Science.gov

Sample records for pre-existing medical conditions

  1. Pre-existing medical conditions associated with Vibrio vulnificus septicaemia.

    PubMed

    Menon, M P; Yu, P A; Iwamoto, M; Painter, J

    2014-04-01

    Vibrio vulnificus (Vv) can result in severe disease. Although pre-existing liver disease is a recognized risk factor for serious infection, the relative importance of other comorbidities has not been fully assessed. We analysed reports of Vv infections submitted to CDC from January 1988 to September 2006 in order to assess the role of pre-existing conditions contributing to severe outcomes. A total of 1212 patients with Vv infection were reported. Only patients with liver disease [adjusted odds ratio (aOR) 5.1)] were more likely to become septic when exposure was due to contaminated food. Patients with liver disease (aOR 4.1), a haematological disease (aOR 3.2), or malignancy (aOR 3.2) were more likely to become septic when infection was acquired via a non-foodborne exposure. As such, patients with these pre-existing medical conditions should be advised of the risk of life-threatening illness after eating undercooked contaminated seafood or exposing broken skin to warm seawater. PMID:23842472

  2. 75 FR 45013 - Pre-Existing Condition Insurance Plan Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-30

    ... Health and Human Services 45 CFR Part 152 Pre-Existing Condition Insurance Plan Program; Interim Final...; ] DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Part 152 RIN 0991-AB71 Pre-Existing Condition Insurance Plan Program AGENCY: Office of Consumer Information and Insurance Oversight, OCIIO, Department of Health...

  3. Your most feared calls: assessing & treating pediatric patients with undiagnosed pre-existing conditions.

    PubMed

    Warren, Linda; Sapien, Robert

    2009-01-01

    During the past several years, EMTs and paramedics have seen more and more children with underlying health conditions, including children with special health-care needs (CSHCN). Advances in medical knowledge, improved technology and more affordable medical equipment have allowed CSHCN to be cared for at home rather than in specialized facilities. As a result, when these children become ill or injured, EMS is called to assist the family in caring for them. The families are typically experts in providing the patient's history and assisting EMS with equipment and devices. However, some pediatric calls can keep you guessing. The patient has no known pre-existing conditions, and the family may be extremely panicked and upset by the emergency. What causes tachypnea, altered mental status (AMS) and seizures in children? How do you assess and treat those causes? The following cases involve actual patients who were seen by an urban ambulance service. Consider how each case presented to the crews, and how you would assess and treat the patients. PMID:19245957

  4. Sports Dermatology: Part 1 of 2 Traumatic or Mechanical Injuries, Inflammatory Conditions, and Exacerbations of Pre-existing Conditions.

    PubMed

    Emer, Jason; Sivek, Rachel; Marciniak, Brian

    2015-04-01

    Competitive athletes endure extreme bodily stress when participating in sports-related activities. An athlete's skin is particularly susceptible to a wide array of repetitive physical and environmental stressors that challenge the skin's protective function. Many unique dermatoses are well-known to the serious athlete due to countless hours of intense physical training, but are frequently unrecognized by many healthcare professionals. Sports dermatology is a distinctive, budding field of dermatology that focuses on dermatoses frequently encountered in athletes. Athletic skin problems are notoriously infectious in nature due to the inherent environment of close-contact physical activity. Nonetheless, other skin conditions can manifest or worsen with recurring mechanical or traumatic injury or exposure to environmental hazards. Additionally, sports-related activities may exacerbate other pre-existing dermatological conditions that may possibly be unknown to the athlete or clinician. The objective of this two-part review is to arm the astute physician with the fundamental knowledge of the range of dermatological conditions distinct to the competitive athlete. Knowledge of these cutaneous conditions in the context of specific sporting events will permit the clinician to manage these unique patients most effectively. Part one will focus on traumatic or mechanical injuries, inflammatory conditions, and exacerbations of pre-existing conditions frequently seen in athletes. PMID:26060516

  5. Sports Dermatology: Part 1 of 2 Traumatic or Mechanical Injuries, Inflammatory Conditions, and Exacerbations of Pre-existing Conditions

    PubMed Central

    Sivek, Rachel; Marciniak, Brian

    2015-01-01

    Competitive athletes endure extreme bodily stress when participating in sports-related activities. An athlete’s skin is particularly susceptible to a wide array of repetitive physical and environmental stressors that challenge the skin’s protective function. Many unique dermatoses are well-known to the serious athlete due to countless hours of intense physical training, but are frequently unrecognized by many healthcare professionals. Sports dermatology is a distinctive, budding field of dermatology that focuses on dermatoses frequently encountered in athletes. Athletic skin problems are notoriously infectious in nature due to the inherent environment of close-contact physical activity. Nonetheless, other skin conditions can manifest or worsen with recurring mechanical or traumatic injury or exposure to environmental hazards. Additionally, sports-related activities may exacerbate other pre-existing dermatological conditions that may possibly be unknown to the athlete or clinician. The objective of this two-part review is to arm the astute physician with the fundamental knowledge of the range of dermatological conditions distinct to the competitive athlete. Knowledge of these cutaneous conditions in the context of specific sporting events will permit the clinician to manage these unique patients most effectively. Part one will focus on traumatic or mechanical injuries, inflammatory conditions, and exacerbations of pre-existing conditions frequently seen in athletes. PMID:26060516

  6. 45 CFR 155.345 - Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan. 155.345 Section 155.345 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER...

  7. Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes

    PubMed Central

    Son, K H; Lim, N-K; Lee, J-W; Cho, M-C; Park, H-Y

    2015-01-01

    Aims To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Methods Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431 deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes. Results Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups. Conclusions The study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications. PMID:25472691

  8. 5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or...

  9. 5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or...

  10. 5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or...

  11. 5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or...

  12. 5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or...

  13. Pre-existing diabetes in pregnancy.

    PubMed

    Padmanabhan, Suja; Zen, Monica; Lee, Vincent; Cheung, Ngai W

    2016-03-01

    The incidence of type 1 and type 2 diabetes amongst women of reproductive age is increasing worldwide. Despite recent advances in treatment options for diabetes outside of pregnancy, women still have a significantly increased risk of adverse obstetric outcomes including perinatal death and congenital malformation, compared to the non-diabetic population. An understanding of the physiological changes during pregnancy, management, early detection and prevention of complications and pre-pregnancy care, specific to women with pre-existing diabetes, is important in improving health outcomes in this growing group of women. This review particularly focuses on areas where there have been recent developments or controversy. PMID:26878562

  14. 5 CFR 2634.409 - Pre-existing trusts.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Pre-existing trusts. 2634.409 Section... FINANCIAL DISCLOSURE, QUALIFIED TRUSTS, AND CERTIFICATES OF DIVESTITURE Qualified Trusts § 2634.409 Pre-existing trusts. An interested party may place a pre-existing irrevocable trust into a qualified...

  15. 17 CFR 151.9 - Pre-existing positions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 17 Commodity and Securities Exchanges 1 2012-04-01 2012-04-01 false Pre-existing positions. 151.9... FUTURES AND SWAPS § 151.9 Pre-existing positions. (a) Non-spot-month position limits. The position limits.... Notwithstanding the pre-existing exemption in non-spot months, a person must comply with spot month limits....

  16. The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center

    PubMed Central

    Wadia, Roxanne J; Yao, Xiaopan; Deng, Yanhong; Li, Jia; Maron, Steven; Connery, Donna; Gunduz-Bruce, Handan; Rose, Michal G

    2015-01-01

    There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care. PMID:26063243

  17. Pre-existing Antibody: Biotherapeutic Modality-Based Review.

    PubMed

    Gorovits, Boris; Clements-Egan, Adrienne; Birchler, Mary; Liang, Meina; Myler, Heather; Peng, Kun; Purushothama, Shobha; Rajadhyaksha, Manoj; Salazar-Fontana, Laura; Sung, Crystal; Xue, Li

    2016-03-01

    Pre-existing antibodies to biotherapeutic drugs have been detected in drug-naïve subjects for a variety of biotherapeutic modalities. Pre-existing antibodies are immunoglobulins that are either specific or cross-reacting with a protein or glycan epitopes on a biotherapeutic compound. Although the exact cause for pre-existing antibodies is often unknown, environmental exposures to non-human proteins, glycans, and structurally similar products are frequently proposed as factors. Clinical consequences of the pre-existing antibodies vary from an adverse effect on patient safety to no impact at all and remain highly dependent on the biotherapeutic drug modality and therapeutic indication. As such, pre-existing antibodies are viewed as an immunogenicity risk factor requiring a careful evaluation. Herein, the relationships between biotherapeutic modalities to the nature, prevalence, and clinical consequences of pre-existing antibodies are reviewed. Initial evidence for pre-existing antibody is often identified during anti-drug antibody (ADA) assay development. Other interfering factors known to cause false ADA positive signal, including circulating multimeric drug target, rheumatoid factors, and heterophilic antibodies, are discussed. PMID:26821802

  18. A Double Whammy: Health Promotion Among Cancer Survivors with Pre-Existing Functional Limitations

    PubMed Central

    Volker, Deborah L.; Becker, Heather; Kang, Sook Jung; Kullberg, Vicki

    2012-01-01

    Purpose/Objectives To explore the experience of living with a cancer diagnosis within the context of a pre-existing functional disability and to identify strategies to promote health in this growing population of cancer survivors. Research Approach Qualitative descriptive Setting Four sites in the United States Participants 19 female cancer survivors with pre-existing disabling conditions Methodologic Approach Four focus groups were conducted. The audiotapes were transcribed and analyzed using content analysis techniques. Main Research Variables cancer survivor, disability, health promotion Findings Analytic categories included living with a cancer diagnosis, health promotion strategies, and wellness program development for survivors with pre-existing functional limitations. Participants described many challenges associated with managing a cancer diagnosis on top of living with a chronic disabling functional limitation. They identified strategies they used to maintain their health and topics to be included in health promotion programs tailored for this unique group of cancer survivors. Conclusions The “double whammy” of a cancer diagnosis for persons with pre-existing functional limitations requires modification of health promotion strategies and programs to promote wellness in this group of cancer survivors. Interpretation Nurses and other health care providers must attend to patients’ pre-existing conditions as well as the challenges of the physical, emotional, social, and economic sequelae of a cancer diagnosis. PMID:23269771

  19. 78 FR 30218 - Pre-Existing Condition Insurance Plan Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-22

    ..., no later than 5 p.m. on July 22, 2013. Because of staff and resource limitations, we cannot accept.... Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You..., work, risk and resources of the service. (Hereafter, we generally refer to this pricing methodology...

  20. 77 FR 52614 - Pre-Existing Condition Insurance Plan Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-30

    ... staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may... 30, 2010 (75 FR 45014). For the reasons explained below, HHS is now issuing an amendment to this... Affordable Insurance Exchanges, 45 CFR 155.20 (77 FR 18310, March 27, 2012), and the premium tax credits,...

  1. 43 CFR 3427.4 - Pre-existing consents.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Pre-existing consents. 3427.4 Section 3427.4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) COMPETITIVE LEASING Split Estate Leasing § 3427.4...

  2. 43 CFR 3427.4 - Pre-existing consents.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Pre-existing consents. 3427.4 Section 3427.4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) COMPETITIVE LEASING Split Estate Leasing § 3427.4...

  3. 43 CFR 3427.4 - Pre-existing consents.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Pre-existing consents. 3427.4 Section 3427.4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) COMPETITIVE LEASING Split Estate Leasing § 3427.4...

  4. Medical conditions with neuropsychiatric manifestations.

    PubMed

    Isaac, Margaret L; Larson, Eric B

    2014-09-01

    Medical disease sometimes affects patients through neuropsychiatric manifestations. When neuropsychiatric symptoms are predominant, identifying medical disease early in the illness course is imperative because many of these conditions are reversible with appropriate treatment. A high index of suspicion is required on the part of clinicians, particularly when patients also present with physical signs or unexplained symptoms that might suggest a broader, systemic process. The processes that most commonly cause neuropsychiatric symptoms include infectious, autoimmune, endocrinologic, metabolic, and neoplastic diseases. This article focuses on the most common of these conditions, and conditions for which early diagnosis and treatment are particularly important. PMID:25134879

  5. Gate dielectric degradation: Pre-existing vs. generated defects

    SciTech Connect

    Veksler, Dmitry E-mail: gennadi.bersuker@sematech.org; Bersuker, Gennadi E-mail: gennadi.bersuker@sematech.org

    2014-01-21

    We consider the possibility that degradation of the electrical characteristics of high-k gate stacks under low voltage stresses of practical interest is caused primarily by activation of pre-existing defects rather than generation of new ones. In nFETs in inversion, in particular, defect activation is suggested to be associated with the capture of an injected electron: in this charged state, defects can participate in a fast exchange of charge carriers with the carrier reservoir (substrate or gate electrode) that constitutes the physical process underlying a variety of electrical measurements. The degradation caused by the activation of pre-existing defects, as opposed to that of new defect generation, is both reversible and exhibits a tendency to saturate through the duration of stress. By using the multi-phonon assisted charge transport description, it is demonstrated that the trap activation concept allows reproducing a variety of experimental results including stress time dependency of the threshold voltage, leakage current, charge pumping current, and low frequency noise. Continuous, long-term degradation described by the power law time dependency is shown to be determined by the activation of defects located in the interfacial SiO{sub 2} layer of the high-k gate stacks. The findings of this study can direct process optimization efforts towards reduction of as-grown precursors of the charge trapping defects as the major factor affecting reliability.

  6. PRESENCE OF PRE-EXISTING ANTIBODIES MEDIATE SURVIVAL IN SEPSIS

    PubMed Central

    Moitra, Rituparna; Beal, Dominic R.; Belikoff, Bryan G.; Remick, Daniel G.

    2011-01-01

    Sepsis is one of the leading causes of death in hospitals worldwide. Even with optimal therapy, severe sepsis results in 50% mortality, indicating variability in the response of individuals towards treatment. We hypothesize that the presence of pre-existing antibodies present in the blood before the onset of sepsis induced by cecal ligation and puncture (CLP) in mice, accounts for the differences in their survival. A Plasma Enhanced Killing (PEK) assay was performed to calculate the PEK capacity of plasma i.e. the ability of plasma to augment PMN killing of bacteria. PEK was calculated as PEK= (1/log (N)) × 100; where N= number of surviving bacteria; a higher PEK indicated better bacterial killing. A range of PEK in plasma collected from mice prior to CLP was observed, documenting individual differences in bacterial killing capacity. Mortality was predicted based on plasma IL-6 levels at 24 hr post CLP. Mice predicted to die (Die-P) had a lower PEK (<14) and higher peritoneal bacterial counts 24 hr post sepsis compared to those predicted to live (Live-P) with a PEK>16. Mice with PEK<14 were 3.1 times more likely to die compared to the PEK>16 group. To understand the mechanism of defense conferred by the pre-existing antibodies, binding of IgM or IgG to enteric bacteria was documented by flow cytometry. To determine the relative contribution of IgM or IgG, the immunoglobulins were specifically immuno-depleted from the naïve plasma samples and the PEK of the depleted plasma measured. Compared to naïve plasma, depletion of IgM had no effect on the PEK. However, depletion of IgG increased PEK suggesting that an inhibitory IgG binds to antigenic sites on bacteria preventing optimal opsonization of the bacteria. These data demonstrate that prior to CLP; circulating inhibitory IgG antibodies exist that prevent bacterial killing by PMNs in a CLP model of sepsis. PMID:21921828

  7. Ionospheric Current Closure of the Pre-existing Auroral Arc

    NASA Astrophysics Data System (ADS)

    Jiang, F.; Kivelson, M.; Strangeway, R. J.; Khurana, K. K.; Walker, R. J.; Weygand, J. M.

    2014-12-01

    An auroral substorm commences when a discrete auroral arc brightens and subsequently expands poleward and azimuthally. The arc that brightens is usually the most equatorward of several auroral arcs that remain quiescent for ~5 to ~60 minutes before the break-up commences. This arc is often referred to as the "pre-existing auroral arc (PAA)" or the "growth-phase arc". Till now, the ionospheric electrodynamics of the PAA has been studied extensively by ground radar, rockets and low-altitude spacecraft, and it is well established that the field-aligned currents (FAC) associated with the PAA in the ionosphere are current sheets that are narrow in latitude and elongated in longitude. However, it remains a question whether the ionospheric currents that connect the FAC pair of the PAA are meridional or azimuthal. In this study, we have identified ~180 PAA events from FAST measurements in 1998 and 1999 and used the statistics to investigate the ionospheric current closure of the PAA. We calculate the height-integrated Pedersen currents from the electric fields measured by FAST using an empirical ionospheric conductance model and infer the FAC density from the divergence of the Pedersen currents. We find that in the vicinity of the PAA, the FAC density inferred from the divergence of perpendicular currents mimics the trend of the FAC density inferred from magnetic perturbations seen on FAST, and that the boundaries between the upward and the downward FAC sheets inferred from two different approaches lie very close together. Additionally, the latitudinal gradient of the azimuthal component of the magnetic perturbation is much larger than the azimuthal gradient of the meridional component of the magnetic perturbation in the vicinity of the PAA, indicating that the density of a meridional current is much larger than that of an azimuthal current. Our observational analysis strongly suggests that the perpendicular current that closes the FAC pair of the PAA is a north-south Pedersen current in the ionosphere.

  8. Pre-existing diabetes mellitus and adverse pregnancy outcomes

    PubMed Central

    2012-01-01

    Background Pregnancies complicated by pre-existing diabetes mellitus (PDM) are associated with a high rate of adverse outcomes, including an increased miscarriage rate, preterm delivery, preeclampsia, perinatal mortality and congenital malformations; compared to the background population. The objectives of this study are to determine the prevalence of PDM and to investigate the maternal and the neonatal outcomes of women with PDM. Methods This is a retrospective cohort study for women who delivered in King Khalid University Hospital (KKUH) during the period of January 1st to the 31st of December 2008. The pregnancy outcomes of the women with PDM were compared to the outcomes of all non-diabetic women who delivered during the same study period. Results A total of 3157 deliveries met the inclusion criteria. Out of the study population 116 (3.7%) women had PDM. There were 66 (57%) women with type 1 diabetes mellitus (T1DM) and 50 (43%) women with type 2 diabetes mellitus (T2DM). Compared to non-diabetic women those with PDM were significantly older, of higher parity, and they had more previous miscarriages. Women with PDM were more likely to be delivered by emergency cesarean section (C/S), OR 2.67, 95% confidence intervals (CI) (1.63-4.32), P < 0.001, or elective C/S, OR 6.73, 95% CI (3.99-11.31), P < 0.001. The neonates of the mothers with PDM were significantly heavier, P < 0.001; and more frequently macrosomic; OR 3.97, 95% CI (2.03-7.65), P = 0.002. They more frequently have APGAR scores <7 in 5 minutes, OR 2.61, 95% CI (0.89-7.05), P 0.057 and more likely to be delivered at <37 gestation weeks, OR 2.24, 95% CI (1.37- 3.67), P 0.003. The stillbirth rate was 2.6 times more among the women with PDM; however the difference did not reach statistical significance, P 0.084. Conclusion PDM is associated with increased risk for C/S delivery, macrosomia, stillbirth, preterm delivery and low APGAR scores at 5 min. PMID:22963905

  9. Effects of Pre-Existing Upstream Turbulence on Magnetic Fields and Particle Acceleration at Astrophysical Shocks

    NASA Astrophysics Data System (ADS)

    Jokipii, J. R.

    2008-04-01

    We consider effects of pre-existing, large-scale turbulence upstream of a shock on the magnetic field and the acceleration of charged particles. Turbulent magnetic-field-line mixing plays a large role in particle transport. Also, turbulent density fluctuations upstream of the shock have a large effect on the magnetic field downstream (Giacalone and Jokipii, Ap. J., 633, L41, 2007). For high Alfvèn-Mach-number shocks, the downstream magnetic field is amplified considerably above the value obtained from the shock jump conditions. These effects may provide a robust and natural understanding of recent observations at astrophysical shocks. The magnetic-field amplification implied by our simulations should exceed factors of 100, consistent with observed X-rays from supernova remnants, which require magnetic fields of 100 μG. These are much larger than expected from the shock jump conditions. In this case, the upstream field is not amplified, so cosmic-rays with energies approaching the ``knee'' in the spectrum require rapid acceleration, which can occur at the quasi-perpendicular part of the supernova blast wave, where the turbulent field-line mixing plays a large role. Further, recent observations by the Voyager 1 spacecraft downstream of the heliospheric termination shock show that the magnetic field has large magnitude fluctuations. We suggest that these and other effects of pre-existing turbulence play an important role in many astrophysical and heliospheric shocks.

  10. Surrogate-based optimization of hydraulic fracturing in pre-existing fracture networks

    NASA Astrophysics Data System (ADS)

    Chen, Mingjie; Sun, Yunwei; Fu, Pengcheng; Carrigan, Charles R.; Lu, Zhiming; Tong, Charles H.; Buscheck, Thomas A.

    2013-08-01

    Hydraulic fracturing has been used widely to stimulate production of oil, natural gas, and geothermal energy in formations with low natural permeability. Numerical optimization of fracture stimulation often requires a large number of evaluations of objective functions and constraints from forward hydraulic fracturing models, which are computationally expensive and even prohibitive in some situations. Moreover, there are a variety of uncertainties associated with the pre-existing fracture distributions and rock mechanical properties, which affect the optimized decisions for hydraulic fracturing. In this study, a surrogate-based approach is developed for efficient optimization of hydraulic fracturing well design in the presence of natural-system uncertainties. The fractal dimension is derived from the simulated fracturing network as the objective for maximizing energy recovery sweep efficiency. The surrogate model, which is constructed using training data from high-fidelity fracturing models for mapping the relationship between uncertain input parameters and the fractal dimension, provides fast approximation of the objective functions and constraints. A suite of surrogate models constructed using different fitting methods is evaluated and validated for fast predictions. Global sensitivity analysis is conducted to gain insights into the impact of the input variables on the output of interest, and further used for parameter screening. The high efficiency of the surrogate-based approach is demonstrated for three optimization scenarios with different and uncertain ambient conditions. Our results suggest the critical importance of considering uncertain pre-existing fracture networks in optimization studies of hydraulic fracturing.

  11. Molecular dynamics study on the interactions between helium projectiles and helium bubbles pre-existing in tungsten surfaces

    NASA Astrophysics Data System (ADS)

    Ding, Yuan; Ma, Chaoqiong; Li, Min; Hou, Qing

    2016-02-01

    Molecular dynamics simulations were performed to study the interactions between low-energy (⩽100 eV) helium (He) projectiles and helium bubbles pre-existing near tungsten (W) surfaces. It is observed that with increasing bubble size, the reflection coefficient of the He projectiles was reduced, and the channelling effect that could be observed with no pre-existing He bubble was depressed. The He projectiles can be captured by pre-existing He bubbles and also knock He atoms out of the bubbles. The spatial distribution of the single He atoms, including both the slowed-down projectiles and the knocked-out He atoms, was extracted. The single He atoms were found distributed around the bubbles in a region with the width of 3-5.5 in lattice lengths of W. Although the results were obtained for the interaction of He projectiles with isolated He bubbles pre-existing in W, they suggest that the reflection and retention status of He projectiles would change during the irradiation of high flux/fluence He on W surfaces due to the change of He bubbles coverage near W surfaces. The results can be coupled with Monte Carlo modelling in conditions closer to that in experiments of high flux/fluence He bombardments on W surfaces.

  12. The Near Earth Asteroid Medical Conditions List

    NASA Technical Reports Server (NTRS)

    Barr, Yael R.; Watkins, S. D.

    2011-01-01

    Purpose: The Exploration Medical Capability (ExMC) element is one of six elements within NASA s Human Research Program (HRP) and is responsible for addressing the risk of "the inability to adequately recognize or treat an ill or injured crewmember" for exploration-class missions. The Near Earth Asteroid (NEA) Medical Conditions List, constructed by ExMC, is the first step in addressing the above-mentioned risk for the 13-month long NEA mission. The NEA mission is being designed by NASA's Human Space Flight Architecture Team (HAT). The purpose of the conditions list is to serve as an evidence-based foundation for determining which medical conditions could affect a crewmember during the NEA mission, which of those conditions would be of concern and require treatment, and for which conditions a gap in knowledge or technology development exists. This information is used to focus research efforts and technology development to ensure that the appropriate medical capabilities are available for exploration-class missions. Scope and Approach: The NEA Medical Conditions List is part of a broader Space Medicine Exploration Medical Conditions List (SMEMCL), which incorporates various exploration-class design reference missions (DRMs). The conditions list contains 85 medical conditions which could occur during space flight and which are derived from several sources: Long-Term Surveillance of Astronaut Health (LSAH) in-flight occurrence data, The Space Shuttle (STS) Medical Checklist, The International Space Station (ISS) Medical Checklist, and subject matter expert opinion. Each medical condition listed has been assigned a clinical priority and a clinical priority rationale based on incidence, consequence, and mitigation capability. Implementation: The conditions list is a "living document" and as such, new conditions can be added to the list, and the priority of conditions on the list can be adjusted as the DRM changes, and as screening, diagnosis, or treatment capabilities change. The NEA medical conditions list was used recently as the basis for identifying gaps in in-flight medical evaluation (screening) capabilities. Learning Objectives: The audience will become familiar with the approach taken by NASA's Exploration Medical Capability element in addressing the risk of inability to recognize and treat medical conditions in the setting of a Near Earth Asteroid mission. Which one of the following statements is incorrect? a) The Near Earth Asteroid (NEA) medical conditions list includes 85 medical conditions which could occur during space flight. b) Each condition on the NEA medical conditions list has been assigned a clinical priority and a clinical priority rationale. c) The NEA medical conditions list targets a mission to Mars. d) The NEA medical conditions list should be viewed as a "living document" where new conditions can be added and clinical priorities adjusted to address changes in the design reference mission or medical capabilities. The incorrect answer is c). The NEA medical conditions list targets a mission to a Near Earth Asteroid.

  13. Medical Conditions and Nearly Lethal Suicide Attempts.

    ERIC Educational Resources Information Center

    Ikeda, Robin M.; Kresnow, Marcie-jo; Mercy, James A.; Powell, Kenneth E.; Simon, Thomas R.; Potter, Lloyd B.; Durant, Tonji M.; Swahn, Monica H.

    2002-01-01

    This population-based, case-control study examined physical illness as a risk factor for suicidal behavior. Case patients were more likely than controls to report having any serious medical conditions. Results suggest that young men with medical conditions are at increased risk for nearly lethal suicide attempts. (Contains 33 references and 3…

  14. Mining FDA drug labels for medical conditions

    PubMed Central

    2013-01-01

    Background Cincinnati Childrens Hospital Medical Center (CCHMC) has built the initial Natural Language Processing (NLP) component to extract medications with their corresponding medical conditions (Indications, Contraindications, Overdosage, and Adverse Reactions) as triples of medication-related information ([(1) drug name]-[(2) medical condition]-[(3) LOINC section header]) for an intelligent database system, in order to improve patient safety and the quality of health care. The Food and Drug Administrations (FDA) drug labels are used to demonstrate the feasibility of building the triples as an intelligent database system task. Methods This paper discusses a hybrid NLP system, called AutoMCExtractor, to collect medical conditions (including disease/disorder and sign/symptom) from drug labels published by the FDA. Altogether, 6,611 medical conditions in a manually-annotated gold standard were used for the system evaluation. The pre-processing step extracted the plain text from XML file and detected eight related LOINC sections (e.g. Adverse Reactions, Warnings and Precautions) for medical condition extraction. Conditional Random Fields (CRF) classifiers, trained on token, linguistic, and semantic features, were then used for medical condition extraction. Lastly, dictionary-based post-processing corrected boundary-detection errors of the CRF step. We evaluated the AutoMCExtractor on manually-annotated FDA drug labels and report the results on both token and span levels. Results Precision, recall, and F-measure were 0.90, 0.81, and 0.85, respectively, for the span level exact match; for the token-level evaluation, precision, recall, and F-measure were 0.92, 0.73, and 0.82, respectively. Conclusions The results demonstrate that (1) medical conditions can be extracted from FDA drug labels with high performance; and (2) it is feasible to develop a framework for an intelligent database system. PMID:23617267

  15. Pre-existing immunity against Ad vectors: humoral, cellular, and innate response, what's important?.

    PubMed

    Fausther-Bovendo, Hugues; Kobinger, Gary P

    2014-01-01

    Pre-existing immunity against human adenovirus (HAd) serotype 5 derived vector in the human population is widespread, thus hampering its clinical use. Various components of the immune system, including neutralizing antibodies (nAbs), Ad specific T cells and type I IFN activated NK cells, contribute to dampening the efficacy of Ad vectors in individuals with pre-existing Ad immunity. In order to circumvent pre-existing immunity to adenovirus, numerous strategies, such as developing alternative Ad serotypes, varying immunization routes and utilizing prime-boost regimens, are under pre-clinical or clinical phases of development. However, these strategies mainly focus on one arm of pre-existing immunity. Selection of alternative serotypes has been largely driven by the absence in the human population of nAbs against them with little attention paid to cross-reactive Ad specific T cells. Conversely, varying the route of immunization appears to mainly rely on avoiding Ad specific tissue-resident T cells. Finally, prime-boost regimens do not actually circumvent pre-existing immunity but instead generate immune responses of sufficient magnitude to confer protection despite pre-existing immunity. Combining the above strategies and thus taking into account all components regulating pre-existing Ad immunity will help further improve the development of Ad vectors for animal and human use. PMID:25483662

  16. The Space Medicine Exploration Medical Condition List

    NASA Technical Reports Server (NTRS)

    Watkins, Sharmi; Barr, Yael; Kerstman, Eric

    2011-01-01

    Exploration Medical Capability (ExMC) is an element of NASA s Human Research Program (HRP). ExMC's goal is to address the risk of the "Inability to Adequately Recognize or Treat an Ill or Injured Crewmember." This poster highlights the approach ExMC has taken to address this risk. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to define the set of medical conditions that are most likely to occur during exploration space flight missions. The list was derived from the International Space Station Medical Checklist, the Shuttle Medical Checklist, in-flight occurrence data from the Lifetime Surveillance of Astronaut Health, and NASA subject matter experts. The list of conditions was further prioritized for eight specific design reference missions with the assistance of the ExMC Advisory Group. The purpose of the SMEMCL is to serve as an evidence-based foundation for the conditions that could affect a crewmember during flight. This information is used to ensure that the appropriate medical capabilities are available for exploration missions.

  17. Solid particle impingement erosion characteristics of cylindrical surfaces, pre-existing holes and slits

    NASA Technical Reports Server (NTRS)

    Rao, P. V.; Buckley, D. H.

    1983-01-01

    The erosion characteristics of aluminum cylinders sand-blasted with both spherical and angular erodent particles were studied and compared with results from previously studied flat surfaces. The cylindrical results are discussed with respect to impact conditions. The relationship between erosion rate and pit morphology (width, depth, and width to depth ratio) is established. The aspects of (1) erosion rate versus time curves on cylindrical surfaces; (2) long-term exposures; and (3) erosion rate versus time curves with spherical and angular particles are presented. The erosion morphology and characteristics of aluminum surfaces with pre-existing circular cylindrical and conical holes of different sizes were examined using weight loss measurements, scanning electron microscopy, a profilometer, and a depth gage. The morphological features (radial and concentric rings) are discussed with reference to flat surfaces, and the erosion features with spherical microglass beads. The similarities and differences of erosion and morphological features are highlighted. The erosion versus time curves of various shapes of holes are discussed and are compared with those of a flat surface. The erosion process at slits is considered.

  18. Asperger Syndrome: Associated Psychiatric and Medical Conditions.

    ERIC Educational Resources Information Center

    Ghaziuddin, Mohammad

    2002-01-01

    This article explores the association of medical and psychiatric conditions with Asperger syndrome, based mainly on publications from the last two decades. It examines comorbidity of Asperger syndrome with mood disorders, schizophrenia, obsessive-compulsive disorder, attention deficit/hyperactivity disorder, tic disorders, violence and aggression,

  19. Asperger Syndrome: Associated Psychiatric and Medical Conditions.

    ERIC Educational Resources Information Center

    Ghaziuddin, Mohammad

    2002-01-01

    This article explores the association of medical and psychiatric conditions with Asperger syndrome, based mainly on publications from the last two decades. It examines comorbidity of Asperger syndrome with mood disorders, schizophrenia, obsessive-compulsive disorder, attention deficit/hyperactivity disorder, tic disorders, violence and aggression,…

  20. Rapid selective sweep of pre-existing polymorphisms and slow fixation of new mutations in experimental evolution of Desulfovibrio vulgaris.

    PubMed

    Zhou, Aifen; Hillesland, Kristina L; He, Zhili; Schackwitz, Wendy; Tu, Qichao; Zane, Grant M; Ma, Qiao; Qu, Yuanyuan; Stahl, David A; Wall, Judy D; Hazen, Terry C; Fields, Matthew W; Arkin, Adam P; Zhou, Jizhong

    2015-11-01

    To investigate the genetic basis of microbial evolutionary adaptation to salt (NaCl) stress, populations of Desulfovibrio vulgaris Hildenborough (DvH), a sulfate-reducing bacterium important for the biogeochemical cycling of sulfur, carbon and nitrogen, and potentially the bioremediation of toxic heavy metals and radionuclides, were propagated under salt stress or non-stress conditions for 1200 generations. Whole-genome sequencing revealed 11 mutations in salt stress-evolved clone ES9-11 and 14 mutations in non-stress-evolved clone EC3-10. Whole-population sequencing data suggested the rapid selective sweep of the pre-existing polymorphisms under salt stress within the first 100 generations and the slow fixation of new mutations. Population genotyping data demonstrated that the rapid selective sweep of pre-existing polymorphisms was common in salt stress-evolved populations. In contrast, the selection of pre-existing polymorphisms was largely random in EC populations. Consistently, at 100 generations, stress-evolved population ES9 showed improved salt tolerance, namely increased growth rate (2.0-fold), higher biomass yield (1.8-fold) and shorter lag phase (0.7-fold) under higher salinity conditions. The beneficial nature of several mutations was confirmed by site-directed mutagenesis. All four tested mutations contributed to the shortened lag phases under higher salinity condition. In particular, compared with the salt tolerance improvement in ES9-11, a mutation in a histidine kinase protein gene lytS contributed 27% of the growth rate increase and 23% of the biomass yield increase while a mutation in hypothetical gene DVU2472 contributed 24% of the biomass yield increase. Our results suggested that a few beneficial mutations could lead to dramatic improvements in salt tolerance. PMID:25848870

  1. Simple scaling laws for the role of pre-existing and shock-induced microstructure on spall strength

    NASA Astrophysics Data System (ADS)

    Wilkerson, Justin; Ramesh, Kt

    2015-06-01

    Failure of ductile metals has long been attributed to void nucleation, growth, and finally coalescence leading to fracture. Under extreme loading conditions, a number of experimental investigations have demonstrated a strong rate-dependence in the dynamic tensile strength of such metals, which may be attributed to the fact that voids are constrained to grow at finite rates. Here we show that bounds on these void growth rates may be derived analytically by considering the constraints imposed by micro-inertia as well as relativistic dislocation drag. We then make use of these bounds to derive simple scaling laws for predicting the rate-dependence of spall strength. Though simple, the derived scaling laws compare well with experimental measurements and prove useful in shedding light on some of the more perplexing observations associated with spall failure. In particular, the scaling laws are helpful in understanding the role of pre-existing microstructure, e.g. second-phase particle spacing and grain size, on the spall strength of metals. Under typical loading conditions, we find that the spall strength is governed by this pre-existing microstructure with void growth governed primarily by micro-inertia. However, under the most extreme loading conditions, we find that the spall strength is governed instead by the shock-induced microstructure with growth mediated by dislocation emission. Lastly, we demonstrate how the scaling laws may be utilized to optimize the pre-existing microstructure, e.g. grain size considering the Hall-Petch effect, of a material for a particular application.

  2. Metabolic effects of milk protein intake strongly depend on pre-existing metabolic and exercise status

    PubMed Central

    2013-01-01

    Milk protein intake has recently been suggested to improve metabolic health. This Perspective provides evidence that metabolic effects of milk protein intake have to be regarded in the context of the individual’s pre-existing metabolic and exercise status. Milk proteins provide abundant branched-chain amino acids (BCAAs) and glutamine. Plasma BCAAs and glutamine are increased in obesity and insulin resistance, but decrease after gastric bypass surgery resulting in weight loss and improved insulin sensitivity. Milk protein consumption results in postprandial hyperinsulinemia in obese subjects, increases body weight of overweight adolescents and may thus deteriorate pre-existing metabolic disturbances of obese, insulin resistant individuals. PMID:24225036

  3. Using an Electronic Highlighter to Eliminate the Negative Effects of Pre-Existing, Inappropriate Highlighting

    ERIC Educational Resources Information Center

    Gier, Vicki; Kreiner, David; Hudnell, Jason; Montoya, Jodi; Herring, Daniel

    2011-01-01

    The purpose of the present experiment was to determine whether using an active learning technique, electronic highlighting, can eliminate the negative effects of pre-existing, poor highlighting on reading comprehension. Participants read passages containing no highlighting, appropriate highlighting, or inappropriate highlighting. We hypothesized…

  4. Are There Pre-Existing Neural, Cognitive, or Motoric Markers for Musical Ability?

    ERIC Educational Resources Information Center

    Norton, Andrea; Winner, Ellen; Cronin, Karl; Overy, Katie; Lee, Dennis J.; Schlaug, Gottfried

    2005-01-01

    Adult musician's brains show structural enlargements, but it is not known whether these are inborn or a consequence of long-term training. In addition, music training in childhood has been shown to have positive effects on visual-spatial and verbal outcomes. However, it is not known whether pre-existing advantages in these skills are found in

  5. Are There Pre-Existing Neural, Cognitive, or Motoric Markers for Musical Ability?

    ERIC Educational Resources Information Center

    Norton, Andrea; Winner, Ellen; Cronin, Karl; Overy, Katie; Lee, Dennis J.; Schlaug, Gottfried

    2005-01-01

    Adult musician's brains show structural enlargements, but it is not known whether these are inborn or a consequence of long-term training. In addition, music training in childhood has been shown to have positive effects on visual-spatial and verbal outcomes. However, it is not known whether pre-existing advantages in these skills are found in…

  6. An Exploratory Examination of Students' Pre-Existing Beliefs about Leadership

    ERIC Educational Resources Information Center

    Caza, Arran; Rosch, David M.

    2014-01-01

    Preparing future leaders is a long-standing priority in higher education, but doubts have been raised about whether this goal is being achieved. Pedagogical research suggests that leadership development can be improved by taking account of students' pre-existing beliefs about leadership; however, little is currently known about those beliefs.…

  7. 26 CFR 20.2045-1 - Applicability to pre-existing transfers or interests.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Applicability to pre-existing transfers or interests. 20.2045-1 Section 20.2045-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Gross...

  8. 26 CFR 20.2045-1 - Applicability to pre-existing transfers or interests.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Applicability to pre-existing transfers or interests. 20.2045-1 Section 20.2045-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Gross...

  9. 26 CFR 20.2045-1 - Applicability to pre-existing transfers or interests.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Applicability to pre-existing transfers or interests. 20.2045-1 Section 20.2045-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Gross...

  10. 26 CFR 20.2045-1 - Applicability to pre-existing transfers or interests.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Applicability to pre-existing transfers or interests. 20.2045-1 Section 20.2045-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Gross...

  11. On Reactivation of a Pre-Existing Fracture by Fluid Injection into Subsurface

    NASA Astrophysics Data System (ADS)

    Sarvaramini, E.; Garagash, D.

    2012-12-01

    The reactivation of pre-existing mechanically-closed but hydraulically-open fractures may control injection of liquid waste (such as super critical CO2) into deep geological formations for storage. These fractures could be either of natural origin or man-made (e.g., hydraulic fractures used to stimulate production from a now depleted reservoir chosen for waste storage). The study of interactions between the fluid, fracture and surrounding porous rock plays a key role to understand the mechanical and hydraulical behavior of the fracture during initial stages of injection when initially mechanically-closed crack is pressurized. The knowledge of the pore fluid pressure evolution with time and space is crucial to observe the fracture transition from mechanically closed (positive effective confining stress) to mechanically open (negative effective confining stress) state, and to the eventual onset of propagation. This requires the accurate study of the crack behavior near zero effective confining stress. In one possible scenario, the crack can be assumed to be uniformly pressurized if hydraulic conductivity of the crack is sufficiently high and/or the fluid injection rate is sufficiently low. In this case the internal fluid pressure will increase with time uniformly along the crack during the transient pressurization until the condition of the crack opening is reached. In order to investigate the extent to which the assumption of uniform internal fluid pressure along the crack is valid, we consider the actual case where the internal fluid pressure may not be uniform along the crack. Adopting a relation between the local hydraulic aperture and the effective normal stress [Gangi 1978], the flow of the fluid inside the mechanically-closed but hydraulically-opened fracture can be described by a lubrication-like equation, and the flow of fluid in the porous rock adjacent to the fracture by the full diffusivity equation. We show that the validity of the uniformly pressurized crack assumption depends upon the representative values of crack properties, fluid properties and operating conditions such as the fluid injection rate, and establish the range of these parameters for which the assumption is justified. The obtained solution for transient pressurization of initially closed and subsequently opened crack allows to evaluate the time from the beginning of the injection to the onset of the fracture propagation and provides initial conditions to the propagation problem.

  12. The association of medical conditions and presenteeism.

    PubMed

    Burton, Wayne N; Pransky, Glenn; Conti, Daniel J; Chen, Chin-Yu; Edington, Dee W

    2004-06-01

    A self-reported measure of four domains of work impairment based on the Work Limitations Questionnaire was completed by 16,651 employees of a large financial services corporation. Using a multivariate model to control for coexisting conditions, age, and gender, significant relationships were observed between medical conditions and patterns of impaired work performance. Depression was highly associated with work limitations in time management (odds ratio [OR] = 2.05), interpersonal/mental functioning (OR = 2.50), and overall output (OR = 2.24). Arthritis (OR = 1.56) and low back pain (OR = 1.32) were associated with physical function limitations. These same two conditions were associated with limitations in mental/interpersonal functioning but with low back pain having the higher odds ratio (OR = 1.54 vs. 1.22). These results suggest that worksite interventions (eg, disease management programs) should be tailored to the unique effects observed with specific medical conditions. More targeted programs could have important benefits for productivity in the workplace. PMID:15194894

  13. Effects of pre-existing discontinuities on the residual strength of rock mass - Insight from a discrete element method simulation

    NASA Astrophysics Data System (ADS)

    Gao, F. Q.; Kang, H. P.

    2016-04-01

    When rock failure is unavoidable, the designer of engineering structures must know and account for the residual strength of the rock mass. This is particularly relevant in underground coal mine openings. Pre-existing discontinuities play an important role in the mechanical behavior of rock masses and thus it is important to understand the effects of such pre-existing discontinuities on the residual strength. For this purpose, the present study demonstrates a numerical analysis using a discrete element method simulation. The numerical results indicate that fracture intensity has no significant influence on the residual strength of jointed rock masses, independent of confining conditions. As confining pressures increase, both peak and residual strengths increase, with residual strength increasing at a faster rate. The finding was further demonstrated by analyzing documented laboratory compressive test data from a variety of rocks along with field data from coal pillars. A comprehensive interpretation of the finding was conducted using a cohesion-weakening-friction-strengthening (CWFS) model. The effect of rock bolts on rock mass strength was also evaluated by using a discrete element method model which suggested that rock bolts can significantly increases residual strength but have limited effect on increasing the peak strength of rock masses.

  14. Pre-existing immunity against vaccine vectors – friend or foe?

    PubMed Central

    Saxena, Manvendra; Van, Thi Thu Hao; Baird, Fiona J.; Coloe, Peter J.

