychological problems prevent these problems to aggravate and it is assumed to be a protective factor for suicide. Our results stress the importance of the promotion of positive attitudes and the reduction of stigma within the general population to facilitate help seeking from professional providers and informal networks. Focusing on these attitudinal factors is believed to be a key aspect of universal mental health and suicide prevention policies.

  10. Seasonal Variations of Indoor Microbial Exposures and Their Relation to Temperature, Relative Humidity, and Air Exchange Rate

    PubMed Central

    Bekö, Gabriel; Timm, Michael; Gustavsen, Sine; Hansen, Erik Wind

    2012-01-01

    Indoor microbial exposure has been related to adverse pulmonary health effects. Exposure assessment is not standardized, and various factors may affect the measured exposure. The aim of this study was to investigate the seasonal variation of selected microbial exposures and their associations with temperature, relative humidity, and air exchange rates in Danish homes. Airborne inhalable dust was sampled in five Danish homes throughout the four seasons of 1 year (indoors, n = 127; outdoors, n = 37). Measurements included culturable fungi and bacteria, endotoxin, N-acetyl-beta-d-glucosaminidase, total inflammatory potential, particles (0.75 to 15 μm), temperature, relative humidity, and air exchange rates. Significant seasonal variation was found for all indoor microbial exposures, excluding endotoxin. Indoor fungi peaked in summer (median, 235 CFU/m3) and were lowest in winter (median, 26 CFU/m3). Indoor bacteria peaked in spring (median, 2,165 CFU/m3) and were lowest in summer (median, 240 CFU/m3). Concentrations of fungi were predominately higher outdoors than indoors, whereas bacteria, endotoxin, and inhalable dust concentrations were highest indoors. Bacteria and endotoxin correlated with the mass of inhalable dust and number of particles. Temperature and air exchange rates were positively associated with fungi and N-acetyl-beta-d-glucosaminidase and negatively with bacteria and the total inflammatory potential. Although temperature, relative humidity, and air exchange rates were significantly associated with several indoor microbial exposures, they could not fully explain the observed seasonal variations when tested in a mixed statistical model. In conclusion, the season significantly affects indoor microbial exposures, which are influenced by temperature, relative humidity, and air exchange rates. PMID:23001651

  11. Widening Access to Higher Education: An Evaluative Case Study of a Foundation Year Alternative to Access

    ERIC Educational Resources Information Center

    Reddy, Peter A.; Moores, Elisabeth

    2008-01-01

    Universities are encouraged to widen access to a broad range of applicants, including mature students taking Access qualifications. Admissions tutors can find it difficult to compare and choose between Access and A-level applications, and Access applicants for popular courses may be disadvantaged relative to students with good A-levels. In this…

  12. Comparison of the boomerang wire vascular access management system versus manual compression alone during percutaneous diagnostic and interventional cardiovascular procedures: The boomerang™ wire vascular access management trial II.

    PubMed

    Goswami, Nilesh J; Smalling, Ronnie G; Sinha, Shantanu; Gammon, Roger S; Ramaiah, Venkatesh G

    2016-01-01

    To evaluate the use of the Boomerang™ Wire as an adjunct to manual compression (MC) in patients requiring diagnostic (Dx) or interventional (Ix) percutaneous procedures. MC remains the standard of care for closure of femoral artery access sites. Adjunctive use of a device to facilitate closure, reduce time to hemostasis (TTH) and ambulation (TTA) without increasing complication rates could reduce costs and hospital resource demands. The Boomerang™ Trial was a prospective, multicenter, randomized, controlled trial comparing use of the Boomerang™ wire, (Cardiva Medical, Sunnyvale, CA) in conjunction with MC versus MC alone to achieve hemostasis in Dx and Ix patients undergoing percutaneous procedures requiring femoral artery access. Endpoints included TTH, TTA, major, and minor access-site related complications. Subjects were randomized 3:1, Boomerang versus MC. No minor or major device-related adverse events were reported. Nondevice related complication rates were 3 (0.9%) in the Boomerang arm (n = 327) and 1 (0.8%) in MC arm (n = 123). Mean TTH for Boomerang vs. MC was 11.2 ± 4.3 vs. 23.2 ± 11 min for Dx (P < 0.0001) and 13.9 ± 5.4 vs. 38.4 ± 57.3 min for Ix patients (P < 0.0001). Mean TTA for Boomerang vs. MC was 3.3 ± 3.0 vs. 4.5 ± 2.0 hr (P < 0.0001)for Dx and 5.4 ± 3.3 vs. 6.8 ± 3.2 hr (P < 0.0001) for Ix patients. Boomerang™ use, in conjunction with MC, was associated with low rates of complications and demonstrated that Boomerang™ as an adjunct to MC can significantly decrease TTH and TTA after both Dx and Ix procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  13. Ethnic differences in smoking rate, nicotine dependence, and cessation-related variables among adult smokers in Hawaii.

    PubMed

    Herzog, Thaddeus A; Pokhrel, Pallav

    2012-12-01

    This study tests hypotheses concerning ethnic disparities in daily cigarette smoking rates, nicotine dependence, cessation motivation, and knowledge and past use of cessation methods (e.g., counseling) and products (e.g., nicotine patch) in a multiethnic sample of smokers in Hawaii. Previous research has revealed significant differences in smoking prevalence among Native Hawaiians, Filipinos, Japanese, and Caucasians in Hawaii. However, no study has examined differences in dependence and cessation-related knowledge and practices among smokers representing these ethnic groups. Participants were recruited through newspaper advertisement as part of a larger smoking cessation intervention study. Participants (N = 919; M age = 45.6, SD = 12.7; 48 % women) eligible to participate provided self-report data through mail and telephone. Participants included 271 self-identified Native Hawaiians, 63 Filipinos, 316 Caucasians, 145 "East Asians" (e.g., Japanese, Chinese), and 124 "other" (e.g., Hispanic, African-American). Pair-wise comparisons of means, controlling for age, gender, income, education, and marital status, indicated that Native Hawaiian smokers reported significantly higher daily smoking rates and higher levels of nicotine dependence compared to East Asians. Native Hawaiian smokers reported significantly lower motivation to quit smoking than Caucasians. Further, Filipino and Native Hawaiian smokers reported lesser knowledge of cessation methods and products, and less frequent use of these methods and products than Caucasians. The results suggest that Native Hawaiian and Filipino smokers could be underserved with regard to receiving cessation-related advice, and may lack adequate access to smoking cessation products and services. In addition, cessation interventions tailored for Native Hawaiian smokers could benefit from a motivational enhancement component.

  14. Accessing doctors at times of need-measuring the distance tolerance of rural residents for health-related travel.

    PubMed

    McGrail, Matthew Richard; Humphreys, John Stirling; Ward, Bernadette

    2015-05-29

    Poor access to doctors at times of need remains a significant impediment to achieving good health for many rural residents. The two-step floating catchment area (2SFCA) method has emerged as a key tool for measuring healthcare access in rural areas. However, the choice of catchment size, a key component of the 2SFCA method, is problematic because little is known about the distance tolerance of rural residents for health-related travel. Our study sought new evidence to test the hypothesis that residents of sparsely settled rural areas are prepared to travel further than residents of closely settled rural areas when accessing primary health care at times of need. A questionnaire survey of residents in five small rural communities of Victoria and New South Wales in Australia was used. The two outcome measures were current travel time to visit their usual doctor and maximum time prepared to travel to visit a doctor, both for non-emergency care. Kaplan-Meier charts were used to compare the association between increased distance and decreased travel propensity for closely-settled and sparsely-settled areas, and ordinal multivariate regression models tested significance after controlling for health-related travel moderating factors and town clustering. A total of 1079 questionnaires were completed with 363 from residents in closely-settled locations and 716 from residents in sparsely-settled areas. Residents of sparsely-settled communities travel, on average, 10 min further than residents of closely-settled communities (26.3 vs 16.9 min, p < 0.001), though this difference was not significant after controlling for town clustering. Differences were more apparent in terms of maximum time prepared to travel (54.1 vs 31.9 min, p < 0.001). Differences of maximum time remained significant after controlling for demographic and other constraints to access, such as transport availability or difficulties getting doctor appointments, as well as after controlling for town

  15. Do Dogs Know Related Rates Rather than Optimization?

    ERIC Educational Resources Information Center

    Perruchet, Pierre; Gallego, Jorge

    2006-01-01

    Although dogs seemingly follow the optimal path where they get to a ball thrown into the water, they certainly do not know the minimization function proposed in the calculus books. Trading the optimization problem for a related rates problem leads to a mathematically identical solution, which, it is argued here, is a more plausible model for the…

  16. Toward one Giga frames per second--evolution of in situ storage image sensors.

    PubMed

    Etoh, Takeharu G; Son, Dao V T; Yamada, Tetsuo; Charbon, Edoardo

    2013-04-08

    The ISIS is an ultra-fast image sensor with in-pixel storage. The evolution of the ISIS in the past and in the near future is reviewed and forecasted. To cover the storage area with a light shield, the conventional frontside illuminated ISIS has a limited fill factor. To achieve higher sensitivity, a BSI ISIS was developed. To avoid direct intrusion of light and migration of signal electrons to the storage area on the frontside, a cross-sectional sensor structure with thick pnpn layers was developed, and named "Tetratified structure". By folding and looping in-pixel storage CCDs, an image signal accumulation sensor, ISAS, is proposed. The ISAS has a new function, the in-pixel signal accumulation, in addition to the ultra-high-speed imaging. To achieve much higher frame rate, a multi-collection-gate (MCG) BSI image sensor architecture is proposed. The photoreceptive area forms a honeycomb-like shape. Performance of a hexagonal CCD-type MCG BSI sensor is examined by simulations. The highest frame rate is theoretically more than 1Gfps. For the near future, a stacked hybrid CCD/CMOS MCG image sensor seems most promising. The associated problems are discussed. A fine TSV process is the key technology to realize the structure.

  17. Streptococcus anginosus group bloodstream infections in the western interior of British Columbia, Canada.

    PubMed

    Laupland, Kevin B; Pasquill, Kelsey; Parfitt, Elizabeth C; Dagasso, Gabrielle; Steele, Lisa

    2018-06-01

    The epidemiology of Streptococcus anginosus group (SaG) bloodstream infections (BSI) has not been well defined in non-selected populations. The objective of this study was to determine the incidence, risk factors and outcome associated with SaG BSI. Population-based surveillance was conducted in the western interior region of British Columbia, Canada between 1 April 2010 and 31 March 2017. Forty-six episodes were identified for an overall annual incidence of 3.7 per 100,000 population. The incidence increased with older age and males were at significantly higher risk (5.2 vs. 2.1 per 100,000; incidence rate ratio, 2.5; 95% confidence interval, 1.3-5.1; p = .004). Nearly one-half (22; 48%) of patients had no chronic co-morbid illness, whereas 17 (40%) had 1-2, six (13%) had 3-4 and one (2%) had 5 Charlson scores with diabetes and cancer being the most common. Predisposing factors for development of SaG BSI were identified in 30 (65%) cases. The gastro-intestinal tract was the most common focus of infection (13; 28%) followed by cardiovascular and skin/soft tissue (six cases each; 13%) and in seven (15%) cases no focus was identified. Drainage procedures were required in 21 (46%) patients of whom seven (15%) patients had percutaneous drains and 14 (30%) required surgical operations. Forty-one (89%) patients were admitted to hospital for a median hospital length stay of 11 (interquartile range, 7-18) days. The in-hospital and 30-day all cause case-fatality rates were 3/41 (7%) and 4/46 (9%), respectively. SaG BSI is an important cause of morbidity and mortality.

  18. Relational interventions in psychotherapy: development of a therapy process rating scale.

    PubMed

    Ulberg, Randi; Ness, Elisabeth; Dahl, Hanne-Sofie Johnsen; Høglend, Per Andreas; Critchfield, Kenneth; Blayvas, Phelix; Amlo, Svein

    2016-09-06

    In psychodynamic psychotherapy, one of the therapists' techniques is to intervene on and encourage exploration of the patients' relationships with other people. The impact of these interventions and the response from the patient are probably dependent on certain characteristics of the context in which the interventions are given and the interventions themselves. To identify and analyze in-session effects of therapists' techniques, process scales are used. The aim of the present study was to develop a simple, not resource consuming rating tool for in-session process to be used when therapists' interventions focus on the patients' relationships outside therapy. The present study describes the development and use of a therapy process rating scale, the Relational Work Scale (RWS). The scale was constructed to identify, categorize and explore therapist interventions that focus on the patient's relationships to family, friends, and colleges Relational Interventions and explore the impact on the in-session process. RWS was developed with sub scales rating timing, content, and valence of the relational interventions, as well as response from the patient. For the inter-rater reliability analyzes, transcribed segments (10 min) from 20 different patients were scored with RWS by two independent raters. Two clinical vignettes of relational work are included in the paper as examples of how to rate transcripts from therapy sessions with RWS. The inter-rater agreement on the RWS items was good to excellent. Relational Work Scale might be a potentially useful tool to identify relational interventions as well as explore the interaction of timing, category, and valence of relational work in psychotherapies. The therapist's interventions on the patient's relationships with people outside therapy and the following patient-therapist interaction might be explored. First Experimental Study of Transference-interpretations (FEST307/95) REGISTRATION NUMBER: ClinicalTrials.gov Identifier

  19. Comparison of Predictors and Mortality Between Bloodstream Infections Caused by ESBL-Producing Escherichia coli and ESBL-Producing Klebsiella pneumoniae.

    PubMed

    Scheuerman, Oded; Schechner, Vered; Carmeli, Yehuda; Gutiérrez-Gutiérrez, Belen; Calbo, Esther; Almirante, Benito; Viale, Pier-Luigy; Oliver, Antonio; Ruiz-Garbajosa, Patricia; Gasch, Oriol; Gozalo, Monica; Pitout, Johann; Akova, Murat; Peña, Carmen; Molina, Jose; Hernández-Torres, Alicia; Venditti, Mario; Prim, Nuria; Origüen, Julia; Bou, German; Tacconelli, Evelina; Tumbarello, Maria; Hamprecht, Axel; Karaiskos, Ilias; de la Calle, Cristina; Pérez, Federico; Schwaber, Mitchell J; Bermejo, Joaquin; Lowman, Warren; Hsueh, Po-Ren; Navarro-San Francisco, Carolina; Bonomo, Robert A; Paterson, David L; Pascual, Alvaro; Rodríguez-Baño, Jesus

    2018-06-01

    OBJECTIVETo compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypesMETHODSAs part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.RESULTSThe study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non-CTX-M ESBLs were detected.CONCLUSIONSClinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.CLINICAL TRIALS IDENTIFIERClinicalTrials.gov. Identifier: NCT01764490.Infect Control Hosp Epidemiol 2018;39:660-667.

  20. Emergency Contraception Pill Awareness and Knowledge in Uninsured Adolescents: High Rates of Misconceptions Concerning Indications for Use, Side Effects, and Access.

    PubMed

    Yen, Sophia; Parmar, Deepika D; Lin, Emily L; Ammerman, Seth

    2015-10-01

    To determine the awareness of, access to, and knowledge of the proper use of emergency contraception pills (ECPs) among uninsured adolescents. Anonymous surveys were used to assess awareness of, knowledge of, and access to ECPs. From 2010 to 2012 at mobile primary care clinic in the San Francisco Bay Area. Patients were uninsured adolescents aged 13 to 25; 40% of the participants were currently or had been homeless in the past year. Ethnicity was 50% Asian, 22% Hispanic, 17% Pacific Islanders, 5.5% white, and 5.5% other/mixed ethnicity. Post survey completion, patients received one-on-one 15-minute dedicated ECP education. Awareness of, knowledge of, and access to ECPs. Of the study population of 439, 30% of the participants were 13-16 years old and 70% were 17-25 years old (mean age 17.8 years); 66% were women. Young women (86%) reported higher rates of "hearing about emergency contraception" than did young men (70%) (P < .0001). Many incorrectly identified or were uncertain if ECPs were an abortion pill (40%) or could be used as regular birth control (40%) or to prevent sexually transmitted infections (19%). Only 40% of women and 43% of men aged 17 and older correctly answered that they could obtain EC over the counter; 72% did not know that males could receive EC for use by their partner; 12% incorrectly selected that infertility was a side effect; 44% were under the false impression that EC had to be taken within 1 day of unprotected sex. Uninsured adolescents have high rates of ECP awareness but low ECP knowledge. These adolescents need more ECP education to alleviate misconceptions and increase practical knowledge, specifically, education about male access, side effects, over-the-counter availability for young men and women, and the 120-hour window of use. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  1. Accessing disability services by people from culturally and linguistically diverse backgrounds in Australia.