    2013-01-01

    Over the last century, the successful attenuation of multiple bacterial and viral pathogens has led to an effective, robust and safe form of vaccination. Recently, these vaccines have been evaluated as delivery vectors for heterologous antigens, as a means of simultaneous vaccination against two pathogens. The general consensus from published studies is that these vaccine vectors have the potential to be both safe and efficacious. However, some of the commonly employed vectors, for example Salmonella and adenovirus, often have pre-existing immune responses in the host and this has the potential to modify the subsequent immune response to a vectored antigen. This review examines the literature on this topic, and concludes that for bacterial vectors there can in fact, in some cases, be an enhancement in immunogenicity, typically humoral, while for viral vectors pre-existing immunity is a hindrance for subsequent induction of cell-mediated responses. PMID:23175507

  15. Pre-existing immunity against vaccine vectors--friend or foe?

    PubMed

    Saxena, Manvendra; Van, Thi Thu Hao; Baird, Fiona J; Coloe, Peter J; Smooker, Peter M

    2013-01-01

    Over the last century, the successful attenuation of multiple bacterial and viral pathogens has led to an effective, robust and safe form of vaccination. Recently, these vaccines have been evaluated as delivery vectors for heterologous antigens, as a means of simultaneous vaccination against two pathogens. The general consensus from published studies is that these vaccine vectors have the potential to be both safe and efficacious. However, some of the commonly employed vectors, for example Salmonella and adenovirus, often have pre-existing immune responses in the host and this has the potential to modify the subsequent immune response to a vectored antigen. This review examines the literature on this topic, and concludes that for bacterial vectors there can in fact, in some cases, be an enhancement in immunogenicity, typically humoral, while for viral vectors pre-existing immunity is a hindrance for subsequent induction of cell-mediated responses. PMID:23175507

  16. U.S. Military Discharges and Pre-existing Personality Disorders: A Health Policy Review.

    PubMed

    Leroux, Todd C

    2015-11-01

    The Department of Defense (DoD) is facing allegations service members were wrongfully discharged for pre-existing personality disorders. From 2001 to 2007, 26,000 enlisted service members were discharged for a pre-existing personality disorder (2.6 % of total discharges). With national media attention of the issue, personality disorder discharges were reduced by 31 % in 2008 with new discharge procedures issued by the DoD. Even with the reduction, a government review found the DoD did not adhere to its discharge protocols. The objective of this paper is to explore personality disorders in the military, analyze various costs to stakeholders, and identify potential policy alternatives. PMID:25378127

  17. Are there pre-existing neural, cognitive, or motoric markers for musical ability?

    PubMed

    Norton, Andrea; Winner, Ellen; Cronin, Karl; Overy, Katie; Lee, Dennis J; Schlaug, Gottfried

    2005-11-01

    Adult musician's brains show structural enlargements, but it is not known whether these are inborn or a consequence of long-term training. In addition, music training in childhood has been shown to have positive effects on visual-spatial and verbal outcomes. However, it is not known whether pre-existing advantages in these skills are found in children who choose to study a musical instrument nor is it known whether there are pre-existing associations between music and any of these outcome measures that could help explain the training effects. To answer these questions, we compared 5- to 7-year-olds beginning piano or string lessons (n=39) with 5- to 7-year-olds not beginning instrumental training (n=31). All children received a series of tests (visual-spatial, non-verbal reasoning, verbal, motor, and musical) and underwent magnetic resonance imaging. We found no pre-existing neural, cognitive, motor, or musical differences between groups and no correlations (after correction for multiple analyses) between music perceptual skills and any brain or visual-spatial measures. However, correlations were found between music perceptual skills and both non-verbal reasoning and phonemic awareness. Such pre-existing correlations suggest similarities in auditory and visual pattern recognition as well a sharing of the neural substrates for language and music processing, most likely due to innate abilities or implicit learning during early development. This baseline study lays the groundwork for an ongoing longitudinal study addressing the effects of intensive musical training on brain and cognitive development, and making it possible to look retroactively at the brain and cognitive development of those children who emerge showing exceptional musical talent. PMID:16054741

  18. Numerical Modelling of Extended Leak-Off Test with a Pre-Existing Fracture

    NASA Astrophysics Data System (ADS)

    Lavrov, A.; Larsen, I.; Bauer, A.

    2016-04-01

    Extended leak-off test (XLOT) is one of the few techniques available for stress measurements in oil and gas wells. Interpretation of the test is often difficult since the results depend on a multitude of factors, including the presence of natural or drilling-induced fractures in the near-well area. Coupled numerical modelling of XLOT has been performed to investigate the pressure behaviour during the flowback phase as well as the effect of a pre-existing fracture on the test results in a low-permeability formation. Essential features of XLOT known from field measurements are captured by the model, including the saw-tooth shape of the pressure vs injected volume curve, and the change of slope in the pressure vs time curve during flowback used by operators as an indicator of the bottomhole pressure reaching the minimum in situ stress. Simulations with a pre-existing fracture running from the borehole wall in the radial direction have revealed that the results of XLOT are quite sensitive to the orientation of the pre-existing fracture. In particular, the fracture initiation pressure and the formation breakdown pressure increase steadily with decreasing angle between the fracture and the minimum in situ stress. Our findings seem to invalidate the use of the fracture initiation pressure and the formation breakdown pressure for stress measurements or rock strength evaluation purposes.

  19. Relationship of Pre-Existing Antibody to Subsequent Infection by Mycoplasma pneumoniae in Adults

    PubMed Central

    McCormick, David P.; Wenzel, Richard P.; Senterfit, Laurence B.; Beam, Walter E.

    1974-01-01

    An extensive study of the epidemiological and serological characteristics of Mycoplasma pneumoniae infection was carried out in a military population. There was an increase in the infection rate at Camp Lejeune during the summer months as indicated by a relative increase in isolations, seroconversions, and hospitalizations for M. pneumoniae pneumonia. Twenty-three percent of the trainees who later became infected had detectable, pre-existing antilipid antibody to M. pneumoniae. When the whole organism was used as antigen, a pre-existing complement fixation (CF) titer of 1:4 or greater correlated with resistance to M. pneumoniae disease as defined by the absence of a fourfold rise in CF antibody, shedding of organisms, and clinical illness. Pre-existing antilipid fraction CF antibody titers of 1:16 or greater correlated with protection against mild and severe M. pneumoniae disease. Antilipid CF antibody titers of 1:4 and 1:8 were related to protection against mild disease but were not associated with protection against pneumonia which required hospitalization. The severity of illness was directly related to the CF antibody response in trainees with acute respiratory disease and pneumonia due to M. pneumoniae. The findings provide a basis for the development of a M. pneumoniae vaccine. PMID:4587385

  20. Pregnant women with pre-existing diabetes: family support in managing the pregnancy process.

    PubMed

    Letherby, Gayle; Stephen, Nicole; Stenhouse, Elizabeth

    2012-12-01

    In this paper, we report on findings from a Diabetes UK funded qualitative research project concerned to explore daughter/mother relationships during pregnancy and the transition to motherhood of women with pre-existing diabetes. In-depth qualitative interviews took place with 12 pregnant women with pre-existing diabetes and four of their mothers, three (male) partners and one father. The study was exploratory in nature and aimed to consider what support pregnant women felt they needed and what support they received from their mothers and other family members to discover policy and practice needs and identify further research concerns. Here, we focus on one theme from the data: management of the pregnancy process from planning for pregnancy and through pregnancy with specific reference to relationships with family members. Respondents reflect on the relationship between diabetes and pregnancy planning, on managing pregnancy and on their relationships with healthcare professionals. The data suggest overwhelmingly that pre-existing diabetes is a significant aspect of pregnancy planning and pregnancy for women and that managing the pregnancy process is a more positive experience if they have the support of family members. PMID:23268726

  1. Exploring mucosal immunization with a recombinant influenza virus carrying an HIV-polyepitope in mice with pre-existing immunity to influenza.

    PubMed

    Garulli, Bruno; Di Mario, Giuseppina; Stillitano, Maria Giuseppina; Kawaoka, Yoshihiro; Castrucci, Maria Rita

    2014-05-01

    HIV-1 vaccines based on recombinant vectors have been developed to elicit immune responses; however, the failure of the STEP HIV-1 vaccine trial has caused concern regarding the impact on vaccine efficacy of pre-existing vector seropositivity in humans. By using a mouse model of infection, we evaluated the immune responses elicited by intranasal and vaginal immunization with the recombinant influenza virus WSN/CKG carrying the PCLUS3-P18 peptide and a Gag epitope in its hemagglutinin, and the impact of pre-existing vector immunity on protection against recombinant vaccinia virus challenge. We found that despite the protective immunity induced in naïve mice by the WSN/CKG virus via either route, the vaginal immunization of mice with pre-existing influenza immunity restricted vPE16 replication more significantly in the ovaries than intranasal immunization. Thus, successful vaccination strategies under limiting conditions, such as pre-existing vector immunity, require the local induction of mucosal immunity at the site of virus infection. PMID:24662706

  2. A historical pyroclastic flow emplaced within a pre-existing Pleistocene lava tube: Silidong, Tianchi Volcano, Changbaishan, northeastern China

    NASA Astrophysics Data System (ADS)

    Chen, Zhengquan; Wei, Haiquan; Liu, Yongshun; Tilling, Robert I.; Xu, Jiandong; Wu, Chengzhi; Nie, Baofeng

    2015-06-01

    Pyroclastic flow deposits recently found within a pre-existing lava tube at Tianchi Volcano represent, to the best of our knowledge, the only such reported occurrence worldwide. In this case, pyroclastic flow of Tianchi's "Millennium eruption" (~1 ka) traveled about 18 km from the summit eruptive source and poured successively into the ~560-m-long accessible segment of Silidong lava tube. Mapping of tube morphology, combined with detailed characterization of the features associated with the pumice flow deposits (e.g., adhering of pyroclastic materials on tube walls, fumarole pipes, rootless vents, and flow fronts of the deposit surface) has enabled plausible inferences regarding the original within-tube conditions and dynamic flow regime during emplacement. We propose a model of an aggrading pyroclastic flow which locally varies its sedimentation rate. The pyroclastic deposit is thicker in locations of reduced flow mobility, and the resultant variations in deposit thickness appear to control the distribution of fumarole pipes and rootless vents.

  3. Role of antineural antibodies in perpetuation of a pre-existing peripheral nerve damage in leprosy.

    PubMed

    Desikan, P; Parkash, O; Narang, P

    1995-01-01

    This study was carried out in order to find out whether antineural antibodies had a role to play in perpetuating pre-existing nerve damage in leprosy. Indirect ELISA was carried out on sera from 20 leprosy patients and five normal controls using antigen prepared from peripheral nerves of a cured bacteriologically negative leprosy patient. None of the patients had significant levels of IgG antibodies whereas eight of them (40%) had significant levels of IgM antibodies. However, there was no correlation with duration of disease, treatment received, nerve enlargement or active neuritis. The nature of these antibodies is discussed. PMID:8576608

  4. 28 CFR 79.34 - Proof of medical condition.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Proof of medical condition. 79.34 Section... COMPENSATION ACT Eligibility Criteria for Claims by Onsite Participants § 79.34 Proof of medical condition. Proof of medical condition under this subpart will be made in the same manner and according to the...

  5. 28 CFR 79.34 - Proof of medical condition.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of medical condition. 79.34 Section... COMPENSATION ACT Eligibility Criteria for Claims by Onsite Participants § 79.34 Proof of medical condition. Proof of medical condition under this subpart will be made in the same manner and according to the...

  6. Ionization-induced annealing of pre-existing defects in silicon carbide.

    PubMed

    Zhang, Yanwen; Sachan, Ritesh; Pakarinen, Olli H; Chisholm, Matthew F; Liu, Peng; Xue, Haizhou; Weber, William J

    2015-01-01

    A long-standing objective in materials research is to effectively heal fabrication defects or to remove pre-existing or environmentally induced damage in materials. Silicon carbide (SiC) is a fascinating wide-band gap semiconductor for high-temperature, high-power and high-frequency applications. Its high corrosion and radiation resistance makes it a key refractory/structural material with great potential for extremely harsh radiation environments. Here we show that the energy transferred to the electron system of SiC by energetic ions via inelastic ionization can effectively anneal pre-existing defects and restore the structural order. The threshold determined for this recovery process reveals that it can be activated by 750 and 850 keV Si and C self-ions, respectively. The results conveyed here can contribute to SiC-based device fabrication by providing a room-temperature approach to repair atomic lattice structures, and to SiC performance prediction as either a functional material for device applications or a structural material for high-radiation environments. PMID:26264864

  7. Ionization-induced annealing of pre-existing defects in silicon carbide

    NASA Astrophysics Data System (ADS)

    Zhang, Yanwen; Sachan, Ritesh; Pakarinen, Olli H.; Chisholm, Matthew F.; Liu, Peng; Xue, Haizhou; Weber, William J.

    2015-08-01

    A long-standing objective in materials research is to effectively heal fabrication defects or to remove pre-existing or environmentally induced damage in materials. Silicon carbide (SiC) is a fascinating wide-band gap semiconductor for high-temperature, high-power and high-frequency applications. Its high corrosion and radiation resistance makes it a key refractory/structural material with great potential for extremely harsh radiation environments. Here we show that the energy transferred to the electron system of SiC by energetic ions via inelastic ionization can effectively anneal pre-existing defects and restore the structural order. The threshold determined for this recovery process reveals that it can be activated by 750 and 850 keV Si and C self-ions, respectively. The results conveyed here can contribute to SiC-based device fabrication by providing a room-temperature approach to repair atomic lattice structures, and to SiC performance prediction as either a functional material for device applications or a structural material for high-radiation environments.

  8. Enhancing the Clinical Potential of AAV Vectors by Capsid Engineering to Evade Pre-Existing Immunity

    PubMed Central

    Bartel, Melissa; Schaffer, David; Büning, Hildegard

    2011-01-01

    Vectors based on adeno-associated viruses (AAV) have shown considerable promise in both preclinical models and increasingly in clinical trials. However, one formidable challenge is pre-existing immunity due to widespread exposure to numerous AAV variants and serotypes within the human population, which affect efficacy of clinical trials due to the accompanying high levels of anti-capsid neutralizing antibodies. Transient immunosuppression has promise in mitigating cellular and humoral responses induced by vector application in naïve hosts, but cannot overcome the problem that pre-existing neutralizing antibodies pose toward the goal of safe and efficient gene delivery. Shielding of AAV from antibodies, however, may be possible by covalent attachment of polymers to the viral capsid or by encapsulation of vectors inside biomaterials. In addition, there has been considerable progress in using rational mutagenesis, combinatorial libraries, and directed evolution approaches to engineer capsid variants that are not recognized by anti-AAV antibodies generally present in the human population. While additional progress must be made, such strategies, alone or in combination with immunosuppression to avoid de novo induction of antibodies, have strong potential to significantly enhance the clinical efficacy of AAV vectors. PMID:22065962

  9. Ionization-induced annealing of pre-existing defects in silicon carbide

    PubMed Central

    Zhang, Yanwen; Sachan, Ritesh; Pakarinen, Olli H.; Chisholm, Matthew F.; Liu, Peng; Xue, Haizhou; Weber, William J.

    2015-01-01

    A long-standing objective in materials research is to effectively heal fabrication defects or to remove pre-existing or environmentally induced damage in materials. Silicon carbide (SiC) is a fascinating wide-band gap semiconductor for high-temperature, high-power and high-frequency applications. Its high corrosion and radiation resistance makes it a key refractory/structural material with great potential for extremely harsh radiation environments. Here we show that the energy transferred to the electron system of SiC by energetic ions via inelastic ionization can effectively anneal pre-existing defects and restore the structural order. The threshold determined for this recovery process reveals that it can be activated by 750 and 850 keV Si and C self-ions, respectively. The results conveyed here can contribute to SiC-based device fabrication by providing a room-temperature approach to repair atomic lattice structures, and to SiC performance prediction as either a functional material for device applications or a structural material for high-radiation environments. PMID:26264864

  10. Effect of anesthesia in a patient with pre-existing anisocoria.

    PubMed

    Aceto, P; Perilli, V; Vitale, E; Sollazzi, L

    2011-02-01

    In this case report, we describe an accentuation of a pre-existing anisocoria shortly after tracheal intubation in a patient undergoing thyroidectomy. A 45-yr-old female patient with unequal pupillary diameter (right 2 mm > than left) and decreased light reflex in the right eye--due to a previous eye trauma--was scheduled for thyroidectomy because of multinodular goiter. Anesthesia was induced with propofol 2,5 mg/kg, fentanyl 3 mcg/kg and cisatracurium 0.15 mcg/kg. Immediately after tracheal intubation, examination of the right eye revealed a markedly dilated pupil (8 mm) which was nonreactive to direct and consensual light reflex. The left pupil was 2 mm, and normally reactive to light. An increase in heart rate was also registered (> 20% of baseline) with spontaneous return to baseline within 2 minutes. The right pupil returned to preoperative size within approximately one hour after awakening. From this case report, it emerges that a preexisting anisocoria may be exacerbated during anesthesia probably due to incomplete abolition of response to painful stimulus, such as tracheal intubation, provided by anesthetic drugs in the affected eye. The main contributing factor for accentuation of anisocoria could be sympathetic dominance in the pupil with pre-existing mechanical interruption in compensatory parasympathetic mechanisms. PMID:21434489

  11. Numerical modeling of the seismic response of a large pre-existing landslide in the Marmara region

    NASA Astrophysics Data System (ADS)

    Bourdeau, Céline; Lenti, Luca; Martino, Salvatore

    2015-04-01

    Turkey is one of the geologically most active regions of Europe prone to natural hazards in particular earthquakes and landslides. Detailed seismological studies show that a catastrophic event is now expected in the Marmara region along the North Anatolian Fault Zone (NAFZ). On the shores of the Marmara sea, about 30km East of Istanbul and 15km North from the NAFZ, urbanization is fastly growing despite the presence of pre-existing large landslides. Whether such landslides could be reactivated under seismic shaking is a key question. In the framework of the MARsite European project, we selected one of the most critical landslides namely the Büyükçekmece landslide in order to assess its local seismic response. Based on detailed geophysical and geotechnical field investigations, a high-resolution engineering-geological model of the landslide slope was reconstructed. A numerical modeling was carried out on a longitudinal cross section of this landslide with a 2D finite difference code FLAC in order to assess the local seismic response of the slope and to evaluate the consistency of conditions suitable for the earthquake-induced reactivation of the landslide. The obtained ground-motion amplification pattern along the slope surface is very complex and is strongly influenced by properties changes between the pre-existing landslide mass and the surrounding material. Further comparisons of 2D versus 1D ground-motion amplifications on the one hand and 2D versus topographic site effects on the other hand will shed light on the parameters controlling the spatial variations of ground-motion amplifications along the slope surface.

  12. Medical Conditions and Medication Use in Adults with Down Syndrome: A Descriptive Analysis

    ERIC Educational Resources Information Center

    Kerins, Gerard; Petrovic, Kimberly; Bruder, Mary Beth; Gruman, Cynthia

    2008-01-01

    Background: We examined the presence of medical conditions and medication use within a sample of adults with Down syndrome. Methods: Retrospective chart review using a sample of 141 adults with Down syndrome and age range of 30 to 65 years. Results: We identify 23 categories of commonly occurring medical conditions and 24 categories of medications

  13. 28 CFR 79.16 - Proof of medical condition.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of medical condition. 79.16 Section... COMPENSATION ACT Eligibility Criteria for Claims Relating to Leukemia § 79.16 Proof of medical condition. (a) Medical documentation is required in all cases to prove that the claimant suffered from or suffers...

  14. Initiation of breakdown in bubbles immersed in liquids: pre-existed charges versus bubble size

    NASA Astrophysics Data System (ADS)

    Babaeva, Natalia Yu; Tereshonok, Dmitry V.; Naidis, George V.

    2015-09-01

    In this paper we report on results from a computational investigation of streamer evolution in bubbles immersed in liquids. We show that avalanche-to-streamer transition and streamer formation in the uniform electric field are determined by the applied external field, the parameter pR (pressure times bubble size), as well as by the location and amount of initial free charges inside the bubble. We found that streamers are not formed in bubbles with a rather small size, unless pre-existed or injected charges are large enough to initiate the breakdown. The present investigation relates the bubble size and the applied field to the minimal possible amount of charge in a bubble.

  15. Localization of volcanic activity: 2. Effects of pre-existing structure

    NASA Astrophysics Data System (ADS)

    Gaffney, Edward S.; Damjanac, Branko; Valentine, Greg A.

    2007-11-01

    The capture of vertically rising dikes by faults is examined with a combination of an analytic solution, numerical simulations and field observations. One of the numerical solutions and the field observations also provide insight into the intrusion of sills into the hanging wall of faults that are reactivated when lubricated by magma. The approximate analytic solution indicates that dike capture by a fault will be limited primarily to steeply-dipping faults. Capture will become easier, meaning that it will be possible for faults with shallower dips, as the intersection of the dike with the fault occurs at smaller depths. Capture will also be easier as it is harder for crack to grow in the hanging wall; this may be interpreted in terms of a higher tensile strength or in terms of shorter pre-existing cracks or higher fracture toughness. Numerical analysis using a discrete element code confirms this conclusion but also shows that the analytic solutions overestimate the difficulty of intruding a pre-existing fault, the maximum deviation occurring for faults dipping at 45°. This finding that dike capture by faults should be restricted to high-angle faults and shallow depths is supported by field observations of exhumed Miocene basaltic volcanic terrain in central Nevada, USA. Differences in style seen in other regions are attributed to both the rock properties and the regional stress field. The numerical solutions also indicate that synintrusive fault slip is likely to lead to formation of sills in the hanging wall at depths of a few hundred meters or less: a finding that is also consistent with the field observations in Nevada.

  16. Numerical Study on Coalescence of Pre-Existing Flaw Pairs in Rock-Like Material

    NASA Astrophysics Data System (ADS)

    Li, Huan-Qiang; Wong, Louis Ngai Yuen

    2014-11-01

    The present numerical study, which is an extension of our previous numerical analysis on cracking processes of a single pre-existing flaw, focuses on the coalescence of two pre-existing parallel open flaws in rock subjected to a uniaxial compressive loading. To facilitate a systematic investigation, the arrangements of the flaw pair are classified into 11 categories. Simulations engaging AUTODYN are conducted on each category. The numerical results are compared with some published physical experimental test results. Eleven typical coalescence patterns are obtained, which are in good agreement with the experimental results, which include two coalescence patterns obtained in flaw pair arrangements (II) and (VIII″) not being reported in previous studies. The information gathered in the simulations helps identify the type (tensile/shear) of each crack segment involved in the coalescence. Most of the coalescence cracks initiate at or around the flaw tips, except those in flaw pair arrangements (II) and (IX') with a very short ligament length, in which the coalescence cracks initiate on the flaw surfaces away from the flaw tip regions. Based on the numerical simulation results, the properties of the 11 coalescence patterns are obtained. Except those in flaw pair arrangements (II) and (IX'), the other coalescence patterns can be interpreted with respect to the basic crack types—tensile wing crack, horsetail crack and anti-wing crack. In addition, based on the type of crack segments involved in coalescence, namely tensile and shear, the coalescence can be classified into T mode (tensile mode), S mode (shear mode) and TS mode (mixed tensile-shear mode).

  17. Relevance of a pre-existing measles immunity prior immunization with a recombinant measles virus vector.

    PubMed

    Knuchel, Marlyse C; Marty, René R; Morin, Teldja Neige Azzouz; Ilter, Orhan; Zuniga, Armando; Naim, Hussein Y

    2013-03-01

    Measles virus (MV) vectors are promising candidates for designing new recombinant vaccines since the parental live vaccines have a well-known safety and efficacy record. Like all viral vectors, the MV vector efficacy in inducing a protecting immune answer could be affected by the pre-existing immunity among the human population. In order to determine the optimal immunization route and regimen, we mimicked a MV pre-immunity by passively administrating MV neutralizing antibodies (MV-nAb) prior intramuscular (i.m.) and/or intranasal (i.n.) immunization with recombinant MV expressing the SIV-gag antigen (rMV-SIVgag). Our results revealed that 500 mIU of MV-nAb allowed the induction of a humoral and cellular immune response against the vector and the transgene, while higher titers of the MV-nAb were significantly inhibitory. In a prime-boost regimen, in the presence of MV-nAb, the intranasal-intramuscular (i.n.-i.m.) or intramuscular-intramuscular (i.m.-i.m.) routes induced higher humoral immune responses against the vector and the transgene (SIV-gag). In naive animals, cellular immune response was significantly higher by i.m. immunization; however, MV pre-immunity did not seem to affect the cellular immune response after an i.n. immunization.   In summary, we show that a pre-existing immunity of up to 500 mIU anti-MV neutralizing antibodies had little effect on the replication of rMV and did not inhibit the induction of significant humoral and cellular immune responses in immune-competent mice. PMID:23324399

  18. 40 CFR Appendix B to Part 434 - Baseline Determination and Compliance Monitoring for Pre-existing Discharges at Remining Operations

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS COAL MINING POINT... establishing effluent limitations for pre-existing discharges at coal remining operations, in accordance with the requirements set forth in subpart G; Coal Remining. The requirements specify that...

  19. 40 CFR Appendix B to Part 434 - Baseline Determination and Compliance Monitoring for Pre-existing Discharges at Remining Operations

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS COAL MINING POINT... establishing effluent limitations for pre-existing discharges at coal remining operations, in accordance with the requirements set forth in Subpart G; Coal Remining. The requirements specify that...

  20. Gene therapy for mucopolysaccharidosis type VI is effective in cats without pre-existing immunity to AAV8.

    PubMed

    Ferla, Rita; O'Malley, Thomas; Calcedo, Roberto; O'Donnell, Patricia; Wang, Ping; Cotugno, Gabriella; Claudiani, Pamela; Wilson, James M; Haskins, Mark; Auricchio, Alberto

    2013-02-01

    Liver gene transfer with adeno-associated viral (AAV) 2/8 vectors is being considered for therapy of systemic diseases like mucopolysaccharidosis type VI (MPS VI), a lysosomal storage disease due to deficiency of arylsulfatase B (ARSB). We have previously reported that liver gene transfer with AAV2/8 results in sustained yet variable expression of ARSB. We hypothesized that the variability we observed could be due to pre-existing immunity to wild-type AAV8. To test this, we compared the levels of AAV2/8-mediated transduction in MPS VI cats with and without pre-existing immunity to AAV8. In addition, since levels of lysosomal enzymes as low as 5% of normal are expected to be therapeutic, we evaluated the impact of pre-existing immunity on MPS VI phenotypic rescue. AAV2/8 administration to MPS VI cats without pre-existing neutralizing antibodies to AAV8 resulted in consistent and dose-dependent expression of ARSB, urinary glycosaminoglycan (GAG) reduction, and femur length amelioration. Conversely, animals with pre-existing immunity to AAV8 showed low levels of ARSB expression and limited phenotypic improvement. Our data support the use of AAV2/8-mediated gene transfer for MPS VI and other systemic diseases, and highlight that pre-existing immunity to AAV8 should be considered in determining subject eligibility for therapy. PMID:23194248

  1. Gene Therapy for Mucopolysaccharidosis Type VI Is Effective in Cats Without Pre-Existing Immunity to AAV8

    PubMed Central

    Ferla, Rita; O'Malley, Thomas; Calcedo, Roberto; O'Donnell, Patricia; Wang, Ping; Cotugno, Gabriella; Claudiani, Pamela; Wilson, James M.; Haskins, Mark

    2013-01-01

    Abstract Liver gene transfer with adeno-associated viral (AAV) 2/8 vectors is being considered for therapy of systemic diseases like mucopolysaccharidosis type VI (MPS VI), a lysosomal storage disease due to deficiency of arylsulfatase B (ARSB). We have previously reported that liver gene transfer with AAV2/8 results in sustained yet variable expression of ARSB. We hypothesized that the variability we observed could be due to pre-existing immunity to wild-type AAV8. To test this, we compared the levels of AAV2/8-mediated transduction in MPS VI cats with and without pre-existing immunity to AAV8. In addition, since levels of lysosomal enzymes as low as 5% of normal are expected to be therapeutic, we evaluated the impact of pre-existing immunity on MPS VI phenotypic rescue. AAV2/8 administration to MPS VI cats without pre-existing neutralizing antibodies to AAV8 resulted in consistent and dose-dependent expression of ARSB, urinary glycosaminoglycan (GAG) reduction, and femur length amelioration. Conversely, animals with pre-existing immunity to AAV8 showed low levels of ARSB expression and limited phenotypic improvement. Our data support the use of AAV2/8-mediated gene transfer for MPS VI and other systemic diseases, and highlight that pre-existing immunity to AAV8 should be considered in determining subject eligibility for therapy. PMID:23194248

  2. Medical Conditions and Medication Use in Adults with Down Syndrome: A Descriptive Analysis

    ERIC Educational Resources Information Center

    Kerins, Gerard; Petrovic, Kimberly; Bruder, Mary Beth; Gruman, Cynthia

    2008-01-01

    Background: We examined the presence of medical conditions and medication use within a sample of adults with Down syndrome. Methods: Retrospective chart review using a sample of 141 adults with Down syndrome and age range of 30 to 65 years. Results: We identify 23 categories of commonly occurring medical conditions and 24 categories of medications…

  3. Mathematical Modelling of a Brain Tumour Initiation and Early Development: A Coupled Model of Glioblastoma Growth, Pre-Existing Vessel Co-Option, Angiogenesis and Blood Perfusion.

    PubMed

    Cai, Yan; Wu, Jie; Li, Zhiyong; Long, Quan

    2016-01-01

    We propose a coupled mathematical modelling system to investigate glioblastoma growth in response to dynamic changes in chemical and haemodynamic microenvironments caused by pre-existing vessel co-option, remodelling, collapse and angiogenesis. A typical tree-like architecture network with different orders for vessel diameter is designed to model pre-existing vasculature in host tissue. The chemical substances including oxygen, vascular endothelial growth factor, extra-cellular matrix and matrix degradation enzymes are calculated based on the haemodynamic environment which is obtained by coupled modelling of intravascular blood flow with interstitial fluid flow. The haemodynamic changes, including vessel diameter and permeability, are introduced to reflect a series of pathological characteristics of abnormal tumour vessels including vessel dilation, leakage, angiogenesis, regression and collapse. Migrating cells are included as a new phenotype to describe the migration behaviour of malignant tumour cells. The simulation focuses on the avascular phase of tumour development and stops at an early phase of angiogenesis. The model is able to demonstrate the main features of glioblastoma growth in this phase such as the formation of pseudopalisades, cell migration along the host vessels, the pre-existing vasculature co-option, angiogenesis and remodelling. The model also enables us to examine the influence of initial conditions and local environment on the early phase of glioblastoma growth. PMID:26934465

  4. Mathematical Modelling of a Brain Tumour Initiation and Early Development: A Coupled Model of Glioblastoma Growth, Pre-Existing Vessel Co-Option, Angiogenesis and Blood Perfusion

    PubMed Central

    Cai, Yan; Wu, Jie; Li, Zhiyong; Long, Quan

    2016-01-01

    We propose a coupled mathematical modelling system to investigate glioblastoma growth in response to dynamic changes in chemical and haemodynamic microenvironments caused by pre-existing vessel co-option, remodelling, collapse and angiogenesis. A typical tree-like architecture network with different orders for vessel diameter is designed to model pre-existing vasculature in host tissue. The chemical substances including oxygen, vascular endothelial growth factor, extra-cellular matrix and matrix degradation enzymes are calculated based on the haemodynamic environment which is obtained by coupled modelling of intravascular blood flow with interstitial fluid flow. The haemodynamic changes, including vessel diameter and permeability, are introduced to reflect a series of pathological characteristics of abnormal tumour vessels including vessel dilation, leakage, angiogenesis, regression and collapse. Migrating cells are included as a new phenotype to describe the migration behaviour of malignant tumour cells. The simulation focuses on the avascular phase of tumour development and stops at an early phase of angiogenesis. The model is able to demonstrate the main features of glioblastoma growth in this phase such as the formation of pseudopalisades, cell migration along the host vessels, the pre-existing vasculature co-option, angiogenesis and remodelling. The model also enables us to examine the influence of initial conditions and local environment on the early phase of glioblastoma growth. PMID:26934465

  5. 28 CFR 79.16 - Proof of medical condition.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Program to contact the appropriate state cancer or tumor registry. The Program will accept as proof of medical condition verification from the state cancer or tumor registry that it possesses medical records... Cancer Institute can make a diagnosis of leukemia to a reasonable degree of medical certainty: (i)...

  6. A Model for Subglacial Flooding Along a Pre-Existing Hydrological Network during the Rapid Drainage of Supraglacial Lakes

    NASA Astrophysics Data System (ADS)

    Adhikari, S.; Tsai, V. C.

    2014-12-01

    Increasingly large numbers of supraglacial lakes form and drain every summer on the Greenland Ice Sheet. Presently, about 15% of the lakes drain rapidly within the timescale of a few hours, and the vertical discharge of water during these events may find a pre-existing subglacial hydrological network, particularly late in the melt season. Here, we present a model for subglacial flooding applied specifically to such circumstances. Given the short timescale of events, we treat ice and bed as purely elastic and assume that the fluid flow in the subglacial conduit is fully turbulent. We evaluate the effect of initial conduit opening, wi, on the rate of flood propagation and along-flow profiles of field variables. We find that floods propagate much faster, particularly in early times, for larger wi. For wi = 10 and 1 cm, for example, floods travel about 68% and 50% farther than in the fully coupled ice/bed scenario after 2 hours of drainage, respectively. Irrespective of the magnitude of wi, we also find that there exists a region of positive pressure gradient. This reversal of pressure gradient draws water in from the farfield and causes the conduit to narrow, respecting mass continuity. While the general shape of the profiles appears similar, greater conduit opening is found for larger wi. For wi = 10 and 1 cm, for example, the elastostatic conduit opening at the point of injection is about 1.39 and 1.26 times that of the fully coupled ice/bed scenario after 2 hours of drainage. The hypothesis of a pre-existing thin film of water is consistent with the spirit of contemporary state-of-the-art continuum models for subglacial hydrology. This also results in avoiding the pressure singularity, which is inherent in classical hydro-fracture models applied to fully coupled ice/bed scenarios, thus opening an avenue for integrating the likes of our model within continuum hydrological models. Furthermore, we foresee that the theory presented can be used to potentially infer subglacial hydrological conditions, particularly wi, given accurate observations of ice surface displacement during drainage events.

  7. EVIDENCE FOR PRE-EXISTING DUST IN THE BRIGHT TYPE IIn SN 2010jl

    SciTech Connect

    Andrews, J. E.; Clayton, Geoffrey C.; Clem, J.; Landolt, A. E-mail: landolt@phys.lsu.edu E-mail: jclem@phys.lsu.edu

    2011-08-15

    SN 2010jl was an extremely bright, Type IIn supernova (SN) which showed a significant infrared (IR) excess no later than 90 days after explosion. We have obtained Spitzer 3.6 and 4.5 {mu}m and JHK observations of SN 2010jl {approx}90 days post-explosion. Little to no reddening in the host galaxy indicated that the circumstellar material lost from the progenitor must lie in a torus inclined out of the plane of the sky. The likely cause of the high mid-IR flux is the reprocessing of the initial flash of the SN by pre-existing circumstellar dust. Using a three-dimensional Monte Carlo radiative-transfer code, we have estimated that between 0.03 and 0.35 M{sub sun} of dust exists in a circumstellar torus around the SN located 6 x 10{sup 17} cm away from the SN and inclined between 60 deg. and 80 deg. to the plane of the sky. On day 90, we are only seeing the illumination of approximately 5% of this torus, and expect to see an elevated IR flux from this material up until day {approx} 450. It is likely this dust was created in a luminous blue variable (LBV) like mass-loss event of more than 3 M{sub sun}, which is large but consistent with other LBV progenitors such as {eta} Carinae.

  8. Psychological distress in an earthquake-devastated area with pre-existing high rate of suicide.

    PubMed

    Tachibana, Akira; Kitamura, Hideaki; Shindo, Masanobu; Honma, Hiroko; Someya, Toshiyuki

    2014-10-30

    On 12 March 2011 an earthquake devastated the Matsunoyama and Matsudai districts of Tōkamachi City, Niigata, Japan. These areas had high pre-existing suicide rates, especially among the elderly. We investigated whether mental health status became worse among the sufferers 5 months after the earthquake, and what kind of factors were implicated in any changes. A 15-item questionnaire that tapped earthquake-related variables and the Kessler 10 Psychological Distress Scale to measure psychological distress were distributed to 1923 residents aged over 40 years. The mean age (S.D.) of the total 1731 respondents (male, 805; female, 926) was 68.2 (13.1) years. Of these, we assessed K10 scores from 1346 respondents. The mean scores (S.D.) for K10 and K6 (six selected items from the K10) were 5.8 (6.3) and 3.4 (3.9), respectively. Among the respondents, 9.1% and 3.2% obtained a score of K10 ≥15 and K6 ≥13, respectively. These scores showed slightly higher psychological distress, especially among the elderly, in comparison with existing community-based data. Categorical regression analysis revealed significant and relatively strong effects of initial psychological impact, decrease in sleep hours, advanced age, and decrease in interpersonal relationships within the community on the K10 score. The last item suggests the importance of socio-environmental factors in post-disaster mental health. PMID:24928758

  9. Pre-existing brain function predicts subsequent practice of mindfulness and compassion meditation.

    PubMed

    Mascaro, Jennifer S; Rilling, James K; Negi, Lobsang Tenzin; Raison, Charles L

    2013-04-01

    While a variety of meditation techniques are increasingly employed as health interventions, the fact that meditation requires a significant commitment of time and effort may limit its potential widespread utility. In the current study, we ask whether baseline subjective reports or brain activity in response to a "Pain for Self and Others" paradigm predicts subsequent engagement in mindfulness and compassion meditation. The study also investigated whether compassion training would impact neural responses when compared to an active health education control group. Prior to training, activation of the left and right anterior insula, an area thought to be important for empathy, in response to the Other pain task was positively related to engagement with compassion meditation as measured by practice time (n=13). On the other hand, activity in the left amygdala during the Self pain task was negatively correlated with mindfulness practice time. Following the study intervention, there was no difference between the compassion group (n=13), and the control group (n=8), in brain responses to either the Self or Other task. These results are the first to indicate that baseline neural responses may predict engagement with meditation training and suggest that pre-existing neurobiological profiles differentially predispose individuals to engage with disparate meditation techniques. PMID:23266748

  10. Flash-ionization of pre-existing circumstellar material around Nova Oph 2015

    NASA Astrophysics Data System (ADS)

    Munari, U.; Walter, F. M.

    2016-01-01

    We have obtained daily high-resolution Echelle spectroscopy of Nova Oph 2015 during its initial evolution. It reveals the presence of pre-existing circumstellar material around the nova, which can be interpreted as the wind of an evolved companion. On earliest observations, the emission line profiles of Nova Oph 2015 displayed a very narrow emission component (full width at half-maximum [FWHM] ˜ 60 km s-1), recombining over a time-scale of 5 days and showing constant low velocity (RV⊙ = -4.5 km s-1), that we interpret as coming from the wind of the secondary recombining after the ionization from the initial UV-flash of the nova. The underlying broad component underwent a marked reduction in both FWHM and width at zero intensity (the latter declining from 4000 to 2000 km s-1 in 10 days) while increasing by six times in flux, that we believe is the result of the high-velocity ejecta of the nova being slowed down while trying to expand within the surrounding wind of the companion. Nova Oph 2015 is possibly unique among novae with evolved companions in having displayed a long rise to maximum brightness and a slow decline from it, an Fe II-type classification, and a probable sub-giant luminosity class for the secondary.

  11. The Influence of Pre-existing Deformation on GMA Welding Distortion in Thin Steel Plates

    NASA Astrophysics Data System (ADS)

    Davies, C. M.; Ahn, J.; Tsunori, M.; Dye, D.; Nikbin, K. M.

    2015-01-01

    Weld distortion is particularly problematic for large thin structures that are used in the assembly of ships. The drive toward lighter ships and thinner plate is restricted by the significant increase in distortion as the plate thickness decreases. The influence of pre-existing deformation in the plates to be joined on the resultant distortion in gas metal arc welded structure has been studied. DH-36 steel plate surface profiles were measured before and after the butt welding of two plates 1000 × 500 × 4 mm in size. Three dimensional finite element models that incorporate the initial plate profile have been created to simulate the welding process and to examine the relationship between the final welded plate profiles and the initial deformation present in the plates. Both symmetric and asymmetric models were considered. A significant variation in the unwelded base plates' initial distortion was observed. Generally, it has been found that if an out-of-plane deformation exists in a plate prior to welding, the level of distortion further increases in the same direction following welding. The final distortions are strongly related to the initial plate profiles. The residual stress distributions in the plates are also to some extent affected by the level of distortion initially present.

  12. 42 CFR 494.170 - Condition: Medical records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Standard: Record retention and preservation. In accordance with 45 CFR § 164.530(j)(2), all patient records... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Medical records. 494.170 Section 494.170... Administration § 494.170 Condition: Medical records. The dialysis facility must maintain complete, accurate,...

  13. 42 CFR 418.102 - Condition of participation: Medical director.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of participation: Organizational Environment § 418.102 Condition of participation: Medical director. The hospice must designate a... is an employee, or is under contract with the hospice. When the medical director is not available,...

  14. 42 CFR 418.102 - Condition of participation: Medical director.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of participation: Organizational Environment § 418.102 Condition of participation: Medical director. The hospice must designate a... is an employee, or is under contract with the hospice. When the medical director is not available,...

  15. Discovery of a Pre-existing Molecular Filament Associated with Supernova Remnant G127.1+0.5

    NASA Astrophysics Data System (ADS)

    Zhou, Xin; Yang, Ji; Fang, Min; Su, Yang

    2014-08-01

    We performed millimeter observations in CO lines toward the supernova remnant (SNR) G127.1+0.5. We found a molecular filament at 4-13 km s-1 consisting of two distinct parts: a straight part coming out of the remnant region and a curved part in the remnant region. The curved part is coincides well with the bright SNR shell detected in 1420 MHz radio continuum and mid-infrared observations in the northeastern region. In addition, redshifted line wing broadening is found only in the curved part of the molecular filament, which indicates a physical interaction. These provide strong evidences, for the first time, to confirm the association between an SNR and a pre-existing long molecular filament. Multi-band observations in the northeastern remnant shell could be explained by the interaction between the remnant shock and the dense molecular filament. RADEX radiative transfer modeling of the quiet and shocked components yield physical conditions consistent with the passage of a non-dissociative J-type shock. We argue that the curved part of the filament is fully engulfed by the remnant's forward shock. A spatial correlation between aggregated young stellar objects (YSOs) and the adjacent molecular filament close to the SNR is also found, which could be related to the progenitor's activity.

  16. Discovery of a pre-existing molecular filament associated with supernova remnant G127.1+0.5

    SciTech Connect

    Zhou, Xin; Yang, Ji; Fang, Min; Su, Yang

    2014-08-20

    We performed millimeter observations in CO lines toward the supernova remnant (SNR) G127.1+0.5. We found a molecular filament at 4-13 km s{sup –1} consisting of two distinct parts: a straight part coming out of the remnant region and a curved part in the remnant region. The curved part is coincides well with the bright SNR shell detected in 1420 MHz radio continuum and mid-infrared observations in the northeastern region. In addition, redshifted line wing broadening is found only in the curved part of the molecular filament, which indicates a physical interaction. These provide strong evidences, for the first time, to confirm the association between an SNR and a pre-existing long molecular filament. Multi-band observations in the northeastern remnant shell could be explained by the interaction between the remnant shock and the dense molecular filament. RADEX radiative transfer modeling of the quiet and shocked components yield physical conditions consistent with the passage of a non-dissociative J-type shock. We argue that the curved part of the filament is fully engulfed by the remnant's forward shock. A spatial correlation between aggregated young stellar objects (YSOs) and the adjacent molecular filament close to the SNR is also found, which could be related to the progenitor's activity.

  17. Interactions between X-ray induced transient defects and pre-existing damage precursors in DKDP crystals

    SciTech Connect

    Negres, R A; Saw, C K; Demos, S G

    2008-10-24

    Large-aperture laser systems, currently designed to achieve high energy densities at the target location (exceeding {approx} 10{sup 11} J/m{sup 3}), will enable studies of the physics of matter and radiation under extreme conditions. As a result, their optical components, such as the frequency conversion crystals (KDP/DKDP), may be exposed to X-rays and other ionizing radiation. This in turn may lead to a change in the damage performance of these materials as they may be affected by radiation-induced effects by either forming new damage initiation centers or interacting with the pre-existing damage initiating defects (so-called damage precursors). We present an experimental study on the laser-induced bulk damage performance at 355-nm of DKDP crystals following X-ray irradiation at room temperature. Results indicate that the damage performance of the material is affected by exposure to X-rays. We attribute this behavior to a change in the physical properties of the precursors which, in turn, affect their individual damage threshold.

  18. Yellowstone Hotspot Melting And Its Relation To Pre-Existing Crustal Structures And Great Basin Extension

    NASA Astrophysics Data System (ADS)

    Glen, J. M.; Ponce, D. A.; Sepulveda, E.

    2004-12-01

    Topography and geophysical data suggest that the path of Yellowstone hotspot (YSHS) volcanism was controlled by pre-existing crustal structures associated with the Snake River Plain (SRP), and that Great Basin (GB) extension is intimately tied to hotspot melting. From its point of inception (Glen and Ponce, 2002), the YSHS migrated south to the southern Snake River Plain (SRP) where it began a steady migration northeast along the eastern SRP to its present position under the Yellowstone caldera. In doing so, however, it had to move through a 90° counter-clockwise turn that is not consistent with a fixed hotspot and its predicted path based on plate motions, and assuming a fixed hotspot. We present evidence suggesting that the SRPs western and eastern branches form a continuous deep crustal structure that guided YSHS volcanism along a track from its inception in eastern Oregon to its present position under the Yellowstone caldera. The western and eastern segments of the SRP, which are interpreted to have different origins and ages, nonetheless form a single topographic depression that curves 180° along a circular arc. Also associated with the SRP is a broad and continuous gravity anomaly indicating a relatively deep-seated crustal structure extending across the western and eastern SRP. Heat flow data, which show an uninterrupted corridor of high heat flow values extending from Yellowstone caldera through the SRP to the inferred inception point of the hotspot, might reflect either the thermal footprint of the hotspot's path or the control on heat flow by a regional-scale crustal discontinuity. While the path of the hotspot could have been directed by crustal structures, the location and timing of mid- to late-Tertiary extension in the GB might, in turn, have been controlled by hotspot melting. Well known is the age-progressive hotspot track along the eastern SRP, presently marked by active volcanism at the Yellowstone caldera. Less well known, is a second age-progressive track trending northwest across the Oregon Plateau ending at the historically active Newberry craters. The present locations of these active melting fronts, at Yellowstone and Newberry, coincide with the eastern and western margins, respectively, of the GB. This remarkable correlation, while suggesting a link between hotspot melting and GB extension, does not reveal whether melting controls the bounds of GB extension or whether GB extension controls the propagation of hotspot volcanism. Another characteristic of GB extension, however, that might reflect a causal relation between magmatism and rifting, is the geometry and orientation of basins and ranges in the GB. The trends of basins and ranges fan out from north-northwest in the eastern GB to northeast in the west. When extrapolated, these trends intersect near the SRP close to where the age-progressive YSHS trend began ˜ 12-14 Ma, suggesting a relationship between the formation of the GB and this period of the hotspot's path. We infer that this fracturing pattern is related to the SRP, perhaps induced by the ˜ 12-14 m.y. old hotspot, and that subsequent extension in the GB exploited these pre-existing crustal weaknesses.

  19. Endoscopic skull base training using 3D printed models with pre-existing pathology.

    PubMed

    Narayanan, Vairavan; Narayanan, Prepageran; Rajagopalan, Raman; Karuppiah, Ravindran; Rahman, Zainal Ariff Abdul; Wormald, Peter-John; Van Hasselt, Charles Andrew; Waran, Vicknes

    2015-03-01

    Endoscopic base of skull surgery has been growing in acceptance in the recent past due to improvements in visualisation and micro instrumentation as well as the surgical maturing of early endoscopic skull base practitioners. Unfortunately, these demanding procedures have a steep learning curve. A physical simulation that is able to reproduce the complex anatomy of the anterior skull base provides very useful means of learning the necessary skills in a safe and effective environment. This paper aims to assess the ease of learning endoscopic skull base exposure and drilling techniques using an anatomically accurate physical model with a pre-existing pathology (i.e., basilar invagination) created from actual patient data. Five models of a patient with platy-basia and basilar invagination were created from the original MRI and CT imaging data of a patient. The models were used as part of a training workshop for ENT surgeons with varying degrees of experience in endoscopic base of skull surgery, from trainees to experienced consultants. The surgeons were given a list of key steps to achieve in exposing and drilling the skull base using the simulation model. They were then asked to list the level of difficulty of learning these steps using the model. The participants found the models suitable for learning registration, navigation and skull base drilling techniques. All participants also found the deep structures to be accurately represented spatially as confirmed by the navigation system. These models allow structured simulation to be conducted in a workshop environment where surgeons and trainees can practice to perform complex procedures in a controlled fashion under the supervision of experts. PMID:25294050

  20. Differentiation of pre-existing trapped methane from thermogenic methane in an igneous-intruded coal by hydrous pyrolysis

    USGS Publications Warehouse

    Dias, Robert F.; Lewan, Michael D.; Birdwell, Justin E.; Kotarba, Maciej J.

    2014-01-01

    So as to better understand how the gas generation potential of coal changes with increasing rank, same-seam samples of bituminous coal from the Illinois Basin that were naturally matured to varying degrees by the intrusion of an igneous dike were subjected to hydrous pyrolysis (HP) conditions of 360 °C for 72 h. The accumulated methane in the reactor headspace was analyzed for δ13C and δ2H, and mol percent composition. Maximum methane production (9.7 mg/g TOC) occurred in the most immature samples (0.5 %Ro), waning to minimal methane values at 2.44 %Ro (0.67 mg/g TOC), and rebounding to 3.6 mg/g TOC methane in the most mature sample (6.76 %Ro). Methane from coal with the highest initial thermal maturity (6.76 %Ro) shows no isotopic dependence on the reactor water and has a microbial δ13C value of −61‰. However, methane from coal of minimal initial thermal maturity (0.5 %Ro) shows hydrogen isotopic dependence on the reaction water and has a δ13C value of −37‰. The gas released from coals under hydrous pyrolysis conditions represents a quantifiable mixture of ancient (270 Ma) methane (likely microbial) that was generated in situ and trapped within the rock during the rapid heating by the dike, and modern (laboratory) thermogenic methane that was generated from the indigenous organic matter due to thermal maturation induced by hydrous pyrolysis conditions. These findings provide an analytical framework for better assessment of natural gas sources and for differentiating generated gas from pre-existing trapped gas in coals of various ranks.

  1. Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations.

    PubMed

    Isambert, Aurlie; Le Du, Dominique; Valro, Marc; Guilhem, Marie-Thrse; Rousse, Carole; Dieudonn, Arnaud; Blanchard, Vincent; Pierrat, Nolle; Salvat, Ccile

    2015-04-01

    The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. PMID:25323441

  2. The effect of multiple pre-existing weaknesses on formation and evolution of faults in extended sandbox models

    NASA Astrophysics Data System (ADS)

    Tong, Hengmao; Koyi, Hemin; Huang, Scott; Zhao, Haitao

    2014-06-01

    High-resolution three-dimensional seismic data show that fault distribution and evolution in rift basins can be very complicated and inconsistent with the classic model of fault formation and propagation. Fault development in the presence of multiple pre-existing weaknesses is still not clearly studied. Trying to understand the role of multiple pre-existing weaknesses in sand models, two series of experiments were prepared. In the first series of models, the mechanical properties of pre-existing weaknesses were the same but their orientations were different, whereas in the second series of models, both mechanical properties and orientations were different. The basic characteristics of fault formation and evolution in a rift basin revealed by the models are as follows: 1) weakness-reactivated faults (faults that formed directly along and above the pre-existing weaknesses) and weakness-related faults (faults which are not located above the pre-existing weaknesses, but have similar orientation) form much earlier than weakness-unrelated faults. The order of formation of different weakness-reactivated faults is determined by the relative reactivation tendency factors (fa) of the weaknesses; 2) weakness-reactivated faults and weakness-related faults develop mainly along or parallel to pre-existing weaknesses. In contrast, weakness-unrelated faults develop nearly perpendicular to the extension direction; 3) a complicated fault system can form during a single extension phase in the presence of multiple pre-existing weaknesses; and 4) the mode of fault formation and propagation and the increase in length and number of faults have close ties to the nature of pre-existing weaknesses. Fault displacement and length do not have a power law relationship for the majority of faults, and there is no unique relationship for different kinds of faults. In addition to providing new insights to the formation of complex fault systems, the experiment results presented here could be reasonably explained using the Reactivation Tendency Theory. They can also be applied to the complicated fault system in rift basin.

  3. Detection and management of pre-existing cognitive impairment and associated behavioral symptoms in the Intensive Care Unit.

    PubMed

    Lee, Hochang B; DeLoatch, Candyce J; Cho, SeongJin; Rosenberg, Paul; Mears, Simon C; Sieber, Frederick E

    2008-10-01

    Recent increase in both the elderly population and associated incidence of dementia are of critical importance to patient care in ICUs in the United States. Identification of pre-existing cognitive impairment, such as mild cognitive impairment and dementia, could prevent delirium and associated morbidity and mortality in the ICU. Additionally, noncognitive behavioral symptoms, such as depression, psychosis, agitation, and catastrophic reactions, are common in patients with pre-existing cognitive impairment. Detection and management of noncognitive behavioral symptoms associated with MRI and dementia in ICU leads to improved delivery of life-saving critical care. PMID:18929940

  4. Reactivation of pre-existing structures during Palaeogene to recent tectonics - the Southern Upper Rhine Graben

    NASA Astrophysics Data System (ADS)

    Ustaszewski, K.; Schumacher, M.; Schmid, S. M.

    2003-04-01

    Contour maps of the top-basement surface were established for part of the southernmost Upper Rhine Graben and the adjacent Jura Mountains based on seismic reflection profiles. Combined with surface data, they emphasise the importance of pre-existing Palaeozoic faults for the Palaeogene to recent structural evolution of the southern Upper Rhine Graben, an area of increased seismicity. The contemporaneous opening of the Palaeogene Upper Rhine Graben and Bresse Graben systems was kinematically linked by the Rhine-Bresse transform zone (RBTZ). The RBTZ formed along ENE-oriented crustal discontinuities, inherited from post-Variscan transtension. This Palaeogene rifting initiated in Late Priabonian times and encompassed sinistral transtensive reactivation of ENE-oriented basement faults and normal faulting along NNE-striking faults during ESE-WNW-directed extension. In the Mesozoic sedimentary cover these movements were accommodated by the formation of ENE-oriented flexures and NNE-striking half-grabens with hanging-wall growth faults. Mio- to Pliocene thin-skinned folding and thrusting of the Jura Mountains encountered a rift-related structural pattern, which had disrupted the Triassic basal décollement. This inherited pattern controlled the nucleation of thrusts and folds, as well as transfer zones, in the detached sedimentary cover, as is evidenced in the high semblance of subsurface faults and surface structures. Horizontal transport directions of the detached sediments (reconstructed by fault plane inversion) reveal NW- to NNE-directed fan-shaped trajectories, which indicate divergent displacements at the thin-skinned Jura front. On the other hand, increasing transpressional shortening of the frontal thrust sheet towards W with a maximum in the proximity of NNE-striking basement faults suggests a clockwise rotation of the detached sediments. Post-2.9Ma shortening of the sedimentary cover is evidenced in an array of ENE- to NE-trending syn- and anticlines, deforming the base of Late Pliocene gravels. This shortening occurred in an overall stress field that remained unchanged since the onset of thin-skinned Jura folding. The deformation mode, however, did change: formerly extensional flexures and faults were reactivated in thick-skinned mode, as indicated by the development of basement-rooted flower-structures.

  5. 42 CFR 418.102 - Condition of participation: Medical director.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Condition of participation: Medical director. 418.102 Section 418.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of participation: Organizational Environment § 418.102 Condition...

  6. 42 CFR 482.22 - Condition of participation: Medical staff.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition of participation: Medical staff. 482.22 Section 482.22 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Basic Hospital Functions § 482.22 Condition...

  7. Evolution of Pre-Existing versus Acquired Resistance to Platinum Drugs and PARP Inhibitors in BRCA-Associated Cancers

    PubMed Central

    Yamamoto, Kimiyo N.; Hirota, Kouji; Takeda, Shunichi; Haeno, Hiroshi

    2014-01-01

    Platinum drugs and PARP inhibitors (“PARPis”) are considered to be effective in BRCA-associated cancers with impaired DNA repair. These agents cause stalled and collapsed replication forks and create double-strand breaks effectively in the absence of repair mechanisms, resulting in arrest of the cell cycle and induction of cell death. However, recent studies have shown failure of these chemotherapeutic agents due to emerging drug resistance. In this study, we developed a stochastic model of BRCA-associated cancer progression in which there are four cancer populations: those with (i) functional BRCA, (ii) dysfunctional BRCA, (iii) functional BRCA and a growth advantage, and (iv) dysfunctional BRCA and a growth advantage. These four cancer populations expand from one cancer cell with normal repair function until the total cell number reaches a detectable amount. We derived formulas for the probability and expected numbers of each population at the time of detection. Furthermore, we extended the model to consider the tumor dynamics during treatment. Results from the model were validated and showed good agreement with clinical and experimental evidence in BRCA-associated cancers. Based on the model, we investigated conditions in which drug resistance during the treatment course originated from either a pre-existing drug-resistant population or a de novo population, due to secondary mutations. Finally, we found that platinum drugs and PARPis were effective if (i) BRCA inactivation is present, (ii) the cancer was diagnosed early, and (iii) tumor growth is rapid. Our results indicate that different types of cancers have a preferential way of acquiring resistance to platinum drugs and PARPis according to their growth and mutational characteristics. PMID:25158060

  8. Parasitic folds with wrong vergence: How pre-existing geometrical asymmetries can be inherited during multilayer buckle folding

    NASA Astrophysics Data System (ADS)

    Frehner, Marcel; Schmid, Timothy

    2016-06-01

    Parasitic folds are typical structures in geological multilayer folds; they are characterized by a small wavelength and are situated within folds with larger wavelength. Parasitic folds exhibit a characteristic asymmetry (or vergence) reflecting their structural relationship to the larger-scale fold. Here we investigate if a pre-existing geometrical asymmetry (e.g., from sedimentary structures or folds from a previous tectonic event) can be inherited during buckle folding to form parasitic folds with wrong vergence. We conduct 2D finite-element simulations of multilayer folding using Newtonian materials. The applied model setup comprises a thin layer exhibiting the pre-existing geometrical asymmetry sandwiched between two thicker layers, all intercalated with a lower-viscosity matrix and subjected to layer-parallel shortening. When the two outer thick layers buckle and amplify, two processes work against the asymmetry: layer-perpendicular flattening between the two thick layers and the rotational component of flexural flow folding. Both processes promote de-amplification and unfolding of the pre-existing asymmetry. We discuss how the efficiency of de-amplification is controlled by the larger-scale fold amplification and conclude that pre-existing asymmetries that are open and/or exhibit low amplitude are prone to de-amplification and may disappear during buckling of the multilayer system. Large-amplitude and/or tight to isoclinal folds may be inherited and develop type 3 fold interference patterns.

  9. Treatment of peripheral neuropathic pain by topical capsaicin: Impact of pre-existing pain in the QUEPP-study

    PubMed Central

    Maihfner, CG; Heskamp, M-LS

    2014-01-01

    Background This study evaluates the impact of the duration of pre-existing peripheral neuropathic pain on the therapeutic response to the capsaicin 8% cutaneous patch. Methods The non-interventional QUEPP (QUTENZA safety and effectiveness in peripheral neuropathic pain) study evaluated the effectiveness of Qutenza in 1044 non-diabetic patients with peripheral neuropathic pain, who received a single application. Follow-up visits were scheduled at weeks 12, 4, 8 and 12. A pre-defined co-analysis of changes in average pain intensity was performed based on the duration of pre-existing pain. Results In patients with pre-existing pain for <6 months, the mean relative change of the numeric pain rating scale score on days 714 to week 12 versus baseline was ?36.6% [4.6 standard error of the mean (SEM); n = 105], ?25.1% (1.9 SEM; n = 311) in patients with pain duration of 6 months to 2 years, ?22.3% (1.6 SEM; n = 391) in patients with pain for >210 years, and ?19.2% (2.6 SEM; n = 99) in patients with pain for >10 years. Thirty percent and 50% responder rates were 61.7% and 39.3% in patients with pre-existing pain for <6 months, 42.3% and 23.3% in patients with pain for 6 months to 2 years, 40.9% and 21.6% in patients with pain for >210 years, and 32.3% and 14.1% in patients with pain for >10 years. Conclusions The highest treatment response to the capsaicin 8% cutaneous patch was observed in patients with a history of pre-existing peripheral neuropathic pain of less than 6 months, suggesting that early initiation of topical treatment might be indicated. PMID:24259265

  10. 14 CFR 67.113 - General medical condition.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false General medical condition. 67.113 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  11. 14 CFR 67.213 - General medical condition.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false General medical condition. 67.213 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  12. 14 CFR 67.313 - General medical condition.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false General medical condition. 67.313 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  13. 14 CFR 67.113 - General medical condition.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false General medical condition. 67.113 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  14. 14 CFR 67.213 - General medical condition.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false General medical condition. 67.213 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  15. 14 CFR 67.313 - General medical condition.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false General medical condition. 67.313 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  16. 14 CFR 67.213 - General medical condition.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false General medical condition. 67.213 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  17. 14 CFR 67.113 - General medical condition.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false General medical condition. 67.113 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  18. 14 CFR 67.313 - General medical condition.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false General medical condition. 67.313 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  19. 14 CFR 67.313 - General medical condition.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false General medical condition. 67.313 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  20. 14 CFR 67.113 - General medical condition.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false General medical condition. 67.113 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  1. 14 CFR 67.213 - General medical condition.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false General medical condition. 67.213 Section... relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be...

  2. Sexual dysfunction among Ghanaian men presenting with various medical conditions

    PubMed Central

    2010-01-01

    Background Several medical conditions can affect and disrupt human sexuality. The alteration of sexuality in these medical conditions often hinder effective communication and empathy between the patients and their sexual partners because of cultural attitudes, social norms and negative feelings such as anxiety and guilt. Validated and standardized sexual inventories might therefore help resolve this problem. The objective of this cross-sectional study was to obtain data on the prevalence of male sexual dysfunction (SD) among Ghanaians with various medical conditions residing in Kumasi. Methods The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was administered to 150 Ghanaian men with various medical conditions between 19 and 66 years old (mean ± standard deviation: 40.01 ± 12.32 years) domiciled in the Kumasi metropolis. Results Out of the total 150 questionnaires administered, 105 (70.0%) men returned the questionnaires. Questionnaires from 3 men were incomplete, leaving 102 complete and evaluable questionnaires, indicating a 68.0% response rate. Of the remaining 102 men, 88.2% were married, 70.6% had attained higher education, 88.2% were non-smokers. Whereas 54.9% were engaged in exercise, 61.8% indulged in alcoholic beverages. The prevalence of the various medical conditions include: diabetes (18%), hypertension (24.5%), migraine (11.8%), ulcer (7.8%), surgery (6.9%), STD (3.9) and others (26.5%). The prevalence of SD among the respondents in the study was 59.8%. The highest prevalence of SD was seen among ulcer patients (100%), followed by patients who have undergone surgery (75%), diabetes (70%), hypertension (50%), STD (50%) and the lowest was seen among migraine patients (41.7%). Conclusions SD rate is high among Ghanaian men with medical conditions (about 60%) and vary according to the condition and age. PMID:20942960

  3. The experience of altered states of consciousness in shamanic ritual: the role of pre-existing beliefs and affective factors.

    PubMed

    Polito, Vince; Langdon, Robyn; Brown, Jac

    2010-12-01

    Much attention has been paid recently to the role of anomalous experiences in the aetiology of certain types of psychopathology, e.g. in the formation of delusions. We examine, instead, the top-down influence of pre-existing beliefs and affective factors in shaping an individual's characterisation of anomalous sensory experiences. Specifically we investigated the effects of paranormal beliefs and alexithymia in determining the intensity and quality of an altered state of consciousness (ASC). Fifty five participants took part in a sweat lodge ceremony, a traditional shamanic ritual which was unfamiliar to them. Participants reported significant alterations in their state of consciousness, quantified using the 'APZ' questionnaire, a standardized measure of ASC experience. Participants endorsing paranormal beliefs compatible with shamanic mythology, and those showing difficulty identifying feelings scored higher on positive dimensions of ASC experience. Our findings demonstrate that variation in an individual's characterisation of anomalous experiences is nuanced by pre-existing beliefs and affective factors. PMID:20558090

  4. Avoiding the requirement for pre-existing optical contact during picosecond laser glass-to-glass welding.

    PubMed

    Chen, Jianyong; Carter, Richard M; Thomson, Robert R; Hand, Duncan P

    2015-07-13

    Previous reports of ultrafast laser welding of glass-to-glass have indicated that a pre-existing optical contact (or very close to) between the parts to be joined is essential. In this paper, the capability of picosecond laser welding to bridge micron-scale gaps is investigated, and successful welding, without cracking, of two glasses with a pre-existing gap of 3 µm is demonstrated. It is shown that the maximum gap that can be welded is not significantly affected by welding speeds, but is strongly dependent on the laser power and focal position relative to the interface between the materials. Five distinct types of material modification were observed over a range of different powers and surface separations, and a mechanism is proposed to explain the observations. PMID:26191923

  5. Phenotypic T cell exhaustion in a murine model of bacterial infection in the setting of pre-existing malignancy.

    PubMed

    Mittal, Rohit; Wagener, Maylene; Breed, Elise R; Liang, Zhe; Yoseph, Benyam P; Burd, Eileen M; Farris, Alton B; Coopersmith, Craig M; Ford, Mandy L

    2014-01-01

    While much of cancer immunology research has focused on anti-tumor immunity both systemically and within the tumor microenvironment, little is known about the impact of pre-existing malignancy on pathogen-specific immune responses. Here, we sought to characterize the antigen-specific CD8+ T cell response following a bacterial infection in the setting of pre-existing pancreatic adenocarcinoma. Mice with established subcutaneous pancreatic adenocarcinomas were infected with Listeria monocytogenes, and antigen-specific CD8+ T cell responses were compared to those in control mice without cancer. While the kinetics and magnitude of antigen-specific CD8+ T cell expansion and accumulation was comparable between the cancer and non-cancer groups, bacterial antigen-specific CD8+ T cells and total CD4+ and CD8+ T cells in cancer mice exhibited increased expression of the coinhibitory receptors BTLA, PD-1, and 2B4. Furthermore, increased inhibitory receptor expression was associated with reduced IFN-γ and increased IL-2 production by bacterial antigen-specific CD8+ T cells in the cancer group. Taken together, these data suggest that cancer's immune suppressive effects are not limited to the tumor microenvironment, but that pre-existing malignancy induces phenotypic exhaustion in T cells by increasing expression of coinhibitory receptors and may impair pathogen-specific CD8+ T cell functionality and differentiation. PMID:24796533

  6. Phenotypic T Cell Exhaustion in a Murine Model of Bacterial Infection in the Setting of Pre-Existing Malignancy

    PubMed Central

    Mittal, Rohit; Wagener, Maylene; Breed, Elise R.; Liang, Zhe; Yoseph, Benyam P.; Burd, Eileen M.; Farris, Alton B.

    2014-01-01

    While much of cancer immunology research has focused on anti-tumor immunity both systemically and within the tumor microenvironment, little is known about the impact of pre-existing malignancy on pathogen-specific immune responses. Here, we sought to characterize the antigen-specific CD8+ T cell response following a bacterial infection in the setting of pre-existing pancreatic adenocarcinoma. Mice with established subcutaneous pancreatic adenocarcinomas were infected with Listeria monocytogenes, and antigen-specific CD8+ T cell responses were compared to those in control mice without cancer. While the kinetics and magnitude of antigen-specific CD8+ T cell expansion and accumulation was comparable between the cancer and non-cancer groups, bacterial antigen-specific CD8+ T cells and total CD4+ and CD8+ T cells in cancer mice exhibited increased expression of the coinhibitory receptors BTLA, PD-1, and 2B4. Furthermore, increased inhibitory receptor expression was associated with reduced IFN-γ and increased IL-2 production by bacterial antigen-specific CD8+ T cells in the cancer group. Taken together, these data suggest that cancer's immune suppressive effects are not limited to the tumor microenvironment, but that pre-existing malignancy induces phenotypic exhaustion in T cells by increasing expression of coinhibitory receptors and may impair pathogen-specific CD8+ T cell functionality and differentiation. PMID:24796533

  7. National health spending by medical condition, 1996-2005.

    PubMed

    Roehrig, Charles; Miller, George; Lake, Craig; Bryant, Jenny

    2009-01-01

    This study responds to recent calls for information about how personal health expenditures from the National Health Expenditure Accounts are distributed across medical conditions. It provides annual estimates from 1996 through 2005 for thirty-two conditions mapped into thirteen all-inclusive diagnostic categories. Circulatory system spending was highest among the diagnostic categories, accounting for 17 percent of spending in 2005. The most costly conditions were mental disorders and heart conditions. Spending growth rates were lowest for lung cancer, chronic obstructive pulmonary disease, pneumonia, coronary heart disease, and stroke, perhaps reflecting benefits of preventive care. PMID:19240056

  8. 28 CFR 79.26 - Proof of medical condition.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Proof of medical condition. 79.26 Section 79.26 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims Relating to Certain Specified Diseases Contracted After Exposure in an Affected Area...

  9. Medical Care, Living Conditions, and Children's Well-Being.

    ERIC Educational Resources Information Center

    Ross, Catherine E.; Duff, Raymond S.

    1982-01-01

    The family's socioeconomic status and the social-psychological aspects of family functioning were found to influence children's physical well-being both directly as well as indirectly through access to good medical care. Quality of psychotherapeutic care had no effect on psychological well being, which was affected by family living conditions.…

  10. 28 CFR 79.16 - Proof of medical condition.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... COMPENSATION ACT Eligibility Criteria for Claims Relating to Leukemia § 79.16 Proof of medical condition. (a... leukemia. Proof that the claimant contracted leukemia must be made either by using the procedure outlined... section. (b) If a claimant was diagnosed as having leukemia in Arizona, Colorado, Nevada, New Mexico,...

  11. 28 CFR 79.16 - Proof of medical condition.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... COMPENSATION ACT Eligibility Criteria for Claims Relating to Leukemia § 79.16 Proof of medical condition. (a... leukemia. Proof that the claimant contracted leukemia must be made either by using the procedure outlined... section. (b) If a claimant was diagnosed as having leukemia in Arizona, Colorado, Nevada, New Mexico,...

  12. Superimposition of wind seas on pre-existing swells off Goa coast

    NASA Astrophysics Data System (ADS)

    Vethamony, P.; Aboobacker, V. M.; Menon, H. B.; Kumar, K. Ashok; Cavaleri, L.

    2011-07-01

    An analysis of wind and wave data collected in the coastal region of Goa, west coast of India, during fair weather season reveals a distinct and systematic diurnal variation in wind speed, wave height and wave period, especially simultaneous increase in wave height and decrease in wave period with increase in local wind speeds due to sea breeze system. During a typical daily cycle, the wave height reaches its peak early in the afternoon, then it decays progressively back to the swell conditions within 5 or 6 h. Measured wave spectra distinctly bring out salient features of deep water swell and wind seas generated by the local sea breeze. Numerical simulations reproduce the characteristics of this daily cycle. The exposure of Goa coast to long distant swells from the southwest and to the local wind seas from the northwest leads to complex cross-sea conditions.

  13. Medical and Orthopaedic Conditions in Special Olympics Athletes

    PubMed Central

    2001-01-01

    Objective: Many Special Olympics athletes experience hypokinetic diseases and comorbid conditions that may predispose them to serious injuries during physical activity. A clear understanding of these conditions and diseases may assist health care professionals in preventing further distress and managing the injuries sustained by these athletes. Such diseases and conditions include overweight and obesity, diabetes, vision problems, seizure disorders, and Down syndrome, which is often associated with atlantoaxial instability. Data Sources: MEDLINE, SPORT Discus, and Special Olympics information sources for the years 1990–2000 using the key terms Special Olympics, mental retardation, comorbidity, Down syndrome, hypokinetic diseases, and physical activity were searched. Data Synthesis: A basic review of hypokinetic diseases and comorbid conditions prepares health care professionals for working with people with mental retardation. Conclusions and Recommendations: Health care volunteers at Special Olympics events treat athletes with mental retardation who may also have some of the comorbid conditions and hypokinetic diseases observed commonly in this population. Moreover, many of these conditions and diseases are typical in athletes without mental retardation. Athletic trainers should be familiar with these conditions and diseases but should review the unique conditions and prescription medications commonly found in the Special Olympics population before providing medical services for these athletes. PMID:16404438

  14. Individual Differences in Reading Comprehension Gains from Assisted Reading Practice: Pre Existing Conditions, Vocabulary Acquisition, and Amounts of Practice

    ERIC Educational Resources Information Center

    Shany, Michal; Biemiller, Andrew

    2010-01-01

    We conducted a study of the effects of assisted reading practice (Shany & Biemiller, 1995). In this paper we examined the original data to find factors affecting gains in reading comprehension. We contrasted 14 children who had below median gains in reading comprehension and 15 who had above median gains. There were no significant correlations…

  15. 45 CFR 155.345 - Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... filer's household income, as defined in 26 CFR 1.36B-1(e), is less than 100 percent of the FPL for the... Exchange must follow procedures established in accordance with 45 CFR 152.45 to transition PCIP enrollees... 45 Public Welfare 1 2013-10-01 2013-10-01 false Coordination with Medicaid, CHIP, the Basic...

  16. 45 CFR 155.345 - Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... filer's household income, as defined in 26 CFR 1.36B-1(e), is less than 100 percent of the FPL for the... Exchange must follow procedures established in accordance with 45 CFR 152.45 to transition PCIP enrollees... 45 Public Welfare 1 2014-10-01 2014-10-01 false Coordination with Medicaid, CHIP, the Basic...

  17. Indium-111-labeled white blood cells in the detection of osteomyelitis complicated by a pre-existing condition

    SciTech Connect

    McCarthy, K.; Velchik, M.G.; Alavi, A.; Mandell, G.A.; Esterhai, J.L.; Goll, S.

    1988-06-01

    Forty-six patients (23M, 23F) ranging in age from 19 to 79 yr with a clinical history of a nonunion fracture, surgery, diabetes or a soft-tissue infection were studied with (/sup 111/In)oxine WBCs to detect osteomyelitis. There were 27 true-positive, nine true-negative, two false-positive and one false-negative. The false-positives and the false-negative occurred in patients with soft-tissue infections overlying the area of interest. All diagnoses were confirmed by intraoperative bone biopsies and cultures. Bone biopsy and scan were performed within 2 days of each other in 39 patients. The overall sensitivity was 97% (27/28), specificity, 82% (9/11) and the diagnostic accuracy, 92% (36/39). The remaining seven patients had negative (/sup 111/In)WBC scans several months after positive bone biopsies and definite antibiotic treatment. This suggests that (In)WBC scans become negative after appropriate therapy is undertaken. Interobserver data was obtained from four nuclear physicians of varying experience blinded to clinical information. A high degree of agreement was found in over 90% of the cases. This study demonstrates the utility of (/sup 111/In)WBC scans in the diagnosis and follow-up of complicated osteomyelitis and a high level of interobserver agreement in scan interpretation.

  18. Non-puerperal mastitis masking pre-existing breast malignancy: importance of follow-up imaging.

    PubMed

    An, Jin Kyung; Woo, Jeong Joo; Lee, Seung A

    2016-04-01

    Mastitis is an inflammatory condition of the breast with common symptoms of pain, swelling, erythema, warmth, and fever. Diagnosis of mastitis is easily made on the basis of typical symptoms and ultrasonographic findings, such as diffusely increased echogenicity of the parenchyma and subcutaneous fat, or skin thickening. However, when it occurs in women middle-aged or older, associated malignancy should be considered. In our cases, we detected irregular hypoechoic malignant masses after the disappearance of inflammatory changes. Therefore, when non-puerperal women have inflammatory signs on their breast, follow-up imaging should be performed. In particular, in the case of persistent or growing palpability after the recovery of breast inflammation, percutaneous core biopsy and short-term follow-up with ultrasonography should be considered to exclude the associated malignancy. PMID:26169080

  19. Non-puerperal mastitis masking pre-existing breast malignancy: importance of follow-up imaging

    PubMed Central

    2016-01-01

    Mastitis is an inflammatory condition of the breast with common symptoms of pain, swelling, erythema, warmth, and fever. Diagnosis of mastitis is easily made on the basis of typical symptoms and ultrasonographic findings, such as diffusely increased echogenicity of the parenchyma and subcutaneous fat, or skin thickening. However, when it occurs in women middle-aged or older, associated malignancy should be considered. In our cases, we detected irregular hypoechoic malignant masses after the disappearance of inflammatory changes. Therefore, when non-puerperal women have inflammatory signs on their breast, follow-up imaging should be performed. In particular, in the case of persistent or growing palpability after the recovery of breast inflammation, percutaneous core biopsy and short-term follow-up with ultrasonography should be considered to exclude the associated malignancy. PMID:26169080

  20. Sleep disorders, medical conditions, and road accident risk.

    PubMed

    Smolensky, Michael H; Di Milia, Lee; Ohayon, Maurice M; Philip, Pierre

    2011-03-01

    Sleep disorders and various common acute and chronic medical conditions directly or indirectly affect the quality and quantity of one's sleep or otherwise cause excessive daytime fatigue. This article reviews the potential contribution of several prevalent medical conditions - allergic rhinitis, asthma, chronic obstructive pulmonary disease, rheumatoid arthritis/osteoarthritis - and chronic fatigue syndrome and clinical sleep disorders - insomnia, obstructive sleep apnea, narcolepsy, periodic limb movement of sleep, and restless legs syndrome - to the risk for drowsy-driving road crashes. It also explores the literature on the cost-benefit of preventive interventions, using obstructive sleep apnea as an example. Although numerous investigations have addressed the impact of sleep and medical disorders on quality of life, few have specifically addressed their potential deleterious effect on driving performance and road incidents. Moreover, since past studies have focused on the survivors of driver crashes, they may be biased. Representative population-based prospective multidisciplinary studies are urgently required to clarify the role of the fatigue associated with common ailments and medications on traffic crash risk of both commercial and non-commercial drivers and to comprehensively assess the cost-effectiveness of intervention strategies. PMID:21130215

  1. Sleep Problems in Children and Adolescents with Common Medical Conditions

    PubMed Central

    Lewandowski, Amy S.; Ward, Teresa M.; Palermo, Tonya M.

    2011-01-01

    Synopsis Sleep is critically important to childrens health and well-being. Untreated sleep disturbances and sleep disorders pose significant adverse daytime consequences and place children at considerable risk for poor health outcomes. Sleep disturbances occur at a greater frequency in children with acute and chronic medical conditions compared to otherwise healthy peers. Sleep disturbances in medically ill children can be associated with sleep disorders (e.g., sleep disordered breathing, restless leg syndrome), co-morbid with acute and chronic conditions (e.g., asthma, arthritis, cancer), or secondary to underlying disease-related mechanisms (e.g. airway restriction, inflammation) treatment regimens, or hospitalization. Clinical management should include a multidisciplinary approach with particular emphasis on routine, regular sleep assessments and prevention of daytime consequences and promotion of healthy sleep habits and health outcomes. PMID:21600350

  2. Liver gene therapy by lentiviral vectors reverses anti-factor IX pre-existing immunity in haemophilic mice.

    PubMed

    Annoni, Andrea; Cantore, Alessio; Della Valle, Patrizia; Goudy, Kevin; Akbarpour, Mahzad; Russo, Fabio; Bartolaccini, Sara; D'Angelo, Armando; Roncarolo, Maria Grazia; Naldini, Luigi

    2013-11-01

    A major complication of factor replacement therapy for haemophilia is the development of anti-factor neutralizing antibodies (inhibitors). Here we show that liver gene therapy by lentiviral vectors (LVs) expressing factor IX (FIX) strongly reduces pre-existing anti-FIX antibodies and eradicates FIX inhibitors in haemophilia B mice. Concomitantly, plasma FIX levels and clotting activity rose to 50-100% of normal. The treatment was effective in 75% of treated mice. FIX-specific plasma cells (PCs) and memory B cells were reduced, likely because of memory B-cell depletion in response to constant exposure to high doses of FIX. Regulatory T cells displaying FIX-specific suppressive capacity were induced in gene therapy treated mice and controlled FIX-specific T helper cells. Gene therapy proved safer than a regimen mimicking immune tolerance induction (ITI) by repeated high-dose FIX protein administration, which induced severe anaphylactoid reactions in inhibitors-positive haemophilia B mice. Liver gene therapy can thus reverse pre-existing immunity, induce active tolerance to FIX and establish sustained FIX activity at therapeutic levels. These data position gene therapy as an attractive treatment option for inhibitors-positive haemophilic patients. PMID:24106222

  3. Impact of Pre-Existing Immunity on Gene Transfer to Nonhuman Primate Liver with Adeno-Associated Virus 8 Vectors

    PubMed Central

    Wang, Lili; Calcedo, Roberto; Bell, Peter; Lin, Jianping; Grant, Rebecca L; Siegel, Don L

    2011-01-01

    Abstract Vectors based on the primate-derived adeno-associated virus serotype 8 (AAV8) are being evaluated in preclinical and clinical models. Natural infections with related AAVs activate memory B cells that produce antibodies capable of modulating the efficacy and safety of the vector. We have evaluated the biology of AAV8 gene transfer in macaque liver, with a focus on assessing the impact of pre-existing humoral immunity. Twenty-one macaques with various levels of AAV neutralizing antibody (NAb) were injected intravenously with AAV8 vector expressing green fluorescent protein. Pre-existing antibody titers in excess of 1:10 substantially diminished hepatocyte transduction that, in the absence of NAbs, was highly efficient. Vector-specific NAb diminished liver deposition of genomes and unexpectedly increased genome distribution to the spleen. The majority of animals showed high-level and stable sequestration of vector capsid protein by follicular dendritic cells of splenic germinal centers. These studies illustrate how natural immunity to a virus that is related to a vector can impact the efficacy and potential safety of in vivo gene therapy. We propose to use the in vitro transduction inhibition assay to evaluate research subjects before gene therapy and to preclude from systemic AAV8 trials those that have titers in excess of 1:10. PMID:21476868

  4. Investigation on the Automatic Geo-Referencing of Archaeological UAV Photographs by Correlation with Pre-Existing Ortho-Photos

    NASA Astrophysics Data System (ADS)

    Karel, W.; Doneus, M.; Briese, C.; Verhoeven, G.; Pfeifer, N.

    2014-06-01

    We present a method for the automatic geo-referencing of archaeological photographs captured aboard unmanned aerial vehicles (UAVs), termed UPs. We do so by help of pre-existing ortho-photo maps (OPMs) and digital surface models (DSMs). Typically, these pre-existing data sets are based on data that were captured at a widely different point in time. This renders the detection (and hence the matching) of homologous feature points in the UPs and OPMs infeasible mainly due to temporal variations of vegetation and illumination. Facing this difficulty, we opt for the normalized cross correlation coefficient of perspectively transformed image patches as the measure of image similarity. Applying a threshold to this measure, we detect candidates for homologous image points, resulting in a distinctive, but computationally intensive method. In order to lower computation times, we reduce the dimensionality and extents of the search space by making use of a priori knowledge of the data sets. By assigning terrain heights interpolated in the DSM to the image points found in the OPM, we generate control points. We introduce respective observations into a bundle block, from which gross errors i.e. false matches are eliminated during its robust adjustment. A test of our approach on a UAV image data set demonstrates its potential and raises hope to successfully process large image archives.

  5. An in vivo neovascularization assay for screening regulators of angiogenesis and assessing their effects on pre-existing vessels.

    PubMed

    Kilarski, Witold W; Petersson, Ludvig; Fuchs, Peder Fredlund; Zielinski, Marcin S; Gerwins, Pr

    2012-12-01

    Therapeutic regulation of tissue vascularization has appeared as an attractive approach to treat a number of human diseases. In vivo neovascularization assays that reflect physiological and pathological formation of neovessels are important in this effort. In this report we present an assay where the effects of activators and inhibitors of angiogenesis can be quantitatively and qualitatively measured. A provisional matrix composed of collagen I and fibrin was formed in a plastic cylinder and implanted onto the chick chorioallantoic membrane. A nylon mesh separated the implanted matrix from the underlying tissue to distinguish new from pre-existing vessels. Vascularization of the matrix in response to fibroblast growth factor-2 or platelet-derived growth factor-BB was scored in a double-blinded manner, or vessel density was measured using a semi-automated image analysis procedure. Thalidomide, fumagillin, U0126 and TGF? inhibited neovessel growth while hydrocortisone exerted a negative and wortmannin a toxic effect on the pre-existing vasculature. This quantitative, inexpensive and rapid in vivo angiogenesis assay might be a valuable tool in screening and characterizing factors that influence wound or tumor induced vascularization and in assessing their effects on the normal vasculature. PMID:22918697

  6. The Prescribed Pediatric Center: A Medical Day Treatment Program for Children with Complex Medical Conditions.

    ERIC Educational Resources Information Center

    Ruppert, Elizabeth S.; Karst, Thomas O.; Brogan, Mark G.

    1998-01-01

    The Prescribed Pediatric Center (Toledo, Ohio) is a community-based, multidisciplinary program for infants and children with chronic, complex medical conditions. This article describes program beginnings; the planning process; and the program's growth, development, and components. Initial program evaluation indicates positive effects on some…

  7. Protective efficacy of a single immunization with capripoxvirus-vectored recombinant peste des petits ruminants vaccines in presence of pre-existing immunity.

    PubMed

    Caufour, Philippe; Rufael, Tesfaye; Lamien, Charles Euloge; Lancelot, Renaud; Kidane, Menbere; Awel, Dino; Sertse, Tefera; Kwiatek, Olivier; Libeau, Geneviève; Sahle, Mesfin; Diallo, Adama; Albina, Emmanuel

    2014-06-24

    Sheeppox, goatpox and peste des petits ruminants (PPR) are highly contagious ruminant diseases widely distributed in Africa, the Middle East and Asia. Capripoxvirus (CPV)-vectored recombinant PPR vaccines (rCPV-PPR vaccines), which have been developed and shown to protect against both Capripox (CP) and PPR, would be critical tools in the control of these important diseases. In most parts of the world, these disease distributions overlap each other leaving concerns about the potential impact that pre-existing immunity against either disease may have on the protective efficacy of these bivalent rCPV-PPR vaccines. Currently, this question has not been indisputably addressed. Therefore, we undertook this study, under experimental conditions designed for the context of mass vaccination campaigns of small ruminants, using the two CPV recombinants (Kenya sheep-1 (KS-1) strain-based constructs) developed previously in our laboratory. Pre-existing immunity was first induced by immunization either with an attenuated CPV vaccine strain (KS-1) or the attenuated PPRV vaccine strain (Nigeria 75/1) and animals were thereafter inoculated once subcutaneously with a mixture of CPV recombinants expressing either the hemagglutinin (H) or the fusion (F) protein gene of PPRV (10(3) TCID50/animal of each). Finally, these animals were challenged with a virulent CPV strain followed by a virulent PPRV strain 3 weeks later. Our study demonstrated full protection against CP for vaccinated animals with prior exposure to PPRV and a partial protection against PPR for vaccinated animals with prior exposure to CPV. The latter animals exhibited a mild clinical form of PPR and did not show any post-challenge anamnestic neutralizing antibody response against PPRV. The implications of these results are discussed herein and suggestions made for future research regarding the development of CPV-vectored vaccines. PMID:24837763

  8. Pre-existing Pulmonary Diseases and Survival in Patients With Stage-dependent Lung Adenocarcinoma: A STROBE-compliant Article.