    PubMed

    Zhou, Qingsheng

    2016-01-01

    To examine whether differences in access to specialist disability services by people from culturally and linguistically diverse (CALD) backgrounds when compared with those born in Australia represent a service gap or the healthy migrant effect. To use the latest disability statistics to measure the different rates of people with disability, and the rates of people with profound and severe disability, of people born in Australia and those born abroad; to compare the difference between those who mainly speak English with those who primarily speak a language other than English at home (LOTE); and examine the age-specific and standardised disability rates of these subgroups. The rate of access of specialist disability services by people with disability who were from CALD backgrounds is highly disproportionate to their presence in the community. As a whole, people from CALD backgrounds have a similar level of disability as Australia-born people. They have a greater rate of profound and severe disability and a higher level of need for assistance in undertaking core activities. For younger age cohorts targeted by specialist disability services, there is little difference in the level of need for assistance between people from CALD backgrounds and the rest of community. Those people who mainly speak LOTE at home have a relatively higher level of need for assistance than those who speak mainly English at home. The paper reveals a substantial gap in specialist disability services between people from CALD and the broader community. This cannot be explained by the difference in the level of need for assistance between Australia-born and overseas-born populations, therefore raises some policy questions as to the barriers to the use of such services and how to effectively narrow the service access gap and improve utilisation rates. The paper reveals a substantial accessibility gap in specialist disability services between people from culturally and linguistically diverse (CALD

  2. Trends in cancer mortality in the European Union and accession countries, 1980-2000.

    PubMed

    Levi, F; Lucchini, F; Negri, E; Zatonski, W; Boyle, P; La Vecchia, C

    2004-09-01

    Cancer mortality rates and trends over the period 1980-2000 for accession countries to the European Union (EU) in May 2004, which include a total of 75 million inhabitants, were abstracted from the World Health Organization (WHO) database, together with, for comparative purposes, those of the current EU. Total cancer mortality for men was 166/100,000 in the EU, but ranged between 195 (Lithuania) and 269/100,000 (Hungary) in central and eastern European accession countries. This excess related to most cancer sites, including lung and other tobacco-related neoplasms, but also stomach, intestines and liver, and a few neoplasms amenable to treatment, such as testis, Hodgkin's disease and leukaemias. Overall cancer mortality for women was 95/100,000 in the EU, and ranged between 100 and 110/100,000 in several central and eastern European countries, and up to 120/100,000 in the Czech Republic and 138/100,000 in Hungary. The latter two countries had a substantial excess in female mortality for lung cancer, but also for several other sites. Furthermore, for stomach and especially (cervix) uteri, female rates were substantially higher in central and eastern European accession countries. Over the last two decades, trends in mortality were systematically less favourable in accession countries than in the EU. Most of the unfavourable patterns and trends in cancer mortality in accession countries are due to recognised, and hence potentially avoidable, causes of cancer, including tobacco, alcohol, dietary habits, pollution and hepatitis B, plus inadequate screening, diagnosis and treatment. Consequently, the application of available knowledge on cancer prevention, diagnosis and treatment may substantially reduce the disadvantage now registered in the cancer mortality of central and eastern European accession countries.

  3. Clinical benefit of ertapenem compared to flomoxef for the treatment of cefotaxime-resistant Enterobacteriaceae bacteremia.

    PubMed

    Lee, Chen-Hsiang; Chen, I-Ling; Li, Chia-Chin; Chien, Chun-Chih

    2018-01-01

    Cefotaxime-resistant Enterobacteriaceae (CE) infections are intractable, with limited treatment options. Though carbapenems are frequently prescribed for CE infections, the emergence of carbapenem-resistant Enterobacteriaceae is of huge concern. Flomoxef is effective against CE in vitro, and some clinical data on its demonstrated effectiveness against CE bloodstream infections (BSIs) exists. We conducted a retrospective study on adults with BSI caused by flomoxef-susceptible CE to investigate the efficacy of flomoxef compared with that of ertapenem. The outcome was evaluated with propensity score-based matching and logistic regression analysis. Demographic and clinical characteristics of patients treated with flomoxef (n = 58) or ertapenem (n = 188) were compared. In the multivariate analysis, severe sepsis (adjusted odds ratio [AOR] = 3.84; 95% confidence interval [CI], 1.16-12.78; p = 0.03), high BSI mortality score (AOR = 5.59; 95% CI, 2.37-13.21; p < 0.01), ultimately or rapidly fatal comorbidity (AOR = 10.60; 95% CI, 3.43-32.75; p < 0.01), and pneumonia (AOR = 10.11; 95% CI, 3.43-29.81; p < 0.01) were independently associated with 28-day mortality. Using propensity scores, 58 flomoxef-treated patients were matched to 116 ertapenem-treated patients. There were no intergroup differences in BSI severity, comorbidity, or BSI sources. The 28-day mortality rates (20.7% vs 13.8%, p = 0.28) did not differ significantly. However, hospitalization length was shorter in the ertapenem group (10.2 ± 8.5 vs. 14.6 ± 9.4 days, p < 0.01). Although similar outcomes were observed between the groups, ertapenem therapy was associated with a shorter hospitalization time in adults after CE BSI.

  4. The learning curve for access creation in solo ultrasonography-guided percutaneous nephrolithotomy and the associated skills.

    PubMed

    Yu, Weimin; Rao, Ting; Li, Xing; Ruan, Yuan; Yuan, Run; Li, Chenglong; Li, Haoyong; Cheng, Fan

    2017-03-01

    The aim of the current trial was to evaluate the learning curve of access creation through solo ultrasonography (US)-guided percutaneous nephrolithotomy (PCNL), and clarify the technical details of the procedure. We evaluated the first 240 solo US-guided PCNLs performed by one surgeon at our institution. The data including the puncture procedure, access characteristics, access-related complications and stone-free rates were assessed in four sequential groups. The puncture duration and number of times decreased from a mean of 4.4 min and 2.1 times for the first 60 patients to 1.3 min and 1.2 times for the last 60 patients. There was a significant decrease from 3.7 min and 1.8 times for the 61th-120th patients to 1.5 min and 1.3 times for the 121th-180th patients. All of the access-related severe bleeding appeared in the first 120 patients, while perforations only occurred in the first 60 patients. The stone-free rates were 68.3, 83.3, 90.0, and 93.3% for the four sequential groups. The increase in experience lead to an improvement in the puncture duration and times, which accompany with better stone-free rates and lower complications. We propose that 60 operations are sufficient to gain competency, and a cutoff point of 120 operations will allow the surgeon to achieve excellence in the solo US-guided PCNL.

  5. National Utility Rate Database: Preprint

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ong, S.; McKeel, R.

    2012-08-01

    When modeling solar energy technologies and other distributed energy systems, using high-quality expansive electricity rates is essential. The National Renewable Energy Laboratory (NREL) developed a utility rate platform for entering, storing, updating, and accessing a large collection of utility rates from around the United States. This utility rate platform lives on the Open Energy Information (OpenEI) website, OpenEI.org, allowing the data to be programmatically accessed from a web browser, using an application programming interface (API). The semantic-based utility rate platform currently has record of 1,885 utility rates and covers over 85% of the electricity consumption in the United States.

  6. Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil.

    PubMed

    Resende, Daiane Silva; Ó, Jacqueline Moreira do; Brito, Denise von Dolinger de; Abdallah, Vânia Olivetti Steffen; Gontijo Filho, Paulo Pinto

    2011-01-01

    Catheter-associated bloodstream infection (CA-BSI) is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. A total of sixty-seven (26.7%) CA-BSIs were observed. There were 46 (32%) episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]). Neonates in the group after implementation of the intervention had 21 (19.6%) episodes of CA-BSI (14.9 per 1,000 CVC days). The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04). In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

  7. ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study.

    PubMed

    Ankomah, Augustine; Ganle, John Kuumuori; Lartey, Margaret Yaa; Kwara, Awewura; Nortey, Priscilla Awo; Okyerefo, Michael Perry Kweku; Laar, Amos Kankponang

    2016-12-07

    Timely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access-related barriers that HIV+ persons linked to care in southern Ghana face. A mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons. All (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors' advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence

  8. 'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England.

    PubMed

    Bion, Julian; Richardson, Annette; Hibbert, Peter; Beer, Jeanette; Abrusci, Tracy; McCutcheon, Martin; Cassidy, Jane; Eddleston, Jane; Gunning, Kevin; Bellingan, Geoff; Patten, Mark; Harrison, David

    2013-02-01

    Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions. We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification. Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely. The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.

  9. Trends in Pre-School Enrolment in Turkey: Unequal Access and Differential Consequences

    ERIC Educational Resources Information Center

    Agirdag, Orhan; Yazici, Zeliha; Sierens, Sven

    2015-01-01

    In this study, a historical and international analysis of early childhood education in Turkey is made. More specifically, we explore the trend in pre-school enrolment, compare Turkey's enrolment rate with other countries, study whether access to pre-school is related to social class and gender, and investigate the impact of pre-school attendance…

  10. Socio-economic and locational determinants of accessibility and utilization of primary health-care.

    PubMed

    Field, K S; Briggs, D J

    2001-09-01

    Differences in levels of utilization vary and are a function of socio-economic and geographical factors. This paper presents the results of a questionnaire study involving twelve GP practices in Northamptonshire, UK, of factors which affect access and utilization in asthmatics and diabetics; these groups were selected to control for differences in utilization behaviour, as a result of different aetiologies. The questionnaire sought data on: residential location of patients, utilization characteristics of primary health-care, personal circumstances and mobility and hindrances to access and utilization. Key themes were identified relating to age, gender, social class, employment, ethnicity and proximity to the GP surgery. The young, elderly and females report higher rates of utilization, as do nonmanual workers and those who are unemployed. However, accessibility and utilization vary greatly in response to mobility and locational characteristics; these variations tend to be masked by data on overall rates of usage. Optimal scaling techniques were used to investigate the interactions between the factors affecting accessibility and utilization, and to characterize patients in terms of their levels of utilization. Results confirmed that current service provision afforded a differential level of service to patients, which does not directly reflect their level of need.

  11. Disparities in access to medical care for individuals with vision impairment.

    PubMed

    Spencer, Christine; Frick, Kevin; Gower, Emily W; Kempen, John H; Wolff, Jennifer L

    2009-01-01

    We investigated the relationship between blindness and vision impairment and access to medical care. Pooled data from the Medical Expenditure Panel Survey (MEPS) years 2002-2004 were used to identify non-institutionalized individuals over the age of 40 with either self-reported blindness, vision impairment, or no vision impairment (n = 40,643). Differences in access to care measures by vision status were assessed, after adjusting for the complex sampling design of the MEPS, using either two-sided z-tests or two-sided t-tests. Individuals with blindness and vision impairment report having more access problems related to cost of care, availability of insurance coverage, transportation issues, and refusal of services by providers, although they do not report lower rates of having a usual source of care compared to those without vision impairment. The results suggest that access to care for individuals with blindness and vision impairment is problematic, for reasons that are amenable to policy interventions.

  12. Intensive inpatient treatment for bulimia nervosa: Statistical and clinical significance of symptom changes.

    PubMed

    Diedrich, Alice; Schlegl, Sandra; Greetfeld, Martin; Fumi, Markus; Voderholzer, Ulrich

    2018-03-01

    This study examines the statistical and clinical significance of symptom changes during an intensive inpatient treatment program with a strong psychotherapeutic focus for individuals with severe bulimia nervosa. 295 consecutively admitted bulimic patients were administered the Structured Interview for Anorexic and Bulimic Syndromes-Self-Rating (SIAB-S), the Eating Disorder Inventory-2 (EDI-2), the Brief Symptom Inventory (BSI), and the Beck Depression Inventory-II (BDI-II) at treatment intake and discharge. Results indicated statistically significant symptom reductions with large effect sizes regarding severity of binge eating and compensatory behavior (SIAB-S), overall eating disorder symptom severity (EDI-2), overall psychopathology (BSI), and depressive symptom severity (BDI-II) even when controlling for antidepressant medication. The majority of patients showed either reliable (EDI-2: 33.7%, BSI: 34.8%, BDI-II: 18.1%) or even clinically significant symptom changes (EDI-2: 43.2%, BSI: 33.9%, BDI-II: 56.9%). Patients with clinically significant improvement were less distressed at intake and less likely to suffer from a comorbid borderline personality disorder when compared with those who did not improve to a clinically significant extent. Findings indicate that intensive psychotherapeutic inpatient treatment may be effective in about 75% of severely affected bulimic patients. For the remaining non-responding patients, inpatient treatment might be improved through an even stronger focus on the reduction of comorbid borderline personality traits.

  13. Fecal ESBL Escherichia coli carriage as a risk factor for bacteremia in patients with hematological malignancies.

    PubMed

    Cornejo-Juárez, Patricia; Suárez-Cuenca, Juan Antonio; Volkow-Fernández, Patricia; Silva-Sánchez, Jesús; Barrios-Camacho, Humberto; Nájera-León, Esmeralda; Velázquez-Acosta, Consuelo; Vilar-Compte, Diana

    2016-01-01

    The purpose of this study is to evaluate the impact of fecal extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) colonization for bloodstream infection (BSI), clinical outcome, and costs in patients with hematologic malignancies (HM) and severe neutropenia. This is a cohort study, carried out at a cancer-referral hospital. The study population comprises patients with HM, hospitalized prior to administration of the first chemotherapy cycle. A stool culture was taken during the first 48 h; they were grouped as colonized by ESBL-EC or non-ESBL-EC. Patients were followed upon completion of chemotherapy or death. The sum of the days of antibiotics and the length of stay of all hospitalizations in the different cycles of chemotherapy were recorded. We included 126 patients with a recent diagnosis of HM, grouped as 63 patients colonized by ESBL-EC and 63 colonized by non-ESBL-EC, aged 42 ± 16 years old, 78 males (62%). BSI by ESBL-EC developed in 14 patients (22.2%) colonized by the same strain and in 5 (7.9%) in the group colonized with non-ESBL-EC. BSI by non-ESBL-EC was observed in 3 patients (4.7%) colonized by ESBL-EC and in 17 (26.9%) patients colonized by non-ESBL-EC. Colonization with ESBL-EC increased the risk of BSI by the same strain (relative risk (RR) = 3.4, 95% confidence interval (95% CI) 1.5-7.8, p = 0.001), shorter time to death (74 ± 62 vs. 95 ± 83 days, p < 0.001), longer hospital stay (64 ± 39 vs. 48 ± 32 days, p = 0.01), and higher infection-related costs ($6528 ± $4348 vs. $4722 ± $3173, p = 0.01). There was no difference in overall mortality between both groups. Fecal colonization by ESBL-EC is associated with increased risk of BSI by this strain, longer hospital stay, and higher related costs.

  14. Historical Permit Fee Rates

    EPA Pesticide Factsheets

    This site will provide basic information on clean air permitting under the title V operating permits program, provide access to state and regional permitting programs, and maintain access to proposed and final regulatory requirements. Historical fee rates.

  15. Modifications of Saccharomyces pastorianus cell wall polysaccharides with brewing process.

    PubMed

    Bastos, Rita; Coelho, Elisabete; Coimbra, Manuel A

    2015-06-25

    The cell wall polysaccharides of brewers spent yeast Saccharomyces pastorianus (BSY) and the inoculum yeast (IY) were studied in order to understand the changes induced by the brewing process. The hot water and alkali extractions performed solubilized mainly mannoproteins, more branched for BSY than those of IY. Also, (31)P solid state NMR showed that the BSY mannoproteins were 3 times more phosphorylated. By electron microscopy it was observed that the final residues of alkali sequential extraction until 4M KOH preserved the yeast three-dimensional structure. The final residues, composed mainly by glucans (92%), showed that the BSY, when compared with IY, contained higher amount of (1→4)-linked Glc (43% for BSY and 16% for IY) and lower (1→3)-linked Glc (17% for BSY and 42% for IY). The enzymatic treatment of final residue showed that both BSY and IY had (α1→4)-linked Glc and (β1→4)-linked Glc, in a 2:1 ratio, showing that S. pastorianus increases their cellulose-like linkages with the brewing process. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Scalable Video Transmission Over Multi-Rate Multiple Access Channels

    DTIC Science & Technology

    2007-06-01

    Rate - compatible punctured convolutional codes (RCPC codes ) and their ap- plications,” IEEE...source encoded using the MPEG-4 video codec. The source encoded bitstream is then channel encoded with Rate Compatible Punctured Convolutional (RCPC...Clark, and J. M. Geist, “ Punctured convolutional codes or rate (n-1)/n and simplified maximum likelihood decoding,” IEEE Transactions on

  17. Perceived Access and Parental Monitoring as Moderators of Impulsivity and Marijuana Use Among Adolescents.

    PubMed

    Haas, Amie L; Zamboanga, Byron L; Bersamin, Melina; Hyke, Travis

    2018-04-01

    The social and political climate regarding marijuana use has been changing in the US over the past decade. Research suggests that many adolescents report relatively easy access to marijuana and perceptions that recreational use involves minimal harm despite a growing body of research implicating the deleterious effects of use on cognitive and psychological development. Not surprisingly, prevalence rates have been rising in recent years, making it important to identify risk and protective factors associated with adolescent marijuana use. We tested a 3-way interaction model designed to (a) examine the relationship between behavioral impulsivity and marijuana use in adolescents, and (b) evaluate the roles of perceived access and parental monitoring as moderators of this relationship. High school students (N = 498, M age  = 15.7, 53% female, 77% White) completed an anonymous self-report assessment examining substance use, perceived access, and psychosocial factors related to substance use (i.e., behavioral impulsivity and parental monitoring). Results indicated that higher levels of impulsivity, greater access, and reduced parental monitoring were related to marijuana use. Significant moderating effects were found for perceived access and parental monitoring, such that use was greater for adolescents who perceived that marijuana was easier to acquire and for those with lower levels of parental monitoring. Among individuals with greater levels of impulsivity, parental monitoring reduced the impact of perceived access. Overall, results highlight risk and protective factors related to adolescent marijuana use and indicate that parental monitoring can be an effective means for reducing consumption.

  18. Relieving the Confusion: Location and Access Made (Relatively) Easy

    ERIC Educational Resources Information Center

    Jansen, Barbara A.

    2005-01-01

    Students need much assistance if they are to successfully use the Location and Access procedure of problem-solving. Guidelines are presented on how classroom teachers and library media specialists can help elementary students manage this Big6 stage.

  19. Completeness and overlap in open access systems: Search engines, aggregate institutional repositories and physics-related open sources.

    PubMed

    Tsay, Ming-Yueh; Wu, Tai-Luan; Tseng, Ling-Li

    2017-01-01

    This study examines the completeness and overlap of coverage in physics of six open access scholarly communication systems, including two search engines (Google Scholar and Microsoft Academic), two aggregate institutional repositories (OAIster and OpenDOAR), and two physics-related open sources (arXiv.org and Astrophysics Data System). The 2001-2013 Nobel Laureates in Physics served as the sample. Bibliographic records of their publications were retrieved and downloaded from each system, and a computer program was developed to perform the analytical tasks of sorting, comparison, elimination, aggregation and statistical calculations. Quantitative analyses and cross-referencing were performed to determine the completeness and overlap of the system coverage of the six open access systems. The results may enable scholars to select an appropriate open access system as an efficient scholarly communication channel, and academic institutions may build institutional repositories or independently create citation index systems in the future. Suggestions on indicators and tools for academic assessment are presented based on the comprehensiveness assessment of each system.