    PubMed

    Jian, Zhi-Hong; Huang, Jing-Yang; Nfor, Oswald Ndi; Jhang, Kai-Ming; Ku, Wen-Yuan; Ho, Chien-Chang; Lung, Chia-Chi; Pan, Hui-Hsien; Liang, Yu-Chiu; Wu, Ming-Fang; Liaw, Yung-Po

    2016-03-01

    Asthma, chronic obstructive pulmonary disease (COPD), and pulmonary tuberculosis (TB) are common lung diseases associated with lung cancer mortality. This study evaluated sex disparities in pre-existing pulmonary diseases and stage-dependent lung adenocarcinoma survival.Patients newly diagnosed with lung adenocarcinoma between 2003 and 2008 were identified using the National Health Insurance Research Database and Cancer Registry. Cases with lung adenocarcinoma were followed until the end of 2010. Survival curves were estimated by the Kaplan-Meier method. Cox proportional-hazard regression was used to calculate the hazard ratio (HR) of pre-existing asthma, COPD, and/or TB, and to estimate all-cause mortality risk in patients with different stages of lung adenocarcinoma.A total of 14,518 cases were identified with lung adenocarcinoma. Specifically, among men, the HRs for TB were 1.69 (95% confidence interval [CI], 1.10-2.58), 1.48 (95% CI, 1.14-1.93), and 1.27 (95% CI, 1.08-1.49) for individuals with stage I + II, III, and IV diseases, respectively. The HRs for asthma were 1.41 (95% CI, 1.00-1.99) in women with stage I + II and 1.14 (95% CI, 1.04-1.26) in men with stage IV disease. For pulmonary disease combinations in men, the HRs were 1.45 (95% CI, 1.12-1.89) for asthma + COPD + TB, 1.35 (95% CI, 1.12-1.63) for COPD + TB, 1.28 (95% CI, 1.01-1.63) for TB, and 1.15 (95%CI, 1.04-1.27) for asthma + COPD, respectively. For women with stage I + II disease, the HR was 6.94 (95% CI, 2.72-17.71) for asthma + COPD + TB.Coexistence of pre-existing pulmonary diseases increased mortality risk in men with adenocarcinoma. TB is at elevated risk of mortality among men with different stages of adenocarcinoma. Asthmatic women with early-stage adenocarcinoma had increased risk of mortality. PMID:26962806

  9. CHARGE syndrome: relations between behavioral characteristics and medical conditions.

    PubMed

    Vervloed, Mathijs P J; Hoevenaars-van den Boom, Marella A A; Knoors, Harry; van Ravenswaaij, Conny M A; Admiraal, Ronald J C

    2006-04-15

    The behaviors and medical problems in 27 persons with CHARGE syndrome were studied, because it was hypothesized that their behavior might be partly dependent on the heterogeneous medical status. With the exception of more tics, cardiac surgery was associated with positive behaviors: less withdrawn behavior, better mood, and a more easy temperament. Tube feeding was also related to positive behavior, since participants with a history of tube feeding showed less intense behavior. Cerebral deficits were associated with three problem behaviors: more intense and withdrawn behavior and a worse mood. Deaf-blindness was associated with developmental delays in expressive and overall communication level, and recurrent middle ear infections correlated with delays in written language. Of all medical conditions, only the presence or absence of heart defects and cardiac surgery could differentiate between the participants with regard to the number of behavioral problems. Participants with heart surgery especially, had less behavior problems. The number of operations and hospitalizations was not associated with behavior, but the total length of the hospitalizations was. Long hospital stays were associated with less problem behavior, especially internalizing behaviors. Cerebral and heart problems did not result in longer hospital stays, whereas esophageal reflux did. Age effects were reflected in older participants, who showed more internalizing problems. Heart surgery and hospitalization may be protective factors, but the protection might not be the actual surgery or hospital stay, as there may be other variables that are the actual cause, such as reduced vitality or altered parent child interactions after heart surgery. The study could not confirm a significant association between medical conditions and autism found in previous studies. PMID:16532469

  10. Aggravation of Pre-Existing Atrioventricular Block, Wenckebach Type, Provoked by Application of X-Ray Contrast Medium

    SciTech Connect

    Brodmann, Marianne Seinost, Gerald; Stark, Gerhard; Pilger, Ernst

    2006-12-15

    Background. Significant bradycardia followed by cardiac arrest related to single bolus administration of X-ray contrast medium into a peripheral artery has not, to our knowledge, been described in the literature. Methods and Results. While performing a percutaneous transluminal angioplasty of the left superficial femoral artery in a 68-year old patient with a pre-existing atrioventricular (AV) block, Wenckebach type, he developed an AV block III after a single bolus injection of intra-arterial X-ray contrast medium. Conclusion. We believe that application of contrast medium causes a transitory ischemia in the obstructed vessel and therefore elevation of endogenous adenosine. In the case of a previously damaged AV node this elevation of endogenous adenosine may be responsible for the development of a short period of third-degree AV block.

  11. Prospects for antibody-based universal influenza vaccines in the context of widespread pre-existing immunity.

    PubMed

    Wheatley, Adam Kenneth; Kent, Stephen John

    2015-01-01

    Influenza inflicts significant global mortality and morbidity that can be combated by effective immunization. However, the protective efficacy of current vaccines is limited by both the significant antigenic diversity of the viral hemagglutinin protein and the capacity for rapid antigenic change. This necessitates global influenza surveillance efforts, frequent vaccine reformulation and annual readministration. There is, therefore, tremendous interest in the development of novel strategies to elicit broad and durable protection against both seasonal and pandemic infection. This review presents an overview of candidate universal influenza vaccines designed to elicit cross-protective antibody responses to hemagglutinin. In particular, we focus on the potential impact that widespread pre-existing influenza immunity may play upon the design, testing and deployment of universal influenza vaccines. PMID:26175180

  12. The Challenges and Future Considerations Regarding Pregnancy-related Outcomes in Women with Pre-Existing Diabetes

    PubMed Central

    Singh, Harsimran; Murphy, Helen R.; Hendrieckx, Christel; Ritterband, Lee; Speight, Jane

    2013-01-01

    Ineffective management of blood glucose levels during preconception and pregnancy hasbeen associated with severe maternal and fetal complications in women with pre-existing diabetes. Studies have demonstrated that preconception counseling and pre-pregnancy care can dramatically reduce these risks. However, pregnancy-related outcomes in women with diabetes continue to be less than ideal. This review highlights and discusses a variety of patient, provider, and organizational factors that can contribute to these suboptimal outcomes. Based on the findings of studies reviewed and authors' clinical and research experiences, recommendations have been proposed focusing on various aspects of care provided, including improved accessibility to effective preconception and pregnancy-related care and better organized clinic consultations that are sensitive to women's diabetes and pregnancy needs. PMID:24013963

  13. Evaluation of accelerated stability test conditions for medicated chewing gums.

    PubMed

    Maggi, Lauretta; Conte, Ubaldo; Nhamias, Alain; Grenier, Pascal; Vergnault, Guy

    2013-10-01

    The overall stability of medicated chewing gums is investigated under different storage conditions. Active substances with different chemical stabilities in solid state are chosen as model drugs. The dosage form is a three layer tablet obtained by direct compression. The gum core contains the active ingredient while the external layers are formulated to prevent gum adhesion to the punches of the tableting machine. Two accelerated test conditions (40°C/75% RH and 30°C/65% RH) are performed for 6 months. Furthermore, a long-term stability test at room conditions is conducted to verify the predictability of the results obtained from the stress tests. Some drugs are stable in all the conditions tested, but other drugs, generally considered stable in solid dosage forms, have shown relevant stability problems particularly when stress test conditions are applied to this particular semi-solid dosage forms. For less stable drugs, the stress conditions of 40°C/75% RH are not always predictable of chewing gum stability at room temperature and may produce false negative; intermediate conditions, 30°C/65% RH, are more predictive for this purpose, the results of drug content found after 6 months at intermediate stress conditions and 12 months at room conditions are generally comparable. But the results obtained show that only long-term conditions stability tests gave consistent results. During aging, the semi solid nature of the gum base itself, may also influence the drug delivery rate during chewing and great attention should be given also to the dissolution stability. PMID:22794248

  14. Pre-existing immunity against swine-origin H1N1 influenza viruses in the general human population.

    PubMed

    Greenbaum, Jason A; Kotturi, Maya F; Kim, Yohan; Oseroff, Carla; Vaughan, Kerrie; Salimi, Nima; Vita, Randi; Ponomarenko, Julia; Scheuermann, Richard H; Sette, Alessandro; Peters, Bjoern

    2009-12-01

    A major concern about the ongoing swine-origin H1N1 influenza virus (S-OIV) outbreak is that the virus may be so different from seasonal H1N1 that little immune protection exists in the human population. In this study, we examined the molecular basis for pre-existing immunity against S-OIV, namely the recognition of viral immune epitopes by T cells or B cells/antibodies that have been previously primed by circulating influenza strains. Using data from the Immune Epitope Database, we found that only 31% (8/26) of B-cell epitopes present in recently circulating H1N1 strains are conserved in the S-OIV, with only 17% (1/6) conserved in the hemagglutinin (HA) and neuraminidase (NA) surface proteins. In contrast, 69% (54/78) of the epitopes recognized by CD8(+) T cells are completely invariant. We further demonstrate experimentally that some memory T-cell immunity against S-OIV is present in the adult population and that such memory is of similar magnitude as the pre-existing memory against seasonal H1N1 influenza. Because protection from infection is antibody mediated, a new vaccine based on the specific S-OIV HA and NA proteins is likely to be required to prevent infection. However, T cells are known to blunt disease severity. Therefore, the conservation of a large fraction of T-cell epitopes suggests that the severity of an S-OIV infection, as far as it is determined by susceptibility of the virus to immune attack, would not differ much from that of seasonal flu. These results are consistent with reports about disease incidence, severity, and mortality rates associated with human S-OIV. PMID:19918065

  15. The Association between Pre-existing Diabetes Mellitus and Pressure Ulcers in Patients Following Surgery: A Meta-analysis

    PubMed Central

    Kang, Zhou-Qing; Zhai, Xiao-Jie

    2015-01-01

    Uncertainty exists about the role of diabetes in the development of surgery-related pressure ulcers. Therefore, we conducted a meta-analysis to explore the association between pre-existing diabetes mellitus and pressure ulcers among patients after surgery. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random effects models. Thirteen eligible studies of 2367 patients in total and 12053 controls were included in the final analysis. Compared with patients without diabetes, the pooled odds ratio (OR) of the incidence of pressure ulcers in diabetic patients was 1.74 [95% confidence interval (CI) = 1.40–2.15, I2 = 51.1%]. Estimates by type of surgery suggested similar results in cardiac surgery [OR = 2.00, 95% CI = 1.42–2.82, I2 = 0%], in general surgery [OR = 1.75, 95% CI = 1.42–2.15, I2 = 0%], and in major lower limb amputations [OR = 1.65, 95% CI = 1.01–2.68, I2 = 0%] for diabetic patients versus non-diabetic controls. We did not find an increased incidence of pressure ulcers in diabetic patients undergoing hip surgery compared with non-diabetic controls [OR = 1.46, 95% CI = 0.62–3.47, I2 = 93.1%]. The excess risk of pressure ulcers associated with pre-existing diabetes was significantly higher in patients undergoing surgery, specifically in patients receiving cardiac surgery. Further studies should be conducted to examine these associations in other types of surgery. PMID:26260124

  16. 43 CFR 404.53 - Does this rule provide authority for the transfer of pre-existing facilities from Federal to...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... RECLAMATION, DEPARTMENT OF THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Miscellaneous § 404.53 Does...-existing facilities or pre-existing components of any water system from Federal to private ownership,...

  17. Prior medical conditions and the risk of amyotrophic lateral sclerosis.

    PubMed

    Seelen, Meinie; van Doormaal, Perry T C; Visser, Anne E; Huisman, Mark H B; Roozekrans, Margot H J; de Jong, Sonja W; van der Kooi, Anneke J; de Visser, Marianne; Voermans, Nicol C; Veldink, Jan H; van den Berg, Leonard H

    2014-10-01

    Sporadic amyotrophic lateral sclerosis (ALS) is believed to be a complex disease in which multiple exogenous and genetic factors interact to cause motor neuron degeneration. Elucidating the association between medical conditions prior to the first symptoms of ALS could lend support to the theory that specific subpopulations are at risk of developing ALS and provide new insight into shared pathogenic mechanisms. We performed a population-based case-control study in the Netherlands, including 722 sporadic ALS patients and 2,268 age and gender matched controls. Data on medical conditions and use of medication were obtained through a structured questionnaire. Multivariate analyses showed that hypercholesterolemia (OR 0.76, 95% CI 0.63-0.92, P = 0.006), the use of statins (OR 0.45, 95% CI 0.35-0.59, P = 1.86 × 10(-9)) or immunosuppressive drugs (OR 0.26, 95% CI 0.08-0.86, P = 0.03) were associated with a decreased risk of ALS. Head trauma was associated with an increased ALS susceptibility (OR 1.95, 95% CI 1.11-3.43, P = 0.02). No association was found with autoimmune diseases, cancer, psychiatric disorders or cardiovascular diseases, or survival. The lower frequency of hypercholesterolemia and less use of statins in ALS patients indicate a favorable lipid profile prior to symptom onset in at least a subpopulation of ALS. Prior head trauma is a risk factor for ALS and the significantly lower use of immunosuppressive drugs in ALS patients could suggest a protective effect. The identification of specific subpopulations at risk for ALS may provide clues towards possible pathogenic mechanisms. PMID:25059395

  18. 28 CFR 79.26 - Proof of medical condition.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... report; (C) Hematology summary or consultation report; (D) Medical oncology summary or consultation... report; (C) Hematology consultation or summary report; or (D) Medical oncology consultation or summary... discharge summary report; (C) Operative summary report; (D) Medical oncology summary or consultation...

  19. 42 CFR 418.102 - Condition of participation: Medical director.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Standard: Medical director contract. (1) A hospice may contract with either of the following— (i) A self... objective medical findings; (4) Current medication and treatment orders; and (5) Information about...

  20. 42 CFR 418.102 - Condition of participation: Medical director.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Standard: Medical director contract. (1) A hospice may contract with either of the following— (i) A self... objective medical findings; (4) Current medication and treatment orders; and (5) Information about...

  1. The effects of aerobic- versus strength-training on body image among young women with pre-existing body image concerns.

    PubMed

    Martin Ginis, Kathleen A; Strong, Heather A; Arent, Shawn M; Bray, Steven R; Bassett-Gunter, Rebecca L

    2014-06-01

    This experiment compared the effects of aerobic-training (AT) versus strength-training (ST) on body image among young women with pre-existing body image concerns. Theory-based correlates of body image change were also examined. Participants were 46 women (M age=21.5 years), randomly assigned to an 8-week AT or ST intervention consisting of supervised exercise 3 days/week. Multidimensional measures of body image were administered pre- and post-intervention, along with measures of physical fitness, perceived fitness, and exercise self-efficacy. Women in the AT condition reported greater reductions in social physique anxiety (p=.001) and tended to report greater improvements in appearance evaluation (p=.06) than women in the ST condition. Changes in perceived fatness, perceived aerobic endurance and aerobic self-efficacy were significantly correlated with body image change (ps<.003). Results provide direction for prescribing exercise to improve body image and advancing theory to account for the effects of exercise. PMID:24958656

  2. The role of pre-existing tectonic structures and magma chamber shape on the geometry of resurgent blocks: Analogue models

    NASA Astrophysics Data System (ADS)

    Marotta, Enrica; de Vita, Sandro

    2014-02-01

    A set of analogue models has been carried out to understand the role of an asymmetric magma chamber on the resurgence-related deformation of a previously deformed crustal sector. The results are then compared with those of similar experiments, previously performed using a symmetric magma chamber. Two lines of experiments were performed to simulate resurgence in an area with a simple graben-like structure and resurgence in a caldera that collapsed within the previously generated graben-like structure. On the basis of commonly accepted scaling laws, we used dry-quartz sand to simulate the brittle behaviour of the crust and Newtonian silicone to simulate the ductile behaviour of the intruding magma. An asymmetric shape of the magma chamber was simulated by moulding the upper surface of the silicone. The resulting empty space was then filled with sand. The results of the asymmetric-resurgence experiments are similar to those obtained with symmetrically shaped silicone. In the sample with a simple graben-like structure, resurgence occurs through the formation of a discrete number of differentially displaced blocks. The most uplifted portion of the deformed depression floor is affected by newly formed, high-angle, inward-dipping reverse ring-faults. The least uplifted portion of the caldera is affected by normal faults with similar orientation, either newly formed or resulting from reactivation of the pre-existing graben faults. This asymmetric block resurgence is also observed in experiments performed with a previous caldera collapse. In this case, the caldera-collapse-related reverse ring-fault is completely erased along the shortened side, and enhances the effect of the extensional faults on the opposite side, so facilitating the intrusion of the silicone. The most uplifted sector, due to an asymmetrically shaped intrusion, is always in correspondence of the thickest overburden. These results suggest that the stress field induced by resurgence is likely dictated by the geometry of the intruding magma body, and the related deformation is partially controlled by pre-existing tectonic and/or volcano-tectonic structures.

  3. Distribution of long-term Quaternary Deformation and Correlation with Pre-existing Tectonic Structures in the Central US

    NASA Astrophysics Data System (ADS)

    Magnani, M.; McIntosh, K. D.; Guo, L.; Hao, Y.

    2012-12-01

    The processes governing earthquakes in intraplate regions are still poorly understood, mostly because the very occurrence of such earthquakes violates plate tectonic theory, recurrence intervals are long, and seismicity occurs in quiescent areas where structures are buried/unexposed. In the central US, most of the seismicity is concentrated along the faults of the New Madrid seismic zone, located in the heart of the Mississippi embayment. However, the clash between the high level of present, historical and prehistorical seismicity, the geodetic vectors, and the puzzling lack of deformation at the surface and in the subsurface suggests that the New Madrid seismic zone might have not been the only fault system active in the region. Indeed, evidence is mounting that Quaternary deformation has been accommodated along structures that are presently aseismic. If seismicity has been migrating throughout the central US during the Quaternary, then what controls the location of seismicity? Here we present the results of ~950 km marine and land high-resolution seismic reflection data acquired along and near the Mississippi River in the Mississippi embayment between 2008 and 2011. The data clearly document Quaternary deformation within the New Madrid seismic zone and at 3 locations well beyond the seismically active region, with displacement of all the unconsolidated sedimentary units from the top of the Paleozoic sedimentary rocks to the base of the Quaternary river alluvium. Beside documenting Quaternary deformation in the region, perhaps one of the most important results of the ~950 km-long seismic survey is that deformation is not uniformly distributed throughout the profile, but is focused along distinct structures, which spatially coincide with the margin of the failed Paleozoic Reelfoot Rift and with the southern margin of the Proterozoic Laurentian continent, marked in this region by the Alabama-Oklahoma transform fault. This spatial correlation indicates a tectonic control, possibly imposed by pre-existing structures, which are capable of concentrating strain and stress and localizing intraplate deformation. Surprisingly, no Quaternary deformation is detected across the buried Paleozoic Ouachita orogenic belt, indicating that under the same stress field, not all the pre-existing structures appear to be capable of focusing deformation.

  4. Medical Signal-Conditioning and Data-Interface System

    NASA Technical Reports Server (NTRS)

    Braun, Jeffrey; Jacobus, charles; Booth, Scott; Suarez, Michael; Smith, Derek; Hartnagle, Jeffrey; LePrell, Glenn

    2006-01-01

    A general-purpose portable, wearable electronic signal-conditioning and data-interface system is being developed for medical applications. The system can acquire multiple physiological signals (e.g., electrocardiographic, electroencephalographic, and electromyographic signals) from sensors on the wearer s body, digitize those signals that are received in analog form, preprocess the resulting data, and transmit the data to one or more remote location(s) via a radiocommunication link and/or the Internet. The system includes a computer running data-object-oriented software that can be programmed to configure the system to accept almost any analog or digital input signals from medical devices. The computing hardware and software implement a general-purpose data-routing-and-encapsulation architecture that supports tagging of input data and routing the data in a standardized way through the Internet and other modern packet-switching networks to one or more computer(s) for review by physicians. The architecture supports multiple-site buffering of data for redundancy and reliability, and supports both real-time and slower-than-real-time collection, routing, and viewing of signal data. Routing and viewing stations support insertion of automated analysis routines to aid in encoding, analysis, viewing, and diagnosis.

  5. Selected medical conditions and risk of pancreatic cancer.

    PubMed

    Olson, Sara H

    2012-01-01

    We review the current evidence for associations of several medical conditions with risk of pancreatic cancer, including allergies, pancreatitis, gall bladder disease, cholecystectomy, ulcers, gastrectomy, appendectomy, and tonsillectomy. There are consistent findings of reduced risk associated with presence of self-reported allergies, particularly hay fever but not asthma; data on other allergies are limited and inconclusive. Several studies provide evidence that patients with pancreatic cancer are more likely than comparison groups to report pancreatitis. Those studies that investigated the time between onset of pancreatitis and diagnosis of pancreatic cancer found that risk estimates declined with longer periods of time; however, increased risks were noted for long-term pancreatitis, indicating that this condition is both a risk factor and a sign of early disease. Increased risk was reported in association with cholelithiasis, but the few studies that considered time before diagnosis of cancer did not find increased risk for cholelithiasis diagnosed in the more distant past. There is weak evidence that cholecystectomy 2 or more years before cancer diagnosis is related to risk, but this is based on only a few studies. There is no consistent association between ulcers and risk, while gastrectomy may increase risk. Overall, study of these conditions, particularly those that are rare, presents methodologic challenges. Time between diagnoses is likely to be important but is not considered in most studies. Lack of adequate control in several studies for risk factors such as smoking and heavy alcohol use also makes it difficult to draw firm conclusions about these results. PMID:22162233

  6. The Role of Pre-Existing Disturbances in the Effect of Marine Reserves on Coastal Ecosystems: A Modelling Approach

    PubMed Central

    Savina, Marie; Condie, Scott A.; Fulton, Elizabeth A.

    2013-01-01

    We have used an end-to-end ecosystem model to explore responses over 30 years to coastal no-take reserves covering up to 6% of the fifty thousand square kilometres of continental shelf and slope off the coast of New South Wales (Australia). The model is based on the Atlantis framework, which includes a deterministic, spatially resolved three-dimensional biophysical model that tracks nutrient flows through key biological groups, as well as extraction by a range of fisheries. The model results support previous empirical studies in finding clear benefits of reserves to top predators such as sharks and rays throughout the region, while also showing how many of their major prey groups (including commercial species) experienced significant declines. It was found that the net impact of marine reserves was dependent on the pre-existing levels of disturbance (i.e. fishing pressure), and to a lesser extent on the size of the marine reserves. The high fishing scenario resulted in a strongly perturbed system, where the introduction of marine reserves had clear and mostly direct effects on biomass and functional biodiversity. However, under the lower fishing pressure scenario, the introduction of marine reserves caused both direct positive effects, mainly on shark groups, and indirect negative effects through trophic cascades. Our study illustrates the need to carefully align the design and implementation of marine reserves with policy and management objectives. Trade-offs may exist not only between fisheries and conservation objectives, but also among conservation objectives. PMID:23593432

  7. Region-Specific Integration of Embryonic Stem Cell-Derived Neuronal Precursors into a Pre-Existing Neuronal Circuit

    PubMed Central

    Neuser, Franziska; Polack, Martin; Annaheim, Christine; Tucker, Kerry L.; Korte, Martin

    2013-01-01

    Enduring reorganization is accepted as a fundamental process of adult neural plasticity. The most dramatic example of this reorganization is the birth and continuously occurring incorporation of new neurons into the pre-existing network of the adult mammalian hippocampus. Based on this phenomenon we transplanted murine embryonic stem (ES)-cell derived neuronal precursors (ESNPs) into murine organotypic hippocampal slice cultures (OHC) and examined their integration. Using a precise quantitative morphological analysis combined with a detailed electrophysiology, we show a region-specific morphological integration of transplanted ESNPs into different subfields of the hippocampal tissue, resulting in pyramidal neuron-like embryonic stem cell-derived neurons (ESNs) in the Cornu Ammonis (CA1 and CA3) and granule neuron-like ESNs in the dentate gyrus (DG), respectively. Subregion specific structural maturation was accompanied by the development of dendritic spines and the generation of excitatory postsynaptic currents (EPSCs). This cell type specific development does not depend upon NMDA-receptor-dependent synaptic transmission. The presented integration approach was further used to determine the cell-autonomous function of the pan-neurotrophin receptor p75 (P75NTR), as a possible negative regulator of ESN integration. By this means we used p75NTR-deficient ESNPs to study their integration into a WT organotypic environment. We show here that p75NTR is not necessary for integration per se but plays a suppressing role in dendritic development. PMID:23840491

  8. Influence of pre-existing topography on downflow lava discharge rates estimated from thermal infrared airborne data

    NASA Astrophysics Data System (ADS)

    Lombardo, V.

    2016-04-01

    Remote sensing thermal data of active lava flows allow the evaluation of effusion rates. This is made possible by a simple formula relating the lava effusion rate to the heat flux radiated per unit time from the surface of the flow. Due to the assumptions of the model, this formula implies that heat flux, surface temperature and lava temperature vary as a function of the flow thickness. These relationships, never verified or validated before, have been used by several authors as a proof of the weakness of the model. Here, multispectral infrared and visible imaging spectrometer (MIVIS) high spatial resolution (5-10 m) thermal data acquired during Etna's 2001 eruption were used to investigate downflow heat flux variations in the lava flow emitted from a vent located at 2100 m a.s.l. A high correlation between the downflow heat flux and the lava flow thickness (measured from a pre-existing digital elevation model) was found. Topography beneath the flow appears to play an important role both in lava emplacement mechanisms and flow dynamics. MIVIS-derived downflow effusion rates are consistent with the law of conservation of mass assessing the reliability of remote sensing techniques.

  9. Characteristics of memory B cells elicited by a highly efficacious HPV vaccine in subjects with no pre-existing immunity.

    PubMed

    Scherer, Erin M; Smith, Robin A; Simonich, Cassandra A; Niyonzima, Nixon; Carter, Joseph J; Galloway, Denise A

    2014-10-01

    Licensed human papillomavirus (HPV) vaccines provide near complete protection against the types of HPV that most commonly cause anogenital and oropharyngeal cancers (HPV 16 and 18) when administered to individuals naive to these types. These vaccines, like most other prophylactic vaccines, appear to protect by generating antibodies. However, almost nothing is known about the immunological memory that forms following HPV vaccination, which is required for long-term immunity. Here, we have identified and isolated HPV 16-specific memory B cells from female adolescents and young women who received the quadrivalent HPV vaccine in the absence of pre-existing immunity, using fluorescently conjugated HPV 16 pseudoviruses to label antigen receptors on the surface of memory B cells. Antibodies cloned and expressed from these singly sorted HPV 16-pseudovirus labeled memory B cells were predominantly IgG (>IgA>IgM), utilized diverse variable genes, and potently neutralized HPV 16 pseudoviruses in vitro despite possessing only average levels of somatic mutation. These findings suggest that the quadrivalent HPV vaccine provides an excellent model for studying the development of B cell memory; and, in the context of what is known about memory B cells elicited by influenza vaccination/infection, HIV-1 infection, or tetanus toxoid vaccination, indicates that extensive somatic hypermutation is not required to achieve potent vaccine-specific neutralizing antibody responses. PMID:25330199

  10. Cross-reactive and pre-existing antibodies to therapeutic antibodies--Effects on treatment and immunogenicity.

    PubMed

    van Schie, Karin A; Wolbink, Gerrit-Jan; Rispens, Theo

    2015-01-01

    The potential for immunogenicity is an ever-present concern during the development of biopharmaceuticals. Therapeutic antibodies occasionally elicit an antibody response in patients, which can result in loss of response or adverse effects. However, antibodies that bind a drug are sometimes found in pre-treatment serum samples, with the amount depending on drug, assay, and patient population. This review summarizes published data on pre-existing antibodies to therapeutic antibodies, including rheumatoid factors, anti-allotype antibodies, anti-hinge antibodies, and anti-glycan antibodies. Unlike anti-idiotype antibodies elicited by the drug, pre-formed antibodies in general appear to have little consequences during treatment. In the few cases where (potential) clinical consequences were encountered, antibodies were characterized and found to bind a distinct, unusual epitope of the therapeutic. Immunogenicity testing strategies should therefore always include a proper level of antibody characterization, especially when pre-formed antibodies are present. This minimizes false-positives, particularly due to rheumatoid factors, and helps to judge the potential threat in case a genuine pre-dose antibody reactivity is identified. PMID:25962087

  11. Characteristics of Memory B Cells Elicited by a Highly Efficacious HPV Vaccine in Subjects with No Pre-existing Immunity

    PubMed Central

    Scherer, Erin M.; Smith, Robin A.; Simonich, Cassandra A.; Niyonzima, Nixon; Carter, Joseph J.; Galloway, Denise A.

    2014-01-01

    Licensed human papillomavirus (HPV) vaccines provide near complete protection against the types of HPV that most commonly cause anogenital and oropharyngeal cancers (HPV 16 and 18) when administered to individuals naive to these types. These vaccines, like most other prophylactic vaccines, appear to protect by generating antibodies. However, almost nothing is known about the immunological memory that forms following HPV vaccination, which is required for long-term immunity. Here, we have identified and isolated HPV 16-specific memory B cells from female adolescents and young women who received the quadrivalent HPV vaccine in the absence of pre-existing immunity, using fluorescently conjugated HPV 16 pseudoviruses to label antigen receptors on the surface of memory B cells. Antibodies cloned and expressed from these singly sorted HPV 16-pseudovirus labeled memory B cells were predominantly IgG (>IgA>IgM), utilized diverse variable genes, and potently neutralized HPV 16 pseudoviruses in vitro despite possessing only average levels of somatic mutation. These findings suggest that the quadrivalent HPV vaccine provides an excellent model for studying the development of B cell memory; and, in the context of what is known about memory B cells elicited by influenza vaccination/infection, HIV-1 infection, or tetanus toxoid vaccination, indicates that extensive somatic hypermutation is not required to achieve potent vaccine-specific neutralizing antibody responses. PMID:25330199

  12. Complex rift geometries resulting from inheritance of pre-existing structures: Insights and regional implications from the Barmer Basin rift

    NASA Astrophysics Data System (ADS)

    Bladon, Andrew J.; Clarke, Stuart M.; Burley, Stuart D.

    2015-02-01

    Structural studies of the Barmer Basin in Rajasthan, northwest India, demonstrate the important effect that pre-existing faults can have on the geometries of evolving fault systems at both the outcrop and basin-scale. Outcrop exposures on opposing rift margins reveal two distinct, non-coaxial extensional events. On the eastern rift margin northwest-southeast extension was accommodated on southwest- and west-striking faults that form a complex, zig-zag fault network. On the western rift margin northeast-southwest extension was accommodated on northwest-striking faults that form classical extensional geometries. Combining these outcrop studies with subsurface interpretations demonstrates that northwest-southeast extension preceded northeast-southwest extension. Structures active during the early, previously unrecognised extensional event were variably incorporated into the evolving fault systems during the second. In the study area, an inherited rift-oblique fault transferred extension from the rift margin to a mid-rift fault, rather than linking rift margin fault systems directly. The resultant rift margin accommodation structure has important implications for early sediment routing and depocentre evolution, as well as wider reaching implications for the evolution of the rift basin and West Indian Rift System. The discovery of early rifting in the Barmer Basin supports that extension along the West Indian Rift System was long-lived, multi-event, and likely resulted from far-field plate reorganisations.

  13. Combinatorial RNA Interference Therapy Prevents Selection of Pre-existing HBV Variants in Human Liver Chimeric Mice

    PubMed Central

    Shih, Yao-Ming; Sun, Cheng-Pu; Chou, Hui-Hsien; Wu, Tzu-Hui; Chen, Chun-Chi; Wu, Ping-Yi; Enya Chen, Yu-Chen; Bissig, Karl-Dimiter; Tao, Mi-Hua

    2015-01-01

    Selection of escape mutants with mutations within the target sequence could abolish the antiviral RNA interference activity. Here, we investigated the impact of a pre-existing shRNA-resistant HBV variant on the efficacy of shRNA therapy. We previously identified a highly potent shRNA, S1, which, when delivered by an adeno-associated viral vector, effectively inhibits HBV replication in HBV transgenic mice. We applied the “PICKY” software to systemically screen the HBV genome, then used hydrodynamic transfection and HBV transgenic mice to identify additional six highly potent shRNAs. Human liver chimeric mice were infected with a mixture of wild-type and T472C HBV, a S1-resistant HBV variant, and then treated with a single or combined shRNAs. The presence of T472C mutant compromised the therapeutic efficacy of S1 and resulted in replacement of serum wild-type HBV by T472C HBV. In contrast, combinatorial therapy using S1 and P28, one of six potent shRNAs, markedly reduced titers for both wild-type and T472C HBV. Interestingly, treatment with P28 alone led to the emergence of escape mutants with mutations in the P28 target region. Our results demonstrate that combinatorial RNAi therapy can minimize the escape of resistant viral mutants in chronic HBV patients. PMID:26482836

  14. Cross-reactive and pre-existing antibodies to therapeutic antibodies—Effects on treatment and immunogenicity

    PubMed Central

    van Schie, Karin A; Wolbink, Gerrit-Jan; Rispens, Theo

    2015-01-01

    The potential for immunogenicity is an ever-present concern during the development of biopharmaceuticals. Therapeutic antibodies occasionally elicit an antibody response in patients, which can result in loss of response or adverse effects. However, antibodies that bind a drug are sometimes found in pre-treatment serum samples, with the amount depending on drug, assay, and patient population. This review summarizes published data on pre-existing antibodies to therapeutic antibodies, including rheumatoid factors, anti-allotype antibodies, anti-hinge antibodies, and anti-glycan antibodies. Unlike anti-idiotype antibodies elicited by the drug, pre-formed antibodies in general appear to have little consequences during treatment. In the few cases where (potential) clinical consequences were encountered, antibodies were characterized and found to bind a distinct, unusual epitope of the therapeutic. Immunogenicity testing strategies should therefore always include a proper level of antibody characterization, especially when pre-formed antibodies are present. This minimizes false-positives, particularly due to rheumatoid factors, and helps to judge the potential threat in case a genuine pre-dose antibody reactivity is identified. PMID:25962087

  15. Evolution of a fold-thrust belt deforming a unit with pre-existing linear asperities: Insights from analog models

    NASA Astrophysics Data System (ADS)

    Burberry, Caroline M.; Swiatlowski, Jerlyn L.

    2016-06-01

    Heterogeneity, whether geometric or rheologic, in crustal material undergoing compression affects the geometry of the structures produced. This study documents the thrust fault geometries produced when discrete linear asperities are introduced into an analog model, scaled to represent bulk upper crustal properties, and compressed. Varying obliquities of the asperities are used, relative to the imposed compression, and the resultant development of thrust fault traces and branch lines in map view is tracked. Once the model runs are completed, cross-sections are created and analyzed. The models show that asperities confined to the base layer promote the clustering of branch lines in the surface thrusts. Strong clustering in branch lines is also noted where several asperities are in close proximity or cross. Slight reverse-sense reactivation of asperities cut through the sedimentary sequence is noted in cross-section, where the asperity and the subsequent thrust belt interact. The model results are comparable to the situation in the Dinaric Alps, where pre-existing faults to the SW of the NE Adriatic Fault Zone contribute to the clustering of branch lines developed in the surface fold-thrust belt. These results can therefore be used to evaluate the evolution of other basement-involved fold-thrust belts worldwide.

  16. Medical Conditions Associated with Out-of-Hospital Endotracheal Intubation

    PubMed Central

    Wang, Henry E.; Balasubramani, G. K.; Cook, Lawrence J.; Yealy, Donald M.; Lave, Judith R.

    2011-01-01

    OBJECTIVE While prior studies describe the clinical presentation of patients requiring paramedic out-of-hospital endotracheal intubation (ETI), limited data characterize the underlying medical conditions or comorbidities. We sought to characterize the medical conditions and comorbidities of patients receiving successful paramedic out-of-hospital ETI. METHODS We used Pennsylvania statewide EMS clinical data, including all successful ETIs performed during 2003–2005. Using multiple imputation triple-match algorithms, we probabilistically linked EMS ETI to statewide death and hospital admission data. Each hospitalization record contained one primary and up to eight secondary diagnoses, classified according to the International Classification of Diseases, Clinical Modification, ninth edition (ICD-9-CM). We determined the proportion of patients in each major ICD-9-CM diagnostic group and subgroup. We calculated the Charlson Comorbidity Index for each patient. Using binomial proportions with confidence intervals, we analyzed the data and combined imputed results using Rubin's method. RESULTS Across the imputed sets, we linked 25,733 (77.7% linkage) successful ETI to death or hospital records; 56.3% died before and 43.7% survived to hospital admission. Of the 14,479 deaths before hospital admission, most (92.7%, 95% CI: 92.5–93.3%) presented to EMS in cardiac arrest. Of the 11,255 hospitalized patents, the leading primary diagnoses were circulatory diseases (32.0%, 30.2–33.7%), respiratory diseases (22.8%, 21.9–23.7%), and injury or poisoning (25.2%; 22.7–27.8%). Prominent primary diagnosis subgroups included: asphyxia and respiratory failure (15.2%), traumatic brain injury and skull fractures (11.3%), acute myocardial infarction and ischemic heart disease (10.9%), poisoning, drug and alcohol disorders (6.7%), dysrhythmias (6.7%), hemorrhagic and non-hemorrhagic stroke (5.9%), acute heart failure and cardiomyopathies (5.6%), pneumonia and aspiration (4.9%), and sepsis, septicemia and septic shock (3.2%). Most of the admitted ETI patients had a secondary circulatory (70.8%), respiratory (61.4%), or endocrine, nutritional or metabolic secondary diagnosis (51.4%). The mean Charlson Index score was 1.6 (95% CI: 1.5–1.7). CONCLUSIONS The majority of successful paramedic ETI occur on patients with cardiac arrest, circulatory and respiratory conditions. Injury, poisoning and other conditions compromise smaller but important portions. ETI patients have multiple comorbidities. These findings may guide the systemic planning of paramedic airway management care and education. PMID:21612386

  17. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS FOR COVERAGE FOR END-STAGE RENAL DISEASE FACILITIES Administration § 494.150 Condition: Responsibilities of the medical director....

  18. 14 CFR 67.313 - General medical condition.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... unable to perform those duties or exercise those privileges. (c) No medication or other treatment that... relating to the medication or other treatment involved, finds— (1) Makes the person unable to...

  19. 14 CFR 67.213 - General medical condition.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... unable to perform those duties or exercise those privileges. (c) No medication or other treatment that... relating to the medication or other treatment involved, finds— (1) Makes the person unable to...

  20. 14 CFR 67.113 - General medical condition.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... unable to perform those duties or exercise those privileges. (c) No medication or other treatment that... relating to the medication or other treatment involved, finds— (1) Makes the person unable to...

  1. The effect of pre-existing affect on the sexual responses of women with and without a history of childhood sexual abuse.

    PubMed

    Rellini, Alessandra H; Elinson, Samantha; Janssen, Erick; Meston, Cindy M

    2012-04-01

    Women with a history of childhood sexual abuse (CSA) are at greater risk for experiencing sexual problems in their adult lives. Yet, little is known about the possible role of cognitive and affective mechanisms in the development of sexual arousal difficulties in this population. This study investigated the role of pre-existing affect (affect prior to exposure to sexual stimuli) on genital responses, subjective sexual arousal, and affect elicited during the presentation of erotic film excerpts in a community sample of 25 women with and 25 women without a history of CSA. The CSA group showed greater pre-existing negative affect and smaller genital responses to the erotic film stimuli compared to the NSA group. Findings support a moderating effect of CSA, in that pre-existing negative affect was associated with strength of genital responses in the NSA but not in the CSA group. The results did not support a mediation model of pre-existing negative affect as an explanation for smaller physiological sexual responses in the CSA group. Taken together, the findings suggest that pre-existing affect may be more relevant for women with no history of CSA and call for more research on factors implicated in impaired sexual responses in women with a history of CSA. PMID:21667233

  2. Towards ethical guidelines for dealing with unsolicited patient emails and giving teleadvice in the absence of a pre-existing patient-physician relationship — systematic review and expert survey

    PubMed Central

    2000-01-01

    Background Many health information providers on the Internet and doctors with email accounts are confronted with the phenomenon of receiving unsolicited emails from patients asking for medical advice. Also, a growing number of websites offer "ask-the-doctor" services, where patients can ask questions to health professionals via email or other means of telecommunication. It is unclear whether these types of interactions constitute medical practice, and whether physicians have the ethical obligation to respond to unsolicited patient emails. Objective To improve the quality of online communication between patients and health professionals (physicians, experts) in the absence of a pre-existing patient-physician relationship or face-to-face communication, by preparing a set of guiding ethical principles applicable to this kind of interaction. Methods Systematic review of the literature, professional, and ethical codes; and consultation with experts. Results Two different types of patient-physician encounters have to be distinguished. "Traditional" clinical encounters or telemedicine applications are called "Type B" interactions here (Bona fide relationship). In comparison, online interactions lack many of the characteristics of bona fide interactions; most notably there is no pre-existing relationship and the information available to the physician is limited if, for example, a physician responds to the email of a patient who he has never seen before. I call these "Type A" consultations (Absence of pre-existing patient-physician relationship). While guidelines for Type B interactions on the Internet exist (Kane, 1998), this is not the case for Type A interactions. The following principles are suggested: Physicians responding to patients' requests on the Internet should act within the limitations of telecommunication services and keep the global nature of the Internet in mind; not every aspect of medicine requires face-to-face communication; requests for help, including unsolicited patient questions, should not be ignored, but dealt with in some appropriate manner; informed consent requires fair and honest labeling; health professionals and information providers must maintain confidentiality; health professionals should define internal procedures and perform quality control measures. Conclusions Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Patients have to be educated that it is unethical to diagnose and treat over the Internet in the absence of a pre-existing patient-physician relationship, and if the interaction is limited to a single email. More research is needed to establish more evidence regarding situations in which teleadvice is beneficial and efficient. PMID:11720920

  3. Pre-existing adversity, level of child protection involvement, and school attendance predict educational outcomes in a longitudinal study.

    PubMed

    Maclean, Miriam J; Taylor, Catherine L; O'Donnell, Melissa

    2016-01-01

    Maltreatment largely occurs in a multiple-risk context. The few large studies adjusting for confounding factors have raised doubts about whether low educational achievement results from maltreatment or co-occurring risk factors. This study examined prevalence, risk and protective factors for low educational achievement among children involved with the child protection system compared to other children. We conducted a population-based record-linkage study of children born in Western Australia who sat national Year 3 reading achievement tests between 2008 and 2010 (N=46,838). The longitudinal study linked data from the Western Australian Department of Education, Department of Child Protection and Family Support, Department of Health, and the Disability Services Commission. Children with histories of child protection involvement (unsubstantiated maltreatment reports, substantiations or out-of-home care placement) were at three-fold increased risk of low reading scores. Adjusting for socio-demographic adversity partially attenuated the increased risk, however risk remained elevated overall and for substantiated (OR=1.68) and unsubstantiated maltreatment (OR=1.55). Risk of low reading scores in the out-of-home care group was fully attenuated after adjusting for socio-demographic adversity (OR=1.16). Attendance was significantly higher in the out-of-home care group and served a protective role. Neglect, sexual abuse, and physical abuse were associated with low reading scores. Pre-existing adversity was also significantly associated with achievement. Results support policies and practices to engage children and families in regular school attendance, and highlight a need for further strategies to prevent maltreatment and disadvantage from restricting children's opportunities for success. PMID:26626345

  4. 41 CFR 105-64.208 - What special conditions apply to release of medical records?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... apply to release of medical records? 105-64.208 Section 105-64.208 Public Contracts and Property....208 What special conditions apply to release of medical records? Medical records containing... writing by you, or by your guardian or conservator. Medical records in an Official Personnel Folder...

  5. 41 CFR 105-64.208 - What special conditions apply to release of medical records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... apply to release of medical records? 105-64.208 Section 105-64.208 Public Contracts and Property....208 What special conditions apply to release of medical records? Medical records containing... writing by you, or by your guardian or conservator. Medical records in an Official Personnel Folder...

  6. 41 CFR 105-64.208 - What special conditions apply to release of medical records?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... apply to release of medical records? 105-64.208 Section 105-64.208 Public Contracts and Property....208 What special conditions apply to release of medical records? Medical records containing... writing by you, or by your guardian or conservator. Medical records in an Official Personnel Folder...

  7. 41 CFR 105-64.208 - What special conditions apply to release of medical records?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... apply to release of medical records? 105-64.208 Section 105-64.208 Public Contracts and Property....208 What special conditions apply to release of medical records? Medical records containing... writing by you, or by your guardian or conservator. Medical records in an Official Personnel Folder...

  8. 41 CFR 105-64.208 - What special conditions apply to release of medical records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... apply to release of medical records? 105-64.208 Section 105-64.208 Public Contracts and Property....208 What special conditions apply to release of medical records? Medical records containing... writing by you, or by your guardian or conservator. Medical records in an Official Personnel Folder...

  9. Recombinant Modified Vaccinia Ankara (MVA) effectively boosts DNA-primed HIV-specific immune responses in humans despite pre-existing vaccinia immunity

    PubMed Central

    Gudmundsdotter, Lindvi; Nilsson, Charlotta; Brave, Andreas; Hejdeman, Bo; Earl, Patricia; Moss, Bernard; Robb, Merlin; Cox, Josephine; Michael, Nelson; Marovich, Mary; Biberfeld, Gunnel; Sandström, Eric; Wahren, Britta

    2016-01-01

    The presence of vector-specific immune responses may hamper the induction of responses to a foreign antigen encoded by the vector. We evaluated the impact of pre-existing immunity to vaccinia virus on the induction of HIV-specific responses after immunization of healthy volunteers with a HIV-1 DNA prime-MVA boost vaccine. Following three priming immunizations with HIV-1 DNA plasmids, the volunteers were boosted with a single injection of recombinant MVA encoding HIV-1 proteins. Pre-existing immunity to vaccinia virus did not reduce the proportion of individuals who responded to HIV-1, but did lower the magnitude of responses. Our results suggest that vaccinia-based vectors can be used to efficiently induce immune responses to vectored HIV-1 antigens, even in individuals with pre-existing immunity to vaccinia virus. PMID:19450644

  10. Risk of Acute Lung Injury/Acute Respiratory Distress Syndrome in Critically Ill Adult Patients with Pre-Existing Diabetes: A Meta-Analysis

    PubMed Central

    Kan, Quan-Cheng; Sun, Tong-Wen

    2014-01-01

    Background The impact of pre-existing diabetes on the development of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in critically ill patients remains unclear. We performed a meta-analysis of cohort studies to evaluate the risk of ALI/ARDS in critically ill patients with and without pre-existing diabetes. Materials and Methods We searched PubMed and Embase from the inception to September 2013 for cohort studies assessing the effect of pre-existing diabetes on ALI/ARDS occurrence. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated using random- or fixed-effect models when appropriate. Results Seven cohort studies with a total of 12,794 participants and 2,937 cases of pre-existing diabetes, and 2,457 cases of ALI/ARDS were included in the meta-analysis. A fixed-effects model meta-analysis showed that pre-existing diabetes was associated with a reduced risk of ALI/ARDS (OR 0.66; 95% CI, 0.55–0.80; p<0.001), with low heterogeneity among the studies (I2 = 18.9%; p = 0.286). However, the asymmetric funnel plot and Egger's test (p = 0.007) suggested publication bias may exist. Conclusions Our meta-analysis suggests that pre-existing diabetes was associated with a decreased risk of ALI/ARDS in critically ill adult patients. However, the result should be interpreted with caution because of the potential bias and confounding in the included studies. PMID:24587357

  11. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... program. (b) Staff education, training, and performance. (c) Policies and procedures. The medical director... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Responsibilities of the medical director... DISEASE FACILITIES Administration § 494.150 Condition: Responsibilities of the medical director....