  20. Hostility Ratings by Parents at Risk for Child Abuse: Impact of Chronic and Temporary Schema Activation

    ERIC Educational Resources Information Center

    Farc, Maria-Magdalena; Crouch, Julie L.; Skowronski, John J.; Milner, Joel S.

    2008-01-01

    Objective: Two studies examined whether accessibility of hostility-related schema influenced ratings of ambiguous child pictures. Based on the social information processing model of child physical abuse (CPA), it was expected that CPA risk status would serve as a proxy for chronic accessibility of hostile schema, while priming procedures were used…

  1. Ecological competition and the incidence of Acinetobacter baumannii bloodstream infections in a teaching hospital in Southeastern Brazil.

    PubMed

    Lastoria, Letícia Chamma; Caldeira, Sílvia Maria; Moreira, Rayana Gonçalves; Akazawa, Renata Tamie; Maion, Júlia Coutinho; Fortaleza, Carlos Magno Castelo Branco

    2014-01-01

    Recently, pathogen ecology has been recognized as an important epidemiological determinant of healthcare-associated infections (HAIs). Acinetobacter baumannii is one of the most important agents known to cause HAIs. It is widespread in healthcare settings and exhibits seasonal variations in incidence. Little is known about the impact of competition with other hospital pathogens on the incidence of A. baumannii infection. We conducted an ecological study, enrolling patients who presented with healthcare-associated bloodstream infections (HA-BSIs) from 2005 to 2010 at a 450-bed teaching hospital in Brazil. HA-BSIs were said to be present when bacteria or fungi were recovered from blood cultures collected at least three days after admission. Monthly incidence rates were calculated for all HA-BSIs (overall or caused by specific pathogens or groups of pathogens). Multivariate Poisson regression models were used to identify the impacts of the incidence of several pathogens on the incidence of A. baumannii. The overall incidence rate of HA-BSI caused by A. baumannii was 2.5 per 10,000 patient-days. In the multivariate analysis, the incidence of HA-BSI caused by A. baumannii was negatively associated with the incidence rates of HA-BSI due to Staphylococcus aureus (rate ratio [RR]=0.88; 95% confidence interval [CI]=0.80-0.97), Enterobacter spp. (RR=0.84; 95%CI=0.74-0.94) and a pool of less common gram-negative pathogens. Our results suggest that competition between pathogens influences the etiology of HA-BSIs. It would be beneficial to take these findings into account in infection control policies.

  2. Brief Symptom Inventory Factor Structure in Antisocial Adolescents: Implications for Juvenile Justice

    ERIC Educational Resources Information Center

    Whitt, Ahmed; Howard, Matthew O.

    2012-01-01

    Objectives: The Brief Symptom Inventory (BSI) is widely used in juvenile justice settings; however, little is known regarding its factor structure in antisocial youth. The authors evaluated the BSI factor structure in a state residential treatment population. Methods: 707 adolescents completed the BSI. Exploratory and confirmatory factor analyses…

  3. Effect of HIV on work-related injury rates in South African gold miners.

    PubMed

    Murray, Jill; Sonnenberg, Pam; Nelson, Gill; Shearer, Stuart; Bester, Andre; Begley, Arthur; Glynn, Judith R

    2005-11-18

    Work-related injuries have severe, well-documented economic and social impacts, and injury is a leading cause of death in working adults. As adults of working age are one of the groups most affected by the HIV epidemic, the interaction between work-related injuries and HIV is important. The objective was to calculate the effect of HIV on the rate and severity of work-related injuries by duration of infection. A large, retrospective seroincident cohort of South African gold miners was studied. Data routinely collected by the mines, and assurance company injury data were analysed. HIV-positive and negative miners were compared, allowing the calculation of injury rates and rate ratios. Severity of injuries was measured by the number of days away from work, percentage of permanent disability, and fatalities. Results were available for 1661 HIV-positive and 6166 HIV-negative miners over 10 years. HIV infection increased the rate of work-related injuries overall (adjusted rate ratio, 1.3; 95% confidence interval, 1.1-1.4), but had less effect on severe injuries. Injury rates in HIV-positive men prior to the first positive test were similar to those in HIV-negative men. The injury rate rose soon after the first HIV positive test. After seroconversion there was only weak evidence of an increase in injury rates by duration of infection. This is the first study to demonstrate an increase in injury rates in HIV-positive individuals. The increase may reflect direct effects of HIV infection as well as behaviour change once HIV is diagnosed.

  4. Effect of survey design and catch rate estimation on total catch estimates in Chinook salmon fisheries

    USGS Publications Warehouse

    McCormick, Joshua L.; Quist, Michael C.; Schill, Daniel J.

    2012-01-01

    Roving–roving and roving–access creel surveys are the primary techniques used to obtain information on harvest of Chinook salmon Oncorhynchus tshawytscha in Idaho sport fisheries. Once interviews are conducted using roving–roving or roving–access survey designs, mean catch rate can be estimated with the ratio-of-means (ROM) estimator, the mean-of-ratios (MOR) estimator, or the MOR estimator with exclusion of short-duration (≤0.5 h) trips. Our objective was to examine the relative bias and precision of total catch estimates obtained from use of the two survey designs and three catch rate estimators for Idaho Chinook salmon fisheries. Information on angling populations was obtained by direct visual observation of portions of Chinook salmon fisheries in three Idaho river systems over an 18-d period. Based on data from the angling populations, Monte Carlo simulations were performed to evaluate the properties of the catch rate estimators and survey designs. Among the three estimators, the ROM estimator provided the most accurate and precise estimates of mean catch rate and total catch for both roving–roving and roving–access surveys. On average, the root mean square error of simulated total catch estimates was 1.42 times greater and relative bias was 160.13 times greater for roving–roving surveys than for roving–access surveys. Length-of-stay bias and nonstationary catch rates in roving–roving surveys both appeared to affect catch rate and total catch estimates. Our results suggest that use of the ROM estimator in combination with an estimate of angler effort provided the least biased and most precise estimates of total catch for both survey designs. However, roving–access surveys were more accurate than roving–roving surveys for Chinook salmon fisheries in Idaho.

  5. How does electronic cigarette access affect adolescent smoking?

    PubMed

    Friedman, Abigail S

    2015-12-01

    Understanding electronic cigarettes' effect on tobacco smoking is a central economic and policy issue. This paper examines the causal impact of e-cigarette access on conventional cigarette use by adolescents. Regression analyses consider how state bans on e-cigarette sales to minors influence smoking rates among 12 to 17 year olds. Such bans yield a statistically significant 0.9 percentage point increase in recent smoking in this age group, relative to states without such bans. Results are robust to multiple specifications as well as several falsification and placebo checks. This effect is both consistent with e-cigarette access reducing smoking among minors, and large: banning electronic cigarette sales to minors counteracts 70 percent of the downward pre-trend in teen cigarette smoking for a given two-year period. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Discordance Between Physician Assessment and Patient-Reported Depressive Symptoms in Parkinson Disease.

    PubMed

    Lachner, Christian; Armstrong, Melissa J; Gruber-Baldini, Ann L; Rezvani, Zahra; Reich, Stephen G; Fishman, Paul S; Salazar, Richard; Shulman, Lisa M

    2017-07-01

    To assess concordance between physician assessment and patient-reported symptoms when screening for depression in Parkinson disease (dPD). Depression in Parkinson disease is highly prevalent (∼40%) and has a significant impact on quality of life and disability, yet physician recognition and treatment remain inadequate. One thousand seventy-six patients with PD completed the Brief Symptom Inventory-18 (BSI-18), a screening questionnaire for psychiatric symptoms, which was compared to item #3 (depression) on the Unified Parkinson's Disease Rating Scale (UPDRS). The mean BSI-18 depression score was 51.4 (9.7). Of the 170 (16%) patients screening positive for dPD on the BSI-18, 104 (61%) were not recognized as depressed by neurologists on the UPDRS. Factors associated with lower neurologist recognition included male gender, better mental health quality of life, and lack of antidepressant use. More than 60% of patients screening positive for depression on self-report were not recognized by neurologists on the UPDRS. A patient-reported screening tool for depression may improve recognition and management of dPD.

  7. Perceived impact and feasibility of strategies to improve access to healthy foods in Washington State, USA.

    PubMed

    Johnson, Donna B; Quinn, Emilee L; Podrabsky, Mary; Beckwith-Stanley, Nadia; Chan, Nadine; Ellings, Amy; Kovacs, Tricia; Lane, Claire

    2013-12-01

    The present study measured the perceived impact and political and implementation feasibility of state-level policy strategies related to increasing access to healthy foods and limiting unhealthy foods. Potential state-level policy strategies to improve access to healthy foods were identified through a review of evidence-based literature and policy recommendations. Respondents rated the perceived impact and political and implementation feasibility of each policy on a five-point scale using online surveys. Washington State policy process. Forty-nine content experts (national researchers and subject experts), forty policy experts (state elected officials or their staff, gubernatorial or legislative policy analysts) and forty-five other stakeholders (state-level advocates, programme administrators, food producers). In aggregate, respondents rated policy impact and implementation feasibility higher than political feasibility. Policy experts rated policy strategies as less politically feasible compared with content experts (P < 0·02) or other stakeholders (P < 0·001). Eight policy strategies were rated above the median for impact and political and implementation feasibility. These included policies related to nutrition standards in schools and child-care facilities, food distribution systems, urban planning projects, water availability, joint use agreements and breast-feeding supports. Although they may be perceived as potentially impactful, some policies will be more difficult to enact than others. Information about the potential feasibility of policies to improve access to healthy foods can be used to focus limited policy process resources on strategies with the highest potential for enactment, implementation and impact.

  8. Ethnic differences in smoking rate, nicotine dependence, and cessation-related variables among adult smokers in Hawaii

    PubMed Central

    Herzog, Thaddeus A; Pokhrel, Pallav

    2012-01-01

    This study tests hypotheses concerning ethnic disparities in daily cigarette smoking rates, nicotine dependence, cessation motivation, and knowledge and past use of cessation methods (e.g., counseling) and products (e.g., nicotine patch) in a multiethnic sample of smokers in Hawaii. Previous research has revealed significant differences in smoking prevalence among Native Hawaiians, Filipinos, Japanese, and Caucasians in Hawaii. However, no study has examined differences in dependence and cessation-related knowledge and practices among smokers representing these ethnic groups. Participants were recruited through newspaper advertisement as part of a larger smoking cessation intervention study. Participants (N=919; M age=45.6, SD=12.7; 48% Women) eligible to participate provided self-report data through mail and telephone. Participants included 271 self-identified Native Hawaiians, 63 Filipinos, 316 Caucasians, 145 “East Asians” (e.g., Japanese, Chinese), and 124 “Other” (e.g., Hispanic, African-American). Pair-wise comparisons of means, controlling for age, gender, income, education, and marital status, indicated that Native Hawaiian smokers reported significantly higher daily smoking rates and higher levels of nicotine dependence compared to East Asians. Native Hawaiian smokers reported significantly lower motivation to quit smoking than Caucasians. Further, Filipino and Native Hawaiian smokers reported lesser knowledge of cessation methods and products, and less frequent use of these methods and products than Caucasians. The results suggest that Native Hawaiian and Filipino smokers could be underserved with regard to receiving cessation-related advice, and may lack adequate access to smoking cessation products and services. In addition, cessation interventions tailored for Native Hawaiian smokers could benefit from a motivational enhancement component. PMID:22438074

  9. Improving School Access Control

    ERIC Educational Resources Information Center

    National Clearinghouse for Educational Facilities, 2008

    2008-01-01

    Few things are more important for school safety and security than controlling access to buildings and grounds. It is relatively easy to incorporate effective access control measures in new school designs but more difficult in existing schools, where most building and site features cannot be readily altered or reconfigured. The National…

  10. Gender dynamics affecting maternal health and health care access and use in Uganda.

    PubMed

    Morgan, Rosemary; Tetui, Moses; Muhumuza Kananura, Rornald; Ekirapa-Kiracho, Elizabeth; George, A S

    2017-12-01

    Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women's lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women's workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women's attitudes and behaviour during pregnancy, men's attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health

  11. Is it feasible to diagnose catheter-related candidemia without catheter withdrawal?

    PubMed

    Fernández-Cruz, Ana; Martín-Rabadán, Pablo; Suárez-Salas, Marisol; Rojas-Wettig, Loreto; Pérez, María Jesús; Guinea, Jesús; Guembe, María; Peláez, Teresa; Sánchez-Carrillo, Carlos; Bouza, Emilio

    2014-07-01

    Many bloodstream infections (BSI) in patients with central venous catheters (CVC) are not catheter-related (CR). Assessment of catheter involvement without catheter withdrawal has not been studied in candidemia. We assessed the value of conservative techniques to evaluate catheters as the origin of candidemia in patients with CVC in a prospective cohort study (superficial Gram stain and culture, Kite technique (Gram stain and culture of the first 1 cm blood drawn from the CVC), proportion of positive blood cultures (PPBCs), differential time to positivity (DTP), and minimal time to positivity (MTP)). All catheters were cultured at withdrawal. From June 2008 to January 2012, 22 cases fulfilled the inclusion criteria. CR-candidemia (CRC) was confirmed in 10. Validity values for predicting CRC were: superficial Gram stain (S, 30%; Sp, 81.83%; PPV, 60%; NPV, 56.3%; Ac, 57.1%), superficial cultures (S, 40%; Sp, 75%; PPV, 57.1%; NPV, 60%; Ac, 59.1%), Kite Gram stain (S, 33.3%; Sp, 66.7%; PPV, 50%; NPV, 50%; Ac, 50%), Kite culture (S, 80%; Sp, 66.7%; PPV, 66.7%; NPV, 80%; Ac, 72.7%), PPBC (S, 50%; Sp, 41.7%; PPV, 41.7%; NPV, 50.0%; Ac, 45.5%), DTP (S, 100%; Sp, 33.3%; PPV, 55.6%; NPV, 100%; Ac, 63.6%), and MTTP (S, 70%; Sp, 58.3%; PPV, 58.3%; NPV, 70%; Ac, 63.6%). While combinations of two tests improved sensitivity and NPV, more than two tests did not improve validity values. Classic tests to assess CR-BSI caused by bacteria cannot be reliably used to diagnose CRC. Combinations of tests could be useful, but more and larger studies are required. © The Author 2014. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Lightning rates relative to tornadic storm evolution on 22 May 1981

    NASA Technical Reports Server (NTRS)

    Macgorman, Donald R.; Burgess, Donald W.; Mazur, Vladislav; Rust, W. David; Taylor, William L.

    1989-01-01

    Lightning and Doppler radar data for two tornadic storms in Oklahoma on May 22, 1981 are used to analyze ground flash rates relative to the time of tornadoes. It is found that the ground flash rates had no obvious relationship with the tornado times, although the stroke rate in both storms was greatest after the tornadic stage ended. The variations in the cyclone shear and the intracloud flash rates within 10 km of the mesocyclone region are examined. The results suggest that most tornadic storms have an increase in total flash rates near the time of the tornado and that this increase is often dominated by intracloud flashes.

  13. Accessing primary care: a simulated patient study.

    PubMed

    Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

    2013-03-01

    Simulated patient, or so-called 'mystery-shopper', studies are a controversial, but potentially useful, approach to take when conducting health services research. To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients' reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders' possible confusion in answering this question. Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients' satisfaction with their practice is not related to practice call handling, but is related to appointment availability.

  14. Heart rate variability in sleep-related migraine without aura.

    PubMed

    Vollono, Catello; Gnoni, Valentina; Testani, Elisa; Dittoni, Serena; Losurdo, Anna; Colicchio, Salvatore; Di Blasi, Chiara; Mazza, Salvatore; Farina, Benedetto; Della Marca, Giacomo

    2013-07-15

    This is an observational study aimed to investigate the activity of autonomic nervous system during sleep in patients with sleep-related migraine. Eight consecutive migraineurs without aura were enrolled (6 women and 2 men), aged 30 to 62 years (mean 48.1 ± 9.3 years). Inclusion criteria were: high frequency of attacks (> 5 per month) and occurrence of more than 75% of the attacks during sleep causing an awakening. Patients were compared with a control group of 55 healthy subjects (23 men and 32 women, mean age 54.2 ± 13.0 years), and with a further control group of 8 age- and gender-matched healthy controls. Patient and controls underwent polysomnography and heart rate variability analysis. A significant reduction of the LF/HF ratio during N2 and N3 sleep stages was observed in migraineurs compared with controls. No differences in sleep macrostructure were observed; cyclic alternating pattern (CAP) time and CAP rate were lower in migraineurs than in controls. These findings indicate a peculiar modification of the autonomic balance during sleep in sleep-related migraine. The reduction of LF/HF ratio in NREM sleep was observed in controls, but it was quantitatively much more evident in migraineurs. Changes in LF/HF could be consequent to an autonomic unbalance which could manifest selectively (or alternatively become more evident) during sleep. These findings, together with the reduction in CAP rate, could be an expression of reduced arousability during sleep in patients with sleep-related migraine. The simultaneous involvement of the autonomic, arousal, and pain systems might suggest involvement of the hypothalamic pathways.

  15. Bringing patient centricity to diabetes medication access in Canada

    PubMed Central

    Glennie, Judith L; Kovacs Burns, Katharina; Oh, Paul

    2016-01-01

    Canada must become proactive in addressing type 2 diabetes. With the second highest rate of diabetes prevalence in the developed world, the number of Canadians living with diabetes will soon reach epidemic levels. Against international comparisons, Canada also performs poorly with respect to diabetes-related hospitalizations, mortality rates, and access to medications. Diabetes and its comorbidities pose a significant burden on people with diabetes (PWD) and their families, through out-of-pocket expenses for medications, devices, supplies, and the support needed to manage their illness. Rising direct and indirect costs of diabetes will become a drain on Canada’s economy and undermine the financial stability of our health care system. Canada’s approach to diabetes medication assessment and funding has created a patchwork of medication access across provinces. Access to treatments for those who rely on public programs is highly restricted compared to Canadians with private drug plans, as well in contrast with public payers in other countries. Each person living with diabetes has different needs, so a “patient-centric” approach ensures treatment focused on individual circumstances. Such tailoring is difficult to achieve, with the linear approach required by public payers. We may be undermining optimal care for PWD because of access policies that are not aligned with individualized approaches – and increasing overall health care costs in the process. The scope of Canada’s diabetes challenge demands holistic and proactive solutions. Canada needs to get out from “behind the eight ball” and get “ahead of the curve” when it comes to diabetes care. Improving access to medications is one of the tools for getting there. Canada’s “call to action” for diabetes starts with effective implementation of existing best practices. A personalized approach to medication access, to meet individual needs and optimize outcomes, is also a key enabler. PWD and

  16. Surface passivation of n-type doped black silicon by atomic-layer-deposited SiO2/Al2O3 stacks

    NASA Astrophysics Data System (ADS)

    van de Loo, B. W. H.; Ingenito, A.; Verheijen, M. A.; Isabella, O.; Zeman, M.; Kessels, W. M. M.