  12. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... program. (b) Staff education, training, and performance. (c) Policies and procedures. The medical director... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Responsibilities of the medical director... DISEASE FACILITIES Administration § 494.150 Condition: Responsibilities of the medical director....

  13. 42 CFR 484.34 - Condition of participation: Medical social services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work assistant... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Medical social...

  14. 42 CFR 484.34 - Condition of participation: Medical social services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work assistant... 42 Public Health 5 2011-10-01 2011-10-01 false Condition of participation: Medical social...

  15. 42 CFR 484.34 - Condition of participation: Medical social services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Condition of participation: Medical social services....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work...

  16. 42 CFR 484.34 - Condition of participation: Medical social services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Condition of participation: Medical social services....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work...

  17. 42 CFR 484.34 - Condition of participation: Medical social services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Condition of participation: Medical social services....34 Condition of participation: Medical social services. If the agency furnishes medical social services, those services are given by a qualified social worker or by a qualified social work...

  18. The role of pre-existing Precambrian structures in rift evolution: The Albertine and Rhino grabens, Uganda

    NASA Astrophysics Data System (ADS)

    Katumwehe, Andrew B.; Abdelsalam, Mohamed G.; Atekwana, Estella A.

    2015-04-01

    We integrated Shuttle Radar Topography Mission (SRTM) Digital Elevation Models (DEM), airborne magnetic, radiometric and three-dimensional Full Tensor Gravity Gradiometry (3D-FTG) data to investigate the role of Precambrian structures in the evolution of the largely amagmatic Miocene-Recent aged Albertine and Rhino grabens in Uganda. These grabens represent the northern segment of the Western Branch of the East African Rift System (EARS). The two NE-trending grabens are connected by a right-stepping transfer zone and they extend within the Archean-Paleoproterozoic Northeast Congo block which represents the northeastern extension of the Congo craton. Our results show the following and highlight the importance of pre-existing structures in the evolution of continental rift systems: (1) The NE-extent of the Albertine full-graben is controlled by NE-trending Precambrian fabric and the graben terminates at its northeastern end when it encounters a multiply folded Precambrian basement terrain with poorly-developed NW-trending structural grain. Additionally, the northeastern termination of the Albertine graben coincides with the presence of NW-trending right-stepping high-density bodies within the Precambrian terrain. (2) The transfer zone between the Albertine and Rhino grabens is controlled by NE-trending Precambrian structures which might have facilitated the development of relay ramp faults. (3) Strain localization within the better-developed southeastern border fault of the Rhino half-graben is facilitated by the presence of Precambrian structures better aligned in a NE-direction in the southeastern part of the basin compared to its northwestern part. (4) Further to the northeast, the Rhino graben is segmented and transitions into a narrower ENE-trending half-graben with a better-developed border fault on its northwestern side. This segmentation coincides with the presence of N-trending Precambrian structures. (5) The Rhino graben terminates farther northeast against the NW-trending Precambrian Aswa shear zone; a prominent structure with complex, but generally NW-trending fabric.

  19. Influence of pre-existing inflammation on the outcome of acute coronary syndrome: a cross-sectional study

    PubMed Central

    Odeberg, Jacob; Freitag, Michael; Forssell, Henrik; Vaara, Ivar; Persson, Marie-Louise; Odeberg, Håkan; Halling, Anders; Råstam, Lennart; Lindblad, Ulf

    2016-01-01

    Objectives Inflammation is a well-established risk factor for the development of coronary artery disease (CAD) and acute coronary syndrome (ACS). However, less is known about its influence on the outcome of ACS. The aim of this study was to determine if blood biomarkers of inflammation were associated specifically with acute myocardial infarction (MI) or unstable angina (UA) in patients with ACS. Design Cross-sectional study. Setting Patients admitted to the coronary care unit, via the emergency room, at a central county hospital over a 4-year period (1992–1996). Participants In a substudy of Carlscrona Heart Attack Prognosis Study (CHAPS) of 5292 patients admitted to the coronary care unit, we identified 908 patients aged 30–74 years, who at discharge had received the diagnosis of either MI (527) or UA (381). Main outcome measures MI or UA, based on the diagnosis set at discharge from hospital. Results When adjusted for smoking, age, sex and duration of chest pain, concentrations of plasma biomarkers of inflammation (high-sensitivity C reactive protein>2 mg/L (OR=1.40 (1.00 to 1.96) and fibrinogen (p for trend=0.035)) analysed at admission were found to be associated with MI over UA, in an event of ACS. A strong significant association with MI over UA was found for blood cell markers of inflammation, that is, counts of neutrophils (p for trend<0.001), monocytes (p for trend<0.001) and thrombocytes (p for trend=0.021), while lymphocyte count showed no association. Interestingly, eosinophil count (p for trend=0.003) was found to be significantly lower in patients with MI compared to those with UA. Conclusions Our results show that, in patients with ACS, the blood cell profile and degree of inflammation at admission was associated with the outcome. Furthermore, our data suggest that a pre-existing low-grade inflammation may dispose towards MI over UA. PMID:26758266

  20. Effects of Mining-Induced Stress Perturbations on Pre-Existing Faults Near a Deep South African Gold Mine

    NASA Astrophysics Data System (ADS)

    Lucier, A. M.; Heesakkers, V.; Zoback, M. D.; Reches, Z.

    2007-12-01

    For over a century, mining-induced earthquakes have been recorded in the deep underground mining region of Witwatersrand Basin in South Africa. The TauTona gold mine experiences an appreciable number of mining- induced earthquakes and is the site of the Natural Earthquake Laboratory in South African Mines (NELSAM) project. In this work, we constrain the virgin (i.e. unperturbed) state of stress near the TauTona gold mine using an iterative forward modeling approach that combines observations of drilling induced borehole failures in borehole images, boundary element modeling of the mining-induced stress perturbations, and forward modeling of borehole failures based on the results of the boundary element modeling. We find that the state of stress is a normal faulting regime with principal stress orientations that are slightly deviated from vertical and horizontal and therefore denoted with a (*). The maximum principal stress, Sv*, is deviated 0° to 20° from vertical towards the NNW and has a magnitude gradient of 27 ± 0.3 MPa/km. The intermediate principal stress, SHmax*, is inclined 0° to 20° from horizontal with an azimuth of 145° to 168° and has a magnitude gradient of 21.5 to 26 MPa/km. The least principal stress, Shmin*, is inclined 0° to 10° from horizontal with an azimuth of 235° to 258° and has a magnitude gradient of 13 to 15.5 MPa/km. Using this constrained stress state, we investigate the likelihood of faulting to occur both on pre-existing fault planes that are optimally-oriented to the virgin stress state and on faults affected by the mining-perturbed stress field, the latter of which is calculated with boundary element modeling. The far-field stress state indicates that the crust is in a state of frictional faulting equilibrium, such that normal faulting is likely to occur on faults striking SSE and NNW and have a dip angle of approximately 45° to 80°. The mining-induced stress perturbation affects faults relatively closer to the mining excavation. We analyze active faults observed in borehole image log data and mapped in the TauTona access tunnels. In the borehole image logs, we find evidence of recent slip on faults that have become critically stressed due to the mining-induced stress perturbation. In our investigation of the Pretorius Fault Zone (PFZ), an ancient (Pre-Cambrian) fault system, we find that stress perturbations due to recent mining advances may be responsible for reactivating segments of the PFZ that were observed to slip during a M2.2 event recorded in December 2004.

  1. The impact of pre-existing antibody on subsequent immune responses to meningococcal A-containing vaccines.

    PubMed

    Idoko, Olubukola T; Okolo, Seline N; Plikaytis, Brian; Akinsola, Adebayo; Viviani, Simonetta; Borrow, Ray; Carlone, George; Findlow, Helen; Elie, Cheryl; Kulkarni, Prasad S; Preziosi, Marie-Pierre; Ota, Martin; Kampmann, Beate

    2014-07-16

    Major epidemics of serogroup A meningococcal meningitis continue to affect the African meningitis belt. The development of an affordable conjugate vaccine against the disease became a priority for World Health Organization (WHO) in the late 1990s. Licensing of meningococcal vaccines has been based on serological correlates of protection alone, but such correlates might differ in different geographical regions. If high pre-vaccination antibody concentrations/titers impacts on the response to vaccination and possibly vaccine efficacy, is not clearly understood. We set out to define the pre-vaccination Meningococcal group A (Men A) antibody concentrations/titers in The Gambia and study their impact on the immunogenicity of Men A containing vaccines. Data from subjects originally enrolled in studies to test the safety and immunogenicity of the MenA vaccine recently developed for Africa meningococcal A polysaccharide conjugated to tetanus toxoid, MenAfriVac(®) (PsA-TT) were analyzed. Participants had been randomized to receive either the study vaccine PsA-TT or the reference quadrivalent plain polysaccharide vaccine containing meningococcal groups A, C, W, and Y, Mencevax(®) ACWY, GlaxoSmithKline (PsACWY) in a 2:1 ratio. Venous blood samples were collected before and 28 days after vaccination. Antibodies were assayed by enzyme-linked immunosorbent assay (ELISA) for geometric mean concentrations and serum bactericidal antibody (SBA) for functional antibody. The inter age group differences were compared using ANOVA and the pre and post-vaccination differences by t test. Over 80% of the ≥19 year olds had pre-vaccination antibody concentrations above putatively protective concentrations as compared to only 10% of 1-2 year olds. Ninety-five percent of those who received the study vaccine had ≥4-fold antibody responses if they had low pre-vaccination concentrations compared to 76% of those with high pre-vaccination concentrations. All subjects with low pre-vaccination titers attained ≥4-fold responses as compared to 76% with high titers where study vaccine was received. Our data confirm the presence of high pre-vaccination Men A antibody concentrations/titers within the African meningitis belt, with significantly higher concentrations in older individuals. Although all participants had significant increase in antibody levels following vaccination, the four-fold or greater response in antibody titers were significantly higher in individuals with lower pre-existing antibody titers, especially after receiving PsA-TT. This finding may have some implications for vaccination strategies adopted in the future. PMID:24863486

  2. 42 CFR 482.22 - Condition of participation: Medical staff.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... appointment to medical staff. The medical staff must be composed of doctors of medicine or osteopathy. In... the committee must be doctors of medicine or osteopathy. (3) The responsibility for organization and... medicine or osteopathy. (ii) A doctor of dental surgery or dental medicine, when permitted by State law...

  3. 42 CFR 482.22 - Condition of participation: Medical staff.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... to medical staff. The medical staff must include doctors of medicine or osteopathy. In accordance... majority of the members of the committee must be doctors of medicine or osteopathy. (3) The responsibility...) An individual doctor of medicine or osteopathy. (ii) A doctor of dental surgery or dental...

  4. 42 CFR 482.22 - Condition of participation: Medical staff.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... practitioner. At a minimum, this information must include all adverse events that result from the telemedicine... practitioner. At a minimum, this information must include all adverse events that result from the telemedicine... to medical staff. The medical staff must include doctors of medicine or osteopathy. In...

  5. Influence of pre-existing invasive aspergillosis on allo-HSCT outcome: a retrospective EBMT analysis by the Infectious Diseases and Acute Leukemia Working Parties.

    PubMed

    Penack, O; Tridello, G; Hoek, J; Socié, G; Blaise, D; Passweg, J; Chevallier, P; Craddock, C; Milpied, N; Veelken, H; Maertens, J; Ljungman, P; Cornelissen, J; Thiebaut-Bertrand, A; Lioure, B; Michallet, M; Iacobelli, S; Nagler, A; Mohty, M; Cesaro, S

    2016-03-01

    Historically, invasive aspergillosis (IA) has been a major barrier for allogeneic hematopoietic stem cell transplantation (allo-HSCT). The influence of invasive IA on long-term survival and on transplant-related complications has not been investigated in a larger patient cohort under current conditions. Our aim was to analyze the long-term outcome of patients undergoing allo-HSCT with a history of prior IA. We used European Society for Blood and Marrow Transplantation database data of first allo-HSCTs performed between 2005 and 2010 in patients with acute leukemia. One thousand one hundred and fifty patients with data on IA before allo-HSCT were included in the analysis. The median follow-up time was 52.1 months. We found no significant impact of IA on major transplant outcome variables such as overall survival, relapse-free survival, non-relapse mortality, cumulative incidence of acute GvHD grade II-IV, chronic GvHD, pulmonary complications and leukemia relapse. However, we found a trend toward lower overall survival (P=0.078, hazard ratio (HR) (95% confidence interval (CI)): 1.16 (0.98, 1.36)) and higher non-relapse mortality (P=0.150, HR (95% CI): 1.19 (0.94, 1.50)) in allo-HSCT recipients with pre-existing IA. Our data suggest that a history of IA should not generally be a contraindication when considering the performance of allo-HSCT in patients with acute leukemia. PMID:26501769

  6. A dairy-based high calcium diet improves glucose homeostasis and reduces steatosis in the context of pre-existing obesity

    Technology Transfer Automated Retrieval System (TEKTRAN)

    High dietary calcium (Ca) in the context of a dairy food matrix has been shown to reduce obesity development and associated inflammation in diet-induced obese (DIO) rodents. The influence of Ca and dairy on these phenotypes in the context of pre-existing obesity is not known. Furthermore, interpre...

  7. A dairy-based high calcium diet improves glucose homeostasis and reduces further weight gain in high fat fed mice in the context of pre-existing obesity

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: High dietary calcium (Ca) in the context of a dairy food matrix has been shown to reduce obesity development and associated inflammation in diet-induced obese (DIO) mice. However, the influence of Ca and dairy on these phenotypes in the context of pre-existing obesity is not known. Met...

  8. Effect of the pre-existing carbides on the grain boundary network during grain boundary engineering in a nickel based alloy

    SciTech Connect

    Liu, Tingguang; Xia, Shuang; Li, Hui; Zhou, Bangxin; Bai, Qin

    2014-05-01

    Grain boundary engineering was carried out on an aging-treated nickel based Alloy 690, which has precipitated carbides at grain boundaries. Electron backscatter diffraction technique was used to investigate the grain boundary networks. Results show that, compared with the solution-annealed samples, the aging-treated samples with pre-existing carbides at grain boundaries need longer duration or higher temperature during annealing after low-strain tensile deformation for forming high proportion of low-Σ coincidence site lattice grain boundaries (more than 75%). The reason is that the primary recrystallization is inhibited or retarded owing to that the pre-existing carbides are barriers to grain boundaries migration. - Highlights: • Study of GBE as function of pre-existing GB carbides, tensile strain and annealing • Recrystallization of GBE is inhibited or retarded by the pre-existing carbides. • Retained carbides after annealing show the original GB positions. • More than 80% of special GBs were formed after the modification of GBE processing. • Multiple twinning during recrystallization is the key process of GBE.

  9. 42 CFR 482.22 - Condition of participation: Medical staff.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... staff that operates under bylaws approved by the governing body and is responsible for the quality of... organized and accountable to the governing body for the quality of the medical care provided to patients....

  10. Lateral propagation of active normal faults throughout pre-existing fault zones: an example from the Southern Apennines, Italy

    NASA Astrophysics Data System (ADS)

    Agosta, Fabrizio; Prosser, Giacomo; Ivo Giano, Salvatore

    2013-04-01

    The main active structures in the Southern Apennines are represented by a set of NW-trending normal faults, which are mainly located in the axial sector of the chain. Evidences arising from neotectonics and seismology show activity of a composite seismic source, the Irpinia - Agri Valley, located across the Campania-Basilicata border. This seismic source is made up of two right-stepping, individual seismic sources forming a relay ramp. Each individual seismic source consists of a series of nearly parallel normal fault segments. The relay ramp area, located around the Vietri di Potenza town, is bounded by two seismic segments, the San Gregorio Magno Fault, to the NW, and the Pergola-Melandro Fault, to the SE. The possible interaction between the two right-stepping fault segments has not been proven yet, since the fault system of the area has never been analyzed in detail. This work is aimed at assessing the geometry of such fault system, inferring the relative age of the different fault sets by studying the crosscutting relationships, characterizing the micromechanics of fault rocks associated to the various fault sets, and understanding the modalities of lateral propagation of the two bounding fault segments. Crosscutting relationships are recognized by combining classical geological mapping with morphotectonic methods. This latter approach, which include the analysis of aerial photographs and field inspection of quaternary slope deposits, is used to identify the most recent structures among those cropping out in the field area. In the relay ramp area, normal faults crosscut different tectonic units of the Apennine chain piled up, essentially, during the Middle to Late Miocene. The topmost unit (only few tens of meter-thick) consists of a mélange containing blocks of different lithologies in a clayish matrix. The intermediate thrust sheet consists of 1-1.5 km-thick platform carbonates of late Triassic-Jurassic age, with dolomites at the base and limestones at the top, unconformably covered by Miocene clastic deposits. The lower thrust sheet is made up of deep-sea deposits of late Triassic to Eocene age, which include pelagic limestones, radiolarites, marls and turbiditic calcarenites. The relay ramp area is comprised of two main fault sets, which are NW-trending (N120-140E) and NE-trending (N60-70E). Minor E-trending (N90-100E) and NNW-trending (N160-170E) faults are also present. Maximum throws of the most developed faults, which are also characterized by the longest traces, are in the order of 300-400 m. Crosscutting relationships and morphotectonic analyses generally show that the NW-trending faults are the most recent, as also shown by the involvement of Quaternary breccias and near surface fault rocks. Our data indicate that propagation of NW-trending normal faults in the relay ramp area took place thanks to the breaking of a pre-existing structural grain made up, mainly, of NE-trending normal faults. This process determined the different multi-scale properties to the two fault sets, and somehow inhibited the lateral growth of the NW-trending normal faults.

  11. Estimating the Reactivation Potential of Pre-Existing Fractures in Subsurface Granitoids from Outcrop Analogues and in-Situ Stress Modeling: Implications for EGS Reservoir Stimulation with an Example from Thuringia (Central Germany)

    NASA Astrophysics Data System (ADS)

    Kasch, N.; Ustaszewski, K. M.; Siegburg, M.; Navabpour, P.; Hesse, G.

    2014-12-01

    The Mid-German Crystalline Rise (MGCR) in Thuringia (central Germany) is part of the European Variscan orogen and hosts large extents of Visean granites (c. 350 Ma), locally overlain by up to 3 km of Early Permian to Mid-Triassic volcanic and sedimentary rocks. A geothermal gradient of 36°C km-1 suggests that such subsurface granites form an economically viable hot dry rock reservoir at > 4 km depth. In order to assess the likelihood of reactivating any pre-existing fractures during hydraulic reservoir stimulation, slip and dilation tendency analyses (Morris et al. 1996) were carried out. For this purpose, we determined orientations of pre-existing fractures in 14 granite exposures along the southern border fault of an MGCR basement high. Additionally, the strike of 192 Permian magmatic dikes affecting the granite was considered. This analysis revealed a prevalence of NW-SE-striking fractures (mainly joints, extension veins, dikes and subordinately brittle faults) with a maximum at 030/70 (dip azimuth/dip). Borehole data and earthquake focal mechanisms reveal a maximum horizontal stress SHmax trending N150°E and a strike-slip regime. Effective in-situ stress magnitudes at 4.5 km depth, assuming hydrostatic conditions and frictional equilibrium along pre-existing fractures with a friction coefficient of 0.85 yielded 230 and 110 MPa for SHmax and Shmin, respectively. In this stress field, fractures with the prevailing orientations show a high tendency of becoming reactivated as dextral strike-slip faults if stimulated hydraulically. To ensure that a stimulation well creates fluid connectivity on a reservoir volume as large as possible rather than dissipating fluids along existing fractures, it should follow a trajectory at the highest possible angle to the orientation of prevailing fractures, i.e. subhorizontal and NE-SW-oriented. References: Morris, A., D. A. Ferrill, and D. B. Henderson (1996), Slip-tendency analysis and fault reactivation, Geology, 24, 275-278.

  12. Patterns and Pre-existing Risk Factors of 30-day Mortality after a Primary Discharge Diagnosis of Syncope or Near Syncope

    PubMed Central

    Derose, Stephen F.; Gabayan, Gelareh Z.; Chiu, Vicki Y.; Sun, Benjamin C.

    2012-01-01

    Objectives The risk of short-term mortality after an emergency department (ED) visit for syncope is poorly understood, resulting in prognostic uncertainty and frequent hospital admission. The authors determined patterns and risk factors for short-term mortality after a diagnosis of syncope or near syncope to aid in medical decision-making. Methods A retrospective cohort study was performed of adult members of Kaiser Permanente Southern California seen at 11 EDs from 2002 to 2006 with a primary discharge diagnosis of syncope or near syncope (ICD-9 780.2). The outcome was 30-day mortality. Proportional hazards time-to-event regression models were used to identify risk factors. Results There were 22,189 participants with 23,951 ED visits, resulting in 307 deaths by 30 days. A relatively lower risk of death was reached within two weeks for ages 18 to 59 years, but not until three months or more for ages 60 and older. Pre-existing comorbidities associated with increased mortality included heart failure (hazard ratio [HR] 14.3 in ages 18 to 59 years, HR 3.09 in ages 60 to 79 years, HR 2.34 in ages 80 years plus, all P < 0.001), diabetes (HR 1.49, P = 0.002), seizure (HR 1.65, P = 0.016), and dementia (HR 1.41, P = 0.034). If the index visit followed one or more visits for syncope in the previous 30 days, it was associated with increased mortality (HR 1.86, P = 0.024). Absolute risk of death at 30 days was under 0.2% in those under 60 years without heart failure and >2.5% across all ages in those with heart failure. Conclusions The low risk of death after an ED visit for syncope or near syncope in patients younger than 60 years old without heart failure, may be helpful when deciding who to admit for inpatient evaluation. The presence of one or more comorbidities that predict death, and a prior visit for syncope, should be considered in clinical decisions and risk stratification tools for patients with syncope. Close clinical follow-up seems advisable in patients 60 years and older due to a prolonged risk of death. PMID:22594351

  13. 42 CFR 410.38 - Durable medical equipment: Scope and conditions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Services 410.38 Durable medical equipment: Scope and conditions. (a) Medicare Part B pays for the rental or purchase of durable medical equipment, including iron lungs, oxygen tents, hospital beds, and... 42 Public Health 2 2012-10-01 2012-10-01 false Durable medical equipment: Scope and...

  14. 42 CFR 410.38 - Durable medical equipment: Scope and conditions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Services 410.38 Durable medical equipment: Scope and conditions. (a) Medicare Part B pays for the rental or purchase of durable medical equipment, including iron lungs, oxygen tents, hospital beds, and... 42 Public Health 2 2011-10-01 2011-10-01 false Durable medical equipment: Scope and...

  15. 28 CFR 79.16 - Proof of medical condition.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 79.16 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE... or abstracts of medical records of the claimant that contain a verified diagnosis of one type of... contain a verified diagnosis of leukemia, the Radiation Exposure Compensation Program will notify...

  16. Schoolchildren with Dysphagia Associated with Medically Complex Conditions

    ERIC Educational Resources Information Center

    Lefton-Greif, Maureen A.; Arvedson, Joan C.

    2008-01-01

    Purpose: This article reviews population trends and general characteristics of children with dysphagia in schools, provides an overview of dysphagia teams and the roles of the speech-language pathologist (SLP) in school and hospital settings, and describes assessment and treatment of swallowing and feeding problems in children with complex medical

  17. Development of Mylonites and Pseudotachylites in Granitic Bodies: Brittle Deformation by Reactivation of Pre-existing Ductile Fabrics Defined by Mica

    NASA Astrophysics Data System (ADS)

    Jiang, H.; Ross, C. H.; Lee, C. T.; Morgan, J. K.

    2014-12-01

    Pseudotachylites are common in brittle deformation zones and represent rapidly crystallized melts produced by friction-induced heating, possibly associated with dynamic rupture and slip during earthquakes. Thus, pseudotachylites may provide insight into how such localized deformation occurs. Here, we investigated the micron to cm scale structure and geochemistry of granitic plutons in the Eastern Peninsular Ranges shear zone (California), which is a large scale thrust rooted in the lower crust. Our U-Pb chronology and Zr thermometry of sphene porphyroblasts in the mylonite indicate that the plutons were deformed at near solidus conditions (780-750 ◦C) between 89 and 78 Ma, which coincides with the last pulse of magmatism. This ductile deformation resulted in a foliated fabric defined by biotite-rich layers. Subsequent brittle deformation is superimposed on this ductile fabric as exemplified by pseudotachylites and ultracataclasites cross-cutting or parallel to the foliation planes. The pseudotachylites are characterized by a glassy matrix with microlites, and the ultracataclasites are characterized by a fine-grained matrix of angular mineral and rock fragments. We measured major and trace compositions of these brittle deformation products using LA-ICPMS. The pseudotachylites are more mafic (lower Si, but higher Fe, Ti and K) than the host granitoid, while the ultracataclasites are intermediate between the pseudotachylites and the host. The mafic compositions of the pseudotachylites indicate that they form almost solely by melting of biotite. The compositions of the ultracastaclasites also suggest preferential involvement of biotite, but with a greater component of feldspar. The compositional discrepancy between the brittle deformation products and the host granitoid begs the question of why brittle deformation appears to preferentially involve biotite. One possibility is that brittle deformation occurred on weak zones inherited from the biotite-rich mylonitic foliation planes. Our observations indicate that such ductile deformation occurred at near-solidus conditions and may have been associated with the assembly of the Cretaceous magmatic arc. We suggest that brittle faulting inherits pre-existing ductile fabrics that, once formed, define long-lived weak shear zones in the crust.

  18. The 3D Numerical Simulation for the Propagation Process of Multiple Pre-existing Flaws in Rock-Like Materials Subjected to Biaxial Compressive Loads

    NASA Astrophysics Data System (ADS)

    Bi, J.; Zhou, X. P.; Qian, Q. H.

    2016-05-01

    General particle dynamics (GPD), which is a novel meshless numerical method, is proposed to simulate the initiation, propagation and coalescence of 3D pre-existing penetrating and embedded flaws under biaxial compression. The failure process for rock-like materials subjected to biaxial compressive loads is investigated using the numerical code GPD3D. Moreover, internal crack evolution processes are successfully simulated using GPD3D. With increasing lateral stress, the secondary cracks keep growing in the samples, while the growth of the wing cracks is restrained. The samples are mainly split into fragments in a shear failure mode under biaxial compression, which is different from the splitting failure of the samples subjected to uniaxial compression. For specimens with macroscopic pre-existing flaws, the simulated types of cracks, the simulated coalescence types and the simulated failure modes are in good agreement with the experimental results.

  19. Oral vaccination with modified vaccinia virus Ankara attached covalently to TMPEG-modified cationic liposomes overcomes pre-existing poxvirus immunity from recombinant vaccinia immunization

    PubMed Central

    Naito, Toshio; Kaneko, Yutaro; Kozbor, Danuta

    2008-01-01

    Development of a safe and effective vaccine for induction of mucosal immunity to the human immunodeficiency virus (HIV) envelope glycoprotein (Env, gp160) represents the best hope for containing the spread of an HIV epidemic worldwide. The highly attenuated modified vaccinia virus Ankara (MVA) is a laboratory virus well suited as a safe vaccine vector. However, the presence of pre-existing immunity to Vaccinia virus in the adult population represents a hindrance that limits the application of the MVA vector for inducing immunity to HIV antigens. Here, cationic liposomes were covalently attached to the surface of recombinant MVA expressing the HIV-1 strain IIIB Env glycoprotein and β-galactosidase (MVAIIIB/β-gal) using tresylmonomethoxypolyethylene glycol (TMPEG) grafted into a lipid membrane without compromising viral infectivity in vitro and in vivo. The orally administered MVAIIIB/β-gal–TMPEG/liposome complexes were capable of delivering the transgenes to mucosal tissues in mice with pre-existing poxvirus immunity based on β-galactosidase gene expression in intestinal tissues measured 18 h after infection. Importantly, the MVAIIIB/β-gal–TMPEG/liposome complexes enhanced Env-specific cellular and humoral immune responses in the mucosal and systemic tissues after repeated oral immunization of BALB/c mice. This approach may prove useful for induction of protective immunity against infectious diseases and cancer in populations with pre-existing immunity to vaccinia from smallpox vaccination. PMID:17170437

  20. Chronic medical conditions among jail detainees in residential psychiatric treatment: a latent class analysis.

    PubMed

    Swartz, James A

    2011-08-01

    Studies of incarcerates with serious mental illnesses have found elevated rates of chronic medical conditions such as asthma and diabetes, and of infectious diseases such as tuberculosis compared with general population rates. This study explored the pattern of chronic medical conditions in a sample of adult detainees in psychiatric treatment in a large urban jail to develop a clinical profile encompassing the full range of medical conditions. A total of 431 male and female detainees were sampled with certainty from admissions to a residential psychiatric treatment program (overall recruitment rate = 67%). Interviews used the World Mental Health version of the Composite International Diagnostic Interview to assess psychiatric and substance use disorders per DSM-IV criteria and chronic medical conditions. Latent class analysis was conducted using 17 medical conditions as class indicators, yielding a 3-class model composed of: a latent class with a high to intermediate probability of multiple medical conditions (HMC; 12.5% of the sample); an intermediate class with a lower probability of having a smaller number of medical conditions (MMC; 43.2%); and a class with a low probability of any medical condition (44.3%). Those in the HMC class were more likely to report respiratory problems, severe headaches, musculoskeletal pain, hypertension, and arthritis, have greater functional impairment, and have a higher number of co-occurring psychiatric disorders. Being older (50+ years) and female were associated with higher odds of being in the HMC or MMC classes. The policy implications for providing medical care to incarcerates with complex mixtures of medical conditions and psychiatric disorders are considered. PMID:21394659

  1. A Comparison of Expedition Medical Condition List Treatment Directives with Integrated Medical Model Simulation Data Presentation and Briefing Report

    NASA Technical Reports Server (NTRS)

    Lewis, Robert

    2013-01-01

    This aerospace medicine clerkship project is under the direction of Dr. Sharmila Watkins and is in cooperation with Dr. Eric Kerstman and Dr. Ronak Shah. The questions of the research project are: 1. What are the main drivers of evacuation and loss of crew life (LOCL) on three Design Reference Missions (DRMs): Near Earth Asteroid (NEA), Lunar Sortie and Lunar Outpost using an inexhaustible International Space Station medical kit 2. What are the treatment designations for these driving medical conditions as listed in Expedition Medical Condition List (EMCL) 3. Do the drivers make sense in the context of the given Design Reference Mission (DRM) 4. Do any EMCL treatment designations need re-assessing.

  2. Tests and Medical Conditions Associated with Dementia Diagnosis

    ERIC Educational Resources Information Center

    Burt, Diana B.; Primeaux-Hart, Sharon; Loveland, Katherine A.; Cleveland, Lynne A.; Lewis, Kay R.; Lesser, Jary; Pearson, Pamela L.

    2005-01-01

    Diagnosis of dementia in adults with intellectual disabilities requires documentation of clinically significant declines in memory and other cognitive skills, as well as changes in everyday and emotional functioning. To improve diagnostic accuracy in adults with Down syndrome, the authors examined conditions often associated with dementia, as well…

  3. The Prevalence of Medical Conditions Among U.S. Chinese Community-Dwelling Older Adults

    PubMed Central

    Chen, Ruijia; Simon, Melissa A.

    2014-01-01

    Background. The burden of medical conditions is increasing among U.S. older adults, yet we have very limited knowledge about medical conditions among Chinese older adults in the United States. This study aimed to examine the prevalence of medical conditions and its sociodemographic and health-related correlates within the context of a population-based cohort study of U.S. Chinese older adults. Method. Using a community-based participatory research approach, community-dwelling Chinese older adults aged 60 years and older in the Greater Chicago area were interviewed between 2011 and 2013. Results. Of the 3,159 participants interviewed, 58.9% were female and the mean age was 72.8 years. In total, 84.3% of older adults had one or more medical condition, 24.6% reported two conditions, 19.5% had three conditions, and 17.0% reported four or more conditions. A sizeable percentage of older adults had never been screened for dyslipidemia (24.4%) or had never been screened for diabetes mellitus (35.7%).For those who reported high cholesterol, 73.0% were taking medications when compared with 76.1% of those who reported having diabetes and 88.3% of those who reported having high blood pressure. Various sociodemographic and health-related characteristics were correlated with medical conditions. Conclusion. Medical conditions were common among U.S. Chinese older adults, yet screening and treatment rates were fairly low. Future longitudinal studies should be conducted to better understand the risk and protective factors associated with medical conditions. PMID:25378445

  4. The Impact of Medical Conditions on the Support of Children with Profound Intellectual and Multiple Disabilities

    ERIC Educational Resources Information Center

    Zijlstra, H. P.; Vlaskamp, C.

    2005-01-01

    Background: The aim of this study was to analyse the impact of medical conditions of children with profound intellectual and multiple disabilities on the professional support they receive in centres for special education. Method: The medical files, the daily records and daily communication records between parents and professionals were reviewed…

  5. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID... PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.61 Condition of participation: Special medical record requirements for psychiatric hospitals. The medical records maintained by a...

  6. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID... PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.61 Condition of participation: Special medical record requirements for psychiatric hospitals. The medical records maintained by a...

  7. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID... PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.61 Condition of participation: Special medical record requirements for psychiatric hospitals. The medical records maintained by a...

  8. 42 CFR 482.24 - Condition of participation: Medical record services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Medical record services. 482.24 Section 482.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... medical records. The system must allow for timely retrieval by diagnosis and procedure, in order...

  9. Adherence to Medication Regimens among Low-Income Patients with Multiple Comorbid Chronic Conditions

    ERIC Educational Resources Information Center

    Mishra, Shiraz I.; Gioia, Deborah; Childress, Saltanat; Barnet, Beth; Webster, Ramothea L.

    2011-01-01

    This qualitative study sought to explore facilitators and barriers to adherence to multiple medications among low-income patients with comorbid chronic physical and mental health conditions. The 50 focus group participants identified personal/contextual and health system factors as major impediments to adherence to multiple medications. These…

  10. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... responsible for the delivery of patient care and outcomes in the facility. The medical director is accountable... 42 Public Health 5 2014-10-01 2014-10-01 false Condition: Responsibilities of the medical director. 494.150 Section 494.150 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

  11. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... responsible for the delivery of patient care and outcomes in the facility. The medical director is accountable... 42 Public Health 5 2012-10-01 2012-10-01 false Condition: Responsibilities of the medical director. 494.150 Section 494.150 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

  12. 42 CFR 416.47 - Condition for coverage-Medical records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., and accurate medical records to ensure adequate patient care. (a) Standard: Organization. The ASC must... operation, including a pathologist's report on all tissues removed during surgery, except those exempted by... 42 Public Health 3 2012-10-01 2012-10-01 false Condition for coverage-Medical records....

  13. Pre-existing hyperlipidaemia increased the risk of new-onset anxiety disorders after traumatic brain injury: a 14-year population-based study

    PubMed Central

    Ho, Chung-Han; Hsieh, Kuang-Yang; Liang, Fu-Wen; Li, Chia-Jung; Wang, Jhi-Joung; Chio, Chung-Ching; Chang, Chin-Hung; Kuo, Jinn-Rung

    2014-01-01

    Objectives Anxiety disorders (ADs) are common after traumatic brain injury (TBI). However, the risk factors of new-onset ADs remain unclear. This study was aimed at evaluating the incidence and risk factors for new-onset ADs, including pre-existing hyperlipidaemia and three major comorbidities (diabetes mellitus, hypertension and cardiovascular disease), in patients with TBI. Setting A matched cohort study was conducted using the Taiwan Longitudinal Health Insurance Database between January 1997 and December 2010. Participants A total of 3822 participants (1274 patients with TBI with hyperlipidaemia and 2548 age-matched and gender-matched patients with TBI without hyperlipidaemia). Outcome measures The incidence and HRs for the development of new-onset ADs after TBI were compared between the two groups. Results The overall incidence rate of new-onset ADs for patients with TBI with hyperlipidaemia is 142.03/10 000 person-years (PYs). Patients with TBI with hyperlipidaemia have a 1.60-fold incidence rate ratio (p<0.0001) and increased HR of ADs (1.58, 95% CI 1.24 to 2.02) compared with those without hyperlipidaemia. The incidence rates of ADs for males and females with hyperlipidaemia, respectively, were 142.12 and 292.32/10 000 PYs, which were higher than those without hyperlipidaemia (93.03 and 171.68/10 000 PYs, respectively). Stratified by age group, hyperlipidaemia is a risk factor of ADs for patients with TBI aged 65 years or younger. Conclusions Pre-existing hyperlipidaemia is an independent predictor of new-onset ADs in patients with TBI, even when controlling for other demographic and clinical variables. Female patients with pre-existing hyperlipidaemia had significantly higher risk of new-onset ADs than males, especially between the ages of 35 and 65 years. PMID:25034630

  14. The social phobia and anxiety inventory: problem of underlying medical conditions.

    PubMed

    Klieger, Douglas M; Johnson, Heather K

    2007-12-01

    The study investigated the possibility of score inflation in the Social Phobia and Anxiety Inventory due to underlying medical conditions in respondents. The Diagnostic and Statistical Manual of Mental Disorders provides an exclusionary rule disallowing a diagnosis of social phobia when the fear is based on the presence of a medical condition. A computer-administered procedure, designed to simulate visually this paper-and-pencil inventory was created and compared to the original in a pilot study with r of .94 between the two procedures. Analysis indicates such medically based responding is common among college men and women (N= 127, M age = 19.0). Specifically, 50% of respondents reported 0 or 1 medical condition(s), while those in the fourth quartile averaged 43 medical bases for their responses. The most frequent self-reports of medical conditions were stuttering (2.8%), acne (2.4%), dry mouth (2.1%), obesity (.9%), and scars (.9%). Several possible solutions were discussed in view of the overall conclusion of a substantive basis for medical responding on this inventory. PMID:18232422

  15. Systematic screening for unsafe driving due to medical conditions: Still debatable

    PubMed Central

    Leproust, Sandy; Lagarde, Emmanuel; Salmi, L Rachid

    2008-01-01

    Background Assessing people's ability to drive has become a public health concern in most industrialized countries. Although age itself is not a predictive factor of an increased risk for dangerous driving, the prevalence of medical conditions that may impair driving increases with age. Because the implementation of a screening for unsafe driving due to medical conditions is a public health issue, its usefulness should be judged using standardised criteria already proposed for screening for chronic disease. The aim of this paper is to propose standardised criteria suitable to assess the scientific validity of screening for unsafe driving due to medical conditions, and identify potential issues to be clarified before screening can be implemented and effective. Discussion Using criteria developed for screening for chronic diseases and published studies on driving with medical conditions, we specify six criteria to judge the opportunity of screening for unsafe driving due to medical conditions. This adaptation was needed because of the complexity of the natural history of medical conditions and their potential consequences on driving and road safety. We then illustrate that published studies pleading for or against screening for unsafe driving due to medical conditions fail to provide the needed documentation. Individual criteria were mentioned in 3 to 72% of 36 papers pleading for or against screening. Quantitative estimates of relevant indicators were provided in at most 42% of papers, and some data, such as the definition of an appropriate unsafe driving period were never provided. Summary The standardised framework described in this paper provides a template for assessing the effectiveness (or lack of effectiveness) of proposed measures for screening for unsafe driving due to medical conditions. Even if most criteria were mentioned in the published literature pleading for or against such a screening, the failure to find quantitative and evidence-based estimates of relevant indicators provides useful insight for further research. PMID:18215269

  16. Phenological asynchrony between herbivorous insects and their hosts: signal of climate change or pre-existing adaptive strategy?

    PubMed Central

    Singer, Michael C.; Parmesan, Camille

    2010-01-01

    Climate change alters phenological relations between interacting species. We might expect the historical baseline, or starting-point, for such effects to be precise synchrony between the season at which a consumer most requires food and the time when its resources are most available. We synthesize evidence that synchrony was not the historical condition in two insect–plant interactions involving Edith's checkerspot butterfly (Euphydryas editha), the winter moth (Operophtera brumata) and their host plants. Initial observations of phenological mismatch in both systems were made prior to the onset of anthropogenically driven climate change. Neither species can detect the phenology of its host plants with precision. In both species, evolution of life history has involved compromise between maximizing fecundity and minimizing mortality, with the outcome being superficially maladaptive strategies in which many, or even most, individuals die of starvation through poor synchrony with their host plants. Where phenological asynchrony or mismatch with resources forms the starting point for effects of anthropogenic global warming, consumers are particularly vulnerable to impacts that exacerbate the mismatch. This vulnerability likely contributed to extinction of a well-studied metapopulation of Edith's checkerspot, and to the skewed geographical pattern of population extinctions underlying a northward and upward range shift in this species. PMID:20819810

  17. DNase I and proteinase K impair Listeria monocytogenes biofilm formation and induce dispersal of pre-existing biofilms.

    PubMed

    Nguyen, Uyen T; Burrows, Lori L

    2014-09-18

    Current sanitation methods in the food industry are not always sufficient for prevention or dispersal of Listeria monocytogenes biofilms. Here, we determined if prevention of adherence or dispersal of existing biofilms could occur if biofilm matrix components were disrupted enzymatically. Addition of DNase during biofilm formation reduced attachment (<50% of control) to polystyrene. Treatment of established 72h biofilms with 100?g/ml of DNase for 24h induced incomplete biofilm dispersal, with <25% biofilm remaining compared to control. In contrast, addition of proteinase K completely inhibited biofilm formation, and 72h biofilms-including those grown under stimulatory conditions-were completely dispersed with 100?g/ml proteinase K. Generally-regarded-as-safe proteases bromelain and papain were less effective dispersants than proteinase K. In a time course assay, complete dispersal of L. monocytogenes biofilms from both polystyrene and type 304H food-grade stainless steel occurred within 5min at proteinase K concentrations above 25?g/ml. These data confirm that both DNA and proteins are required for L. monocytogenes biofilm development and maintenance, and that these components of the biofilm matrix can be targeted for effective prevention and removal of biofilms. PMID:25043896

  18. Suppressed neuroendocrine stress response in depressed women on job-stress related long-term sick-leave: A stable marker potentially suggestive of pre-existing vulnerability

    PubMed Central

    Wahlberg, Kristina; Ghatan, Per Hamid; Modell, Sieglinde; Nygren, Åke; Ingvar, Martin; Åsberg, Marie; Heilig, Markus

    2009-01-01

    Background We recently reported marked hyporeactivity of the hypothalamo-pituitary-adrenal (HPA) axis in depressed females on job-stress related long-term sick-leave (LTSL). This unexpected finding prompted the question whether HPA-axis hypofunction in this group results from stress exposure, or reflects pre-existing vulnerability. Here, as a first step toward addressing this question, we assessed temporal stability of HPA-axis reactivity in these subjects. Methods We used the combined dexamethasone/corticotropin-releasing hormone (DEX-CRH) test to retest HPA-axis reactivity in 29 patients and 27 controls after 12 months follow-up. Clinical status and cognitive performance was also retested. Results Despite marked clinical improvement, and normalization of initially observed impairments in attention and working memory, marked HPA-axis hyporeactivity persisted in patients. A high test – retest correlation was found both at the level of ACTH (R=0.85, p<0.001) and cortisol (R=0.76, p<0.001) responses. Conclusions Hyporeactivity of the HPA was stable over 12 months in LTSL subjects, independently of clinical improvement and normalized cognitive function. The stability of this response over time suggests that decreased DEX-CRH responses in this group may be a trait rather than a state marker. This finding is compatible with a hypothesis that HPA-axis hyporeactivity may reflect a pre-existing vulnerability in these subjects. PMID:19058782

  19. Increased CD8+ T cell memory to concurrent infection at the expense of increased erosion of pre-existing memory: the paradoxical role of IL-15.