    2017-06-01

    Black silicon (b-Si) nanotextures can significantly enhance the light absorption of crystalline silicon solar cells. Nevertheless, for a successful application of b-Si textures in industrially relevant solar cell architectures, it is imperative that charge-carrier recombination at particularly highly n-type doped black Si surfaces is further suppressed. In this work, this issue is addressed through systematically studying lowly and highly doped b-Si surfaces, which are passivated by atomic-layer-deposited Al2O3 films or SiO2/Al2O3 stacks. In lowly doped b-Si textures, a very low surface recombination prefactor of 16 fA/cm2 was found after surface passivation by Al2O3. The excellent passivation was achieved after a dedicated wet-chemical treatment prior to surface passivation, which removed structural defects which resided below the b-Si surface. On highly n-type doped b-Si, the SiO2/Al2O3 stacks result in a considerable improvement in surface passivation compared to the Al2O3 single layers. The atomic-layer-deposited SiO2/Al2O3 stacks therefore provide a low-temperature, industrially viable passivation method, enabling the application of highly n- type doped b-Si nanotextures in industrial silicon solar cells.

  17. Business and Office. Access Skills. Vocational Readiness Skills. Missouri LINC. Accessing Vocational Education.

    ERIC Educational Resources Information Center

    Missouri Univ., Columbia. Dept. of Practical Arts and Vocational-Technical Education.

    This document contains business and office occupations-related materials to help teachers and parents teach access skills to Missouri junior high and high school special needs students who want to pursue a vocational program in secretarial and office technology, bookkeeping, accounting, and payroll, or data entry. Access skills are defined as…

  18. Poor Access for African Researchers to African Emergency Care Publications: A Cross-sectional Study.

    PubMed

    Bruijns, Stevan R; Maesela, Mmapeladi; Sinha, Suniti; Banner, Megan

    2017-10-01

    Based on relative population size and burden of disease, emergency care publication outputs from low- and middle-income regions are disproportionately lower than those of high-income regions. Ironically, outputs from regions with higher publication rates are often less relevant in the African context. As a result, the dissemination of and access to local research is essential to local researchers, but the cost of this access (actual and cost-wise) remains unknown. The aim of this study was to describe access to African emergency care publications in terms of publisher-based access (open access or subscription) and alternate access (self-archived or author provided), as well as the cost of access. We conducted a retrospective, cross-sectional study using all emergency medicine publications included in Scopus between 2011 and 2015. A sequential search strategy described access to each article, and we calculated mean article charges against the purchasing power parity index (used to describe out-of-pocket expense). We included 666 publications from 49 journals, of which 395 (59.3%) were open access. For subscription-based articles, 106 (39.1%) were self-archived, 60 (22.1%) were author-provided, and 105 (38.8%) were inaccessible. Mean article access cost was $36.44, and mean processing charge was $2,319.34. Using the purchasing power parity index it was calculated that equivalent out-of-pocket expenditure for South African, Ghanaian and Tanzanian authors would respectively be $15.77, $10.44 and $13.04 for access, and $1,004.02, $664.36 and $830.27 for processing. Based on this, the corrected cost of a single-unit article access or process charge for South African, Ghanaian and Tanzanian authors, respectively, was 2.3, 3.5 and 2.8 times higher than the standard rate. One in six African emergency care publications are inaccessible outside institutional library subscriptions; additionally, the cost of access to publications in low- and middle-income countries appears

  19. The role of savannas in the terrestrial Si cycle: A case-study from Lamto, Ivory Coast

    NASA Astrophysics Data System (ADS)

    Alexandre, Anne; Bouvet, Mickael; Abbadie, Luc

    2011-08-01

    Savannas currently occupy a fifth of the earth's land surface and are predicted to expand in the next few centuries at the expense of tropical forests, mainly as a result of deforestation and human fires. Can such a vegetation trend impact, through changes in plant Si cycling, the lithogenic silicon (LSi) release into soils (through chemical weathering) and the net dissolved Si (DSi) outputs from soils to stream water (through chemical denudation)? The first step of an investigation requires quantifying the net Si fluxes involved in the plant/soil system. Here, a schematic steady-state Si cycle, established for a tropical humid savanna (Lamto, Ivory Coast) that developed on a ferruginous soil and is subjected to annual fires, is presented. Erosion was assumed to be insignificant. LSi and biogenic Si (BSi under the form of phytoliths) pools were measured, and Si fluxes were estimated from Si concentrations and mass balance calculation. Identification of plant and soil phytoliths indicated that the soil BSi pool is in equilibrium with the current BSi input by the savanna. In the soil column, mixing between a young rapidly recycled BSi pool and an old stable BSi pool is attested by a mixing line equation. Storage of the old BSi pool is assimilated as a BSi output from the plant/soil system. A BSi output additionally occurs after annual fires, when ashes are exported. Both BSi outputs decrease as much the BSi dissolution. In order to uptake constant DSi flux, the savanna increases by three to eight times the net LSi release, depending upon the post-fire ash exportation scenario. A comparison between savanna and rainforest Si cycles that maximizes the differences in plant/soil systems and minimizes differences in climate is presented. The comparison revealed that BSi storage is higher in the savanna soil than in the rainforest soil, mainly due to BSi production that is twice higher in the savanna (127 vs 67 kg/ha/yr). The resulting LSi release that is enhanced by plant

  20. The role of savannas in the terrestrial Si cycle: A case-study from Lamto, Ivory Coast

    NASA Astrophysics Data System (ADS)

    Alexandre, A. E.; Abbadie, L.

    2011-12-01

    Savannas currently occupy a fifth of the earth's land surface and are predicted to expand in the next few centuries at the expense of tropical forests, mainly as a result of deforestation and human fires. Can such a vegetation trend impact, through changes in plant Si cycling, the lithogenic silicon (LSi) release into soils (through chemical weathering) and the net dissolved Si (DSi) outputs from soils to stream water (through chemical denudation)? The first step of an investigation requires quantifying the net Si fluxes involved in the plant/soil system. Here, a schematic steady-state Si cycle, established for a tropical humid savanna (Lamto, Ivory Coast) that developed on a ferruginous soil and is subjected to annual fires, is presented. Erosion was assumed to be insignificant. LSi and biogenic Si (BSi under the form of phytoliths) pools were measured, and Si fluxes were estimated from Si concentrations and mass balance calculation. Identification of plant and soil phytoliths indicated that the soil BSi pool is in equilibrium with the current BSi input by the savanna. In the soil column, mixing between a young rapidly recycled BSi pool and an old stable BSi pool is attested by a mixing line equation. Storage of the old BSi pool is assimilated as a BSi output from the plant/soil system. A BSi output additionally occurs after annual fires, when ashes are exported. Both BSi outputs decrease as much the BSi dissolution. In order to uptake constant DSi flux, the savanna increases by three to eight times the net LSi release, depending upon the post-fire ash exportation scenario. A comparison between savanna and rainforest Si cycles that maximizes the differences in plant/soil systems and minimizes differences in climate is presented. The comparison revealed that BSi storage is higher in the savanna soil than in the rainforest soil, mainly due to BSi production that is twice higher in the savanna (127 vs 67 kg/ha/yr). The resulting LSi release that is enhanced by plant

  1. Non-tuberculous mycobacterial bloodstream infections in patients with indwelling vascular catheters - the role of sickle cell anaemia.

    PubMed

    Edun, Babatunde; Shah, Ansal; Durkin, Martin; Whitmire, Melanie; Williams, Shanetta Patterson; Albrecht, Helmut; Al-Hasan, Majdi; Weissman, Sharon

    2017-05-01

    Few studies have examined risk factors for nontuberculous mycobacteria (NTM) bloodstream infections (BSI) involving indwelling vascular catheters (IDVC). Sickle cell anaemia (HbSS/SC) is known to affect several aspects of the immune system leading to relative immune deficiency. The purpose of this retrospective nested case-control study was to determine if HbSS/SC is a risk factor for NTM BSI among individuals with IDVCs. All NTM IDVC infections (cases) at two tertiary hospitals from 2008 to 2014 were reviewed. Cases were matched 2:1 with controls who had IDVC infections due to organisms other than NTM. Matching criteria included age within 10 years and IDVC infection within three months of index case. Logistic regression was used to identify risk factors for IDVC infection due to NTM. Nineteen NTM BSIs were identified. Three cases were excluded because they did not have IDVCs at the time their BSI was identified. Sixteen cases of NTM IDVC infection were matched to 32 controls with IDVC infections due to other organisms. The mean age of patients with IDVC infections was 48.5 years and 28 (58%) were male. Compared to the control group those with NTM BSI were more likely to have HbSS/SC 38% (6/16) versus 6% (2/32) (p = .006). IDVCs are a risk factor for NTM BSI. Sickle cell anaemia appears to be a risk factor for IDVC infections due to NTM. This study is limited by the small sample size. A larger study is needed to further investigate the association between HbSS/SC and NTM IDVC infections.

  2. Clinical Characteristics and Validation of Bronchiectasis Severity Score Systems for Post-Tuberculosis Bronchiectasis.

    PubMed

    Wang, Hong; Ji, Xiao-Bin; Li, Cheng-Wei; Lu, Hai-Wen; Mao, Bei; Liang, Shuo; Cheng, Ke-Bin; Bai, Jiu-Wu; Martinez-Garcia, Miguel Angel; Xu, Jin-Fu

    2018-05-23

    Lung damage related to tuberculosis is a major contributor to the etiology of bronchiectasis in China. It is unknown whether bronchiectasis severity score systems are applicable in these cases. To evaluate the clinical characteristics and validation of bronchiectasis severity score systems for post-tuberculosis bronchiectasis. The study enrolled 596 bronchiectasis patients in Shanghai Pulmonary Hospital between January 2011 and December 2012. The data for calculating FACED and bronchiectasis severity index (BSI) scores along with mortality, readmission, and exacerbation outcomes were collected and analyzed within a follow-up period with a median length of 48 months (interquartile range 43-54 months). The study enrolled 101 post-tuberculosis bronchiectasis patients and 495 non-tuberculosis bronchiectasis patients. Compared with non-post-tuberculosis bronchiectasis, post-tuberculosis bronchiectasis patients experienced less bilateral bronchiectasis (P=0.004), a higher frequency of right upper lobe involvement (P<0.001), and showed the cylindrical type more often (P<0.001). Follow-up data indicated that both scoring systems were able to predict 48(43-54) month mortality in post-tuberculosis patients as assessed by the area under the receiver operator characteristic curve (AUC) (FACED AUC=0.81, BSI AUC=0.70), but they did not predict readmission (FACED and BSI=0.56) or exacerbation (FACED and BSI=0.52) well. There are apparent differences on radiologic features between bronchiectasis patients with and without history of pulmonary tuberculosis. Both FACED and BSI can predict mortality in post-tuberculosis bronchiectasis. This article is protected by copyright. All rights reserved. © 2018 John Wiley & Sons Ltd.

  3. The Impact of Depression on Abstinence Self-Efficacy and Substance Use Outcomes among Emerging Adults in Residential Treatment

    PubMed Central

    Greenfield, Brenna L.; Venner, Kamilla L.; Kelly, John F.; Slaymaker, Valerie; Bryan, Angela D.

    2012-01-01

    A large proportion of emerging adults treated for substance use disorder (SUD) present with symptoms of negative affect and major depressive disorder (MDD). However, little is known regarding how these comorbidities influence important mechanisms of treatment response, such as increases in abstinence self-efficacy (ASE). This study tested the degree to which MDD and/or depressive symptoms interacted with during-treatment changes in ASE and examined these variables' relation to outcome at 3-months post-treatment. Participants (N = 302; 74% male) completed measures at intake, mid-treatment, end-of-treatment, and at 3-month follow-up. ASE was measured with the Alcohol and Drug Use Self-Efficacy (ADUSE) scale; depressive symptoms were assessed with the Brief Symptom Inventory 18 (BSI 18) Depression scale; and current MDD diagnoses were deduced from the Structured Clinical Interview for the DSM-IV. Random coefficient regression analyses focused on during-treatment changes in ASE, with BSI 18 scores and MDD diagnosis included as moderators. At intake, individuals with MDD or high levels of depressive symptoms had significantly lower ASE, particularly in negative affect situations. No evidence for moderation was found: ASE significantly increased during treatment regardless of MDD status. There was a main effect of BSI 18 Depression scores: those with lower BSI 18 scores had lower ASE scores at each time point. MDD and BSI 18 Depression did not predict three-month outcome, but similar to previous findings ASE did predict abstinence status at three months. Treatment-seeking emerging adults with MDD merit particular clinical attention because of their lower reported self-efficacy throughout treatment. PMID:22288980

  4. Clinical benefit of ertapenem compared to flomoxef for the treatment of cefotaxime-resistant Enterobacteriaceae bacteremia

    PubMed Central

    Lee, Chen-Hsiang; Chen, I-Ling; Li, Chia-Chin; Chien, Chun-Chih

    2018-01-01

    Objectives Cefotaxime-resistant Enterobacteriaceae (CE) infections are intractable, with limited treatment options. Though carbapenems are frequently prescribed for CE infections, the emergence of carbapenem-resistant Enterobacteriaceae is of huge concern. Flomoxef is effective against CE in vitro, and some clinical data on its demonstrated effectiveness against CE bloodstream infections (BSIs) exists. Patients and methods We conducted a retrospective study on adults with BSI caused by flomoxef-susceptible CE to investigate the efficacy of flomoxef compared with that of ertapenem. The outcome was evaluated with propensity score-based matching and logistic regression analysis. Results Demographic and clinical characteristics of patients treated with flomoxef (n = 58) or ertapenem (n = 188) were compared. In the multivariate analysis, severe sepsis (adjusted odds ratio [AOR] = 3.84; 95% confidence interval [CI], 1.16–12.78; p = 0.03), high BSI mortality score (AOR = 5.59; 95% CI, 2.37–13.21; p < 0.01), ultimately or rapidly fatal comorbidity (AOR = 10.60; 95% CI, 3.43–32.75; p < 0.01), and pneumonia (AOR = 10.11; 95% CI, 3.43–29.81; p < 0.01) were independently associated with 28-day mortality. Using propensity scores, 58 flomoxef-treated patients were matched to 116 ertapenem-treated patients. There were no intergroup differences in BSI severity, comorbidity, or BSI sources. The 28-day mortality rates (20.7% vs 13.8%, p = 0.28) did not differ significantly. However, hospitalization length was shorter in the ertapenem group (10.2 ± 8.5 vs. 14.6 ± 9.4 days, p < 0.01). Conclusion Although similar outcomes were observed between the groups, ertapenem therapy was associated with a shorter hospitalization time in adults after CE BSI. PMID:29503575

  5. Evaluation of the Accelerate Pheno System for Fast Identification and Antimicrobial Susceptibility Testing from Positive Blood Cultures in Bloodstream Infections Caused by Gram-Negative Pathogens.

    PubMed

    Marschal, Matthias; Bachmaier, Johanna; Autenrieth, Ingo; Oberhettinger, Philipp; Willmann, Matthias; Peter, Silke

    2017-07-01

    Bloodstream infections (BSI) are an important cause of morbidity and mortality. Increasing rates of antimicrobial-resistant pathogens limit treatment options, prompting an empirical use of broad-range antibiotics. Fast and reliable diagnostic tools are needed to provide adequate therapy in a timely manner and to enable a de-escalation of treatment. The Accelerate Pheno system (Accelerate Diagnostics, USA) is a fully automated test system that performs both identification and antimicrobial susceptibility testing (AST) directly from positive blood cultures within approximately 7 h. In total, 115 episodes of BSI with Gram-negative bacteria were included in our study and compared to conventional culture-based methods. The Accelerate Pheno system correctly identified 88.7% (102 of 115) of all BSI episodes and 97.1% (102 of 105) of isolates that are covered by the system's identification panel. The Accelerate Pheno system generated an AST result for 91.3% (95 of 104) samples in which the Accelerate Pheno system identified a Gram-negative pathogen. The overall category agreement between the Accelerate Pheno system and culture-based AST was 96.4%, the rates for minor discrepancies 1.4%, major discrepancies 2.3%, and very major discrepancies 1.0%. Of note, ceftriaxone, piperacillin-tazobactam, and carbapenem resistance was correctly detected in blood culture specimens with extended-spectrum beta-lactamase-producing Escherichia coli ( n = 7) and multidrug-resistant Pseudomonas aeruginosa ( n = 3) strains. The utilization of the Accelerate Pheno system reduced the time to result for identification by 27.49 h ( P < 0.0001) and for AST by 40.39 h ( P < 0.0001) compared to culture-based methods in our laboratory setting. In conclusion, the Accelerate Pheno system provided fast, reliable results while significantly improving turnaround time in blood culture diagnostics of Gram-negative BSI. Copyright © 2017 American Society for Microbiology.