    PubMed

    Chapdelaine, Yvan; Smith, Dean K; Pedras-Vasconcelos, Joao A; Krishnan, Lakshmi; Sad, Subash

    2003-11-15

    The use of cytokines during vaccination, particularly IL-15, is being considered due to the unique ability of IL-15 to enhance the proliferation of memory CD8(+) T cells. However, as homeostatic mechanisms limit excessive lymphocyte expansion, we addressed the consequences of this enhancement of T cell memory by IL-15. Infection of mice with either recombinant Mycobacterium bovis (BCG) expressing IL-15 (BCG-IL-15) or BCG and purified IL-15 resulted in an increased CD44, IL-2Rbeta expression and increased frequency of IFN-gamma-secreting CD8(+) T cells. Surprisingly, the enhancement of memory to concurrent infection by IL-15 exacerbated the attrition of pre-existing memory. Infection of mice with Listeria monocytogenes expressing OVA resulted in potent OVA(257-264)-specific CD8(+) T cell memory, and a challenge of these mice with either BCG-IL-15 or BCG and purified IL-15 resulted in an increased erosion of OVA(257-264)-specific CD8(+) T cell memory, relative to BCG. Enhancement in the erosion of OVA-specific CD8(+) T cell memory by BCG-IL-15 resulted in a consequently greater impairment in protection against a challenge with OVA-expressing tumor cells. We thus raise important questions regarding vaccinations that are aimed at maximizing T cell memory without considering the impact on pre-existing T cell memory. PMID:14607951

  20. Pre-existing immunity to norovirus GII-4 virus-like particles does not impair de novo immune responses to norovirus GII-12 genotype.

    PubMed

    Tamminen, Kirsi; Huhti, Leena; Vesikari, Timo; Blazevic, Vesna

    2013-04-01

    Noroviruses (NoVs) are one of the leading causes of acute nonbacterial gastroenteritis in humans of all ages. In the 1990s, NoV genotype GII-4 became responsible for the majority of NoV sporadic gastroenteritis cases and outbreaks worldwide. Vaccine development against NoV GII-4 is underway. At the same time, there is concern of new emerging NoV genotypes, such as GII-12, which has been recently associated with increasing numbers of NoV outbreaks worldwide. The specific question is whether type-specific pre-existing immunity to NoV GII-4 might impair cognate immune response induced by new viral infections or vaccines. Using GII-4 and GII-12 virus-like particles, we tested the impact of the immunity generated against NoV GII-4 on de novo antibody responses to GII-12 in mice. We found that pre-existing immunity to NoV GII-4 did not impair de novo immune response to the novel antigen, therefore suggesting lack of original antigenic sin (OAS). PMID:23438469

  1. Reduction in Noise-Induced Functional Loss of the Cochleae in Mice with Pre-Existing Cochlear Dysfunction Due to Genetic Interference of Prestin

    PubMed Central

    Cai, Qunfeng; Wang, Bo; Coling, Donald; Zuo, Jian; Fang, Jie; Yang, Shiming; Vera, Krystal; Hu, Bo Hua

    2014-01-01

    Various cochlear pathologies, such as acoustic trauma, ototoxicity and age-related degeneration, cause hearing loss. These pre-existing hearing losses can alter cochlear responses to subsequent acoustic overstimulation. So far, the knowledge on the impacts of pre-existing hearing loss caused by genetic alteration of cochlear genes is limited. Prestin is the motor protein expressed exclusively in outer hair cells in the mammalian cochlea. This motor protein contributes to outer hair cell motility. At present, it is not clear how the interference of prestin function affects cochlear responses to acoustic overstimulation. To address this question, a genetic model of prestin dysfunction in mice was created by inserting an internal ribosome entry site (IRES)-CreERT2-FRT-Neo-FRT cassette into the prestin locus after the stop codon. Homozygous mice exhibit a threshold elevation of auditory brainstem responses with large individual variation. These mice also display a threshold elevation and a shift of the input/output function of the distortion product otoacoustic emission, suggesting a reduction in outer hair cell function. The disruption of prestin function reduces the threshold shifts caused by exposure to a loud noise at 120 dB (sound pressure level) for 1 h. This reduction is positively correlated with the level of pre-noise cochlear dysfunction and is accompanied by a reduced change in Cdh1 expression, suggesting a reduction in molecular responses to the acoustic overstimulation. Together, these results suggest that prestin interference reduces cochlear stress responses to acoustic overstimulation. PMID:25486270

  2. C/EBPα Activates Pre-existing and De Novo Macrophage Enhancers during Induced Pre-B Cell Transdifferentiation and Myelopoiesis

    PubMed Central

    van Oevelen, Chris; Collombet, Samuel; Vicent, Guillermo; Hoogenkamp, Maarten; Lepoivre, Cyrille; Badeaux, Aimee; Bussmann, Lars; Sardina, Jose Luis; Thieffry, Denis; Beato, Miguel; Shi, Yang; Bonifer, Constanze; Graf, Thomas

    2015-01-01

    Summary Transcription-factor-induced somatic cell conversions are highly relevant for both basic and clinical research yet their mechanism is not fully understood and it is unclear whether they reflect normal differentiation processes. Here we show that during pre-B-cell-to-macrophage transdifferentiation, C/EBPα binds to two types of myeloid enhancers in B cells: pre-existing enhancers that are bound by PU.1, providing a platform for incoming C/EBPα; and de novo enhancers that are targeted by C/EBPα, acting as a pioneer factor for subsequent binding by PU.1. The order of factor binding dictates the upregulation kinetics of nearby genes. Pre-existing enhancers are broadly active throughout the hematopoietic lineage tree, including B cells. In contrast, de novo enhancers are silent in most cell types except in myeloid cells where they become activated by C/EBP factors. Our data suggest that C/EBPα recapitulates physiological developmental processes by short-circuiting two macrophage enhancer pathways in pre-B cells. PMID:26235892

  3. Pre-existing oblique transfer zones and transfer/transform relationships in continental margins: New insights from the southeastern Gulf of Aden, Socotra Island, Yemen

    NASA Astrophysics Data System (ADS)

    Bellahsen, N.; Leroy, S.; Autin, J.; Razin, P.; d'Acremont, E.; Sloan, H.; Pik, R.; Ahmed, A.; Khanbari, K.

    2013-11-01

    Transfer zones are ubiquitous features in continental rifts and margins, as are transform faults in oceanic lithosphere. Here, we present a structural study of the Hadibo Transfer Zone (HTZ), located in Socotra Island (Yemen) in the southeastern Gulf of Aden. There, we interpret this continental transfer fault zone to represent a reactivated pre-existing structure. Its trend is oblique to the direction of divergence and it has been active from the early up to the latest stages of rifting. One of the main oceanic fracture zones (FZ), the Hadibo-Sharbithat FZ, is aligned with and appears to be an extension of the HTZ and is probably genetically linked to it. Comparing this setting with observations from other Afro-Arabian rifts as well as with passive margins worldwide, it appears that many continental transfer zones are reactivated pre-existing structures, oblique to divergence. We therefore establish a classification system for oceanic FZ based upon their relationship with syn-rift structures. Type 1 FZ form at syn-rift structures and are late syn-rift to early syn-OCT. Type 2 FZ form during the OCT formation and Type 3 FZ form within the oceanic domain, after the oceanic spreading onset. The latter are controlled by far-field forces, magmatic processes, spreading rates, and oceanic crust rheology.

  4. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Condition of participation: Special medical record requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS...

  5. If You Pop Over There: A Corpus-based Study of Conditionals in Medical Discourse.

    ERIC Educational Resources Information Center

    Ferguson, Gibson

    2001-01-01

    Focuses on if conditionals in medical discourse. Three genres are examined: research articles, journal editorials, and doctor-patient consultations. Analyzes a variety of formal, semantic, and pragmatic aspects of conditionals across genres. Concludes with brief reflections on pedagogic implications. (Author/VWL)

  6. Effects of pre-existing ice crystals on cirrus clouds and comparison between different ice nucleation parameterizations with the Community Atmosphere Model (CAM5)

    NASA Astrophysics Data System (ADS)

    Shi, X.; Liu, X.; Zhang, K.

    2015-02-01

    In order to improve the treatment of ice nucleation in a more realistic manner in the Community Atmosphere Model version 5.3 (CAM5.3), the effects of pre-existing ice crystals on ice nucleation in cirrus clouds are considered. In addition, by considering the in-cloud variability in ice saturation ratio, homogeneous nucleation takes place spatially only in a portion of the cirrus cloud rather than in the whole area of the cirrus cloud. Compared to observations, the ice number concentrations and the probability distributions of ice number concentration are both improved with the updated treatment. The pre-existing ice crystals significantly reduce ice number concentrations in cirrus clouds, especially at mid- to high latitudes in the upper troposphere (by a factor of ~10). Furthermore, the contribution of heterogeneous ice nucleation to cirrus ice crystal number increases considerably. Besides the default ice nucleation parameterization of Liu and Penner (2005, hereafter LP) in CAM5.3, two other ice nucleation parameterizations of Barahona and Nenes (2009, hereafter BN) and Kärcher et al. (2006, hereafter KL) are implemented in CAM5.3 for the comparison. In-cloud ice crystal number concentration, percentage contribution from heterogeneous ice nucleation to total ice crystal number, and pre-existing ice effects simulated by the three ice nucleation parameterizations have similar patterns in the simulations with present-day aerosol emissions. However, the change (present-day minus pre-industrial times) in global annual mean column ice number concentration from the KL parameterization (3.24 × 106 m-2) is less than that from the LP (8.46 × 106 m-2) and BN (5.62 × 106 m-2) parameterizations. As a result, the experiment using the KL parameterization predicts a much smaller anthropogenic aerosol long-wave indirect forcing (0.24 W m-2) than that using the LP (0.46 W m-2) and BN (0.39 W m-2) parameterizations.

  7. Self-Medication of Somatic and Psychiatric Conditions Using Botanical Marijuana.

    PubMed

    Osborn, Lawrence A; Lauritsen, Kirstin J; Cross, Nicole; Davis, Alan K; Rosenberg, Harold; Bonadio, Francis; Lang, Brent

    2015-01-01

    As a complement to research evaluating botanical marijuana as a medical therapy for various somatic and psychiatric conditions, there is a growing body of research assessing marijuana users' self-reports of the symptoms and conditions for which they use marijuana without a physician's recommendation. As part of two larger web-based surveys and one in-situ survey at an outdoor marijuana festival, we asked regular marijuana users if they consumed the drug without a physician's recommendation and, if so, to describe (or select from a checklist) the conditions for which they used marijuana as a medication. Participants reported using marijuana to self-medicate a wide variety of both somatic conditions (such as pain, diabetes, and irritable bowel syndrome) and psychiatric conditions (such as depression, anxiety, and insomnia). Because fewer than half of the American states, and only a few countries, allow physicians to recommend medicinal marijuana, these findings may be of interest to clinicians as they treat patients, to lawmakers and policymakers as they consider legislation allowing physicians to recommend botanical marijuana for somatic and psychiatric conditions, and to researchers evaluating conditions that individuals elect to self-medicate using botanical marijuana. PMID:26595140

  8. [The main ways of improvement of medical support of the Air Forces in modern conditions].

    PubMed

    Blaginin, A A; Grebeniuk, A N; Lizogub, I N

    2014-02-01

    Blaginin A.A., Grebenyuk A.N., Lizogub LN. - The main ways of improvement of medical support of the Air Forces in modern conditions. Aircrew conducting active hostilities suffers from the whole spectrum of factors and conditions of the combat situation. The main task for the medical service of the Air Force is to carry out preventive and curative action for aviation specialists who are responsible for the combat capability of aircraft formations. The medical service of the Air Force must have forces and facilities for planning, organization and implementation of the treatment of lightly wounded and sick aviation professionals with short periods of recovery, medical rehabilitation of aircrew qfter suffering injuries, diseases, sanatorium therapy of aircrew with partial failure of health, outpatient and inpatient medical examination aircrew - flight commissions, preventive rest of aviation specialists with symptoms of chronic fatigue. Should be trained aviation physicians, including both basic military medical education and in-depth study of the medical aspects of various fields of personnel of the Air Force. PMID:25046924

  9. Effects of pre-existing anti-carrier immunity and antigenic element multiplicity on efficacy of a modular virus-like particle vaccine.

    PubMed

    Chuan, Yap P; Rivera-Hernandez, Tania; Wibowo, Nani; Connors, Natalie K; Wu, Yang; Hughes, Fiona K; Lua, Linda H L; Middelberg, Anton P J

    2013-09-01

    Modularization of a peptide antigen for presentation on a microbially synthesized murine polyomavirus (MuPyV) virus-like particle (VLP) offers a new alternative for rapid and low-cost vaccine delivery at a global scale. In this approach, heterologous modules containing peptide antigenic elements are fused to and displayed on the VLP carrier, allowing enhancement of peptide immunogenicity via ordered and densely repeated presentation of the modules. This study addresses two key engineering questions pertaining to this platform, exploring the effects of (i) pre-existing carrier-specific immunity on modular VLP vaccine effectiveness and (ii) increase in the antigenic element number per VLP on peptide-specific immune response. These effects were studied in a mouse model and with modular MuPyV VLPs presenting a group A streptococcus (GAS) peptide antigen, J8i. The data presented here demonstrate that immunization with a modular VLP could induce high levels of J8i-specific antibodies despite a strong pre-existing anti-carrier immune response. Doubling of the J8i antigenic element number per VLP did not enhance J8i immunogenicity at a constant peptide dose. However, the strategy, when used in conjunction with increased VLP dose, could effectively increase the peptide dose up to 10-fold, leading to a significantly higher J8i-specific antibody titer. This study further supports feasibility of the MuPyV modular VLP vaccine platform by showing that, in the absence of adjuvant, modularized GAS antigenic peptide at a dose as low as 150 ng was sufficient to raise a high level of peptide-specific IgGs indicative of bactericidal activity. PMID:23532896

  10. Ectopic expression of select innexins in individual central neurons couples them to pre-existing neuronal or glial networks that express the same innexin.

    PubMed

    Firme, Constantine P; Natan, Ryan G; Yazdani, Neema; Macagno, Eduardo R; Baker, Michael W

    2012-10-10

    Fifteen of the 21 innexin (Inx) genes (Hve-inx) found in the genome of the medicinal leech, Hirudo verbana, are expressed in the CNS (Kandarian et al., 2012). Two are expressed pan-neuronally, while the others are restricted in their expression to small numbers of cells, in some cases reflecting the membership of known networks of electrically coupled and dye-coupled neurons or glial cells. We report here that when Hve-inx genes characteristic of discrete coupled networks were expressed ectopically in neurons known not to express them, the experimental cells were found to become dye coupled with the other cells in that network. Hve-inx6 is normally expressed by only three neurons in each ganglion, which form strongly dye-coupled electrical connections with each other [Shortening-Coupling interneuron (S-CI) network] (Muller and Scott, 1981; Dykes and Macagno, 2006). But when Hve-inx6 was ectopically expressed in a variety of central embryonic neurons, those cells became dye coupled with the S-CI network. Similarly, Hve-inx2 is normally uniquely expressed by the ganglion's large glial cells, but when it was ectopically expressed in different central neurons, they became dye coupled to the glial cells. In contrast, overexpression of the pan-neuronal Inx genes Hve-inx1 and Hve-inx14 did not yield any novel instances of dye coupling to pre-existent neuronal networks. These results reveal that expression of certain innexins is sufficient to couple individual neurons to pre-existing networks in the CNS. We propose that a primary determinant of selective neuronal connectivity and circuit formation in the leech is the surface expression of unique subsets of gap junctional proteins. PMID:23055495

  11. Fitness Conferred by BCR-ABL Kinase Domain Mutations Determines the Risk of Pre-Existing Resistance in Chronic Myeloid Leukemia

    PubMed Central

    Skaggs, Brian; Gorre, Mercedes; Sawyers, Charles L.; Michor, Franziska

    2011-01-01

    Chronic myeloid leukemia (CML) is the first human malignancy to be successfully treated with a small molecule inhibitor, imatinib, targeting a mutant oncoprotein (BCR-ABL). Despite its successes, acquired resistance to imatinib leads to reduced drug efficacy and frequent progression of disease. Understanding the characteristics of pre-existing resistant cells is important for evaluating the benefits of first-line combination therapy with second generation inhibitors. However, due to limitations of assay sensitivity, determining the existence and characteristics of resistant cell clones at the start of therapy is difficult. Here we combined a mathematical modeling approach using branching processes with experimental data on the fitness changes (i.e., changes in net reproductive rate) conferred by BCR-ABL kinase domain mutations to investigate the likelihood, composition, and diversity of pre-existing resistance. Furthermore, we studied the impact of these factors on the response to tyrosine kinase inhibitors. Our approach predicts that in most patients, there is at most one resistant clone present at the time of diagnosis of their disease. Interestingly, patients are no more likely to harbor the most aggressive, pan-resistant T315I mutation than any other resistance mutation; however, T315I cells on average establish larger-sized clones at the time of diagnosis. We established that for patients diagnosed late, the relative benefit of combination therapy over monotherapy with imatinib is significant, while this benefit is modest for patients with a typically early diagnosis time. These findings, after pre-clinical validation, will have implications for the clinical management of CML: we recommend that patients with advanced-phase disease be treated with combination therapy with at least two tyrosine kinase inhibitors. PMID:22140458

  12. Early colonoscopy confers survival benefits on colon cancer patients with pre-existing iron deficiency anemia: a nationwide population-based study.

    PubMed

    Teng, Chieh-Lin Jerry; Yu, Jui-Ting; Chen, Yi-Huei; Lin, Ching-Heng; Hwang, Wen-Li

    2014-01-01

    This study aimed to examine the prognostic significance of pre-existing iron deficiency anemia (IDA) and the benefits of early colonoscopy in patients with colon cancer, since these have not been clearly established to date. Using the Taiwanese National Health Insurance Research Database, we retrieved and retrospectively reviewed the records of patients aged ≥ 55 years who were diagnosed with colon cancer between 2000 and 2005. The patient cohort was divided into two groups: patients with (n = 1,260) or without (n = 15,912) an IDA diagnosis during ≤ 18 months preceding the date of colon cancer diagnosis. We found that diabetes (27.9% vs. 20.3%, p<0.0001), cardiovascular disease (61.6% vs. 54.7%, p<0.001), and chronic kidney disease (4.6% vs. 2.2%, p<0.0001) were more common among patients with IDA than among those without IDA. The median overall survival times for patients with IDA and those without IDA were 4.6 and 5.7 years, respectively (p = 0.002). Patients who underwent colonoscopy ≤ 30 days, 31-90, and ≥ 91 days after IDA diagnosis showed median overall survival times of 5.79, 4.43, and 4.04 years, respectively (p = 0.003). Delayed colonoscopy was an independent factor associated with poor overall survival (adjusted hazard ratio, 1.28; 95% confidence interval, 1.07-1.53; p = 0.01). In conclusion, colon cancer patients with IDA were more likely to experience comorbidities than were those without IDA. Pre-existing IDA was a poor prognostic factor in adult men and postmenopausal women who had colon cancer. Early colonoscopy could improve overall survival possibly by facilitating early diagnosis and treatment. PMID:24466209

  13. Manganese [III] Tetrakis [5,10,15,20]-Benzoic Acid Porphyrin Reduces Adiposity and Improves Insulin Action in Mice with Pre-Existing Obesity

    PubMed Central

    Brestoff, Jonathan R.; Brodsky, Tim; Sosinsky, Alexandra Z.; McLoughlin, Ryan; Stansky, Elena; Fussell, Leila; Sheppard, Aaron; DiSanto-Rose, Maria; Kershaw, Erin E.; Reynolds, Thomas H.

    2015-01-01

    The superoxide dismutase mimetic manganese [III] tetrakis [5,10,15,20]-benzoic acid porphyrin (MnTBAP) is a potent antioxidant compound that has been shown to limit weight gain during short-term high fat feeding without preventing insulin resistance. However, whether MnTBAP has therapeutic potential to treat pre-existing obesity and insulin resistance remains unknown. To investigate this, mice were treated with MnTBAP or vehicle during the last five weeks of a 24-week high fat diet (HFD) regimen. MnTBAP treatment significantly decreased body weight and reduced white adipose tissue (WAT) mass in mice fed a HFD and a low fat diet (LFD). The reduction in adiposity was associated with decreased caloric intake without significantly altering energy expenditure, indicating that MnTBAP decreases adiposity in part by modulating energy balance. MnTBAP treatment also improved insulin action in HFD-fed mice, a physiologic response that was associated with increased protein kinase B (PKB) phosphorylation and expression in muscle and WAT. Since MnTBAP is a metalloporphyrin molecule, we hypothesized that its ability to promote weight loss and improve insulin sensitivity was regulated by heme oxygenase-1 (HO-1), in a similar fashion as cobalt protoporphyrins. Despite MnTBAP treatment increasing HO-1 expression, administration of the potent HO-1 inhibitor tin mesoporphyrin (SnMP) did not block the ability of MnTBAP to alter caloric intake, adiposity, or insulin action, suggesting that MnTBAP influences these metabolic processes independent of HO-1. These data demonstrate that MnTBAP can ameliorate pre-existing obesity and improve insulin action by reducing caloric intake and increasing PKB phosphorylation and expression. PMID:26397111

  14. The dual PPARα/γ agonist tesaglitazar blocks progression of pre-existing atherosclerosis in APOE*3Leiden.CETP transgenic mice

    PubMed Central

    van der Hoorn, JWA; Jukema, JW; Havekes, LM; Lundholm, E; Camejo, G; Rensen, PCN; Princen, HMG

    2009-01-01

    Background and purpose: We have evaluated the effects of a peroxisome proliferator-activated receptor (PPAR)α/γ agonist on the progression of pre-existing atherosclerotic lesions in APOE*3Leiden.cholesteryl ester transfer protein (E3L.CETP) transgenic mice. Experimental approach E3L.CETP mice were fed a high-cholesterol diet for 11 weeks to induce atherosclerosis, followed by a low-cholesterol diet for 4 weeks to obtain a lower plasma total cholesterol level of ∼10 mmol·L−1. Mice were divided into three groups, which were either killed before (baseline) or after an 8 week treatment period with low-cholesterol diet without (control) or with the PPARα/γ agonist tesaglitazar (10 µg·kg−1·day−1). Atherosclerosis was assessed in the aortic root. Key results: Treatment with tesaglitazar significantly reduced plasma triglycerides, total cholesterol, CETP mass and CETP activity, and increased high-density lipoprotein-cholesterol. At baseline, substantial atherosclerosis had developed. During the 8 week low-cholesterol diet, atherosclerosis progressed in the control group with respect to lesion area and severity, whereas tesaglitazar inhibited lesion progression during this period. Tesaglitazar reduced vessel wall inflammation, as reflected by decreased monocyte adhesion and macrophage area, and modified lesions to a more stabilized phenotype, with increased smooth muscle cell content in the cap and collagen content. Conclusions and implications: Dual PPARα/γ agonism with tesaglitazar markedly improved the atherogenic triad by reducing triglycerides and very low-density lipoprotein-cholesterol and increasing high-density lipoprotein-cholesterol and additionally reduced cholesterol-induced vessel wall activation. These actions resulted in complete inhibition of progression and stabilization of pre-existing atherosclerotic lesions in E3L.CETP mice. PMID:19220285

  15. Enhancing the performance of multi-crystalline silicon photovoltaic module by encapsulating high efficient Eu3+ complex into its pre-existing EVA layer

    NASA Astrophysics Data System (ADS)

    Wang, Tongxin; Yu, Bo; Hu, Zhijia; Wang, Xin; Zou, Gang; Zhang, Qijin

    2013-03-01

    Luminescent down shifting (LDS) technique is one effective way to improve the poor response of multi-crystalline silicon (mc-Si) photovoltaic (PV) modules at short wavelength less than 400 nm. Eu3+ complexes are effective LDS species for PV modules due to their large stokes' shift and high luminescent quantum efficiency (LQE). Although Eu3+ complexes have been utilized in PV modules as LDS species widely, they have not been encapsulated into the pre-existing poly-ethylene vinyl acetate (EVA) layer of modules between glass and solar cell by now. The aim of our work is to enhance the performance of mc-Si PV modules by encapsulating high efficient Eu3+ complexes into their pre-existing EVA layers which would not modify the well-established manufacturing process for PV modules. In this work, two Eu3+ complexes with different absorption spectrum were encapsulated into the commercial EVA layer by soaking method for the first time and used in the encapsulation of mc-Si PV modules. Hereinto, Eu(TTA)3(TPPO)2 (TTA = 2-thenoyltrifluoroacetonate, TPPO = triphenylphosphine oxide) (EuTT) with absorption spectrum less than 400 nm and high LQE (0.73) improves the external quantum efficiency of mc-Si PV module from 0.05 to 0.20, which produces a 0.42% increases in its power conversion efficiency. In addition, it is found that the enhancement brought by Eu(TTA)3(TPPO)2 can reduce cost of power generated by mc-Si devices from US1/Wp to US0.98/Wp according to the calculation. Therefore, Eu(TTA)3(TPPO)2 as LDS species with high LQE and low cost is promising for enhancing the performance of mc-Si PV modules in practical application.

  16. Bovine adenoviral vector-based H5N1 influenza vaccine overcomes exceptionally high levels of pre-existing immunity against human adenovirus.

    PubMed

    Singh, Neetu; Pandey, Aseem; Jayashankar, Lakshmi; Mittal, Suresh K

    2008-05-01

    Because of the high prevalence of adenovirus (Ad) infections in humans, it is believed that pre-existing Ad-neutralizing antibodies (vector immunity) may negatively impact the immune response to vaccine antigens when delivered by human Ad (HAd) vectors. In order to evaluate whether bovine Ad subtype 3 (BAd3), a non-HAd vector, can effectively elude high levels of pre-existing vector immunity, naïve and HAd serotype 5 (HAd)-primed mice were immunized with BAd-H5HA [BAd3 vector expressing the hemagglutinin (HA) gene from H5N1 influenza virus]. Even in the presence of very high levels of HAd-specific neutralizing antibody, no significant reductions in HA-specific humoral and cell-mediated immune (CMI) responses were observed in HAd-primed mice immunized with BAd-H5HA. In naïve mice immunized with HAd-H5HA (HAd5 vector expressing H5N1 HA) and boosted with BAd-H5HA, the humoral responses elicited were significantly higher (P < 0.01) than with either HAd-H5HA or BAd-H5HA alone, while the CMI responses were comparable in the groups. This finding underlines the importance of a heterologous prime-boost approach for achieving an enhanced immune response. The immunization of naïve or HAd-primed mice with BAd-H5HA bestowed full protection from morbidity and mortality following a potentially lethal challenge with A/Hong Kong/483/97. These results demonstrate the importance of BAd vectors as an alternate or supplement to HAd vectors for influenza pandemic preparedness. PMID:18301400

  17. Pre-existing vector immunity does not prevent replication deficient adenovirus from inducing efficient CD8 T-cell memory and recall responses.

    PubMed

    Steffensen, Maria Abildgaard; Jensen, Benjamin Anderschou Holbech; Holst, Peter Johannes; Bassi, Maria Rosaria; Christensen, Jan Pravsgaard; Thomsen, Allan Randrup

    2012-01-01

    Adenoviral vectors have shown a great potential for vaccine development due to their inherent ability to induce potent and protective CD8 T-cell responses. However, a critical issue regarding the use of these vectors is the existence of inhibitory immunity against the most commonly used Ad5 vector in a large part of the human population. We have recently developed an improved adenoviral vaccine vector system in which the vector expresses the transgene tethered to the MHC class II associated invariant chain (Ii). To further evaluate the potential of this system, the concept of pre-existing inhibitory immunity to adenoviral vectors was revisited to investigate whether the inhibition previously seen with the Ad5 vector also applied to the optimized vector system. We found this to be the case, and antibodies dominated as the mechanism underlying inhibitory vector immunity. However, presence of CD8 T cells directed against epitopes in the adenoviral vector seemed to correlate with repression of the induced response in re-vaccinated B-cell deficient mice. More importantly, despite a repressed primary effector CD8 T-cell response in Ad5-immune animals subjected to vaccination, memory T cells were generated that provided the foundation for an efficient recall response and protection upon subsequent viral challenge. Furthermore, the transgene specific response could be efficiently boosted by homologous re-immunization. Taken together, these studies indicate that adenoviral vectors can be used to induce efficient CD8 T-cell memory even in individuals with pre-existing vector immunity. PMID:22514686

  18. Temporary Increases in Problem Behavior and Sleep Disruption Following Decreases in Medication: A Descriptive Analysis of Conditional Rates

    ERIC Educational Resources Information Center

    Rapp, John T.; Swanson, Greg; Dornbusch, Kaitlin

    2007-01-01

    Conditional rates of problem behavior for weeks that followed medication decreases and no medication changes were compared for 12 individuals who exhibited severe problem behavior (e.g., self-injury, aggression). The results indicate that conditional rates of problem behavior were higher following medication decreases than following no changes in…

  19. Prevalence of Chronic Medical Conditions among Inmates in the Texas Prison System

    PubMed Central

    Baillargeon, Jacques G.; Pruitt, Sandi L.; Pulvino, John S.; Paar, David P.; Kelley, Michael F.

    2010-01-01

    Given the rapid growth and aging of the US prison population in recent years, the disease profile and health care needs of inmates portend to have far-reaching public health implications. Although numerous studies have examined infectious disease prevalence and treatment in incarcerated populations, little is known about the prevalence of non-infectious chronic medical conditions in US prison populations. The purpose of this study was to estimate the prevalence of selected non-infectious chronic medical conditions among inmates in the Texas prison system. The study population consisted of the total census of inmates who were incarcerated in the Texas Department of Criminal Justice for any duration from September 1, 2006 through August 31, 2007 (N = 234,031). Information on medical diagnoses was obtained from a system-wide electronic medical record system. Overall crude prevalence estimates for the selected conditions were as follows: hypertension, 18.8%; asthma, 5.4%; diabetes, 4.2%; ischemic heart disease, 1.7%; chronic obstructive pulmonary disease, 0.96%; and cerebrovascular disease, 0.23%. Nearly one quarter (24.5%) of the study population had at least one of the selected conditions. Except for asthma, crude prevalence estimates of the selected conditions increased monotonically with age. Nearly two thirds (64.6%) of inmates who were ≥55 years of age had at least one of the selected conditions. Except for diabetes, crude prevalence estimates for the selected conditions were lower among Hispanic inmates than among non-Hispanic White inmates and African American inmates. Although age-standardized prevalence estimates for the selected conditions did not appear to exceed age-standardized estimates from the US general population, a large number of inmates were affected by one or more of these conditions. As the prison population continues to grow and to age, the burden of these conditions on correctional and community health care systems can be expected to increase. PMID:20393884

  20. 42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... that meets the Medicare DMEPOS Supplier Quality and Accreditation Standards at 42 CFR 424.57. ..., medical supplies, and durable medical equipment. 418.106 Section 418.106 Public Health CENTERS FOR...: Drugs and biologicals, medical supplies, and durable medical equipment. Medical supplies and...

  1. Epidemiology of Autism Spectrum Disorder in Portugal: Prevalence, Clinical Characterization, and Medical Conditions

    ERIC Educational Resources Information Center

    Oliveira, Guiomar; Ataide, Assuncao; Marques, Carla; Miguel, Teresa S.; Coutinho, Ana Margarida; Mota-Vieira, Luisa; Goncalves, Esmeralda; Lopes, Nazare Mendes; Rodrigues, Vitor; Carmona da Mota, Henrique; Vicente, Astrid Moura

    2007-01-01

    The objective of this study was to estimate the prevalence of autistic spectrum disorder (ASD) and identify its clinical characterization, and medical conditions in a paediatric population in Portugal. A school survey was conducted in elementary schools, targeting 332 808 school-aged children in the mainland and 10 910 in the Azores islands.

  2. Coping and Depressive Symptoms in Adolescents with a Chronic Medical Condition: A Search for Intervention Targets

    ERIC Educational Resources Information Center

    Kraaij, Vivian; Garnefski, Nadia

    2012-01-01

    The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for adolescents with a chronic medical condition. A wide range of coping techniques were studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 176 adolescents participated. They were…

  3. Academic and Family Conditions Associated with Intrinsic Academic Motivation in Japanese Medical Students: A Pilot Study

    ERIC Educational Resources Information Center

    Tanaka, Masaaki; Watanabea, Yasuyoshi

    2012-01-01

    Objective: Intrinsic academic motivation is one of the most important psychological concepts in education, and it is related to academic outcomes in medical students. This study examined the relationships between academic and family conditions and intrinsic academic motivation. Design: Cross-sectional design. Setting: The study group consisted of…

  4. Epidemiology of Autism Spectrum Disorder in Portugal: Prevalence, Clinical Characterization, and Medical Conditions

    ERIC Educational Resources Information Center

    Oliveira, Guiomar; Ataide, Assuncao; Marques, Carla; Miguel, Teresa S.; Coutinho, Ana Margarida; Mota-Vieira, Luisa; Goncalves, Esmeralda; Lopes, Nazare Mendes; Rodrigues, Vitor; Carmona da Mota, Henrique; Vicente, Astrid Moura

    2007-01-01

    The objective of this study was to estimate the prevalence of autistic spectrum disorder (ASD) and identify its clinical characterization, and medical conditions in a paediatric population in Portugal. A school survey was conducted in elementary schools, targeting 332 808 school-aged children in the mainland and 10 910 in the Azores islands.…

  5. Evaluation of treatment effects in obese children with co-morbid medical or psychiatric conditions

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The need for effective treatments for pediatric overweight is well known. We evaluated the applicability of an evidence-based treatment in an applied clinic setting that includes children with severe obesity and comorbid medical or psychiatric conditions. Forty-eight overweight children and their fa...

  6. Comorbid conditions are associated with healthcare utilization, medical charges and mortality of patients with rheumatoid arthritis.

    PubMed

    Han, Guang-Ming; Han, Xiao-Feng

    2016-06-01

    This study aims to examine the associations between comorbid conditions and healthcare utilization, medical charges, or mortality of patients with rheumatoid arthritis (RA). Nebraska state emergency department (ED) discharge, hospital discharge, and death certificate data from 2007 to 2012 were used to study the comorbid conditions of patients with RA. RA was defined using the standard International Classification of Diseases (ICD-9-CM 714 or ICD-10-CM M05, M06, and M08). There were more comorbid conditions in patients with RA than in patients without RA. Comorbid conditions were majorly related to healthcare utilization and mortality of patients with RA. In addition to injury, fracture, sprains, and strains, symptoms of cardiovascular and digestive systems, respiratory infection, and chronic obstructive pulmonary disease (COPD) were common comorbid conditions for ED visits. In addition to joint replacement and fracture, infections, COPD and cardiovascular comorbidities were common comorbid conditions for hospitalizations. Cardiovascular, cerebrovascular, and respiratory comorbidities, dementia, malignant neoplasm, and diabetes mellitus were common comorbid conditions for deaths of patients with RA. In addition, the numbers of comorbid conditions were significantly associated with the length of hospital stay and hospital charges for patients with RA. The findings in this study indicated that comorbid conditions are associated with healthcare utilization, medical charges, and mortality of patients with RA. PMID:27106546

  7. MANAGEMENT OF ACUTE SPORTS INJURIES AND MEDICAL CONDITIONS BY PHYSICAL THERAPISTS: ASSESSMENT VIA CASE SCENARIOS

    PubMed Central

    Karges, Joy Renae; Salsbery, Mitchell A.; Smith, Danna; Stanley, Erica J.

    2011-01-01

    Purpose/Background: Some physical therapists (PTs) provide services at sporting events, but there are limited studies investigating whether PTs are properly prepared to provide such services. The purpose of this study was to assess acute sports injury and medical condition management decision-making skills of PTs. Methods: A Web-based survey presented 17 case scenarios related to acute medical conditions and sport injuries. PTs from the Sports Physical Therapy Section of The American Physical Therapy Association were e-mailed a cover letter/Web link to the survey and invited to participate over a 30-day period. Data were analyzed using SPSS 18.0. Results: A total of 411 of 5158 PTs who were members of the Sports Physical Therapy Association in 2009 and had valid e-mail addresses completed the survey, of which 389 (7.5%) were appropriate for analysis. Over 75.0% of respondents felt “prepared” or “somewhat prepared” to provide immediate care for 13 out of 16 medical conditions, with seizures, spinal cord injuries, and internal organ injuries having the lowest percentages. Over 75.0% of the respondents made “appropriate” or “overly cautious” decisions for 11 of the 17 acute injury or medical condition cases. Conclusions: Results of the current study indicate that PTs felt more “prepared” and tended to make “appropriate” return to play decisions on the acute sports injury and medical condition case studies more often than coaches who participated in a similar study, regardless of level of importance of the game or whether the athlete was a starter vs. non-starter. However, for PTs who plan on assisting at sporting events, additional preparation/education may be recommended, such as what is taught in an emergency responder course. PMID:21904695

  8. Pre-existing adenovirus immunity modifies a complex mixed Th1 and Th2 cytokine response to an Ad5/HIV-1 vaccine candidate in humans.

    PubMed

    Pine, Samuel O; Kublin, James G; Hammer, Scott M; Borgerding, Joleen; Huang, Yunda; Casimiro, Danilo R; McElrath, M Juliana

    2011-01-01

    The results of the recent Step Study highlight a need to clarify the effects of pre-existing natural immunity to a vaccine vector on vaccine-induced T-cell responses. To investigate this interaction, we examined the relationship between pre-existing Ad5 immunity and T-cell cytokine response profiles in healthy, HIV-uninfected recipients of MRKAd5 HIV-1 gag vaccine (HVTN 050, ClinicalTrials.gov #NCT00849732). Participants were grouped by baseline Ad5 neutralizing antibody titer as either Ad5-seronegative (titer ≤18; n = 36) or Ad5-seropositive (titer >200; n = 34). Samples from vaccine recipients were analyzed for immune responses to either HIV-1 Gag peptide pools or Ad5 empty vector using an ex vivo assay that measures thirty cytokines in the absence of long-term culture. The overall profiles of cytokine responses to Gag and Ad5 had similar combinations of induced Th1- and Th2-type cytokines, including IFN-γ, IL-2, TNF-α, IP-10, IL-13, and IL-10, although the Ad5-specific responses were uniformly higher than the Gag-specific responses (p<0.0001 for 9 out of 11 significantly expressed analytes). At the peak response time point, PBMC from Ad5-seronegative vaccinees secreted significantly more IP-10 in response to Gag (p = 0.008), and significantly more IP-10 (p = 0.0009), IL-2 (p = 0.006) and IL-10 (p = 0.05) in response to Ad5 empty vector than PBMC from Ad5-seropositive vaccinees. Additionally, similar responses to the Ad5 vector prior to vaccination were observed in almost all subjects, regardless of Ad5 neutralizing antibody status, and the levels of secreted IFN-γ, IL-10, IL-1Ra and GM-CSF were blunted following vaccination. The cytokine response profile of Gag-specific T cells mirrored the Ad5-specific response present in all subjects before vaccination, and included a number of Th1- and Th2-associated cytokines not routinely assessed in current vaccine trials, such as IP-10, IL-10, IL-13, and GM-CSF. Together, these results suggest that vector-specific humoral responses may reduce vaccine-induced T-cell responses by previously undetected mechanisms. PMID:21533229

  9. Induced and pre-existing anti-polyethylene glycol antibody in a trial of every 3-week dosing of pegloticase for refractory gout, including in organ transplant recipients

    PubMed Central

    2014-01-01

    Introduction Pegloticase, a PEGylated recombinant porcine uricase, is approved for treating refractory gout at a dose of 8 mg intravenous (IV) every 2 weeks. However, during phase 1 testing, pharmacokinetics supported less frequent dosing. Also, single doses of pegloticase unexpectedly induced antibodies (Ab) that bound to polyethylene glycol (PEG). We have conducted a phase 2 trial to evaluate every 3-week dosing, and to further define the Ab response to pegloticase. Organ transplant recipients were included, as they are prone to severe gout that is difficult to manage, and because treatment to prevent graft rejection might influence the immune response to pegloticase. Methods Plasma uricase activity (pUox), urate concentration (pUA), and clinical response were monitored during up to 5 infusions in 30 patients, including 7 organ transplant recipients. Depending on whether pUA <6 mg/dL was achieved and maintained, patients were classified as non (NR), persistent (PR), or transient (TR) responders. Ab to pegloticase and 10 kDa mPEG were monitored by enzyme linked immunosorbent assay and specificity was further defined. Results We observed 17 PR, 12 TR, and 1 NR; 21 patients (16 PR, 5 TR) received all 5 infusions. Over the 15-week trial, pUA in PR averaged 1.0 ± 0.4 mg/dL; T½ for pUox was approximately 13 days, and area under the curve after dose 5 was approximately 30% higher than after dose 1. PR showed clinical benefit and in some, tophi resolved. In 11 of 12 TR, pUox fell rapidly and hyperuricemia recurred before dose 2. In all TR and NR, loss of response to pegloticase was accompanied by Ab to PEG, which was pre-existing in half of those who had no prior exposure to pegloticase. No PR, and 1 one out of 7 organ transplant recipients, had a sustained Ab response to pegloticase. Conclusions Every 3-week dosing is effective and may enhance the utility of pegloticase for treating refractory gout. Ab to PEG, which were pre-existing or induced by treatment, caused rapid loss of efficacy and increased the risk of infusion reactions. Organ transplant recipients can benefit from pegloticase, and may be less prone than non-recipients to developing anti-PEG Ab. Investigation of immunosuppressive strategies to minimize anti-PEG Ab is warranted. Trial registration ClincalTrials.gov identifier: NCT00111657 PMID:24602182

  10. Rare medical conditions and suggestive past-life memories: a case report and literature review.

    PubMed

    Lucchetti, Giancarlo; dos Santos Camargo, Luizete; Lucchetti, Alessandra L G; Schwartz, Gary E; Nasri, Fabio

    2013-01-01

    We aim to report the case of a 38-year-old male with suggestive past-life memories during a regression session and to show how these memories were related to unusual medical conditions: (1) isolated obstruction of the right coronary artery in a young patient, (2) omental infarction, and (3) right aortic arch with isolation of the left subclavian artery. These conditions were related to the following suggestive past-life memories: (1) a priest who committed suicide with a crucifix nailed to his chest and (2) a medieval weapon (skull flail) hitting his cervical and left back region. There was an intriguing relation between the patient's suggestive past-life memories and rare medical conditions. In this article, the authors highlight possible explanations, rarity of findings, and similarities/differences from previous cases and potential pitfalls in this area. PMID:24199777

  11. Twenty-five additional cases of trisomy 9 mosaic: Birth information, medical conditions, and developmental status.

    PubMed

    Bruns, Deborah A; Campbell, Emily

    2015-05-01

    Limited literature exists on children and adults diagnosed with the mosaic form of trisomy 9. Data from the Tracking Rare Incidence Syndromes (TRIS) project has provided physical characteristics and medical conditions for 14 individuals. This article provides TRIS Survey results of 25 additional cases at two data points (birth and survey completion) as well as developmental status. Results confirmed a number of phenotypic features and medical conditions. In addition, a number of cardiac anomalies were reported along with feeding and respiratory difficulties in the immediate postnatal period. In addition, developmental status data indicated a range in functioning level up to skills in the 36 and 48-month range. Strengths were also noted across the sample in language and communication, fine motor and social-emotional development. Implications for professionals caring for children with this genetic condition are offered. PMID:25755087

  12. Chronic Medical Conditions and Wishes to Die Among Older Primary Care Patients*

    PubMed Central

    Kim, Yeowon A.; Bogner, Hillary R.; Brown, Gregory K.; Gallo, Joseph J.

    2010-01-01

    Objective To determine the prevalence of wishes to die and the medical correlates of wishes to die among primary care patients aged 65 years and older. Method Three-hundred and fifty-five adults with and without significant depressive symptoms who were screened in primary care offices and invited to participate completed a baseline in-home assessment. Participants were interviewed using standardized measures of medical conditions, functional status, and psychological status. Thoughts of death and wishes to die were assessed with standard questions from the Composite International Diagnostic Interview (CIDI) Depression Section. Results The weighted point prevalence of thoughts of death was 9.7% and 6.1% for the wish to die. Several medical conditions were associated with a wish to die, for example myocardial infarction (MI). In multivariate models that adjusted for potentially influential characteristics, the association between a history of MI and the wish to die remained statistically significant (odds ratio (OR) = 3.32, 95% confidence interval (CI) (1.26, 8.75). Conclusions Thoughts of death and a wish to die are common in older primary care patients and were more likely among persons with chronic medical conditions. Persons with a history of myocardial infarction may be particularly vulnerable to a wish to die. PMID:17154148

  13. [The working conditions of medical personnel handling the SMTA brand copper amalgam].