  6. Silica in invasive wetland plant species of lagoons, Côte d'Ivoire: Spatio-temporal patterns

    NASA Astrophysics Data System (ADS)

    José-mathieu Koné, Yéfanlan; Schoelynck, Jonas

    2017-04-01

    Tropical wetlands are known to accumulate a large quantity of Biogenic Silica (BSi) produced by wetland plant species (Struyf et al., 2015), and approximately 70-80% of the total supply of Dissolved Si (DSi) to the coastal zone occurs in (sub) tropical river systems (Jennerjahn et al. 2006). However, the data at these latitudes are limited. Here, we present the BSi concentration from eleven invasive macrophyte species randomly collected in three small ( 800ha) lagoons of Côte d'Ivoire during 12 months. Our data showed a large spatio-temporal variability of BSi in the three lagoons with no consistent trends. In general, the BSi concentrations obtained were high and values ranged from 0 to 54 mg g-1 through the entire sampling period, with the highest values found in Acroceras zizaniodes (emergent species of Poaceae). In general, free floating species had significantly less BSi than emergent species (P<0.0001) which corroborates with the earlier findings of Schoelynck and Struyf (2016). However, the concentrations of BSi found in Salvinia molesta (a free floating species of fern, Salviniaceae) at the young stage were similar to those found in the emergent species. Based on yearly averages, highest BSi values were observed in Kodjoboué lagoon, and the lowest in the Ono lagoon that is 80% covered by macrophytes. Moreover, the dissolved silica (DSi) concentrations were systematically higher in Ono Lagoon than in Kodjoboué Lagoon. We conclude that in an eutrophic system Si accumulating in aquatic macrophytes is not related to Si availability but to other environmental factors. Jennerjahn, T.C., Knoppers, B.A., de Souze, W.F.L., Brunskill, G.J., Silva, E.I.L., Adi, S. et al., 2006. Factors controlling dissolved silica in tropical rivers. In: Ittekot, V. (ed) The silicon cycle. Island Press, Washington, D. C, pp 29-51 Schoelynck J and Struyf E, 2016. Silicon in aquatic vegetation. Functional Ecology. 30: 1323-1330. Struyf, E., Mosimane, K., Van Pelt, D., Murray

  7. Estimation of clinical trial success rates and related parameters.

    PubMed

    Wong, Chi Heem; Siah, Kien Wei; Lo, Andrew W

    2018-01-31

    Previous estimates of drug development success rates rely on relatively small samples from databases curated by the pharmaceutical industry and are subject to potential selection biases. Using a sample of 406 038 entries of clinical trial data for over 21 143 compounds from January 1, 2000 to October 31, 2015, we estimate aggregate clinical trial success rates and durations. We also compute disaggregated estimates across several trial features including disease type, clinical phase, industry or academic sponsor, biomarker presence, lead indication status, and time. In several cases, our results differ significantly in detail from widely cited statistics. For example, oncology has a 3.4% success rate in our sample vs. 5.1% in prior studies. However, after declining to 1.7% in 2012, this rate has improved to 2.5% and 8.3% in 2014 and 2015, respectively. In addition, trials that use biomarkers in patient-selection have higher overall success probabilities than trials without biomarkers. © The Author 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Gender and access in the African school

    NASA Astrophysics Data System (ADS)

    Adams, Milton N.; Kruppenbach, Susan E.

    1987-12-01

    The educational system in major parts of Africa, where post-primary enrolment rates are the lowest in the world, is treated in this article. In particular, female access patterns to formal education in Botswana, Liberia, Niger and Somalia are compared. One primary conclusion reached by the authors is that enrolment levels are linked with general economic development. Factors leading to the comparatively high rate of females having gained access to a primary level of education on the one hand, and a very low rate of post-primary enrolment on the other, are discussed and the following issues are touched on: the marginal link between school expansion policies and actual female enrolment, and their predominance in the urban sector.

  9. International Policies on Sharing Genomic Research Results with Relatives: Approaches to Balancing Privacy with Access

    PubMed Central

    Branum, Rebecca; Wolf, Susan M.

    2015-01-01

    Returning genetic research results to raises complex issues. In order to inform the U.S. debate, this paper analyzes international law and policies governing the sharing of genetic research results with relatives and identifies key themes and lessons. The laws and policies from other countries demonstrate a range of approaches to balancing individual privacy and autonomy with family access for health benefit, offering important lessons for further development of approaches in the United States. PMID:26479568

  10. Preventing central venous catheter-associated primary bloodstream infections: characteristics of practices among hospitals participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) study.

    PubMed

    Braun, Barbara I; Kritchevsky, Stephen B; Wong, Edward S; Solomon, Steve L; Steele, Lynn; Richards, Cheryl L; Simmons, Bryan P

    2003-12-01

    To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI. This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected. Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites). Process information was obtained for 3,320 CVC insertions with an average of 58.2 (+/- 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information. Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25% were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5%) and gowns (76.8%); 58.1% used large drapes. Few hospitals (18.1%) used an intravenous team to manage ICU CVCs. Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.

  11. Risk factors and mortality for nosocomial bloodstream infections in elderly patients.

    PubMed

    Reunes, S; Rombaut, V; Vogelaers, D; Brusselaers, N; Lizy, C; Cankurtaran, M; Labeau, S; Petrovic, M; Blot, S

    2011-10-01

    To determine risk factors for nosocomial bloodstream infection (BSI) and associated mortality in geriatric patients in geriatric and internal medicine wards at a university hospital. Single-center retrospective (1992-2007), pairwise-matched (1:1-ratio) cohort study. Geriatric patients with nosocomial BSI were matched with controls without BSI on year of admission and length of hospitalization before onset of BSI. Demographic, microbiological, and clinical data are collected. One-hundred forty-two BSI occurred in 129 patients. Predominant microorganisms were Escherichia coli (23.2%), coagulase-negative Staphylococci (19.4%), Pseudomonas aeruginosa (8.4%), Staphylococcus aureus (7.1%), Klebsiella pneumoniae (5.8%) and Candida spp. (5.8%). Matching was successful for 109 cases. Compared to matched control subjects, cases were more frequently female, suffered more frequently from arthrosis, angina pectoris and pressure ulcers, had worse Activities of Daily Living-scores, had more often an intravenous or bladder catheter, and were more often bedridden. Logistic regression demonstrated presence of an intravenous catheter (odds ratio [OR] 7.5, 95% confidence interval [CI] 2.5-22.9) and being bedridden (OR 2.9, 95% CI 1.6-5.3) as independent risk factors for BSI. In univariate analysis nosocomial BSI was associated with increased mortality (22.0% vs. 11.0%; P=0.029). After adjustment for confounding co-variates, however, nosocomial BSI was not associated with mortality (hazard ratio 1.3, 95% CI 0.6-2.6). Being bedridden and increasing age were independent risk factors for death. Intravenous catheters and being bedridden are the main risk factors for nosocomial BSI. Although associated with higher mortality, this infectious complication seems not to be an independent risk factor for death in geriatric patients. Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. Serum Albumin and Disease Severity of Non-Cystic Fibrosis Bronchiectasis.

    PubMed

    Lee, Seung Jun; Kim, Hyo-Jung; Kim, Ju-Young; Ju, Sunmi; Lim, Sujin; Yoo, Jung Wan; Nam, Sung-Jin; Lee, Gi Dong; Cho, Hyun Seop; Kim, Rock Bum; Cho, Yu Ji; Jeong, Yi Yeong; Kim, Ho Cheol; Lee, Jong Deog

    2017-08-01

    A clinical classification system has been developed to define the severity and predict the prognosis of subjects with non-cystic fibrosis (CF) bronchiectasis. We aimed to identify laboratory parameters that are correlated with the bronchiectasis severity index (BSI) and FACED score. The medical records of 107 subjects with non-CF bronchiectasis for whom BSI and FACED scores could be calculated were retrospectively reviewed. The correlations between the laboratory parameters and BSI or FACED score were assessed, and multiple-linear regression analysis was performed to identify variables independently associated with BSI and FACED score. An additional subgroup analysis was performed according to sex. Among all of the enrolled subjects, 49 (45.8%) were male and 58 (54.2%) were female. The mean BSI and FACED scores were 9.43 ± 3.81 and 1.92 ± 1.59, respectively. The serum albumin level (r = -0.49), bilirubin level (r = -0.31), C-reactive protein level (r = 0.22), hemoglobin level (r = -0.2), and platelet/lymphocyte ratio (r = 0.31) were significantly correlated with BSI. Meanwhile, serum albumin (r = -0.37) and bilirubin level (r = -0.25) showed a significant correlation with the FACED score. Multiple-linear regression analysis showed that the serum bilirubin level was independently associated with BSI, and the serum albumin level was independently associated with both scoring systems. Subgroup analysis revealed that the level of uric acid was also a significant variable independently associated with the BSI in male bronchiectasis subjects. Several laboratory variables were identified as possible prognostic factors for non-CF bronchiectasis. Among them, the serum albumin level exhibited the strongest correlation and was identified as an independent variable associated with the BSI and FACED scores. Copyright © 2017 by Daedalus Enterprises.

  13. Procalcitonin fails to predict bacteremia in SIRS patients: a cohort study.

    PubMed

    Hoenigl, M; Raggam, R B; Wagner, J; Prueller, F; Grisold, A J; Leitner, E; Seeber, K; Prattes, J; Valentin, T; Zollner-Schwetz, I; Schilcher, G; Krause, R

    2014-10-01

    Procalcitonin (PCT) has previously been proposed as useful marker to rule out bloodstream-infection (BSI). The objective of this study was to evaluate the sensitivity of different PCT cut-offs for prediction of BSI in patients with community (CA)- and hospital-acquired (HA)-BSI. A total of 898 patients fulfilling systemic-inflammatory-response-syndrome (SIRS) criteria were enrolled in this prospective cohort study at the Medical University of Graz, Austria. Of those 666 patients had positive blood cultures (282 CA-BSI, 384 HA-BSI, enrolled between January 2011 and December 2012) and 232 negative blood cultures (enrolled between January 2011 and July 2011 at the emergency department). Blood samples for determination of laboratory infection markers (e.g. PCT) were collected simultaneously with blood cultures. Procalcitonin was significantly (p < 0.001) higher in SIRS patients with bacteremia/fungemia than in those without. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value of 0.675 for PCT (95% CI 0.636-0.714) for differentiating patients with BSI from those without. AUC for IL-6 was 0.558 (95% CI 0.515-0.600). However, even at the lowest cut-off evaluated (i.e. 0.1 ng/ml) PCT failed to predict BSI in 7% (n = 46) of patients. In the group of patients with SIRS and negative blood culture 79% (n = 185) had PCT levels > 0.1. Procalcitonin was significantly higher in patients with BSI than in those without and superior to IL-6 and CRP. The clinical importance of this is questionable, because a suitable PCT threshold for excluding BSI was not established. An approach where blood cultures are guided by PCT only can therefore not be recommended. © 2014 John Wiley & Sons Ltd.

  14. Completeness and overlap in open access systems: Search engines, aggregate institutional repositories and physics-related open sources

    PubMed Central

    Wu, Tai-luan; Tseng, Ling-li

    2017-01-01

    This study examines the completeness and overlap of coverage in physics of six open access scholarly communication systems, including two search engines (Google Scholar and Microsoft Academic), two aggregate institutional repositories (OAIster and OpenDOAR), and two physics-related open sources (arXiv.org and Astrophysics Data System). The 2001–2013 Nobel Laureates in Physics served as the sample. Bibliographic records of their publications were retrieved and downloaded from each system, and a computer program was developed to perform the analytical tasks of sorting, comparison, elimination, aggregation and statistical calculations. Quantitative analyses and cross-referencing were performed to determine the completeness and overlap of the system coverage of the six open access systems. The results may enable scholars to select an appropriate open access system as an efficient scholarly communication channel, and academic institutions may build institutional repositories or independently create citation index systems in the future. Suggestions on indicators and tools for academic assessment are presented based on the comprehensiveness assessment of each system. PMID:29267327

  15. Impact of in Vitro Gastrointestinal Digestion and Transepithelial Transport on Antioxidant and ACE-Inhibitory Activities of Brewer's Spent Yeast Autolysate.

    PubMed

    Vieira, Elsa F; das Neves, José; Vitorino, Rui; Dias da Silva, Diana; Carmo, Helena; Ferreira, Isabel M P L V O

    2016-10-05

    Brewer's spent yeast (BSY) autolysates may have potential applications as food ingredients or nutraceuticals due to their antioxidant and ACE-inhibitory activities. The impact of simulated gastrointestinal (GI) digestion, the interaction with intracellular sources of oxidative stress, the intestinal cell permeability of BSY peptides, and the antioxidant and ACE-inhibitory activities of BSY permeates were assayed. Gastrointestinal digestion of BSY autolysates enhanced antioxidant and ACE-inhibitory activities as measured in vitro. No cytotoxic effects were observed on Caco-2 cells after exposure to the digested BSY autolysates within a concentration range of 0.5 to 3.0 mg of peptides/mL. A protective role to induced oxidative stress was observed. The transepithelial transport assays indicate high apparent permeability coefficient (P app ) values for BSY peptides across Caco-2/HT29-MTX cell monolayer (14.5-26.1 × 10 -6 cm/s) and for Caco-2 cell monolayer model (12.4-20.8 × 10 -6 cm/s), while the antioxidant and ACE-inhibitory activities found in flux material from the basolateral side suggest transepithelial absorption of bioactive compounds.

  16. Accessing primary care: a simulated patient study

    PubMed Central

    Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

    2013-01-01

    Background Simulated patient, or so-called ‘mystery-shopper’, studies are a controversial, but potentially useful, approach to take when conducting health services research. Aim To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Design and setting Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Method Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Results Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients’ reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders’ possible confusion in answering this question. Conclusion Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients’ satisfaction with their practice is not related to practice call handling, but is related to appointment availability. PMID:23561783

  17. Retroperitoneal versus direct femoral artery approach for thoracic endovascular aortic repair access: a case-control study.

    PubMed

    Etezadi, Vahid; Katzen, Barry T; Benenati, James F; Alehashemi, Sara; Tsoukas, Athanassios I; Puente, Orlando A

    2011-04-01

    Many individuals who are candidates for thoracic endovascular aortic repair (TEVAR) are found to have iliac artery anatomy and/or disease that preclude transfemoral endovascular access and require retroperitoneal surgical approach through more proximal arteries. This relatively more invasive technique could potentially affect the procedural outcomes. This study compares the retroperitoneal with transfemoral access used for TEVAR in a single center. In this study, 133 consecutive patients (96 men; mean age ± SD: 69.5 ± 14.7 years) who underwent TEVAR between 1994 and 2009 in a single center were retrospectively evaluated. The type of endovascular access was identified in all the patients. The basic demographics, access method, endograft type, 30-day morbidity and mortality rates, as well as procedure recordings including fluoroscopic and procedure duration, estimated blood loss, and duration of hospitalization were compared between the TEVAR procedures performed using a surgical retroperitoneal approach and those using the standard femoral access. Retroperitoneal access was used in 19 (14.3%; 13 women; mean age ± SD: 71 ± 12.2 years) and direct femoral access in 114 (85.7%; 24 women; mean age ± SD: 69 ± 15.4 years) patients. Two of the retroperitoneal accesses were obtained after failure of femoral approach. Techniques that were used included iliac artery conduit (seven patients), aortic artery conduit (eight patients), aortobifemoral artery graft conduit (one patient), and direct sheath introduction through the distal aorta (two patients) or common iliac artery (one patient). Retroperitoneal approach was used more frequently in women (35%) as compared with men (6%) (p = 0.0001). In all, 79% of the retroperitoneal approaches were associated with use of delivery sheath sizes larger than 24F (p = 0.049). TEVAR technical success was 100% with retroperitoneal and 97.3% with femoral access (p > 0.05). Thirty-day mortality rates were 0% and 8.8% and the rates of

  18. Effect of clinic related factors on continuation rates of IUDs.

    PubMed

    Reading, A E; Goldstuck, N D

    1982-01-01

    This paper concerns factors relating to the clinic and the way in which the insertion of IUDs is managed from a psychological and technical standpoint. 3 aspects of clinical service are examined: 1) the influence of the psychological state at time of insertion, 2) individual differences in relation to side effects amongst users and the way in which those are influenced by managment techniques, and 3) technical aspects of the insertion of the device. Insertion pain and discomfort may influence subsequent tolerance of the IUD in 3 ways: 1) patient compliance may be enhanced by trouble-free insertion, 2) an unpleasant experience may influence attitudes towards the IUD, and 3) the experience of pain at insertion may reduce subsequent tolerance of discomfort. IUDs increase the amount of menstrual flow which, along with pain, constitute frequent requests for removal. Removal rates for pain and bleeding vary from 0-16.8/100 users. Removal rates for bleeding are also influenced by cultural attitudes. Insertion techniques influence acceptability of IUDs. Also, the incidence of expulsion, pregnancy, and removal declines with increasing age and parity. Discontinuation rates after 24 months were 91% for women below 2nd parity and only 37% for women of 6 or more parity. In the youngest age group the discontinuation rate was 76% compared with 35% in the oldest age group. The timing of IUD insertion and positioning of the IUD influence continuation rates. An implication of these concerns is that IUD insertion procedures may have to become more complex to achieve compatibility between IUD-uterine configurations.

  19. Comparative Effectiveness of Vancomycin Versus Daptomycin for MRSA Bacteremia With Vancomycin MIC >1 mg/L: A Multicenter Evaluation.

    PubMed

    Moise, Pamela A; Culshaw, Darren L; Wong-Beringer, Annie; Bensman, Joyce; Lamp, Kenneth C; Smith, Winter J; Bauer, Karri; Goff, Debra A; Adamson, Robert; Leuthner, Kimberly; Virata, Michael D; McKinnell, James A; Chaudhry, Saira B; Eskandarian, Romic; Lodise, Thomas; Reyes, Katherine; Zervos, Marcus J

    2016-01-01

    Clinical studies comparing vancomycin with alternative therapy for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia are limited. The objective of this study was to compare outcomes of early daptomycin versus vancomycin treatment for MRSA bacteremia with high vancomycin MICs in a geographically diverse multicenter evaluation. This nationwide, retrospective, multicenter (N = 11), matched, cohort study compared outcomes of early daptomycin with vancomycin for MRSA bloodstream infection (BSI) with vancomycin MICs 1.5 to 2 µg/mL. Matching variables, based on propensity regression analysis, included age, intensive care unit (ICU), and type of BSI. Outcomes were as follows: (1) composite failure (60-day all-cause mortality, 7-day clinical or microbiologic failure, 30-day BSI relapse, or end-of-treatment failure (EOT; discontinue/change daptomycin or vancomycin because of treatment failure or adverse event]); (2) nephrotoxicity; and (2) day 4 BSI clearance. A total of 170 patients were included. The median (interquartile range) age was 60 years (50-74); the median (range) Acute Physiology and Chronic Health Evaluation II score was 15 (10-18); 31% were in an ICU; and 92% had an infectious disease consultation. BSI types included endocarditis/endovascular (39%), extravascular (55%), and central catheter (6%). The median daptomycin dose was 6 mg/kg, and the vancomycin trough level was 17 mg/L. Overall composite failure was 35% (59 of 170): 15% due to 60-day all-cause mortality, 14% for lack of clinical or microbiologic response by 7 days, and 17% due to failure at end of therapy (discontinue/change because of treatment failure or adverse event). Predictors of composite failure according to multivariate analysis were age >60 years (odds ratio, 3.7; P < 0.01) and ICU stay (odds ratio, 2.64; P = 0.03). Notable differences between treatment groups were seen with: (1) end of therapy failure rates (11% vs 24% for daptomycin vs vancomycin; P = 0.025); (2) acute kidney

  20. The Traveler's Guide to E-mail Access.

    ERIC Educational Resources Information Center

    Clyde, Anne

    1999-01-01

    Presents options that travelers can use to keep in e-mail contact. Discusses equipment/access issues related to traveling with a laptop; Internet cafes; free e-mail services; accessing home mail via a Web page; and new options e-mail access for travelers. Includes Internet resources on Internet access providers. (AEF)

  1. 45 CFR 153.230 - Calculation of reinsurance payments made under the national contribution rate.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Calculation of reinsurance payments made under the national contribution rate. 153.230 Section 153.230 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK...

  2. 45 CFR 153.230 - Calculation of reinsurance payments made under the national contribution rate.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Calculation of reinsurance payments made under the national contribution rate. 153.230 Section 153.230 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK...

  3. The Use of Bloodstream Infection Mortality to Measure the Impact of Antimicrobial Stewardship Interventions: Assessing the Evidence.

    PubMed

    Coulter, Sonali; Roberts, Jason A; Hajkowicz, Krispin; Halton, Kate

    2017-03-30

    This review sets out to evaluate the current evidence on the impact of inappropriate therapy on bloodstream infections (BSI) and associated mortality. Based on the premise that better prescribing practices should result in better patient outcomes, BSI mortality may be a useful metric to evaluate antimicrobial stewardship (AMS) interventions. A systematic search was performed in key medical databases to identify papers published in English between 2005 and 2015 that examined the association between inappropriate prescribing and BSI mortality in adult patients. Only studies that included BSIs caused by ESKAPE ( Enterococcus faecium/faecalis , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa and Enterobacter species ) organisms were included. Study quality was assessed using the GRADE criteria and results combined using a narrative synthesis. We included 46 studies. Inappropriate prescribing was associated with an overall increase in mortality in BSI. In BSI caused by resistant gram positive organisms, such as methicillin resistant S. aureus , inappropriate therapy resulted in up to a 3-fold increase in mortality. In BSI caused by gram negative (GN) resistant organisms a much greater impact ranging from 3 to 25 fold increase in the risk of mortality was observed. While the overall quality of the studies is limited by design and the variation in the definition of appropriate prescribing, there appears to be some evidence to suggest that inappropriate prescribing leads to increased mortality in patients due to GN BSI. The highest impact of inappropriate prescribing was seen in patients with GN BSI, which may be a useful metric to monitor the impact of AMS interventions.

  4. The Use of Bloodstream Infection Mortality to Measure the Impact of Antimicrobial Stewardship Interventions: Assessing the Evidence

    PubMed Central

    Coulter, Sonali; Roberts, Jason A.; Hajkowicz, Krispin; Halton, Kate

    2017-01-01

    This review sets out to evaluate the current evidence on the impact of inappropriate therapy on bloodstream infections (BSI) and associated mortality. Based on the premise that better prescribing practices should result in better patient outcomes, BSI mortality may be a useful metric to evaluate antimicrobial stewardship (AMS) interventions. A systematic search was performed in key medical databases to identify papers published in English between 2005 and 2015 that examined the association between inappropriate prescribing and BSI mortality in adult patients. Only studies that included BSIs caused by ESKAPE (Enterococcus faecium/faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species) organisms were included. Study quality was assessed using the GRADE criteria and results combined using a narrative synthesis. We included 46 studies. Inappropriate prescribing was associated with an overall increase in mortality in BSI. In BSI caused by resistant gram positive organisms, such as methicillin resistant S. aureus, inappropriate therapy resulted in up to a 3-fold increase in mortality. In BSI caused by gram negative (GN) resistant organisms a much greater impact ranging from 3 to 25 fold increase in the risk of mortality was observed. While the overall quality of the studies is limited by design and the variation in the definition of appropriate prescribing, there appears to be some evidence to suggest that inappropriate prescribing leads to increased mortality in patients due to GN BSI. The highest impact of inappropriate prescribing was seen in patients with GN BSI, which may be a useful metric to monitor the impact of AMS interventions. PMID:28458799

  5. Early identification of microorganisms in blood culture prior to the detection of a positive signal in the BACTEC FX system using matrix-assisted laser desorption/ionization-time of flight mass spectrometry.

    PubMed

    Wang, Ming-Cheng; Lin, Wei-Hung; Yan, Jing-Jou; Fang, Hsin-Yi; Kuo, Te-Hui; Tseng, Chin-Chung; Wu, Jiunn-Jong

    2015-08-01

    Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) is a valuable method for rapid identification of blood stream infection (BSI) pathogens. Integration of MALDI-TOF MS and blood culture system can speed the identification of causative BSI microorganisms. We investigated the minimal microorganism concentrations of common BSI pathogens required for positive blood culture using BACTEC FX and for positive identification using MALDI-TOF MS. The time to detection with positive BACTEC FX and minimal incubation time with positive MALDI-TOF MS identification were determined for earlier identification of common BSI pathogens. The minimal microorganism concentrations required for positive blood culture using BACTEC FX were >10(7)-10(8) colony forming units/mL for most of the BSI pathogens. The minimal microorganism concentrations required for identification using MALDI-TOF MS were > 10(7) colony forming units/mL. Using simulated BSI models, one can obtain enough bacterial concentration from blood culture bottles for successful identification of five common Gram-positive and Gram-negative bacteria using MALDI-TOF MS 1.7-2.3 hours earlier than the usual time to detection in blood culture systems. This study provides an approach to earlier identification of BSI pathogens prior to the detection of a positive signal in the blood culture system using MALDI-TOF MS, compared to current methods. It can speed the time for identification of BSI pathogens and may have benefits of earlier therapy choice and on patient outcome. Copyright © 2013. Published by Elsevier B.V.

  6. Association of State Access Standards With Accessibility to Specialists for Medicaid Managed Care Enrollees.

    PubMed

    Ndumele, Chima D; Cohen, Michael S; Cleary, Paul D

    2017-10-01

    Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care. To compare ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of specialty access standards. We used Consumer Assessment of Healthcare Providers and Systems survey data to conduct a quasiexperimental difference-in-differences (DID) analysis of 20 163 nonelderly adult Medicaid managed care (MMC) enrollees and 54 465 commercially insured enrollees in 5 states adopting access standards, and 37 290 MMC enrollees in 5 matched states that previously adopted access standards. Reported access to specialty care in the previous 6 months. Seven thousand six hundred ninety-eight (69%) Medicaid enrollees and 28 423 (75%) commercial enrollees reported that it was always or usually easy to get an appointment with a specialist before the policy implementation (or at baseline) compared with 11 889 (67%) of Medicaid enrollees in states that had previously implemented access standards. Overall, there was no significant improvement in timely access to specialty services for MMC enrollees in the period following implementation of standard(s) (adjusted difference-in-differences, -1.2 percentage points; 95% CI, -2.7 to 0.1), nor was there any impact of access standards on insurance-based disparities in access (0.6 percentage points; 95% CI, -4.3 to 5.4). There was heterogeneity across states, with 1 state that implemented both time and distance standards demonstrating significant improvements in access and reductions in disparities

  7. Indicators of Student Flow Rates in Honduras: An Assessment of an Alternative Methodology, with Two Methodologies for Estimating Student Flow Rates. BRIDGES Research Report No. 6.

    ERIC Educational Resources Information Center

    Cuadra, Ernesto; Crouch, Luis

    Student promotion, repetition, and dropout rates constitute the basic data needed to forecast future enrollment and new resources. Information on student flow is significantly related to policy formulation aimed at improving internal efficiency, because dropping out and grade repetition increase per pupil cost, block access to eligible school-age…

  8. Oral health-related quality of life in youth receiving cleft-related surgery: self-report and proxy ratings.

    PubMed

    Broder, Hillary L; Wilson-Genderson, Maureen; Sischo, Lacey

    2017-04-01

    This paper evaluated the impact of cleft-related surgery on the oral health-related quality of life (OHRQoL) of youth with cleft over time. Data were derived from a 5-year, multi-center, prospective, longitudinal study of 1196 youth with cleft lip and/or palate and their caregivers. Eligible youth were between 7.5 and 18.5 years old, spoke English or Spanish, and were non-syndromic. During each observational period, which included baseline, and 1- and 2-year post-baseline follow-up visits, youths and their caregivers completed the Child Oral Health Impact Profile, a validated measure of OHRQoL. Multilevel mixed-effects models were used to analyze the effects of receipt of craniofacial surgery on OHRQoL over time. During the course of this study a total of 516 patients (43 %) received at least one surgery. Youth in the surgery recommendation group had lower self- (β = -2.18, p < 0.05) and proxy-rated (β = -2.92, p < 0.02) OHRQoL when compared to non-surgical self- and proxy-rated OHRQoL at baseline. Both surgical and non-surgical youth (β = 3.73, p < 0.001) and caregiver (β = 1.91, p < 0.05) ratings of OHRQoL improved over time. There was significant incremental improvement (time × surgery interaction) in self-reported OHRQoL for youth postsurgery (β = 1.04, p < 0.05), but this postsurgery increment was not seen in the caregiver proxy ratings. Surgical intervention impacts OHRQoL among youth with cleft. Youth who were surgical candidates had lower baseline self- and caregiver-rated OHRQoL when compared to non-surgical youth. Youth who underwent cleft-related surgery had significant incremental improvements in self-rated but not caregiver (proxy)-rated OHRQoL after surgery.

  9. Metabolite biodiversity in pepper (Capsicum) fruits of thirty-two diverse accessions: variation in health-related compounds and implications for breeding.

    PubMed

    Wahyuni, Yuni; Ballester, Ana-Rosa; Sudarmonowati, Enny; Bino, Raoul J; Bovy, Arnaud G

    2011-08-01

    A comprehensive study on morphology and biochemical compounds of 32 Capsicum spp. accessions has been performed. Accessions represented four pepper species, Capsicum annuum, Capsicum frutescens, Capsicum chinense and Capsicum baccatum which were selected by their variation in morphological characters such as fruit color, pungency and origin. Major metabolites in fruits of pepper, carotenoids, capsaicinoids (pungency), flavonoid glycosides, and vitamins C and E were analyzed and quantified by high performance liquid chromatography. The results showed that composition and level of metabolites in fruits varied greatly between accessions and was independent of species and geographical location. Fruit color was determined by the accumulation of specific carotenoids leading to salmon, yellow, orange, red and brown colored fruits. Levels of both O- and C-glycosides of quercetin, luteolin and apigenin varied strongly between accessions. All non-pungent accessions were devoid of capsaicins, whereas capsaicinoid levels ranged from 0.07 up to 80 mg/100g fr. wt. in fruit pericarp. In general, pungent accessions accumulated the highest capsaicinoid levels in placenta plus seed tissue compared to pericarp. The non-pungent capsaicinoid analogs, capsiates, could be detected at low levels in some pungent accessions. All accessions accumulated high levels of vitamin C, up to 200 mg/100g fr. wt. The highest vitamin E concentration found was 16 mg/100g fr. wt. Based on these metabolic data, five accessions were selected for further metabolic and molecular analysis, in order to isolate key genes involved in the production of these compounds and to assist future breeding programs aimed at optimizing the levels of health-related compounds in pepper fruit. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Assessing Released Inmates for Substance-Abuse-Related Service Needs

    ERIC Educational Resources Information Center

    Belenko, Steven

    2006-01-01

    High rates of substance abuse and recidivism and limited in-prison and postrelease treatment access and transitional planning complicate community reintegration. Moreover, drug-related health and social problems are related to treatment outcomes. In the framework of risk-responsivity theory and structured, integrated reentry models, this article…

  11. Open access intrapartum CTG database.

    PubMed

    Chudáček, Václav; Spilka, Jiří; Burša, Miroslav; Janků, Petr; Hruban, Lukáš; Huptych, Michal; Lhotská, Lenka

    2014-01-13

    Cardiotocography (CTG) is a monitoring of fetal heart rate and uterine contractions. Since 1960 it is routinely used by obstetricians to assess fetal well-being. Many attempts to introduce methods of automatic signal processing and evaluation have appeared during the last 20 years, however still no significant progress similar to that in the domain of adult heart rate variability, where open access databases are available (e.g. MIT-BIH), is visible. Based on a thorough review of the relevant publications, presented in this paper, the shortcomings of the current state are obvious. A lack of common ground for clinicians and technicians in the field hinders clinically usable progress. Our open access database of digital intrapartum cardiotocographic recordings aims to change that. The intrapartum CTG database consists in total of 552 intrapartum recordings, which were acquired between April 2010 and August 2012 at the obstetrics ward of the University Hospital in Brno, Czech Republic. All recordings were stored in electronic form in the OB TraceVue®;system. The recordings were selected from 9164 intrapartum recordings with clinical as well as technical considerations in mind. All recordings are at most 90 minutes long and start a maximum of 90 minutes before delivery. The time relation of CTG to delivery is known as well as the length of the second stage of labor which does not exceed 30 minutes. The majority of recordings (all but 46 cesarean sections) is - on purpose - from vaginal deliveries. All recordings have available biochemical markers as well as some more general clinical features. Full description of the database and reasoning behind selection of the parameters is presented in the paper. A new open-access CTG database is introduced which should give the research community common ground for comparison of results on reasonably large database. We anticipate that after reading the paper, the reader will understand the context of the field from clinical and

  12. Does the Noun Phrase Accessibility Hierarchy Predict the Difficulty Order in the Acquisition of Japanese Relative Clauses?

    ERIC Educational Resources Information Center

    Ozeki, Hiromi; Shirai, Yasuhiro

    2007-01-01

    Although Keenan and Comrie's (1977) noun phrase accessibility hierarchy (NPAH) has been shown to predict the difficulty order of relative clauses (RCs) in SLA, most studies of the NPAH have been on European languages. This paper tests the prediction for Japanese. Study 1 analyzes RCs in an oral interview corpus from 90 learners of Japanese at four…

  13. Animacy-Based Accessibility and Competition in Relative Clause Production in Hindi and Malayalam.

    PubMed

    Perera, C K; Srivastava, A K

    2016-08-01

    Two studies investigated interaction of animacy-based accessibility and competition processes with language specific constraints in shaping production preferences. Relative clause elicitation tasks (Gennari et al. in Cogn Psychol 65:141-176, 2012) were performed by two groups with 40 participants in each. Significantly more passives were produced with animate question/focus and assigned subject function to them in Malayalam, while the difference was insignificant in Hindi with animacy not equating with grammatical function assignment. Both languages produced active objects with OSV order significantly more with animate question/focus. This indicates animacy effect on word order. Animacy also influenced the expression of the agent phase in both languages as a tendency was found to omit the agent by-phase or to delay its appearance, when the two animate nouns entering into the structure are highly similar. The results point to language specific constraints in relative clause production and variability in the role of animacy-based retrieval order across languages.

  14. Vascular access in critical limb ischemia.

    PubMed

    Kang, Won Yu; Campia, Umberto; Ota, Hideaki; Didier, Romain J; Negi, Smita I; Kiramijyan, Sarkis; Koifman, Edward; Baker, Nevin C; Magalhaes, Marco A; Lipinski, Michael J; Escarcega, Ricardo O; Torguson, Rebecca; Waksman, Ron; Bernardo, Nelson L

    2016-01-01

    Currently, percutaneous endovascular intervention is considered a first line of therapy for treating patients with critical limb ischemia. As the result of remarkable development of techniques and technologies, percutaneous endovascular intervention has led to rates of limb salvage comparable to those achieved with bypass surgery, with fewer complications, even in the presence of lower rates of long-term patency. Currently, interventionalists have a multiplicity of access routes including smaller arteries, with both antegrade and retrograde approaches. Therefore, the choice of the optimal access site has become an integral part of the success of the percutaneous intervention. By understanding the technical aspects, as well as the advantages and limitations of each approach, the interventionalists can improve clinical outcomes in patients with severe peripheral arterial disease. This article reviews the access routes in critical limb ischemia, their advantages and disadvantages, and the clinical outcomes of each. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. A Computational Framework to Optimize Subject-Specific Hemodialysis Blood Flow Rate to Prevent Intimal Hyperplasia

    NASA Astrophysics Data System (ADS)

    Mahmoudzadeh, Javid; Wlodarczyk, Marta; Cassel, Kevin

    2017-11-01

    Development of excessive intimal hyperplasia (IH) in the cephalic vein of renal failure patients who receive chronic hemodialysis treatment results in vascular access failure and multiple treatment complications. Specifically, cephalic arch stenosis (CAS) is known to exacerbate hypertensive blood pressure, thrombosis, and subsequent cardiovascular incidents that would necessitate costly interventional procedures with low success rates. It has been hypothesized that excessive blood flow rate post access maturation which strongly violates the venous homeostasis is the main hemodynamic factor that orchestrates the onset and development of CAS. In this article, a computational framework based on a strong coupling of computational fluid dynamics (CFD) and shape optimization is proposed that aims to identify the effective blood flow rate on a patient-specific basis that avoids the onset of CAS while providing the adequate blood flow rate required to facilitate hemodialysis. This effective flow rate can be achieved through implementation of Miller's surgical banding method after the maturation of the arteriovenous fistula and is rooted in the relaxation of wall stresses back to a homeostatic target value. The results are indicative that this optimized hemodialysis blood flow rate is, in fact, a subject-specific value that can be assessed post vascular access maturation and prior to the initiation of chronic hemodialysis treatment as a mitigative action against CAS-related access failure. This computational technology can be employed for individualized dialysis treatment.