    PubMed

    Chuev, V P; Pobochina, V V; Chechina, G N

    1994-01-01

    To assess the working conditions of medical staff the authors compared mercury vapor concentrations released during manipulations with various copper amalgams, TMAC-01 tableted copper amalgam manufactured by Nikitiv Mercury Plant, its foreign copper analog manufactured be "Becht" (Germany), and a new CMTA capsulated copper amalgam. Use of CMTA copper amalgam was found not hazardous for medical staff provided sanitary and hygienic regulations were adhered to. Moreover, mercury vapor concentrations released during work allow its use in rooms without ventilation cabinets, whereas tableted copper amalgams TMAC-01 and Becht may be used only in dentistry rooms equipped with such cabinets. PMID:7846722

  14. College Health Service Capacity to Support Youth With Chronic Medical Conditions

    PubMed Central

    Lawlor, Katherine; Scherer, Emily A.; Kelemen, Skyler; Weitzman, Elissa R.

    2014-01-01

    BACKGROUND AND OBJECTIVE: Twenty percent of US youth have a chronic medical condition and many attend college. Guidelines for transition from pediatric to adult care do not address college health services, and little is known about their capacity to identify, support, and provide care for these youth. The objective of this study was to describe college health center policies, practices, and resources for youth with chronic medical conditions (YCMC). METHODS: Survey of medical directors from health centers of a representative sample of 200 4-year US colleges with ≥400 enrolled undergraduate students. Patterns of identification, management, and support for youth with a general chronic medical condition and with asthma, diabetes, and depression, were investigated; χ2 and Fisher exact tests were used to ascertain differences by institutional demographics. RESULTS: Directors at 153 institutions completed the survey (76.5% response rate). Overall, 42% of schools had no system to identify YCMC. However, almost a third (31%) did identify and add to a registry of incoming YCMC on review of medical history, more likely in private (P < .001) and small (<5000 students, P = .002) colleges; 24% of health centers contacted YCMC to check-in/make initial appointments. Most institutions could manage asthma and depression (83% and 69%, respectively); 51% could manage diabetes on campus. CONCLUSIONS: Relatively few US colleges have health systems to identify and contact YCMC, although many centers have capacity to provide primary care and management of some conditions. Guidelines for transition should address policy and practices for pediatricians and colleges to enhance comanagement of affected youth. PMID:25349315

  15. Pre-existence and Persistence of Resistant Minority Hepatitis C Virus Variants in Genotype 1-Infected Patients Treated With Simeprevir/Peginterferon/Ribavirin

    PubMed Central

    Fevery, Bart; Thys, Kim; Van Eygen, Veerle; Verbinnen, Thierry; Van Rossem, Elizabeth; Buelens, Annemie; Aerssens, Jeroen; Witek, James; Picchio, Gaston; De Meyer, Sandra; Lenz, Oliver

    2016-01-01

    Background. The pre-existence of minority hepatitis C virus (HCV) variants and their impact on treatment outcome, as well as the persistence of emerging resistant variants posttreatment in patients failing treatment with simeprevir/peginterferon/ribavirin (SMV/PR), were assessed by deep sequencing (DS). Methods. Population sequencing (PS) and Illumina DS were performed on HCV genotype 1 isolates from patients treated with SMV/PR in Phase 2b (PILLAR [NCT00882908] and ASPIRE [NCT00980330]) and Phase 3 (QUEST-1 [NCT01289782], QUEST-2 [NCT01290679], and PROMISE [NCT01281839]) trials. Results. Minority polymorphisms (ie, detected pretreatment by DS only) reducing SMV activity in vitro were uncommon (3.6%, 19 of 534 patients). These SMV-resistant minority polymorphisms were detected in similar proportions of patients achieving (3.7%) and not achieving (3.3%) sustained virologic response with SMV/PR and generally did not emerge as major variants at time of failure. SMV-resistant variants emerging at time of failure were no longer detected at end of study in 69.3% and 52.0% of the patients by PS and DS, respectively. Conclusions. Minority polymorphisms did not impact outcome of SMV/PR treatment. The majority of emerging variants that became undetectable at end of study by PS were also undetectable by DS. These results suggest no added value of DS for clinical usage of SMV. PMID:27186579

  16. Pre-existing anti-Salmonella vector immunity prevents the development of protective antigen-specific CD8 T-cell frequencies against murine listeriosis.

    PubMed

    Sevil Domènech, Victòria E; Panthel, Klaus; Meinel, Katrin M; Winter, Sebastian E; Rüssmann, Holger

    2007-10-01

    Our laboratory has focused its research on the use of the type III secretion system of Salmonella enterica serovar Typhimurium to translocate heterologous antigens directly into the cytosol of antigen-presenting cells. We have previously reported that the single oral immunization of mice with a recombinant Salmonella aroA/sptP mutant strain expressing the translocated Yersinia outer protein E fused to the immunodominant antigen p60 from Listeria monocytogenes in a type III-mediated fashion results in the efficient induction of p60-specific CD8 T cells and confers protection against a lethal Listeria challenge infection. In the present study, we determined whether pre-existing anti-Salmonella vector immunity influences the induction of p60-specific CD8 T cells and modulates protective immunity against listeriosis after oral vaccination with recombinant Salmonella. After single oral immunization, the Salmonella aroA/sptP double mutant strain was found to colonize spleens of mice for 21days. In contrast, the period of colonization was significantly shortened to 6days due to anti-Salmonella vector immunity after second oral immunization. The latter scenario led to the induction of low-level frequencies of antigen-specific CD8 T cells. Compared to the significantly higher numbers of p60-specific T lymphocytes elicited after single oral immunization, the low amount of Listeria-specific CD8 T cells did not confer protection against listeriosis. PMID:17913544

  17. Influenza M2 virus-like particles confer a broader range of cross protection to the strain-specific pre-existing immunity.

    PubMed

    Kim, Min-Chul; Lee, Yu-Na; Hwang, Hye Suk; Lee, Young-Tae; Ko, Eun-Ju; Jung, Yu-Jin; Cho, Min Kyoung; Kim, Yu-Jin; Lee, Jong Seok; Ha, Suk-Hoon; Kang, Sang-Moo

    2014-10-01

    Immunity in humans with annual vaccination does not provide effective protection against antigenically distinct strains. As an approach to improve cross-protection in the presence of pre-existing strain-specific immunity, we investigated the efficacy of heterologous and heterosubtypic protection in previously vaccinated mice at earlier times after subsequent immunization with conserved-antigenic target influenza M2 ectodomain (M2e) virus-like particle vaccine (M2e5× VLP). Immunization of mice with H1N1 split vaccine induced virus specific antibodies to homologous influenza virus but did not provide heterosubtypic hemagglutination inhibiting antibody responses and cross-protection. However, subsequent M2e5× VLP immunization induced an M2e specific antibody response as well as interferon-γ (IFN-γ) producing cells in systemic and mucosal sites. Upon lethal challenge with H3N2 or H5N1 subtype influenza viruses, subsequently immunized mice with M2e5× VLP were well protected against heterosubtypic influenza viruses. These results provide evidence that non-seasonal immunization with M2e5× VLP, an experimental candidate for universal vaccine, is a promising approach for broadening the cross-protection even in the presence of strain-specific immunity. PMID:25171841

  18. Novel application of stereotactic ablative radiotherapy using CyberKnife® for early-stage renal cell carcinoma in patients with pre-existing chronic kidney disease: Initial clinical experiences

    PubMed Central

    LO, CHENG-HSIANG; HUANG, WEN-YEN; CHAO, HSING-LUNG; LIN, KUEN-TZE; JEN, YEE-MIN

    2014-01-01

    The treatment of renal cell carcinoma (RCC) in patients diagnosed with chronic kidney disease (CKD) requires particular care in order to preserve the remaining renal function. The present study aimed to investigate the potential of a novel nephron-sparing treatment, which is capable of targeting tumors embedded deep within tissues. The present study analyzed three patients, with pre-existing CKD and multiple comorbidities, who were successfully treated for stage I RCC using the CyberKnife® stereotactic ablative radiotherapy (SABR) system. The total prescribed dose was 40 Gy in five fractions administered over five consecutive days. Treatment efficiency was determined using computed tomography scans of the tumors and periodic measurements of the glomerular filtration rate over a period of 12–40 months. Local control, defined as a radiologically stable condition, was achieved in all patients. Lung metastasis was observed in one patient nine months after SABR; however, the side-effects were generally mild and self-limiting. One patient developed renal failure 26 months after SABR, while the severity of CKD was only marginally altered in the other two patients and renal failure did not occur. In conclusion, in the present study, SABR with CyberKnife® was observed to be well tolerated in the patients, with an acceptable acute toxicity effect. Therefore, it may represent a potential therapeutic option for patients with early-stage RCC who have previously been diagnosed with CKD, but for whom other nephron-sparing treatments are contraindicated. PMID:24959276

  19. Novel application of stereotactic ablative radiotherapy using CyberKnife(®) for early-stage renal cell carcinoma in patients with pre-existing chronic kidney disease: Initial clinical experiences.

    PubMed

    Lo, Cheng-Hsiang; Huang, Wen-Yen; Chao, Hsing-Lung; Lin, Kuen-Tze; Jen, Yee-Min

    2014-07-01

    The treatment of renal cell carcinoma (RCC) in patients diagnosed with chronic kidney disease (CKD) requires particular care in order to preserve the remaining renal function. The present study aimed to investigate the potential of a novel nephron-sparing treatment, which is capable of targeting tumors embedded deep within tissues. The present study analyzed three patients, with pre-existing CKD and multiple comorbidities, who were successfully treated for stage I RCC using the CyberKnife(®) stereotactic ablative radiotherapy (SABR) system. The total prescribed dose was 40 Gy in five fractions administered over five consecutive days. Treatment efficiency was determined using computed tomography scans of the tumors and periodic measurements of the glomerular filtration rate over a period of 12-40 months. Local control, defined as a radiologically stable condition, was achieved in all patients. Lung metastasis was observed in one patient nine months after SABR; however, the side-effects were generally mild and self-limiting. One patient developed renal failure 26 months after SABR, while the severity of CKD was only marginally altered in the other two patients and renal failure did not occur. In conclusion, in the present study, SABR with CyberKnife(®) was observed to be well tolerated in the patients, with an acceptable acute toxicity effect. Therefore, it may represent a potential therapeutic option for patients with early-stage RCC who have previously been diagnosed with CKD, but for whom other nephron-sparing treatments are contraindicated. PMID:24959276

  20. How prepared are medical students to diagnose and manage common ocular conditions

    PubMed Central

    Esparaz, Elizabeth Shanika; Binder, S. Bruce; Borges, Nicole J.

    2014-01-01

    It is essential that primary care physicians have a solid fund of knowledge of the diagnosis and management of common eye conditions as well as ocular emergencies, as management of these diseases commonly involves appropriate referral to an ophthalmologist. Thus, it is crucial to receive comprehensive clinical knowledge of ophthalmic disease in the primary care setting during medical school. This study investigated how well prepared medical students are to diagnose and manage common ocular conditions. The study used scores from a standardized 12-question quiz administered to fourth-year medical students (N = 97; 88% response rate) and second-year medical students (N = 97; 97% response rate). The quiz comprising diagnosis and referral management questions covered the most frequently tested ophthalmology topics on board exams and assessed students’ ability to recognize when referral to an ophthalmologist is appropriate. Fourth-year medical students had quiz scores ranging from 0%-94.5% with an average score of 68.7%. Second-year students had quiz scores ranging from 27.2%–86.4%, with an average score of 63.8%. Passing rate was 70%. Student’s t-test showed fourth-year students had a significantly higher quiz average (P = 0.003). In general, both classes performed better on diagnostic questions (fourth-year, 73.7%; second year, 65.8%) rather than on management questions (fourth-year, 64.8%; second year, 61.8%). Both second-year and fourth-year students on average fell short on passing the ophthalmology proficiency quiz, and in general students were more adept at diagnosing rather than managing ocular conditions and emergencies. PMID:25417863

  1. Medical conditions associated with driving cessation in community-dwelling, ambulatory elders.

    PubMed

    Campbell, M K; Bush, T L; Hale, W E

    1993-07-01

    The decision to stop driving leads to severe contraction of independence, and most localities do not curtail driving privileges in impaired elders. In a population of community-based, ambulatory individuals 70-96 years old, annual medical screening showed that 276 of 1,656 (16.7 +/- 1.8%) who reported driving regularly in the past do not currently drive. The cessation of driving behavior was examined in terms of specific medical conditions occurring within the past 5 years. Retired drivers were disproportionately female, and driving cessation risk rose with age. Age-sex-adjusted logistic regression found that six conditions explained about 50 percent of the decisions to stop driving: macular degeneration; retinal hemorrhage; any deficit in Activities of Daily Living; Parkinson's disease; stroke-related residual paralysis or weakness; and syncope. Strikingly, only 1.8 percent of those who stopped driving had ever had a license revoked; 58.7 percent reported voluntarily stopping; 31.9 percent gave health or medical reasons. Clearly, the decision to cede driving privileges is complex and not dependent solely on medical problems. PMID:8315247

  2. A Review of Therapeutic Uses of Mirtazapine in Psychiatric and Medical Conditions

    PubMed Central

    Voronovich, Zoya; Carley, Joseph A.

    2013-01-01

    Objective: To review the literature examining the use of mirtazapine with an emphasis on its therapeutic benefits for psychiatric patients with comorbid medical conditions. Data Sources: MEDLINE, PsycINFO, Global Health, and AGRICOLA were searched using the terms mirtazapine OR Remeron. Limits were English language, human, year 1980–2012, treatment and prevention, and therapy. Study Selection: Two hundred ninety-three articles were identified. Data Extraction: Identified articles were reviewed with a focus on indications and therapeutic benefits in patients with medical comorbidities. Results: Mirtazapine is an effective antidepressant with unique mechanisms of action. It is characterized by a relatively rapid onset of action, high response and remission rates, a favorable side-effect profile, and several unique therapeutic benefits over other antidepressants. Mirtazapine has also shown promise in treating some medical disorders, including neurologic conditions, and ameliorating some of the associated debilitating symptoms of weight loss, insomnia, and postoperative nausea and vomiting. Conclusions: Mirtazapine offers clinicians multiple therapeutic advantages especially when treating patients with comorbid medical illness. PMID:24511451

  3. Receipt of Prescription Contraception by Commercially Insured Women With Chronic Medical Conditions

    PubMed Central

    DeNoble, Anna E.; Hall, Kelli S.; Xu, Xiao; Zochowski, Melissa K.; Piehl, Kenneth; Dalton, Vanessa K.

    2014-01-01

    Objective To assess differences in receipt of prescription contraception among women with and without chronic medical conditions. Methods This observational study used 3 years of administrative claims records for insured women aged 2145 years who were enrolled in a commercial insurance company in Michigan between 2004 and 2009. Women were considered to have a chronic medical condition if they had at least two claims for one of the following conditions, in order of prevalence in our study population: hypertension, asthma, hypothyroidism, diabetes, obesity, rheumatoid arthritis, inflammatory bowel disease, or systemic lupus erythematosus. Our primary outcome was receipt of prescription contraception, defined by a pharmacy claim or diagnostic or procedural code. We used multivariable logistic regression to estimate the association of chronic condition status with the odds of receiving prescription contraception within 3 years, adjusting for age, community-level socioeconomic status, total outpatient visits, and cervical cancer screening. Results Of 11,649 women studied, 16.0% (n=1,862) had at least one of the chronic conditions we considered. Of those with a chronic condition, 33.5% (n=623) received prescription contraception during the 3-year study period compared to 41.1% (n=4,018) of those without a chronic condition (p<0.001). After adjusting for covariates, women with a chronic condition remained less likely than women without a chronic condition to have received prescription contraception (adjusted odds ratio=0.85; 95% CI 0.76, 0.96; p=0.010). Conclusion Despite a greater risk for adverse outcomes with an unplanned pregnancy, women with these chronic conditions were less likely to receive prescription contraception. PMID:24807345

  4. Epidemiology of autism spectrum disorder in Portugal: prevalence, clinical characterization, and medical conditions.

    PubMed

    Oliveira, Guiomar; Ataíde, Assunção; Marques, Carla; Miguel, Teresa S; Coutinho, Ana Margarida; Mota-Vieira, Luísa; Gonçalves, Esmeralda; Lopes, Nazaré Mendes; Rodrigues, Vitor; Carmona da Mota, Henrique; Vicente, Astrid Moura

    2007-10-01

    The objective of this study was to estimate the prevalence of autistic spectrum disorder (ASD) and identify its clinical characterization, and medical conditions in a paediatric population in Portugal. A school survey was conducted in elementary schools, targeting 332,808 school-aged children in the mainland and 10,910 in the Azores islands. Referred children were directly assessed using the Diagnostic and Statistical Manual of Mental Disorders (4th edn), the Autism Diagnostic Interview-Revised, and the Childhood Autism Rating Scale. Clinical history and a laboratory investigation was performed. In parallel, a systematic multi-source search of children known to have autism was carried out in a restricted region. The global prevalence of ASD per 10,000 was 9.2 in mainland, and 15.6 in the Azores, with intriguing regional differences. A diversity of associated medical conditions was documented in 20%, with an unexpectedly high rate of mitochondrial respiratory chain disorders. PMID:17880640

  5. Coping and depressive symptoms in adolescents with a chronic medical condition: a search for intervention targets.

    PubMed

    Kraaij, Vivian; Garnefski, Nadia

    2012-12-01

    The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for adolescents with a chronic medical condition. A wide range of coping techniques were studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 176 adolescents participated. They were contacted through social networking websites or Internet forums and through schools for children with a physical disability. Several cognitive and behavioral coping strategies and goal adjustment were found to be related to symptoms of depression. The cognitive coping strategies had the strongest influence on depressive symptoms. Especially self-blame, rumination and catastrophizing seemed to be important factors. If these findings can be confirmed, they could contribute to the focus and content of intervention programs for adolescents with a chronic medical condition. PMID:22771158

  6. The efficacy of sodium bicarbonate in preventing contrast-induced nephropathy in patients with pre-existing renal insufficiency: a meta-analysis

    PubMed Central

    Zhang, Bin; Liang, Long; Chen, Wenbo; Liang, Changhong; Zhang, Shuixing

    2015-01-01

    Objective The aim of this meta-analysis was to explore the efficacy of sodium bicarbonate in preventing contrast-induced nephropathy (CIN). Methods We searched PubMed, Medline and the Cochrane Library from 1 January 2004 to 1 August 2014. The effect estimate was expressed as a pooled OR with 95% CI, using the fixed-effects or random-effects model. Results 20 randomised controlled trials (n=4280) were identified. Hydration with sodium bicarbonate was associated with a significant decrease in CIN among patients with pre-existing renal insufficiency (OR 0.67, 95% CI 0.47 to 0.96; p=0.027). However, moderate heterogeneity was noted across trials (I2=48%; p=0.008). Subgroup analyses indicated a better effect of sodium bicarbonate in studies using low-osmolar (OR 0.59, 95% CI 0.37 to 0.93; p=0.024) compared with iso-osmolar contrast agents (OR 0.76, 95% CI 0.43 to 1.34; p=0.351). The odds of CIN with sodium bicarbonate were lower in studies including only patients undergoing emergency (OR 0.16, 95% CI 0.05 to 0.51; p=0.002) compared with elective procedures (OR 0.76, 95% CI 0.54 to 1.06; p=0.105). Sodium bicarbonate was more beneficial in patients given a bolus injection before procedures (OR 0.15, 95% CI 0.04 to 0.54; p=0.004) compared with continuous infusion (OR 0.75, 95% CI 0.53 to 1.05; p=0.091). Sodium bicarbonate plus N-acetylcysteine (OR 0.17, 95% CI 0.04 to 0.79; p=0.024) was better than sodium bicarbonate alone (OR 0.71, 95% CI 0.48 to 1.03; p=0.071). The effect of sodium bicarbonate was considered greater in papers published before (OR 0.19, 95% CI 0.09 to 0.41; p=0.000) compared with after 2008 (OR 0.85, 95% CI 0.62 to 1.16; p=0.302). However, no significant differences were found in mortality (OR 0.69, 95% CI 0.36 to 1.32; p=0.263) or requirement for dialysis (OR 1.08, 95% CI 0.52 to 2.25; p=0.841). Conclusions Sodium bicarbonate is effective in preventing CIN among patients with pre-existing renal insufficiency. However, it fails to lower the risks of dialysis and mortality and therefore cannot improve the clinical prognosis of patients with CIN. PMID:25783425

  7. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions

    PubMed Central

    Fattori, A.; Neri, L.; Aguglia, E.; Bellomo, A.; Bisogno, A.; Camerino, D.; Carpiniello, B.; Cassin, A.; Costa, G.; De Fazio, P.; Di Sciascio, G.; Favaretto, G.; Fraticelli, C.; Giannelli, R.; Leone, S.; Maniscalco, T.; Marchesi, C.; Mauri, M.; Mencacci, C.; Polselli, G.; Quartesan, R.; Risso, F.; Sciaretta, A.; Vaggi, M.; Vender, S.; Viora, U.

    2015-01-01

    Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants (N = 1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p < 0.01; SF-12 MCS: 59.4% versus 74.3%, p < 0.01). The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers' quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions. PMID:26557692

  8. Modeling pre-existing immunity to adenovirus in rodents: immunological requirements for successful development of a recombinant adenovirus serotype 5-based ebola vaccine.

    PubMed

    Choi, Jin Huk; Schafer, Stephen C; Zhang, Lihong; Juelich, Terry; Freiberg, Alexander N; Croyle, Maria A

    2013-09-01

    Pre-existing immunity (PEI) to human adenovirus serotype 5 (Ad5) worldwide is the primary limitation to routine clinical use of Ad5-based vectors in immunization platforms. Using systemic and mucosal PEI induction models in rodents (mice and guinea pigs), we assessed the influence of PEI on the type of adaptive immune response elicited by an Ad5-based vaccine for Ebola with respect to immunization route. Splenocytes isolated from vaccinated animals revealed that immunization by the same route in which PEI was induced significantly compromised Ebola Zaire glycoprotein (ZGP)-specific IFN-γ+ CD8+ T cells and ZGP-specific multifunctional CD8+ T cell populations. ZGP-specific IgG1 antibody levels were also significantly reduced and a sharp increase in serum anti-Ad5 neutralizing antibody (NAB) titers were noted following immunization. These immune parameters correlated with poor survival after lethal challenge with rodent-adapted Ebola Zaire virus (ZEBOV). Although the number of IFN-γ+ CD8+ T cells was reduced in animals given the vaccine by a different route from that used for PEI induction, the multifunctional CD8+ T cell response was not compromised. Survival rates in these groups were higher than when PEI was induced by the same route as immunization. These results suggest that antigen-specific multifunctional CD8(+) T cell and Th2 type antibody responses compromised by PEI to Ad5 are required for protection from Ebola. They also illustrate that methods for induction of PEI used in preclinical studies must be carefully evaluated for successful development of novel Ad5-based vaccines. PMID:23915419

  9. Mechanical Behavior of Brittle Rock-Like Specimens with Pre-existing Fissures Under Uniaxial Loading: Experimental Studies and Particle Mechanics Approach

    NASA Astrophysics Data System (ADS)

    Cao, Ri-hong; Cao, Ping; Lin, Hang; Pu, Cheng-zhi; Ou, Ke

    2016-03-01

    Joints and fissures with similar orientation or characteristics are common in natural rocks; the inclination and density of the fissures affect the mechanical properties and failure mechanism of the rock mass. However, the strength, crack coalescence pattern, and failure mode of rock specimens containing multi-fissures have not been studied comprehensively. In this paper, combining similar material testing and discrete element numerical method (PFC2D), the peak strength and failure characteristics of rock-like materials with multi-fissures are explored. Rock-like specimens were made of cement and sand and pre-existing fissures created by inserting steel shims into cement mortar paste and removing them during curing. The peak strength of multi-fissure specimens depends on the fissure angle α (which is measured counterclockwise from horizontal) and fissure number ( N f). Under uniaxial compressional loading, the peak strength increased with increasing α. The material strength was lowest for α = 25°, and highest for α = 90°. The influence of N f on the peak strength depended on α. For α = 25° and 45°, N f had a strong effect on the peak strength, while for higher α values, especially for the 90° sample, there were no obvious changes in peak strength with different N f. Under uniaxial compression, the coalescence modes between the fissures can be classified into three categories: S-mode, T-mode, and M-mode. Moreover, the failure mode can be classified into four categories: mixed failure, shear failure, stepped path failure, and intact failure. The failure mode of the specimen depends on α and N f. The peak strength and failure modes in the numerically simulated and experimental results are in good agreement.

  10. The influence of pre-existing structure on the growth of syn-sedimentary normal faults in a deltaic setting, Niger Delta

    NASA Astrophysics Data System (ADS)

    Fazli Khani, Hamed; Back, Stefan

    2015-04-01

    Three dimensional seismic-reflection data from the western Niger Delta were used to investigate the segmentation and linkage of a syn-sedimentary normal fault array and to estimate the influence of a pre-existing normal fault on the geometry and growth of younger faults. The nucleation, growth and linkage of a regional (seaward-dipping) deltaic fault system were analyzed on reflectivity time-/horizon slices and vertical seismic sections. In the deep subsurface, a master fault that consists of two segments (northwestern, NW, and southeastern, SE) grew through time into a single fault by lateral tip propagation reaching a final length of about 15 km. After attaining this length, displacement along the fault system developed non-uniformly through time. The analysis of the hanging-wall sediments of the deep-seated master fault shows two different processes of vertical linkage above the NW and SE segment. The SE segment links vertically to several younger faults contemporaneously with displacement accumulation on the master fault; in contrast, fault linkage above the NW segment occurred only after an interval of master-fault inactivity connecting the deep-seated structure upwards to a single syn-sedimentary normal fault. The observed differences in fault development suggest that although multi-segment deltaic faults form single fault systems after segment linkage, individual pre-linkage characteristics can be preserved, supporting a possibly diverse upward growth and connection to younger faults in the overburden. The geological interpretations presented highlight the influence of large deep-rooted structures on the development, location and geometry of shallow deltaic faults, documenting the influence of an older structural grain on delta tectonics.

  11. Influence of pre-existing basement faults on the structural evolution of the Zagros Simply Folded belt: 3D numerical modelling

    NASA Astrophysics Data System (ADS)

    Ruh, Jonas B.; Gerya, Taras

    2015-04-01

    The Simply Folded Belt of the Zagros orogen is characterized by elongated fold trains symptomatically defining the geomorphology along this mountain range. The Zagros orogen results from the collision of the Arabian and the Eurasian plates. The Simply Folded Belt is located southwest of the Zagros suture zone. An up to 2 km thick salt horizon below the sedimentary sequence enables mechanical and structural detachment from the underlying Arabian basement. Nevertheless, deformation within the basement influences the structural evolution of the Simply Folded Belt. It has been shown that thrusts in form of reactivated normal faults can trigger out-of-sequence deformation within the sedimentary stratigraphy. Furthermore, deeply rooted strike-slip faults, such as the Kazerun faults between the Fars zone in the southeast and the Dezful embayment and the Izeh zone, are largely dispersing into the overlying stratigraphy, strongly influencing the tectonic evolution and mechanical behaviour. The aim of this study is to reveal the influence of basement thrusts and strike-slip faults on the structural evolution of the Simply Folded Belt depending on the occurrence of intercrustal weak horizons (Hormuz salt) and the rheology and thermal structure of the basement. Therefore, we present high-resolution 3D thermo-mechnical models with pre-existing, inversively reactivated normal faults or strike-slip faults within the basement. Numerical models are based on finite difference, marker-in-cell technique with (power-law) visco-plastic rheology accounting for brittle deformation. Preliminary results show that deep tectonic structures present in the basement may have crucial effects on the morphology and evolution of a fold-and-thrust belt above a major detachment horizon.

  12. Concomitant dietary supplement and prescription medication use is prevalent among US adults with doctor-informed medical conditions.

    PubMed

    Farina, Emily K; Austin, Krista G; Lieberman, Harris R

    2014-11-01

    Information on patterns of concomitant dietary supplement (DS) and prescription medication (PM) use among US adults is limited. Thus, the prevalence of concomitant DS and PM use as a function of doctor-informed medical conditions (DIMC) was determined in a cross-sectional, observational study of a nationally representative sample of noninstitutionalized, civilian adults aged ?20 years in the United States (N=9,950) from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Data were weighted for the complex, multistage, probability sampling design. Approximately one third (34.3%) of all US adults reported concomitant DS and PM use (approximately one in three adults). The prevalence of use was significantly higher among those with vs without a DIMC (47.3% vs 17.3%). Adults with a DIMC were more than two and a half times more likely to concomitantly use DS and PM than adults without a DIMC, after adjustment for sex, age, education, and household income. Multivitamin plus other ingredient(s), followed by antacids and multivitamin plus botanical ingredient(s), were the most prevalent DS categories used with a PM among those with and without a DIMC. The most prevalent PM categories used with a DS were cardiovascular agents (among those with a DIMC) and hormones (among those without a DIMC). These findings demonstrate that presence of a DIMC may be a risk factor for concomitant DS and PM use among US adults. Multivitamins containing nonvitamin or mineral ingredients are more commonly used than standard multivitamins with PM by US adults. This may be an emerging trend that warrants further consideration. PMID:24703929

  13. Influence of Dopaminergic Medication on Conditioned Pain Modulation in Parkinson's Disease Patients

    PubMed Central

    Buhmann, Carsten; Forkmann, Katarina; Diedrich, Sabrina; Wesemann, Katharina; Bingel, Ulrike

    2015-01-01

    Background Pain is highly prevalent in patients with Parkinson’s disease (PD), but little is known about the underlying pathophysiological mechanisms. The susceptibility to pain is known to depend on ascending and descending pathways. Because parts of the descending pain inhibitory system involve dopaminergic pathways, dysregulations in dopaminergic transmission might contribute to altered pain processing in PD. Deficits in endogenous pain inhibition can be assessed using conditioned pain modulation (CPM) paradigms. Methods Applying such a paradigm, we investigated i) whether CPM responses differ between PD patients and healthy controls, ii) whether they are influenced by dopaminergic medication and iii) whether there are effects of disease-specific factors. 25 patients with idiopathic PD and 30 healthy age- and gender-matched controls underwent an established CPM paradigm combining heat pain test stimuli at the forearm and the cold pressor task on the contralateral foot as the conditioning stimulus. PD patients were tested under dopaminergic medication and after at least 12 hours of medication withdrawal. Results No significant differences between CPM responses of PD patients and healthy controls or between PD patients “on” and “off” medication were found. These findings suggest (i) that CPM is insensitive to dopaminergic modulations and (ii) that PD is not related to general deficits in descending pain inhibition beyond the known age-related decline. However, at a trend level, we found differences between PD subtypes (akinetic-rigid, tremor-dominant, mixed) with the strongest impairment of pain inhibition in the akinetic-rigid subtype. Conclusions There were no significant differences between CPM responses of patients compared to healthy controls or between patients “on” and “off” medication. Differences between PD subtypes at a trend level point towards different pathophysiological mechanisms underlying the three PD subtypes which warrant further investigation and potentially differential therapeutic strategies in the future. PMID:26270817

  14. Hospital Competition, Managed Care, and Mortality after Hospitalization for Medical Conditions in California

    PubMed Central

    Rogowski, Jeannette; Jain, Arvind K; Escarce, José J

    2007-01-01

    Objective To assess the effect of hospital competition and health maintenance organization (HMO) penetration on mortality after hospitalization for six medical conditions in California. Data Source Linked hospital discharge and vital statistics data for short-term general hospitals in California in the period 1994–1999. The study sample included adult patients hospitalized for one of the following conditions: acute myocardial infarction (N = 227,446), hip fracture (N = 129,944), stroke (N = 237,248), gastrointestinal hemorrhage (GIH,N = 216,443), congestive heart failure (CHF,N = 355,613), and diabetes (N = 154,837). Study Design The outcome variable was 30-day mortality. We estimated multivariate logistic regression models for each study condition with hospital competition, HMO penetration, hospital characteristics, and patient severity measures as explanatory variables. Principal Findings Higher hospital competition was associated with lower 30-day mortality for three to five of the six study conditions, depending on the choice of competition measure, and this finding was robust to a variety of sensitivity analyses. Higher HMO penetration was associated with lower mortality for GIH and CHF. Conclusions Hospitals that faced more competition and hospitals in market areas with higher HMO penetration provided higher quality of care for adult patients with medical conditions in California. Studies using linked hospital discharge and vital statistics data from other states should be conducted to determine whether these findings are generalizable. PMID:17362213

  15. Medical costs and lost productivity from health conditions at volatile organic compound-contaminated Superfund sites

    SciTech Connect

    Lybarger, J.A.; Spengler, R.F.; Brown, D.R.; Lee, R.; Vogt, D.P.; Perhac, R.M. Jr.

    1998-10-01

    This paper estimates the health costs at Superfund sites for conditions associated with volatile organic compounds (VOCs) in drinking water. Health conditions were identified from published literature and registry information as occurring at excess rates in VOC-exposed populations. These health conditions were: (1) some categories of birth defects, (2) urinary tract disorders, (3) diabetes, (4) eczema and skin conditions, (5) anemia, (6) speech and hearing impairments in children under 10 years of age, and (7) stroke. Excess rates were used to estimate the excess number of cases occurring among the total population living within one-half mile of 258 Superfund sites. These sites had evidence of completed human exposure pathways for VOCs in drinking water. For each type of medical condition, an individual`s expected medical costs, long-term care costs, and lost work time due to illness or premature mortality were estimated. Costs were calculated to be approximately $330 million per year, in the absence of any remediation or public health intervention programs. The results indicate the general magnitude of the economic burden associated with a limited number of contaminants at a portion of all Superfund sites, thus suggesting that the burden would be greater than that estimated in this study if all contaminants at all Superfund sites could be taken into account.

  16. Concurrent medical conditions and long-term outcome in dogs with nontraumatic intracranial hemorrhage.

    PubMed

    Lowrie, Mark; De Risio, Luisa; Dennis, Ruth; Llabrés-Díaz, Francisco; Garosi, Laurent

    2012-01-01

    Nontraumatic intracranial hemorrhage is bleeding originating from the brain or surrounding structures. It results from blood vessel rupture and may be primary or secondary in origin. The magnetic resonance imaging (MRI) characteristics of 75 dogs with nontraumatic intracranial hemorrhage were reviewed to determine signalment; intracranial compartment involved, size and number of lesions; type and prevalence of concurrent medical conditions; and long-term outcome. Hemorrhagic lesions were intraparenchymal (n = 72), subdural (n = 2) or intraventricular (n = 1). Thirty-three of 75 dogs had a concurrent medical condition. A concurrent condition was detected in 13 of 43 dogs with a single lesion ≥5 mm and included Angiostrongylus vasorum infection, intracranial lymphoma and meningioma. Of the 20 dogs with multiple lesions ≥5 mm, 7 had A. vasorum infection, 2 had hemangiosarcoma metastasis, 5 had suspected brain metastasis, and 1 was septicemic. Of the 12 dogs with multiple lesions, 2 had hyperadrenocorticism, 2 had chronic kidney disease, and 1 had hypothyroidism. Of these five dogs, all were hypertensive and four died within 12 months. No dog had a single lesion <5 mm. Long-term outcome was favorable in 26 of 43 dogs with single lesions ≥5 mm, 6 of 20 dogs with multiple lesions ≥5 mm, and 8 of 12 dogs with multiple lesions <5 mm. A. vasorum infection was the most common concurrent condition in dogs with nontraumatic intracranial hemorrhage (16/75), with an excellent outcome in 14 of 16 dogs. Prognosis in nontraumatic intracranial hemorrhage is reported in terms of concurrent medical conditions and the number and size of lesions. PMID:22537251

  17. Discovering medical conditions associated with periodontitis using linked electronic health records

    PubMed Central

    Boland, Mary Regina; Hripcsak, George; Albers, David J.; Wei, Ying; Wilcox, Adam B.; Wei, Jin; Li, Jianhua; Lin, Steven; Breene, Michael; Myers, Ronnie; Zimmerman, John; Papapanou, Panos N.; Weng, Chunhua

    2013-01-01

    Aim To use linked electronic medical and dental records to discover associations between periodontitis and medical conditions independent of a priori hypotheses. Materials and Methods This case-control study included 2475 patients who underwent dental treatment at the College of Dental Medicine at Columbia University and medical treatment at NewYork-Presbyterian Hospital. Our cases are patients who received periodontal treatment and our controls are patients who received dental maintenance but no periodontal treatment. Chi-square analysis was performed for medical treatment codes and logistic regression was used to adjust for confounders. Results Our method replicated several important periodontitis associations in a largely Hispanic population, including diabetes mellitus type I (OR = 1.6, 95% CI 1.30–1.99, p < 0.001) and type II (OR = 1.4, 95% CI 1.22–1.67, p < 0.001), hypertension (OR = 1.2, 95% CI 1.10–1.37, p < 0.001), hypercholesterolaemia (OR = 1.2, 95% CI 1.07–1.38, p = 0.004), hyperlipidaemia (OR = 1.2, 95% CI 1.06–1.43, p = 0.008) and conditions pertaining to pregnancy and childbirth (OR = 2.9, 95% CI: 1.32–7.21, p = 0.014). We also found a previously unreported association with benign prostatic hyperplasia (OR = 1.5, 95% CI 1.05–2.10, p = 0.026) after adjusting for age, gender, ethnicity, hypertension, diabetes, obesity, lipid and circulatory system conditions, alcohol and tobacco abuse. Conclusions This study contributes a high-throughput method for associating periodontitis with systemic diseases using linked electronic records. PMID:23495669

  18. Use of an emergency medical pictorial communication book during simulated disaster conditions.

    PubMed

    Behar, Solomon; Benson Ii, Richard; Kurzweil, Ami; Azen, Colleen; Nager, Alan L

    2013-10-01

    During disasters, the needs of victims outstrip available resources. Rapid assessment of patients must be performed; however, language barriers can be an impediment to efficient patient assessment, especially if interpreter resources are limited. Dependency on interpretive services requiring technology such a telephones, cell phones, and video conferencing may be inefficient, as they may be unavailable during disaster conditions. A low-tech, portable tool that aids in communication with non-English speakers would be beneficial. The medical emergency communication (MEC) book, developed at Children's Hospital Los Angeles, has the potential to be a useful tool in this capacity. The goal of this pilot study was to compare the accuracy of a newly developed disaster-focused medical history obtained from Spanish-speaking patients or caregivers using the MEC book, compared to a control group with whom no book was used. Our hypothesis was that use of the MEC book improves accuracy of medical history taking between English-only speaking health care workers and Spanish-speaking patients better than a monolingual clinician trying to take a medical history without it. We anticipated a higher overall score in the group of subjects whose histories were taken using the MEC book than in the control group. Patient satisfaction with the MEC book also was measured. PMID:24274127

  19. Medical Treatment of Aortic Aneurysms in Marfan Syndrome and other Heritable Conditions

    PubMed Central

    Jost, Christine H. Attenhofer; Greutmann, Matthias; Connolly, Heidi M.; Weber, Roland; Rohrbach, Marianne; Oxenius, Angela; Kretschmar, Oliver; Luscher, Thomas F.; Matyas, Gabor

    2014-01-01

    Thoracic aortic aneurysms can be triggered by genetic disorders such as Marfan syndrome (MFS) and related aortic diseases as well as by inflammatory disorders such as giant cell arteritis or atherosclerosis. In all these conditions, cardiovascular risk factors, such as systemic arterial hypertension, may contribute to faster rate of aneurysm progression. Optimal medical management to prevent progressive aortic dilatation and aortic dissection is unknown. β-blockers have been the mainstay of medical treatment for many years despite limited evidence of beneficial effects. Recently, losartan, an angiotensin II type I receptor antagonist (ARB), has shown promising results in a mouse model of MFS and subsequently in humans with MFS and hence is increasingly used. Several ongoing trials comparing losartan to β-blockers and/or placebo will better define the role of ARBs in the near future. In addition, other medications, such as statins and tetracyclines have demonstrated potential benefit in experimental aortic aneurysm studies. Given the advances in our understanding of molecular mechanisms triggering aortic dilatation and dissection, individualized management tailored to the underlying genetic defect may be on the horizon of individualized medicine. We anticipate that ongoing research will address the question whether such genotype/pathogenesis-driven treatments can replace current phenotype/syndrome-driven strategies and whether other forms of aortopathies should be treated similarly. In this work, we review currently used and promising medical treatment options for patients with heritable aortic aneurysmal disorders. PMID:24527681

  20. Gains in medication affordability following Medicare Part D are eroding among elderly with multiple chronic conditions

    PubMed Central

    Naci, Huseyin; Soumerai, Stephen B; Ross-Degnan, Dennis; Zhang, Fang; Briesacher, Becky A; Gurwitz, Jerry H; Madden, Jeanne M

    2014-01-01

    Elderly Americans, especially those with multiple chronic conditions, face difficulties paying for prescriptions, resulting in worse adherence and discontinuation of therapy (“cost-related medication nonadherence” or CRN). We investigated whether the gains in medication affordability attributable to Medicare Part D implementation in January 2006 persisted during the six years that followed. Overall, we found continued incremental improvements in medication affordability in the early years of Part D (2007–2009), which then eroded during more recent years (2009–2011). Among elderly beneficiaries with four or more chronic conditions, we observed an increase in the prevalence of CRN from 14.4% in 2009 to 17.0% in 2011, reversing previous downward trends. Similarly, the prevalence of forgoing basic needs in order to purchase medicines among the sickest elderly decreased from 8.7% in 2007 to 6.8% in 2009, then rose to 10.2% in 2011. Our findings highlight the need for targeted policy efforts to alleviate the persistent burden of drug treatment costs in this vulnerable population. PMID:25092846

  1. Leisure Engagement: Medical Conditions, Mobility Difficulties, and Activity Limitations—A Later Life Perspective

    PubMed Central

    Nilsson, Ingeborg; Nyqvist, Fredrica; Gustafson, Yngve; Nygård, Mikael

    2015-01-01

    Objectives. This study aims to investigate the impact of medical conditions, mobility difficulties, and activity limitations on older people's engagement in leisure activities. Methods. The analyses are based on a cross regional survey carried out in 2010 in the Bothnia region (Northern Sweden and Western Finland). A posted questionnaire, which included questions on different aspects of leisure engagement, medical history, and health, was sent out to older persons in the region. The final sample consisted of 5435 persons aged 65, 70, 75, and 80 years. The data was analyzed by using ordinary least squares (OLS) multivariate regression. Results. The most important predictor of leisure engagement abstention among older people is the prevalence of activity limitations, whereas mobility difficulties and medical conditions play less important roles. The strong negative association between activity limitations and leisure engagement remains significant even after we control for individual, sociodemographic characteristics, and country. Discussion. This study provides a window into leisure engagement in later life and factors influencing the magnitude of engagement in leisure activities. PMID:26346706

  2. Gorlin-Goltz syndrome – a medical condition requiring a multidisciplinary approach

    PubMed Central

    Kiwilsza, Małgorzata; Sporniak-Tutak, Katarzyna

    2012-01-01

    Summary Gorlin-Goltz syndrome is a rare genetic condition showing a variable expressiveness. It is inherited in a dominant autosomal way. The strongest characteristic of the disease includes multiple basal cell carcinomas, jaw cysts, palmar and plantar pits, skeletal abnormalities and other developmental defects. Owing to the fact that the condition tends to be a multisystemic disorder, familiarity of various medical specialists with its manifestations may reduce the time necessary for providing a diagnosis. It will also enable them to apply adequate methods of treatment and secondary prevention. In this study, we present symptoms of the disease, its diagnostic methods and currently used treatments. We searched 2 scientific databases: Medline (EBSCO) and Science Direct, for the years 1996 to 2011. In our search of abstracts, key words included nevoid basal cell carcinoma syndrome and Gorlin-Goltz syndrome. We examined 287 studies from Medline and 80 from Science Direct, all published in English. Finally, we decided to use 60 papers, including clinical cases and literature reviews. Patients with Gorlin-Goltz syndrome need particular multidisciplinary medical care. Knowledge of multiple and difficult to diagnose symptoms of the syndrome among professionals of various medical specialties is crucial. The consequences of the disease pose a threat to the health and life of patients. Therefore, an early diagnosis creates an opportunity for effective prevention and treatment of the disorder. Prevention is better than cure. PMID:22936202

  3. MDS 3.0 section M: Skin Conditions: what the medical director needs to know.

    PubMed

    Levine, Jeffrey M; Ayello, Elizabeth A

    2011-03-01

    The Centers for Medicare and Medicaid Services has released the new Resident Assessment Instrument version 3.0, which went into effect October 1, 2010. The intention of the revised Resident Assessment Instrument is to improve health-related quality of life and care planning, and incorporate evolving standards of terminology, assessment, and technology. To reach this goal, Section M: Skin Conditions has been greatly expanded and will alter the process of pressure ulcer assessment in all long-term care facilities across America. Details of this assessment instrument include upgraded criteria for risk factors, staging, identification, tracking, and evolution of pressure ulcers. The medical director can and should assume a leadership role in education and collaboration with primary care physicians and wound clinicians to accommodate changes in revised Section M. Integrating the medical director into the facility's wound care program will improve the quality of care for residents of long-term care facilities. PMID:21333918

  4. Testing the influence of vertical, pre-existing joints on normal faulting using analogue and 3D discrete element models (DEM)

    NASA Astrophysics Data System (ADS)

    Kettermann, Michael; von Hagke, Christoph; Virgo, Simon; Urai, Janos L.