  16. Youth suicide prevention: does access to care matter?

    PubMed

    Campo, John V

    2009-10-01

    Recent increases in adolescent suicide rates after a decade of decline highlight the relevance of pediatric suicide prevention. Existing strategies to intervene with youth at risk for suicide are largely based on the premise that access to effective services is of critical importance. This review aims to examine the relationship between youth suicide and access to care. Promising reductions in suicidal thinking and behavior have been associated with the application of manualized psychotherapies, collaborative interventions in primary care, lithium for mood-disordered adults, and clozapine in schizophrenia. Suicide rates correlate inversely with indices of care access across the lifespan, including antidepressant prescription rates. Suicide is a preventable cause of death, and any public health relevant effort to prevent youth suicide must include improving access to effective care for at-risk youth as a strategy. Education and training of professionals and consumers, the integration of mental health services in primary care, and the use of novel technologies to track and maintain contact with at-risk youth are worthy of study. Additional research on the relationship between specific treatments, especially antidepressants, and youth suicide risk reduction is desperately needed.

  17. Urban Telemedicine Enables Equity in Access to Acute Illness Care.

    PubMed

    Ronis, Sarah D; McConnochie, Kenneth M; Wang, Hongyue; Wood, Nancy E

    2017-02-01

    Children with care for acute illness available through the Health-e-Access telemedicine model at childcare and schools were previously found to have 22% less emergency department (ED) use than counterparts without this service, but they also had 24% greater acute care use overall. We assessed the hypothesis that increased utilization reflected improved access among impoverished inner-city children to a level experienced by more affluent suburban children. This observational study compared utilization among children without and with telemedicine access, beginning in 1993, ending in 2007, and based on 84,287 child-months of billing claims-based observation. Health-e-Access Telemedicine was initiated in stepwise manner over 187 study-months among 74 access sites (childcare, schools, community centers), beginning in month 105. Children dwelled in inner city, rest-of-city Rochester, NY, or in surrounding suburbs. Rate of total acute care visits (office, ED, telemedicine) was measured as visits per 100 child-years. Observed utilization rates were adjusted in multivariate analysis for age, sex, insurance type, and season of year. When both suburban and inner-city children lacked telemedicine access, overall acute illness visits were 75% greater among suburban than inner-city children (suburban:inner-city rate ratio 1.75, p < 0.0001). After telemedicine became available to inner-city children, their overall acute visits approximated those of suburban children (suburban:inner-city rate ratio 0.80, p = 0.07), whereas acute visits among suburban children remained at least (worst-case comparison) 56% greater than inner-city children without telemedicine (rate ratio 1.56, p < 0.0001). At baseline, overall acute illness utilization of suburban children exceeded that of inner-city children. Overall utilization for inner-city children increased with telemedicine to that of suburban children at baseline. Without telemedicine, however, inner-city use remained

  18. Modeling coding-sequence evolution within the context of residue solvent accessibility.

    PubMed

    Scherrer, Michael P; Meyer, Austin G; Wilke, Claus O

    2012-09-12

    Protein structure mediates site-specific patterns of sequence divergence. In particular, residues in the core of a protein (solvent-inaccessible residues) tend to be more evolutionarily conserved than residues on the surface (solvent-accessible residues). Here, we present a model of sequence evolution that explicitly accounts for the relative solvent accessibility of each residue in a protein. Our model is a variant of the Goldman-Yang 1994 (GY94) model in which all model parameters can be functions of the relative solvent accessibility (RSA) of a residue. We apply this model to a data set comprised of nearly 600 yeast genes, and find that an evolutionary-rate ratio ω that varies linearly with RSA provides a better model fit than an RSA-independent ω or an ω that is estimated separately in individual RSA bins. We further show that the branch length t and the transition-transverion ratio κ also vary with RSA. The RSA-dependent GY94 model performs better than an RSA-dependent Muse-Gaut 1994 (MG94) model in which the synonymous and non-synonymous rates individually are linear functions of RSA. Finally, protein core size affects the slope of the linear relationship between ω and RSA, and gene expression level affects both the intercept and the slope. Structure-aware models of sequence evolution provide a significantly better fit than traditional models that neglect structure. The linear relationship between ω and RSA implies that genes are better characterized by their ω slope and intercept than by just their mean ω.

  19. Emergent relation between surface vapor conductance and relative humidity profiles yields evaporation rates from weather data

    NASA Astrophysics Data System (ADS)

    Salvucci, Guido D.; Gentine, Pierre

    2013-04-01

    The ability to predict terrestrial evapotranspiration (E) is limited by the complexity of rate-limiting pathways as water moves through the soil, vegetation (roots, xylem, stomata), canopy air space, and the atmospheric boundary layer. The impossibility of specifying the numerous parameters required to model this process in full spatial detail has necessitated spatially upscaled models that depend on effective parameters such as the surface vapor conductance (Csurf). Csurf accounts for the biophysical and hydrological effects on diffusion through the soil and vegetation substrate. This approach, however, requires either site-specific calibration of Csurf to measured E, or further parameterization based on metrics such as leaf area, senescence state, stomatal conductance, soil texture, soil moisture, and water table depth. Here, we show that this key, rate-limiting, parameter can be estimated from an emergent relationship between the diurnal cycle of the relative humidity profile and E. The relation is that the vertical variance of the relative humidity profile is less than would occur for increased or decreased evaporation rates, suggesting that land-atmosphere feedback processes minimize this variance. It is found to hold over a wide range of climate conditions (arid-humid) and limiting factors (soil moisture, leaf area, energy). With this relation, estimates of E and Csurf can be obtained globally from widely available meteorological measurements, many of which have been archived since the early 1900s. In conjunction with precipitation and stream flow, long-term E estimates provide insights and empirical constraints on projected accelerations of the hydrologic cycle.

  20. Emergent relation between surface vapor conductance and relative humidity profiles yields evaporation rates from weather data.

    PubMed

    Salvucci, Guido D; Gentine, Pierre

    2013-04-16

    The ability to predict terrestrial evapotranspiration (E) is limited by the complexity of rate-limiting pathways as water moves through the soil, vegetation (roots, xylem, stomata), canopy air space, and the atmospheric boundary layer. The impossibility of specifying the numerous parameters required to model this process in full spatial detail has necessitated spatially upscaled models that depend on effective parameters such as the surface vapor conductance (C(surf)). C(surf) accounts for the biophysical and hydrological effects on diffusion through the soil and vegetation substrate. This approach, however, requires either site-specific calibration of C(surf) to measured E, or further parameterization based on metrics such as leaf area, senescence state, stomatal conductance, soil texture, soil moisture, and water table depth. Here, we show that this key, rate-limiting, parameter can be estimated from an emergent relationship between the diurnal cycle of the relative humidity profile and E. The relation is that the vertical variance of the relative humidity profile is less than would occur for increased or decreased evaporation rates, suggesting that land-atmosphere feedback processes minimize this variance. It is found to hold over a wide range of climate conditions (arid-humid) and limiting factors (soil moisture, leaf area, energy). With this relation, estimates of E and C(surf) can be obtained globally from widely available meteorological measurements, many of which have been archived since the early 1900s. In conjunction with precipitation and stream flow, long-term E estimates provide insights and empirical constraints on projected accelerations of the hydrologic cycle.

  1. Enteric gram-negative bacilli bloodstream infections: 17 years' experience in a neonatal intensive care unit.

    PubMed

    Cordero, Leandro; Rau, Rachel; Taylor, David; Ayers, Leona W

    2004-06-01

    To assess the occurrence of enteric gram-negative bacilli (EGNB) bloodstream infections (BSI) in a neonatal intensive care setting during a 17-year period in which a consistent antibiotic treatment program was in place. To document infections, outbreaks, or epidemics, emergence of antibiotic resistance, clinical correlates, and outcomes of the most prevalent EGNB (Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae). This study analyzed demographic, clinical, and bacteriologic information from 360 infants born 1986-2002 who developed 633 blood culture-proven BSI. A total of 121 EGNB were isolated (E coli, K pneumoniae, and E cloacae). Early-onset BSI were discovered within 48 hours from birth, and late-onset BSI were those that occurred thereafter. Suspected early-onset BSI were treated with ampicillin and gentamicin, suspected late-onset BSI with vancomycin and gentamicin. Antibiotics were changed on the basis of organism antimicrobial susceptibility. Early-onset BSI were noted in 52 of 21,336 (244/100,000) live births (1986-1991), 40 of 20,402 (196/100,000) live births (1992-1997), and 25 of 17,926 (139/100,000) live births (1998-2002). Of these cases, 39 were caused by E coli and 4 by K pneumoniae. Antibiograms for E coli isolated during the last 5 years of the study showed an increase in antibiotic resistance that coincided with obstetric group B streptococcus antepartum antibiotic prophylaxis. Group B streptococcus declined from 41 to 4 cases from the first to the last period. Late-onset BSI increased from 111 to 230 cases from the first to the second 6-year study period and declined modestly (171 cases) during the last. Fifteen percent (78 cases) of late-onset BSI were caused by EGNB, 5% by other gram-negative bacilli, 67% primarily by coagulase-negative staphylococcus, and 13% by fungus. Nonspecific clinical and hematologic signs of late-onset BSI were similar across EGNB species, but necrotizing enterocolitis was often associated with E coli

  2. Macroscopic characterisations of Web accessibility

    NASA Astrophysics Data System (ADS)

    Lopes, Rui; Carriço, Luis

    2010-12-01

    The Web Science framework poses fundamental questions on the analysis of the Web, by focusing on how microscopic properties (e.g. at the level of a Web page or Web site) emerge into macroscopic properties and phenomena. One research topic on the analysis of the Web is Web accessibility evaluation, which centres on understanding how accessible a Web page is for people with disabilities. However, when framing Web accessibility evaluation on Web Science, we have found that existing research stays at the microscopic level. This article presents an experimental study on framing Web accessibility evaluation into Web Science's goals. This study resulted in novel accessibility properties of the Web not found at microscopic levels, as well as of Web accessibility evaluation processes themselves. We observed at large scale some of the empirical knowledge on how accessibility is perceived by designers and developers, such as the disparity of interpretations of accessibility evaluation tools warnings. We also found a direct relation between accessibility quality and Web page complexity. We provide a set of guidelines for designing Web pages, education on Web accessibility, as well as on the computational limits of large-scale Web accessibility evaluations.

  3. Socializing in an open drug scene: the relationship between access to private space and drug-related street disorder.

    PubMed

    Debeck, Kora; Wood, Evan; Qi, Jiezhi; Fu, Eric; McArthur, Doug; Montaner, Julio; Kerr, Thomas

    2012-01-01

    Limited attention has been given to the potential role that the structure of housing available to people who are entrenched in street-based drug scenes may play in influencing the amount of time injection drug users (IDU) spend on public streets. We sought to examine the relationship between time spent socializing in Vancouver's drug scene and access to private space. Using multivariate logistic regression we evaluated factors associated with socializing (three+ hours each day) in Vancouver's open drug scene among a prospective cohort of IDU. We also assessed attitudes towards relocating socializing activities if greater access to private indoor space was provided. Among our sample of 1114 IDU, 43% fit our criteria for socializing in the open drug scene. In multivariate analysis, having limited access to private space was independently associated with socializing (adjusted odds ratio: 1.80, 95% confidence interval: 1.28-2.55). In further analysis, 65% of 'socializers' reported positive attitudes towards relocating socializing if they had greater access to private space. These findings suggest that providing IDU with greater access to private indoor space may reduce one component of drug-related street disorder. Low-threshold supportive housing based on the 'housing first' model that include safeguards to manage behaviors associated with illicit drug use appear to offer important opportunities to create the types of private spaces that could support a reduction in street disorder. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  4. Socializing in an Open Drug Scene: The relationship Between Access to Private Space and Drug-Related Street Disorder

    PubMed Central

    DeBeck, Kora; Wood, Evan; Qi, Jiezhi; Fu, Eric; McArthur, Doug; Montaner, Julio; Kerr, Thomas

    2011-01-01

    Background Limited attention has been given to the potential role that the structure of housing available to people who are entrenched in street-based drug scenes may play in influencing the amount of time injection drug users (IDU) spend on public streets. We sought to examine the relationship between time spent socializing in Vancouver's drug scene and access to private space. Methods Using multivariate logistic regression we evaluated factors associated with socializing (three+ hours each day) in Vancouver's open drug scene among a prospective cohort of IDU. We also assessed attitudes towards relocating socializing activities if greater access to private indoor space was provided. Results Among our sample of 1114 IDU, 43% fit our criteria for socializing in the open drug scene. In multivariate analysis, having limited access to private space was independently associated with socializing (adjusted odds ratio: 1.80, 95% confidence interval: 1.28 – 2.55). In further analysis, 65% of ‘socializers’ reported positive attitudes towards relocating socializing if they had greater access to private space. Conclusion These findings suggest that providing IDU with greater access to private indoor space may reduce one component of drug-related street disorder. Low-threshold supportive housing based on the ‘housing first’ model that include safeguards to manage behaviors associated with illicit drug use appear to offer important opportunities to create the types of private spaces that could support a reduction in street disorder. PMID:21764528

  5. Measuring task-related changes in heart rate variability.

    PubMed

    Moses, Ziev B; Luecken, Linda J; Eason, James C

    2007-01-01

    Small beat-to-beat differences in heart rate are the result of dynamic control of the cardiovascular system by the sympathetic and parasympathetic nervous systems. Heart rate variability (HRV) has been positively correlated with both mental and physical health. While many studies measure HRV under rest conditions, few have measured HRV during stressful situations. We describe an experimental protocol designed to measure baseline, task, and recovery values of HRV as a function of three different types of stressors. These stressors involve an attention task, a cold pressor test, and a videotaped speech presentation. We found a measurable change in heart rate in participants (n=10) during each task (all p's < 0.05). The relative increase or decrease from pre-task heart rate was predicted by task (one-way ANOVA, p= 0.0001). Spectral analysis of HRV during the attention task revealed consistently decreased measures of both high (68+/-7%, mean+/-S.E.) and low (62+/-13%) frequency HRV components as compared to baseline. HRV spectra for the cold pressor and speech tasks revealed no consistent patterns of increase or decrease from baseline measurements. We also found no correlation in reactivity measures between any of our tasks. These findings suggest that each of the tasks in our experimental design elicits a different type of stress response in an individual. Our experimental approach may prove useful to biobehavioral researchers searching for factors that determine individual differences in responses to stress in daily life.

  6. Management of paediatric splenic injury in the New South Wales trauma system.

    PubMed

    Adams, Susan E; Holland, Andrew; Brown, Julie

    2017-01-01

    Since the 1980's, paediatric surgeons have increasingly managed blunt splenic injury (BSI) in children non-operatively. However, studies in North America have shown higher operation rates in non-paediatric centres and by adult surgeons. This association has not been examined elsewhere. To investigate the management of BSI in New South Wales (NSW) children, to determine the patient and hospital factors related to the odds of operation. Secondarily, to investigate whether the likelihood of operation varied by year. Children age 0-16 admitted to a NSW hospital between July 2000 and December 2011 with a diagnosis of BSI were identified in the NSW Admitted Patient Data Collection, and linked to deaths data from Registry of Births Deaths and Marriages, and Bureau of Statistics. The operation rate was calculated and compared between different hospital types. Univariable analysis was used to determine patient and hospital factors associated with operative management. The difference in the odds of operation between the oldest data (July 2000-December 2005) and most recent (January 2006-December 2011) was also examined. Multivariable logistic regression with stepwise elimination was then performed to determine likelihood of operative management according to hospital category and era, adjusting for potential confounders. 955 cases were identified, with 101(10.6%) managed operatively. On multivariable analysis, factors associated with operation included age (OR 1.11, 95% CI 1.01-1.18, p<0.05), massive splenic disruption (OR 3.10, 95% CI 1.61-6.19, p<0.001), hollow viscus injury (OR 11.03, 95% CI 3.46-34.28, p<0.001) and transfusion (OR 7.70, 95% CI 4.54-13.16, p<0.001). Management outside a paediatric trauma centre remained significantly associated with operation, whether it be metropolitan adult trauma centre (OR 4.22 95% CI 1.70-10.52, p<0.01), rural trauma centre (OR 3.72 95% CI 1.83-7.83, p<0.001) or metropolitan local hospital (OR 5.23, 95% CI 1.22-18.93 p<0

  7. Self and near relative ratings of functional level one year after traumatic brain injury.

    PubMed

    Sandhaug, Maria; Andelic, Nada; Berntsen, Svein A; Seiler, Stephen; Mygland, Aase

    2012-01-01

    To quantify traumatic brain injury (TBI) patients' perceptions of own function by the Patient Competency Rating Scale (PCRS) one year after injury, and to examine self-awareness of functional deficits by comparing PCRS ratings from patients (PCRS-P) and PCRS ratings from near relatives (PCRS-R), and to identify predictors of awareness deficits. A cohort of 50 severe (n = 33) and moderate (n = 17) TBI patients. Awareness of deficits was investigated by subtracting PCRS relative ratings from PCRS patient ratings. Predictors of PCRS ratings and differences were assessed by stepwise multiple regression analyses. The average patient PCRS sum score was 122/150 (95% CI = 115; 129) as compared to a sum score of 117/150 (95% CI = 110; 125), given by their relatives (p = 0.93). The patients scored themselves slightly higher than their relatives in the domains of activities of daily living (ADL) and cognitive function (p < 0.001, p < 0.001). Regression analyses showed that Glasgow Coma Scale (GCS)score at admission to rehabilitation was the strongest predictor of patient PCRS (B = 3.314, p = 0.008). The strongest predictor of differences between patient and relative PCRS was GCS acute (B = -3.530, p = 0.001). TBI patients demonstrated a slight "awareness gap" in ADL and cognitive function. Low GCS in the acute phase and high age were the strongest predictors of self- awareness deficits.

  8. Fertility effects of abortion and birth control pill access for minors.

    PubMed

    Guldi, Melanie

    2008-11-01

    This article empirically assesses whether age-restricted access to abortion and the birth control pill influence minors' fertility in the United States. There is not a strong consensus in previous literature regarding the relationship between laws restricting minors' access to abortion and minors' birth rates. This is the first study to recognize that state laws in place prior to the 1973 Roe v. Wade decision enabled minors to legally consent to surgical treatment-including abortion-in some states but not in others, and to construct abortion access variables reflecting this. In this article, age-specific policy variables measure either a minor's legal ability to obtain an abortion or to obtain the birth control pill without parental involvement. I find fairly strong evidence that young women's birth rates dropped as a result of abortion access as well as evidence that birth control pill access led to a drop in birth rates among whites.

  9. The work-related fatal injury study: numbers, rates and trends of work-related fatal injuries in New Zealand 1985-1994.

    PubMed

    Feyer, A M; Langley, J; Howard, M; Horsburgh, S; Wright, C; Alsop, J; Cryer, C

    2001-01-26

    To determine the number and rates of work-related fatal injuries by employment status, occupation, industry, age and gender in New Zealand 1985-1994. Potential cases of work-related injury deaths of persons aged 15-84 years were identified from the national electronic mortality data files. Main exclusions were deaths due to suicide and deaths due to motor vehicle crashes. The circumstances of the deaths of each fatal incident meeting inclusion criteria were then reviewed directly from coronial files to determine work-relatedness. The rate of work-related fatal injury in New Zealand was 5.03/100000 workers per year for the study period. There was a significant decline in crude rate over the study period. However, this was in substantial part accounted for by changes in occupation and industry mix. Older workers, male workers, self-employed workers, and particular occupational groups, all had substantially elevated rates. Agricultural and helicopter pilots, forestry workers and fishery workers had the highest rates. Farmers, forestry workers, and fishery workers also had high numbers of deaths, together accounting for nearly 40% of all deaths. This study has demonstrated that work-related fatal injury remains a pressing problem for New Zealand. Several areas in urgent need of prevention efforts were highlighted.

  10. Leaf responses to drought stress in Mediterranean accessions of Solanum lycopersicum: anatomical adaptations in relation to gas exchange parameters.

    PubMed

    Galmés, Jeroni; Ochogavía, Joan Manuel; Gago, Jorge; Roldán, Emilio José; Cifre, Josep; Conesa, Miquel Àngel

    2013-05-01

    In a previous study, important acclimation to water stress was observed in the Ramellet tomato cultivar (TR) from the Balearic Islands, related to an increase in the water-use efficiency through modifications in both stomatal (g(s)) and mesophyll conductances (g(m)). In the present work, the comparison of physiological and morphological traits between TR accessions grown with and without water stress confirmed that variability in the photosynthetic capacity was mostly explained by differences in the diffusion of CO2 through stomata and leaf mesophyll. Maximization of gm under both treatments was mainly achieved through adjustments in the mesophyll thickness and porosity and the surface area of chloroplasts exposed to intercellular airspace (S(c)). In addition, the lower g(m) /S(c) ratio for a given porosity in drought-acclimated plants suggests that the decrease in gm was due to an increased cell wall thickness. Stomatal conductance was also affected by drought-associated changes in the morphological properties of stomata, in an accession and treatment-dependent manner. The results confirm the presence of advantageous physiological traits in the response to drought stress in Mediterranean accessions of tomato, and relate them to particular changes in the leaf anatomical properties, suggesting specific adaptive processes operating at the leaf anatomical level. © 2012 Blackwell Publishing Ltd.

  11. Suicide rate differences by sex, age, and urbanicity, and related regional factors in Korea.

    PubMed

    Cheong, Kyu-Seok; Choi, Min-Hyeok; Cho, Byung-Mann; Yoon, Tae-Ho; Kim, Chang-Hun; Kim, Yu-Mi; Hwang, In-Kyung

    2012-03-01

    Identify the characteristics related to the suicide rates in rural and urban areas of Korea and discover the factors that influence the suicide rate of the rural and urban areas. Using the data on causes of death from 2006 to 2008, the suicide rates were calculated and compared after age-standardization based on gender, age group and urbanicity. And, in order to understand the factors that influence suicide rate, total 10 local characteristics in four domains--public service, social integration, residential environment, and economic status--were selected for multiple regression analysis. The suicide rates were higher in men than women, in rural areas than urban, and in older people than the younger. Generally, although there were variations according to age group and urbanicity, suicide rates were significantly related to residential environment and regional economic status but not related to regional welfare spending and social integration. In addition, the population over the age of 65 years, only regional economic status has significantly influence on their suicide rates. The influence of characteristics of regions on suicide rate is various by age-group, gender, and urbanicity. Therefore, in order to lower suicide rate and reduce the gap between regions, various approaches must be adopted by taking into account the socioeconomic characteristics of the regions.

  12. Access to scientific publications: the scientist's perspective.

    PubMed

    Voronin, Yegor; Myrzahmetov, Askar; Bernstein, Alan

    2011-01-01

    Scientific publishing is undergoing significant changes due to the growth of online publications, increases in the number of open access journals, and policies of funders and universities requiring authors to ensure that their publications become publicly accessible. Most studies of the impact of these changes have focused on the growth of articles available through open access or the number of open-access journals. Here, we investigated access to publications at a number of institutes and universities around the world, focusing on publications in HIV vaccine research--an area of biomedical research with special importance to the developing world. We selected research papers in HIV vaccine research field, creating: 1) a first set of 50 most recently published papers with keywords "HIV vaccine" and 2) a second set of 200 articles randomly selected from those cited in the first set. Access to the majority (80%) of the recently published articles required subscription, while cited literature was much more accessible (67% freely available online). Subscriptions at a number of institutions around the world were assessed for providing access to subscription-only articles from the two sets. The access levels varied widely, ranging among institutions from 20% to 90%. Through the WHO-supported HINARI program, institutes in low-income countries had access comparable to that of institutes in the North. Finally, we examined the response rates for reprint requests sent to corresponding authors, a method commonly used before internet access became widespread. Contacting corresponding authors with requests for electronic copies of articles by email resulted in a 55-60% success rate, although in some cases it took up to 1.5 months to get a response. While research articles are increasingly available on the internet in open access format, institutional subscriptions continue to play an important role. However, subscriptions do not provide access to the full range of HIV vaccine

  13. Glossary of access to health care and related concepts for low- and middle-income countries (LMICs): a critical review of international literature.

    PubMed

    Cabieses, Baltica; Bird, Philippa

    2014-01-01

    Access to health care is a multidimensional and complex concept. Achieving equitable access to care is an important goal for all countries, but particularly challenging in Low- and Middle-Income Countries (LMICs). Despite wide use of the concept of access, it continues to be defined and measured in very different ways. This glossary is a structured overview of key definitions for concepts related to access to health care, with special focus on the interpretation for LMICs. It aims to help people with interest in health service delivery to draw an overview and provide some pointers for further reading in both conceptual and empirical advances in access to health care in LMICs. This document is structured in five sections. The first introduces a general description of the concept of access to health care and its relevance to LMICs, the second displays the search conducted on access to health care for LMICs and the framework used for presentation of glossary terms, the third describes theoretical models most frequently used in the past when looking at access to health care in LMICs, the fourth is the list of terms, and the final section is a discussion of the most salient aspects of this critical review.

  14. Factors influencing antimicrobial resistance and outcome of Gram-negative bloodstream infections in children.

    PubMed

    Ivády, Balázs; Kenesei, Éva; Tóth-Heyn, Péter; Kertész, Gabriella; Tárkányi, Klára; Kassa, Csaba; Ujhelyi, Enikő; Mikos, Borbála; Sápi, Erzsébet; Varga-Heier, Krisztina; Guóth, Gábor; Szabó, Dóra

    2016-06-01

    The aim of this study was to collect data about pediatric Gram-negative bloodstream infections (BSI) to determine the factors that influence multidrug resistance (MDR), clinical course and outcome of children affected by Gram-negative sepsis. In this observational, prospective, multicenter study we collected cases of pediatric Gram-negative BSI during a 2-year period. We analyzed epidemiological, microbiological and clinical factors that associated with acquisition of MDR infections and outcome. One-hundred and thirty-five BSI episodes were analyzed. Median age of children was 0.5 years (IQR 0.1-6.17, range 0-17 years). Predominant bacteria were Enterobacteriaceae (68.3 %), and Pseudomonas spp. (17.9 %). Multidrug resistance was detected in 45/134 cases (33.6 %), with the highest rates in Escherichia coli, Enterobacter and Pseudomonas spp. Acquisition of MDR pathogens was significantly associated with prior cephalosporin treatment, older age, admission to hemato-oncology unit, polymicrobial infections, higher rate of development of septic shock, and multiple organ failures. All-cause mortality was 17.9 %. Presence of septic shock at presentation and parenteral nutrition were associated with higher mortality. Pseudomonas spp., and Enterobacter spp. BSIs had the highest rate of mortality. Inappropriate empiric antibiotic therapy was more frequent in MDR patients, although not significantly associated with poor outcome. Rates of multidrug resistance and mortality in children with Gram-negative bloodstream infections remain high in our settings. Empiric broad-spectrum antibiotics and combination therapy could be recommended, especially in children with malignant diseases, patients admitted to the PICU, and for cases with septic shock, who have higher mortality risk.

  15. Reinforced aneurysmorrhaphy for true aneurysmal haemodialysis vascular access.

    PubMed

    Rokošný, S; Baláž, P; Wohlfahrt, P; Palouš, D; Janoušek, L

    2014-04-01

    In 2008, a new technique of reinforced aneurysmorrhaphy with a polyester mesh tube for salvaging true aneurysmal arteriovenous (AV) haemodialysis access was described by us. In this study, the long-term patency and complication rates associated with this procedure were analysed, and the effect of reinforced aneurysmorrhaphy on high-flow vascular access was assessed. This was a retrospective non-randomised study with prospectively collected data performed at a single centre. Patients with true aneurysmal haemodialysis AV access who underwent aneurysmorrhaphy with external mesh prosthesis between March 2007 and October 2012 were included. Clinical assessment and duplex ultrasound were performed preoperatively, 1, 3, and 12 months postoperatively, and annually thereafter. Data from 62 patients (median age 60 years, range 28-81 years; 63% men) were analysed. The commonest indication was high-flow vascular access associated with the risk of high output cardiac failure (24 patients, 39%). The mean follow-up time was 14.66 ± 12.80 months. Primary patency rates at 6 and 12 months were 86% and 79% respectively. Assisted primary patency rates at 6 and 12 months were 89% and 80% respectively. In 23 patients (96%) operated on for high-flow vascular access, decreased vascular access flow was observed after the procedure. The average flow reduction after aneurysmorrhaphy was 2,197 mL/minute. Postoperative bleeding and infection necessitating surgical revision occurred in three (4.8%) and three (4.8%) patients respectively. Reinforced aneurysmorrhaphy with an external mesh prosthesis is an effective method for treating true aneurysmal haemodialysis AV access, with excellent long-term patency and minimal complications due to infection. Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Handbook of noise ratings

    NASA Technical Reports Server (NTRS)

    Pearsons, K. S.; Bennett, R. L.

    1974-01-01

    The handbook was compiled to provide information in a concise form, describing the multitude of noise rating schemes. It is hoped that by describing the noise rating methods in a single volume the user will have better access to the definitions, application and calculation procedures of the current noise rating methods.

  17. The evaluation of radiologic methods for access guidance in percutaneous nephrolithotomy: a systematic review of the literature.

    PubMed

    Breda, Alberto; Territo, Angelo; Scoffone, Cesare; Seitz, Christian; Knoll, Thomas; Herrmann, Thomas; Brehmer, Mariannhe; Osther, Palle J S; Liatsikos, Evangelos

    2017-11-12

    Percutaneous nephrolithotomy (PNL) is the treatment of choice for larger and complex renal calculi. First step in performing PNL is to obtain access to the renal cavity using either fluoroscopy or ultrasound (US) guidance or a combination of both. Which guiding method to choose is controversial? A systematic review of the literature was performed comparing image guidance modalities for obtaining access in PNL. Evidence acquisition and synthesis: A PubMed, Scopus and Cochrane search for peer-reviewed studies was performed using the keywords "ultrasound" AND "fluoroscopy" AND "Percutaneous nephrolithotomy". Eligible articles were reviewed according to PRISMA criteria. Two hundred and forty records were identified using the keywords. Of these twelve studies were considered relevant. US guidance seems to be associated with a slightly lower complication rate, which may be related to fewer puncture attempts needed for obtaining access and to better peri-renal organ visualization. On the other hand, US-guidance alone needs the adjunct of fluoroscopy in a significant number of cases for achieving access. Stone free rate (SFR) was comparable between groups. Using US for renal access unequivocally reduces radiation exposure. Current evidence indicates that both fluoroscopy and US guidance may be successfully used for obtaining percutaneous renal access. Combining the image-guiding modalities - US and fluoroscopy - seems to increase outcome in PNL both with regard to success in achieving access and reducing complications. Furthermore, including US in the access strategy of PNL reduces radiation exposure to surgeon and staff as well as patients.

  18. Sociocultural variables in youth access to tobacco: replication 5 years later.

    PubMed

    Landrine, H; Klonoff, E A; Campbell, R; Reina-Patton, A

    2000-05-01

    A prior study presented the only systematic investigation of the role of sociocultural variables in youth access to tobacco. White, black, and Latino girls and boys attempted to purchase cigarettes in the same 72 stores at the same time of day. Results revealed significantly greater sales to girls than to boys and to minorities than to whites. Before concluding that sociocultural variables must be addressed in merchant intervention programs designed to reduce youth access to tobacco, this study must be replicated, particularly in light of the significant decreases in youth access in the past 5 years. This article presents that replication. The stores used in the prior study were selected, and 12 white, black, and Latino girls and boys attempted to purchase cigarettes in those stores at the same time of day. Results Youths' access rate in 1999 (12.7%) was significantly lower than in the prior (1993-1995) study (41%). No effect for minors' gender was found, but the ethnicity effect again emerged: Black and Latino youth were 2.5 times more likely to be sold cigarettes than their white counterparts. Multiple sociocultural variables affect youth access to tobacco when access rates are high, but only youth ethnicity plays a role when access rates are low. Merchant interventions designed to reduce youth access to tobacco must address ethnic issues.

  19. Youth access to tobacco.

    PubMed

    Rigotti, N A

    1999-01-01

    To start smoking, young people need a supply of tobacco products. Reducing youth access to tobacco is a new approach to preventing tobacco use that has been a focus of federal, state, and local tobacco control efforts over the past decade. All 50 states ban tobacco sales to minors, but compliance is poor because laws are not enforced. Consequently, young people have little trouble obtaining tobacco products. Commercial sources of tobacco (stores and vending machines) are important for underage smokers, who often purchase their own cigarettes. Underage youths also obtain tobacco from noncommercial sources such as friends, relatives, older adolescents, and adults. Educating retailers about tobacco sales laws has not produced long-term improvement in their compliance. Active enforcement of tobacco sales laws changes retailer behavior, but whether this reduces young people's access to tobacco or their tobacco use is not clear. The effectiveness of new local, state, and federal actions that aim to reduce youth access to tobacco remains to be determined. Can enforcing tobacco sales laws reduce young people's access to tobacco? If so, will this prevent or delay the onset of their tobacco use? How will youths' sources of tobacco change as commercial sources are restricted? What are the social (noncommercial) sources of tobacco for minors and how can youths' access to tobacco from these sources be reduced? What is the impact of the new federal policies aimed at reducing youth access to tobacco? Do new state and local laws that ban youth possession or use of tobacco have a net positive or negative impact on youth attitudes, access to tobacco, or tobacco use? What is the relative effectiveness and cost-effectiveness of efforts to reduce the supply of tobacco compared to those that aim to reduce demand for tobacco? Will either work alone or are both necessary to achieve reductions in youth smoking?

  20. Poverty, Transportation Access, and Medication Nonadherence.

    PubMed

    Hensley, Caroline; Heaton, Pamela C; Kahn, Robert S; Luder, Heidi R; Frede, Stacey M; Beck, Andrew F

    2018-04-01

    Variability in primary medication nonadherence (PMN), or failure to fill a new prescription, influences disparities and widens equity gaps. This study sought to evaluate PMN across 1 metropolitan area and assess relationships with underlying zip code-level measures. This was a retrospective observational study using data extracted from 1 regional community pharmacy market-share leader (October 2016-April 2017). Data included patient age, sex, payer, medication type, and home zip code. This zip code was connected to US census measures enumerating poverty and vehicle access, which were treated as continuous variables and within quintiles. The prescription-level outcome was whether prescriptions were not filled within 30 days of reaching the pharmacy. The ecological-level outcome was PMN calculated for each zip code (numerator, unfilled prescriptions; denominator, received prescriptions). There were 213 719 prescriptions received by 54 included pharmacies; 12.2% were unfilled. Older children, boys, and those with public insurance were more likely to have prescriptions not filled. Prescriptions originating from the highest poverty quintile were significantly more likely to not be filled than those from the lowest poverty quintile (adjusted odds ratio 1.60; 95% confidence interval 1.52-1.69); a similar pattern was noted for vehicle access (adjusted odds ratio 1.77; 95% confidence interval 1.68-1.87). At the ecological level, there were significant, graded relationships between PMN rates and poverty and vehicle access (both P < .0001); these gradients extended across all medication classes. Poverty and vehicle access are related to significant differences in prescription- and ecological-level PMN across 1 metropolitan area. Pharmacists and pharmacies can be key partners in population health efforts. Copyright © 2018 by the American Academy of Pediatrics.