    2015-04-01

    Brittle rocks are often affected by different generations of fractures that influence each other. We study pre-existing vertical joints followed by a faulting event. Understanding the effect of these interactions on fracture/fault geometries as well as the development of dilatancy and the formation of cavities as potential fluid pathways is crucial for reservoir quality prediction and production. Our approach combines scaled analogue and numerical modeling. Using cohesive hemihydrate powder allows us to create open fractures prior to faulting. The physical models are reproduced using the ESyS-Particle discrete element Modeling Software (DEM), and different parameters are investigated. Analogue models were carried out in a manually driven deformation box (30x28x20 cm) with a 60° dipping pre-defined basement fault and 4.5 cm of displacement. To produce open joints prior to faulting, sheets of paper were mounted in the box to a depth of 5 cm at a spacing of 2.5 cm. Powder was then sieved into the box, embedding the paper almost entirely (column height of 19 cm), and the paper was removed. We tested the influence of different angles between the strike of the basement fault and the joint set (0°, 4°, 8°, 12°, 16°, 20°, and 25°). During deformation we captured structural information by time-lapse photography that allows particle imaging velocimetry analyses (PIV) to detect localized deformation at every increment of displacement. Post-mortem photogrammetry preserves the final 3-dimensional structure of the fault zone. We observe that no faults or fractures occur parallel to basement-fault strike. Secondary fractures are mostly oriented normal to primary joints. At the final stage of the experiments we analyzed semi-quantitatively the number of connected joints, number of secondary fractures, degree of segmentation (i.e. number of joints accommodating strain), damage zone width, and the map-view area fraction of open gaps. Whereas the area fraction does not change distinctly, the number of secondary fractures and connected joints increases strongly with increasing angles between basement fault and joint strike. Integrating these models with a 3-dimensional DEM code using the ESyS-Particle software allows for retrieving 4D information from the models, as well as for testing other parameters such as joint spacing or joint depth. Our DEM models are capable of robustly reproducing all characteristic features observed in the analogue models, and will provide a quantitative measure of the influence of joint-fault angle on permeability of cohesive rocks that have experienced more than one brittle deformation phase.

  5. Cost effectiveness of lowering cholesterol concentration with statins in patients with and without pre-existing coronary heart disease: life table method applied to health authority population.

    PubMed Central

    Pharoah, P. D.; Hollingworth, W.

    1996-01-01

    OBJECTIVES--To estimate the cost effectiveness of statins in lowering serum cholesterol concentration in people at varying risk of fatal cardiovascular disease and to explore the implications of changing the criteria for intervention on cost and cost effectiveness for a purchasing authority. DESIGN--A life table method was used to model the effect of treatment with a statin on survival over 10 years in men and women aged 45-64. The costs of intervention were estimated from the direct costs of treatment, offset by savings associated with a reduction in coronary angiographies, non-fatal myocardial infarctions, and revascularisation procedures. The robustness of the model to various assumptions was tested in a sensitivity analysis. SETTING--Population of a typical district health authority. MAIN OUTCOME MEASURE--Cost per life year saved. RESULTS--The average cost effectiveness of treating men aged 45-64 with no history of coronary heart disease and a cholesterol concentration > 6.5 mmol/l for 10 years with a statin was 136,000 pounds per life year saved. The average cost effectiveness for patients with pre-existing coronary heart disease and a cholesterol concentration > 5.4 mmol/l was 32,000 pounds. These averages hide enormous differences in cost effectiveness between groups at different risk, ranging from 6000 pounds per life year in men aged 55-64 who have had a myocardial infarction and whose cholesterol concentration is above 7.2 mmol/l to 361,000 pounds per life year saved in women aged 45-54 with angina and a cholesterol concentration of 5.5-6.0 mmol/l. CONCLUSIONS--Lowering serum cholesterol concentration in patients with and without preexisting coronary heart disease is effective and safe, but treatment for all those in whom treatment is likely to be effective is not sustainable within current NHS resources. Data on cost effectiveness data should be taken into account when assessing who should be eligible for treatment. PMID:8664620

  6. I-type granitoids associated with the early Paleozoic intracontinental orogenic collapse along pre-existing block boundary in South China

    NASA Astrophysics Data System (ADS)

    Yu, Yang; Huang, Xiao-Long; He, Peng-Li; Li, Jie

    2016-04-01

    The early Paleozoic Wuyi-Yunkai orogeny resulted in extensive magmatism in the Cathaysia and eastern Yangtze blocks, South China. Identifying the nature of related magmatism is essential for understanding the orogeny that remains enigmatic with regard to its tectonic setting and geodynamic driving force. The Zhangjiafang pluton (438 ± 3 Ma) in western Jiangxi province is composed of predominant granodiorite with abundant coeval mafic-intermediate microgranular enclaves (MMEs) (~ 433 ± 5 Ma). The granodiorite samples are weakly peraluminous (A/CNK = 1.05-1.09) and have low SiO2 (61.9-64.9 wt.%) and high Fe2O3 (4.6-5.6 wt.%), MgO (2.2-2.8 wt.%) and CaO (4.3-4.8 wt.%), belonging to I-type suite due to abundant amphibole in the rocks. They exhibit strongly negative whole-rock εNd(t) values (- 11 to - 9) and zircon εHf(t) values (- 14 to - 4), similar to the basement of the Cathaysia Block, but distinguishable from simultaneous I-type granites of the Banshanpu and Hongxiaqiao plutons in eastern Yangtze Block in much lower Sr, Ba, Th and U. The MME samples show pronounced negative Nb-Ta-Ti anomalies and have overall less negative whole-rock εNd(t) (- 9 to - 7) and zircon εHf(t) values (- 9 to - 4) than the host granodiorite, which are best interpreted as products of mantle-derived melts that mixed insufficiently with crust-derived magma. The block boundary between the eastern Yangtze and Cathaysia blocks should pass through the nearby west area (i.e., Pingxiang City) of the Zhangjiafang pluton. The Early Paleozoic I-type granitic rocks near the block boundary have all negative εNd(t) and εHf(t) values, demonstrating an overall ancient basement of the two blocks prior to the Wuyi-Yunkai orogeny, preferring an intracontinental orogeny model. However, the early Paleozoic mafic rocks and I-type granites with coeval MMEs were frequently present along the Jiangshan-Shaoxing-Pingxiang Fault zone, illustrating widespread modification of the ancient basement adjacent to the block boundary by mantle-derived melt during the orogenic collapse. The pre-existing block boundary might have promoted asthenosphere upwelling and basaltic underplating during the intracontinental orogenic collapse.

  7. Oroclinal bending in the Caledonides of western Ireland: a mid-Palaeozoic feature controlled by a pre-existing structural grain

    NASA Astrophysics Data System (ADS)

    Mac Niocaill, Conall; Smethurst, Mark A.; Ryan, Paul D.

    1998-12-01

    The Caledonides of the west of Ireland mark a segment of the Caledonian-Appalachian orogen where the structural grain swings from the NE-SW trend that typifies the Caledonides of northern Britain to an E-W orientation. The origin of this arcuate structure has previously been proposed to be either primary, reflecting the original geometry of promontories and embayments in the Laurentian margin in this sector of the orogen, or secondary, as evidenced by palaeomagnetically determined clockwise rotations in Silurian rocks in the region. We report the results of a palaeomagnetic investigation of the Early to middle Ordovician Mweelrea Ignimbrites (Llanvirn), from an accreted Taconic arc (the South Mayo Trough) in that part of the western Irish Caledonides that has an E-W trend. After removal of a low-temperature component of magnetisation, (L), interpreted to represent a viscous component of the earth's present field, a high-temperature component of magnetisation, (H), was isolated at fifteen sites in four ignimbrite flows. H passes a palaeomagnetic fold test yielding a tilt-corrected mean remanence direction D=132.6°, I=29.1°, α95=17.9° which corresponds to a palaeopole at 36.4°E, 9.9°S. The pole is in reasonable agreement with established Early to middle Ordovician reference poles for Laurentia and indicates that no significant rotation occurred between the E-W South Mayo Trough and the Laurentian margin after accretion, and therefore that the curvature of this segment of the orogen is likely to be primary. This contrasts with other results from Silurian sequences to the south, which record significant post-Silurian clockwise rotations. Examination of all reliable palaeomagnetic data from the region indicates that the clockwise rotations are restricted to the rocks south of the South Mayo Trough. We propose that the rotations in the south are linked with the superposition of the pre-existing structural grain on the younger rock units during Late Silurian and Early Devonian sinistral transpression.

  8. Patterns of Risk for Multiple Co‐Occurring Medical Conditions Replicate Across Distinct Cohorts of Children with Autism Spectrum Disorder

    PubMed Central

    Aldinger, Kimberly A.; Lane, Christianne J.; Veenstra‐VanderWeele, Jeremy

    2015-01-01

    Children with autism spectrum disorder (ASD) may present with multiple medical conditions in addition to ASD symptoms. This study investigated whether there are predictive patterns of medical conditions that co‐occur with ASD, which could inform medical evaluation and treatment in ASD, as well as potentially identify etiologically meaningful subgroups. Medical history data were queried in the multiplex family Autism Genetic Resource Exchange (AGRE). Fourteen medical conditions were analyzed. Replication in the Simons Simplex Collection (SSC) was attempted using available medical condition data on gastrointestinal disturbances (GID), sleep problems, allergy and epilepsy. In the AGRE cohort, no discrete clusters emerged among 14 medical conditions. GID and seizures were enriched in unaffected family members, and together with sleep problems, were represented in both AGRE and SSC. Further analysis of these medical conditions identified predictive co‐occurring patterns in both samples. For a child with ASD, the presence of GID predicts sleep problems and vice versa, with an approximately 2‐fold odds ratio in each direction. These risk patterns were replicated in the SSC sample, and in addition, there was increased risk for seizures and sleep problems to co‐occur with GID. In these cohorts, seizure alone was not predictive of the other conditions co‐occurring, but behavioral impairments were more severe as the number of co‐occurring medical symptoms increased. These findings indicate that interdisciplinary clinical care for children with ASD will benefit from evaluation for specific patterns of medical conditions in the affected child and their family members. Autism Res 2015, 8: 771–781. © 015 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research. PMID:26011086

  9. Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy.

    PubMed

    Lauridsen, M M; Poulsen, L; Rasmussen, C K; Høgild, M; Nielsen, M K; de Muckadell, O B Schaffalitzky; Vilstrup, H

    2016-04-01

    Many chronic medical conditions are accompanied by cognitive disturbances but these have only to a very limited extent been psychometrically quantified. An exception is liver cirrhosis where hepatic encephalopathy is an inherent risk and mild forms are diagnosed by psychometric tests. The preferred diagnostic test battery in cirrhosis is often the Continuous Reaction Time (CRT) and the Portosystemic Encephalopathy (PSE) tests but the effect on these of other medical conditions is not known. We aimed to examine the effects of common chronic (non-cirrhosis) medical conditions on the CRT and PSE tests. We studied 15 patients with heart failure (HF), 15 with end stage renal failure (ESRF), 15 with dysregulated type II diabetes (DMII), 15 with chronic obstructive pulmonary disease (COPD), and 15 healthy persons. We applied the CRT test, which is a 10-min computerized test measuring sustained attention and reaction time stability and the PSE test, which is a paper-pencil test battery consisting of 5 subtests. We found that a high fraction of the patients with HF (8/15, 0.002) or COPD (7/15, p = 0.006) had pathological CRT test results; and COPD patients also frequently had an abnormal PSE test result (6/15, p < 0.0001). Both tests were unaffected by ESRF and DMII. Half of the patients with HF or COPD had psychometrically measurable cognitive deficits, whereas those with ESRF or DMII had not. This adds to the understanding of the clinical consequences of chronic heart- and lung disease, and implies that the psychometric tests should be interpreted with great caution in cirrhosis patients with heart- or lung comorbidity. PMID:26435407

  10. The influence of medical conditions associated with hormones on the risk of breast cancer.

    PubMed

    Moseson, M; Koenig, K L; Shore, R E; Pasternack, B S

    1993-12-01

    Medical conditions related to hormonal abnormalities were investigated in a case-control study of breast cancer among women who attended a screening centre. Information was obtained by telephone interview regarding physician-diagnosed medical conditions such as thyroid or liver diseases, diabetes, and hypertension, as well as hirsutism, acne, galactorrhoea, and reproductive, menstrual, and gynaecological factors. Results are presented for 354 cases and 747 controls. Women with fertility problems who never succeeded in becoming pregnant were at significantly increased breast cancer risk (adjusted odds ratio [OR] = 3.5; 95% confidence interval [CI]:1.1-10.9). An elevated cancer risk was also associated with having excess body hair (OR = 1.5; 95% CI:1.0-2.3), or having excess body hair in addition to persistent adult acne (OR = 6.8; 95% CI:1.7-27.1). Recurrent amenorrhea (OR = 3.5; 95% CI:1.1-11.5), and a treated hyperthyroid condition (OR = 2.2; 95% CI:1.1-4.4) were significantly associated with risk. A non-significant elevation of risk was present for endometrial hyperplasia (OR = 1.8; 95% CI: 0.8-4.0). There was a suggestion of an association between a history of galactorrhoea and breast cancer risk (OR = 2.0; 95% CI:0.8-4.9) among premenopausal women. No associations were found with other medical or gynaecological factors. The possibility that some of these findings are due to chance cannot be excluded because of the problem of multiple comparisons. PMID:8144280

  11. PERSONAL ATTITUDES, PERCEIVED SOCIAL NORMS, AND HEALTH RISK BEHAVIOR AMONG FEMALE ADOLESCENTS WITH CHRONIC MEDICAL CONDITIONS

    PubMed Central

    Kunz, Jennifer Hauser; Greenley, Rachel Neff; Mussatto, Kathleen A.; Roth-Wojcicki, Betsy; Miller, Tami; Freeman, Mary Ellen; Lerand, Sarah

    2015-01-01

    Purpose To examine whether perceived peer/parent norms or personal beliefs about adolescent substance use influence substance use among female adolescents with chronic medical conditions. Methods 68 females reported on substance use, personal beliefs, and perceived peer/parent norms. Results Personal beliefs and perceived peer/parent norms were associated with adolescent’s current and future substance use. Although perceived peer norms accounted for variance in current substance use, only personal beliefs accounted for variance in future alcohol use. Conclusions Targeting perceived peer norms may be effective for intervention efforts among adolescents endorsing current substance use, whereas alcohol use prevention efforts should target personal beliefs. PMID:23524992

  12. Race and Ethnic Group Differences in Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Chronic Medical Conditions.

    PubMed

    Watkins, Daphne C; Assari, Shervin; Johnson-Lawrence, Vicki

    2015-09-01

    This study tested whether race and ethnic group differences exist for lifetime major depressive disorder and/or general anxiety disorder with one or more chronic medical conditions. Data from the National Survey of American Life, which included 3570 African American, 1438 Caribbean Black, and 891 non-Hispanic White adults were analyzed. Outcomes included at least one and multiple chronic medical conditions, from a list of 14 medical conditions (e.g., arthritis, cancer, diabetes, kidney disease, stroke, heart disease, etc.). Logistic regressions were fitted to data to determine how the association between major depressive disorder, general anxiety disorder, and one or more chronic medical conditions vary across race and ethnicity. Lifetime major depressive disorder (but not lifetime general anxiety disorder) was associated with at least one chronic medical condition among African Americans and Caribbean Blacks, but not non-Hispanic Whites. Lifetime major depressive disorder was similarly associated with multiple chronic medical conditions among African Americans, Caribbean Blacks, and non-Hispanic Whites. For Caribbean Blacks, stronger associations were found between major depressive disorder and general anxiety disorder with one or more chronic medical conditions compared to African Americans and non-Hispanic Whites. Findings suggest that race and ethnicity may shape the links between comorbid psychiatric disorders and chronic medical conditions. Mental health screening of individuals with chronic medical conditions in primary health-care settings may benefit from tailoring based on race and ethnicity. More research is needed to understand why associations between physical and mental health vary among race and ethnic groups. PMID:26863467

  13. [The accessibility of high-tech medical care of newborns with surgical pathology in conditions of Far North].

    PubMed

    Polunina, n V; Razumovskiĭ, A Iu; Savvina, V A; Varfolomeev, A R; Nikolaev, V N

    2014-01-01

    The actual stage of development of public health rendering of specialized medical care is based on principles of generality, accessibility, addressness, qualitativeness, and effectiveness. However, the problem of rendering specialized medical care to population is one of most critical targets in district centers and requires immediate solution. The main mean of resolving this problem is re-hospitalization of patient in more large-scale medical institutions. The rendering of high-tech medical care, surgery care included, to newborns in the Republic of Sakha (Yakutia) is possible only in conditions of metropolitan health institutions i.e. medical institutions of third level. Annually, almost half of newborns with surgical pathology is transported from central district hospital. The organization of reanimation counseling center, maintenance of remote monitoring of newborns and development of telemedicine and means of sanitary aviation play main role in supporting accessibility of high-tech medical care in conditions of this region. PMID:25373299

  14. Veterinary homeopathy: systematic review of medical conditions studied by randomised placebo-controlled trials.

    PubMed

    Mathie, Robert T; Clausen, Jürgen

    2014-10-18

    A systematic review of randomised controlled trials (RCTs) of veterinary homeopathy has not previously been undertaken. Using Cochrane methods, this review aims to assess risk of bias and to quantify the effect size of homeopathic intervention compared with placebo for each eligible peer-reviewed trial. Judgement in seven assessment domains enabled a trial's risk of bias to be designated as low, unclear or high. A trial was judged to comprise reliable evidence if its risk of bias was low or was unclear in specified domains. A trial was considered to be free of vested interest if it was not funded by a homeopathic pharmacy. The 18 eligible RCTs were disparate in nature, representing four species and 11 different medical conditions. Reliable evidence, free from vested interest, was identified in two trials: homeopathic Coli had a prophylactic effect on porcine diarrhoea (odds ratio 3.89, 95 per cent confidence interval [CI], 1.19 to 12.68, P=0.02); and individualised homeopathic treatment did not have a more beneficial effect on bovine mastitis than placebo intervention (standardised mean difference -0.31, 95 per cent CI, -0.97 to 0.34, P=0.35). Mixed findings from the only two placebo-controlled RCTs that had suitably reliable evidence precluded generalisable conclusions about the efficacy of any particular homeopathic medicine or the impact of individualised homeopathic intervention on any given medical condition in animals. PMID:25324413

  15. Cluster analyses of association of weather, daily factors and emergent medical conditions.

    PubMed

    Malkić, Jasmin; Sarajlić, Nermin; Smrke, Barbara U R; Smrke, Dragica

    2013-03-01

    The goal of this study was to evaluate associations between the meteorological conditions and the number of emergency cases for five distinctive causes of dispatch groups reported to SOS dispatch centre in Uppsala, Sweden. Center's responsibility include alerting to 17 ambulances in whole Uppsala County, area of 8,209 km2 with around 320,000 inhabitants representing the target patient group. Source of the medical data for this study is the database of dispatch data for the year of 2009, while the metrological data have been provided from Uppsala University Department of Earth Sciences yearly weather report. Medical and meteorological data were summoned into the unified data space where each point represents a day with its weather parameters and dispatch cause group cardinality. DBSCAN data mining algorithm was implemented to five distinctive groups of dispatch causes after the data spaces have gone through the variance adjustment and the principal component analyses. As the result, several point clusters were discovered in each of the examined data spaces indicating the distinctive conditions regarding the weather and daily cardinality of the dispatch cause, as well as the associations between these two. Most interesting finding is that specific type of winter weather formed a cluster only around the days with the high count of breathing difficulties, while one of the summer weather clusters made similar association with the days with low number of cases. Findings were confirmed by confidence level estimation based on signal to noise ratio for the observed data points. PMID:23697272

  16. Medical conditions among Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System

    PubMed Central

    Carone, Marco; Al-Saedy, Huda; Nyce, Sayre; Ghosn, Jad; Mutuerandu, Timothy; Black, Robert E

    2012-01-01

    Abstract Objective To determine the range and burden of health services utilization among Iraqi refugees receiving health assistance in Jordan, a country of first asylum. Methods Medical conditions, diagnosed in accordance with the tenth revision of the International classification of diseases, were actively monitored from 1January to 31December 2010 using a pilot centralized database in Jordan called the Refugee Assistance Information System. Findings There were 27 166 medical visits by 7642 Iraqi refugees (mean age: 37.4 years; 49% male; 70% from Baghdad; 6% disabled; 3% with a history of torture). Chronic diseases were common, including essential hypertension (22% of refugees), visual disturbances (12%), joint disorders (11%) and type II diabetes mellitus (11%). The most common reasons for seeking acute care were upper respiratory tract infection (11%), supervision of normal pregnancy (4%) and urinary disorders (3%). The conditions requiring the highest number of visits per refugee were cerebrovascular disease (1.46 visits), senile cataract (1.46) and glaucoma (1.44). Sponsored care included 31 747 referrals or consultations to a specialty service, 18 432 drug dispensations, 2307 laboratory studies and 1090 X-rays. The specialties most commonly required were ophthalmology, dentistry, gynaecology and orthopaedic surgery. Conclusion Iraqi refugees in countries of first asylum and resettlement require targeted health services, health education and sustainable prevention and control strategies for predominantly chronic diseases. PMID:22690034

  17. Medical Privacy and the Disclosure of Personal Medical Information: The Beliefs and Experiences of Those with Genetic and Other Clinical Conditions

    PubMed Central

    Kass, Nancy E.; Hull, Sara Chandros; Natowicz, Marvin R.; Faden, Ruth R.; Plantinga, Laura; Gostin, Lawrence O.; Slutsman, Julia

    2016-01-01

    There has been heightened legislative attention to medical privacy and to protections from genetic discrimination, without large-scale studies to document privacy concerns or analysis of whether experiences differ by whether the condition is genetic (defined here as a single-gene disorder) or non-genetic. To determine whether experiences regarding privacy, disclosure, and consequences of disclosure differ by whether one's medical condition is genetic, we conducted a descriptive study with one-time, structured quantitative and qualitative interviews. We interviewed approximately 100 adults or parents of children with each of the following medical conditions: sickle cell disease, cystic fibrosis, diabetes, and HIV, and 200 adults with or at risk for breast cancer or colon cancer. The percentages of the total 597 respondents experiencing positive or negative consequences of disclosure and the degree to which experiences differed by whether the condition was genetic were the outcomes of interest. Seventy-four percent were glad and 13% regretted others knew about their condition; these findings did not differ significantly by genetic vs. non-genetic condition. Reports of job and health insurance discrimination were not uncommon for the overall study population (19 and 27%, respectively) but were more likely among those with genetic conditions (30 and 37%, respectively). Legislation and other policymaking should target the needs of persons with all conditions and not focus exclusively on genetic discrimination, given that experiences and concerns generally do not differ based on the genetic etiology of the condition. PMID:15216547

  18. Concomitant Medical Conditions and Therapies Preclude Accurate Classification of Children With Severe or Severe Complicated Clostridium difficile Infection.

    PubMed

    Kociolek, Larry K; Patel, Sameer J; Shulman, Stanford T; Gerding, Dale N

    2015-12-01

    Severe and severe complicated Clostridium difficile infections (SCDI/SCCDI) were retrospectively assessed in a pediatric cohort. Underlying medical conditions and concomitant medical therapy preclude accurate classification of children with SCDI/SCCDI, using current CDI severity definitions. Revised CDI definitions in children should focus on more objective, age-appropriate, and CDI-specific markers of severity. PMID:26582882

  19. 3-D numerical modelling of the influence of reactivated pre-existing faults on the distribution of deformation: example of North-Western Ghana around 2.15-2.00 Ga

    NASA Astrophysics Data System (ADS)

    FENG, Xiaojun; Gerbault, Muriel; Martin, Roland; Ganne, Jérôme; Jessell, Mark

    2015-04-01

    High strain zones appear to play a significant role in feeding the upper crust with fluids and partially molten material from lower crust sources. The Bole-Bulenga terrain (North-Western Ghana) is located in between two subvertical shear zones, and mainly consists of high-grade orthogneisses, paragneisses and metabasites intruded by partially molten lower crustal material with monzogranites and orthogneisses (Eburnean orogeny, around 2.1 Ga). In order to understand the location of these high grade rocks at the edges and in between these two shear zones, a three dimensional numerical model was built to test the influence of different orientations of a system of branched strike-slip faults on visco-plastic deformation, under compressional and simple shear boundary conditions. Our models indicate domains of tensile vs. compressional strain as well as shear zones, and show that not only internal fault zones but also the host rock in between the faults behave relatively softer than external regions. Under both applied compressive and simple shear boundary conditions, these softened domains constitute preferential zones of tensile strain accommodation (dilation) in the upper crust, which may favor infilling by deeper partially molten rocks. Our modeled pre-existing faults zones are assumed to have formed during an early D1 stage of deformation, and they are shown to passively migrate and rotate together with the solid matrix under applied external boundary conditions (corresponding to a post D1 - early D2 phase of deformation). We suggest that in the Bole-Bulenga terrain, fluids or partially molten material stored in deeper crustal domains, preferentially intruded the upper crust within these highly (shear and tensile) strained domains, thanks to this D2 shearing deformation phase. Building relief at the surface is primarily controlled by fault orientations, together with mechanical parameters and external boundary conditions. In particular, greatest magnitudes of relief are obtained when faults dip in parallel one with the other and when they are inclined at depth, as they thus facilitate stress rotation and material transfer from depth. The host rock density does not play a primary role in producing relief compared to variations in friction angle at the crustal scale (30km thick). Relief increases by 200 - 300 m when the host rock density is increased by 200 kg/m3 , whereas relief drops by about 1200 m when decreasing the host rock friction from φ = 20° to 10°.

  20. The State of Health in Older Adults in Japan: Trends in Disability, Chronic Medical Conditions and Mortality

    PubMed Central

    Ishii, Shinya; Ogawa, Sumito; Akishita, Masahiro

    2015-01-01

    Both life expectancy and healthy life expectancy in Japan have been increasing and are among the highest in the world, but the gap between them has also been widening. To examine the recent trends in old age disability, chronic medical conditions and mortality in Japan, we retrospectively analyzed three nationally representative datasets: Comprehensive Survey of Living Conditions (2001–2013), Patient Survey (1996–2011) and Vital Statistics (1995–2010). We obtained the sex- and age-stratified trends in disability rate, treatment rates of nine selected chronic medical conditions (cerebrovascular diseases, joint disorders, fractures, osteoporosis, ischemic heart disease, diabetes mellitus, hypertension, pneumonia and malignant neoplasms), total mortality rate and mortality rates from specific causes (cerebrovascular diseases, heart diseases, pneumonia and malignant neoplasms) in both sexes in four age strata (65–69, 70–74, 75–79, 80–84 years). Disability rates declined significantly in both sexes. Treatment rates of all selected medical conditions also decreased significantly, except for fractures in women and pneumonia. Both total mortality rate and cause-specific mortality rates decreased in both sexes. We concluded that the recent decline in disability rates, treatment rates of chronic medical conditions and mortality rates points toward overall improvement in health conditions in adults over the age of 65 years in Japan. Nonetheless, considering the increase in the number of older adults, the absolute number of older adults with disability or chronic medical conditions will continue to increase and challenge medical and long-term care systems. PMID:26431468

  1. Maternal Recall Versus Medical Records of Metabolic Conditions from the Prenatal Period: A Validation Study.

    PubMed

    Krakowiak, Paula; Walker, Cheryl K; Tancredi, Daniel J; Hertz-Picciotto, Irva

    2015-09-01

    To assess validity of maternally-reported diabetes and hypertensive disorders, and reliability of BMI measurements during periconception and pregnancy compared with medical records when mothers are interviewed 2-5 years after delivery. To investigate whether reporting accuracy differed by child's case status (autism, delays, typical development). Participants were mothers of 2-5 year old children with and without neurodevelopmental disorders from the CHARGE (CHildhood Autism Risks from Genetics and the Environment) Study who had both prenatal/delivery records and telephone interviews. Sensitivity and specificity of self-report in telephone interview was assessed by comparison with medical records; agreement was evaluated by kappa statistics. Deviations in reported BMI were evaluated with Bland-Altman plots and concordance correlation coefficient (CCC). Mothers of children with neurodevelopmental disorders (autism or developmental delay) reported metabolic conditions slightly more accurately than control mothers. For diabetes, sensitivity ranged from 73 to 87% and specificity was ≥98% across groups. For hypertensive disorders, sensitivity ranged from 57 to 77% and specificity from 93 to 98%. Reliability of BMI was high (CCC = 0.930); when grouped into BMI categories, a higher proportion of mothers of delayed children were correctly classified (κ(wt) = 0.93) compared with the autism group and controls (κ(wt) = 0.85 and κ(wt) = 0.84, respectively; P = 0.05). Multiparity was associated with higher discrepancies in BMI and misreporting of hypertensive disorders. For purposes of etiologic studies, self-reported diabetes and hypertensive disorders during periconception and pregnancy show high validity among mothers irrespective of child's case status. Recall of pre-pregnancy BMI is reliable compared with self-reported values in medical records. PMID:25656730

  2. 42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... that meets the Medicare DMEPOS Supplier Quality and Accreditation Standards at 42 CFR 424.57. ... provided pharmacist services must include evaluation of a patient's response to medication therapy... ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in...

  3. Factors associated with geographic variation in cost per episode of care for three medical conditions

    PubMed Central

    2014-01-01

    Objective To identify associations between market factors, especially relative reimbursement rates, and the probability of surgery and cost per episode for three medical conditions (cataract, benign prostatic neoplasm, and knee degeneration) with multiple treatment options. Methods We use 2004–2006 Medicare claims data for elderly beneficiaries from sixty nationally representative communities to estimate multivariate models for the probability of surgery and cost per episode of care as a function local market factors, including Medicare physician reimbursement for surgical versus non-surgical treatment and the availability of primary care and specialty physicians. We used Symmetry’s Episode Treatment Groups (ETG) software to group claims into episodes for the three conditions (n = 540,874 episodes). Results Higher Medicare reimbursement for surgical episodes and greater availability of the relevant specialists are significantly associated with more surgery and higher cost per episode for all three conditions, while greater availability of primary care physicians is significantly associated with less frequent surgery and lower cost per episode. Conclusion Relative Medicare reimbursement rates for surgical vs. non-surgical treatments and the availability of both primary care physicians and relevant specialists are associated with the likelihood of surgery and cost per episode. PMID:24949281

  4. [Elderly victims of trauma: preexisting conditions, medications taken at home and indexes of trauma].

    PubMed

    Degani, Gláucia Costa; Pereira Júnior, Gerson Alves; Rodrigues, Rosalina Aparecida Partezani; Luchesi, Bruna Moretti; Marques, Sueli

    2014-01-01

    The objective was to identify the sociodemographic profile of the elderly victims of trauma, to characterize preexisting conditions and medications taken at home, and to calculate indices of trauma and clinical outcomes. This is a retrospective and exploratory analysis from a database of a general hospital between 2008 and 2010. There were studied 131 elderly, mean age 69.9 years, 73.3% male, 55.1% married, 54.7% retired, 65.6% had preexisting conditions and 48.9% used drugs at home. There was a representative number of falls (31.3%), followed by running over (28.2%), with the head/neck region being the most affected (59.5%). Moderate trauma prevailed (44.3%), with conditions of survival after the event (80.2%). There was an association between mechanism of trauma and preexisting disease (p=0.01) and between mechanism of trauma and sex (p=0.03). The knowledge of the variables involved with the elderly victims of trauma enables healthcare professionals to plan preventive measures aimed at improving the assistance. PMID:25517670

  5. Hospital competition, managed care, and mortality after hospitalization for medical conditions: evidence from three states.

    PubMed

    Escarce, José J; Jain, Arvind K; Rogowski, Jeannette

    2006-12-01

    This study assessed the effect of hospital competition and HMO penetration on mortality after hospitalization for six medical conditions in California, New York, and Wisconsin. We used linked hospital-discharge and vital-statistics data to study adults hospitalized for myocardial infarction, hip fracture, stroke, gastrointestinal hemorrhage, congestive heart failure, or diabetes. We estimated logistic regression models with death within 30 days of admission as the dependent variable and hospital competition, HMO penetration, and hospital and patient characteristics as explanatory variables. Higher hospital competition was associated with lower mortality in California and New York but not Wisconsin. Higher HMO penetration was associated with lower mortality in California but higher mortality in New York. These findings suggest that hospitals in highly competitive markets compete on quality even in the absence of mature managed-care markets. The findings also underscore the need to consider geographic effects in studies of market structure and hospital quality. PMID:17099132

  6. The Integrated Medical Model: A Probabilistic Simulation Model Predicting In-Flight Medical Risks

    NASA Technical Reports Server (NTRS)

    Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G., Jr.

    2015-01-01

    The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting mass and volume constraints.

  7. The Integrated Medical Model: A Probabilistic Simulation Model for Predicting In-Flight Medical Risks

    NASA Technical Reports Server (NTRS)

    Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G.

    2015-01-01

    The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting mass and volume constraints.

  8. Feasibility of Remote Ischemic Peri-conditioning during Air Medical Transport of STEMI Patients.

    PubMed

    Martin-Gill, Christian; Wayne, Max; Guyette, Francis X; Olafiranye, Oladipupo; Toma, Catalin

    2016-01-01

    Remote ischemic peri-conditioning (RIPC) has gained interest as a means of reducing ischemic injury in patients with acute ST-elevation myocardial infarction (STEMI) who are undergoing emergent primary percutaneous coronary intervention (pPCI). We aimed to evaluate the feasibility, process, and patient-related factors related to the delivery of RIPC during air medical transport of STEMI patients to tertiary pPCI centers. We performed a retrospective review of procedural outcomes of a cohort of STEMI patients who received RIPC as part of a clinical protocol in a multi-state air medical service over 16 months (March 2013 to June 2014). Eligible patients were transported to two tertiary PCI centers and received up to four cycles of RIPC by inflating a blood pressure cuff on an upper arm to 200 mmHg for 5 minutes and subsequently deflating the cuff for 5 minutes. Data regarding feasibility, process variables, patient comfort, and occurrence of hypotension were obtained from prehospital records and prospectively completed quality improvement surveys. The primary outcome was whether at least 3 cycles of RIPC were completed by air medical transport crews prior to pPCI. Secondary outcomes included the number of cycles completed prior to pPCI, time spent with the patient prior to transport (bedside time), patient discomfort level, and incidence of hypotension (systolic blood pressure <90 mmHg) during the procedure. RIPC was initiated in 99 patients (91 interfacility, 8 scene transports) and 83 (83.3%) received 3 or 4 cycles of RIPC, delivered over 25-35 minutes. Median bedside time for interfacility transfers was 8 minutes (IQR 7, 10). More than half of patients reported no pain related to the procedure (N = 53, 53.3%), whereas 5 (5.1%) patients reported discomfort greater than 5 out of 10. Two patients developed hypotension while receiving RIPC and both had experienced hypotension prior to initiation of RIPC. RIPC is feasible and safe to implement for STEMI patients undergoing air medical transport for pPCI, without occurrence of prolonged bedside times. The incidence of excessive RIPC-related discomfort or hemodynamic instability is rare. STEMI patients requiring on average >30 minutes transport for pPCI may be the ideal group for RIPC utilization. PMID:26270795

  9. 20 CFR 10.719 - If a settlement or judgment is received for more than one wound or medical condition, can the...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim... received for more than one wound or medical condition, can the refundable disbursements paid on a single... to the United States? (a) All wounds, diseases or other medical conditions accepted by OWCP...

  10. 20 CFR 10.719 - If a settlement or judgment is received for more than one wound or medical condition, can the...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim... received for more than one wound or medical condition, can the refundable disbursements paid on a single... to the United States? (a) All wounds, diseases or other medical conditions accepted by OWCP...

  11. 20 CFR 10.719 - If a settlement or judgment is received for more than one wound or medical condition, can the...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim... received for more than one wound or medical condition, can the refundable disbursements paid on a single... to the United States? (a) All wounds, diseases or other medical conditions accepted by OWCP...

  12. 20 CFR 10.719 - If a settlement or judgment is received for more than one wound or medical condition, can the...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim... received for more than one wound or medical condition, can the refundable disbursements paid on a single... to the United States? (a) All wounds, diseases or other medical conditions accepted by OWCP...

  13. 20 CFR 10.719 - If a settlement or judgment is received for more than one wound or medical condition, can the...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim... received for more than one wound or medical condition, can the refundable disbursements paid on a single... to the United States? (a) All wounds, diseases or other medical conditions accepted by OWCP...

  14. [About development of medical maintenance of military air forces in modern conditions].

    PubMed

    Radchenko, S N; Arsen'ev, Iu G

    2010-10-01

    The authors prove the necessity of transformation of medical service of Air Force of all levels within the framework of the realization of program "Development of medical supply of Armed Forces of Russian Federation 2008-2012". Goals, functions of different elements of medical service, responsibilities of performers are developed. These goals have fundamental differences from previous one. New organizational structure of medical service of Air Forces and criteria of the estimation of its effectiveness are suggested. Offers of further optimization of organizational medical structure and improvement of medical supply of Air Forces are developed. PMID:21254586

  15. Which common clinical conditions should medical students be able to manage by graduation? A perspective from Australian interns.

    PubMed

    Rolfe, I E; Pearson, S-A; Sanson-Fisher, R W; Ringland, C; Bayley, S; Hart, A; Kelly, S

    2002-01-01

    The objectives of the study were to report the development of a core curriculum that details the clinical conditions medical students should be able to manage upon graduation; and to canvass the opinion of interns (first-year postgraduate doctors) regarding their perceptions of the level of skill required to manage each condition. Literature relating to core curriculum development and training of junior medical officers was reviewed and stakeholders in the education and training of medical students and junior doctors in the state of New South Wales, Australia (intern supervisors, academics, registrars, nurses and interns) were consulted. The final curriculum spanned 106 conditions, 77 'differentiated' and 29 'undifferentiated'. Four levels of skill at which conditions should potentially be managed were also identified: 'Theoretical knowledge only'; 'Recognize symptoms and signs without supervision'; Initiate preliminary investigations, management and/or treatment without supervision'; and 'Total investigation, management and/or treatment without supervision'. The list of conditions in the curriculum was converted to a survey format and a one-in-two random sample of interns (n = 193) practising in New South Wales who graduated from the state's three medical schools were surveyed regarding the level of skill required for managing each clinical condition at graduation. A total of 51.3% of interns responded to the survey. Interns felt they should be able to initiate preliminary investigation, management and/or treatment for most conditions in the curriculum, with more than half acknowledging this level of management for 53 of the differentiated and 28 of the undifferentiated conditions. It is concluded that developing core curricula in medical education can involve multiple stakeholders, including junior doctors as the consumers of educational experiences. The data gathered may be useful to medical schools revising their curricula. PMID:12098452

  16. Critical Illness in Pregnancy: Part II: Common Medical Conditions Complicating Pregnancy and Puerperium.

    PubMed

    Guntupalli, Kalpalatha K; Karnad, Dilip R; Bandi, Venkata; Hall, Nicole; Belfort, Michael

    2015-11-01

    The first of this two-part series on critical illness in pregnancy dealt with obstetric disorders. In Part II, medical conditions that commonly affect pregnant women or worsen during pregnancy are discussed. ARDS occurs more frequently in pregnancy. Strategies commonly used in nonpregnant patients, including permissive hypercapnia, limits for plateau pressure, and prone positioning, may not be acceptable, especially in late pregnancy. Genital tract infections unique to pregnancy include chorioamnionitis, group A streptococcal infection causing toxic shock syndrome, and polymicrobial infection with streptococci, staphylococci, and Clostridium perfringens causing necrotizing vulvitis or fasciitis. Pregnancy predisposes to VTE; D-dimer levels have low specificity in pregnancy. A ventilation-perfusion scan is preferred over CT pulmonary angiography in some situations to reduce radiation to the mother's breasts. Low-molecular-weight or unfractionated heparins form the mainstay of treatment; vitamin K antagonists, oral factor Xa inhibitors, and direct thrombin inhibitors are not recommended in pregnancy. The physiologic hyperdynamic circulation in pregnancy worsens many cardiovascular disorders. It increases risk of pulmonary edema or arrhythmias in mitral stenosis, heart failure in pulmonary hypertension or aortic stenosis, aortic dissection in Marfan syndrome, or valve thrombosis in mechanical heart valves. Common neurologic problems in pregnancy include seizures, altered mental status, visual symptoms, and strokes. Other common conditions discussed are aspiration of gastric contents, OSA, thyroid disorders, diabetic ketoacidosis, and cardiopulmonary arrest in pregnancy. Studies confined to pregnant women are available for only a few of these conditions. We have, therefore, reviewed pregnancy-specific adjustments in the management of these disorders. PMID:26020727

  17. Trends, Productivity Losses, and Associated Medical Conditions Among Toxoplasmosis Deaths in the United States, 2000–2010

    PubMed Central

    Cummings, Patricia L.; Kuo, Tony; Javanbakht, Marjan; Sorvillo, Frank

    2014-01-01

    Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000–2010. A matched case–control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups. PMID:25200264

  18. Review of the Evidence: Prevalence of Medical Conditions in the United States Population with Serious Mental Illness

    PubMed Central

    Janssen, Ellen M.; McGinty, Emma E.; Azrin, Susan T.; Juliano-Bult, Denise; Daumit, Gail L.

    2015-01-01

    Objective Persons with serious mental illness (SMI) have high rates of premature mortality from preventable medical conditions, but this group is underrepresented in epidemiologic surveys and we lack national estimates of the prevalence of conditions such as obesity and diabetes in this group. We performed a comprehensive review to synthesize estimates of the prevalence of 15 medical conditions among the population with SMI. Method We reviewed studies published in the peer-reviewed literature from January 2000-August 2012. Studies were included if they assessed prevalence in a sample of 100 or more US adults with schizophrenia or bipolar disorder. Results 57 studies were included in the review. For most medical conditions, the prevalence estimates varied considerably. For example, estimates of obesity prevalence ranged from 26% to 55%. This variation appeared to be due to differences in measurement (e.g. self-report versus clinical measures) and underlying differences in study populations. Few studies assessed prevalence in representative, community samples of persons with SMI. Conclusions In many studies, the prevalence of medical conditions among the population with SMI was higher than among the overall US population. Screening for and monitoring of these conditions should be common practice in clinical settings serving persons with SMI. PMID:25881768

  19. Urinary heavy metals and associated medical conditions in the US adult population.

    PubMed

    Mendy, Angelico; Gasana, Janvier; Vieira, Edgar Ramos

    2012-01-01

    Health effects of heavy metals have been widely investigated, but further evaluation is required to comprehensively delineate their toxicity. Using data from the 2007-2008 National Health and Nutrition Examination Survey, a multivariate logistic regression analysis was performed on 1,857 adults to examine the relationship between urinary heavy metals and various medical conditions. Cardiovascular diseases were correlated to cadmium (OR: 4.94, 95% CI: 1.48-16.56) and lead (OR: 5.32, 95% CI: 1.08-26.21). Asthma was related to tungsten (OR: 1.72, 95% CI: 1.15-2.59) and uranium (OR: 1.52, 95% CI: 1.01-2.28). Hepatotoxicity was associated with molybdenum (OR: 3.09, 95% CI: 1.24-7.73) and uranium (OR: 4.79, 95% CI: 1.74-13.19). Surprising inverse relationships occurred for excessive weight with lead (OR: 0.72, 95% CI: 0.52-0.98), reduced visual acuity with cobalt (OR: 0.65, 95% CI: 0.44-0.95) and cesium (OR: 0.52, 95% CI: 0.35-0.77). This study supports some previous evidence of potential relationships and provides insights for future research. PMID:21854105

  20. Ethnic Differences in Diabetes Management in Patients With and Without Comorbid Medical Conditions

    PubMed Central

    Alshamsan, Riyadh; Majeed, Azeem; Vamos, Eszter Panna; Khunti, Kamlesh; Curcin, Vasa; Rawaf, Salman; Millett, Christopher

    2011-01-01

    OBJECTIVE To examine ethnic disparities in diabetes management among patients with and without comorbid medical conditions after a period of sustained investment in quality improvement in the U.K. RESEARCH DESIGN AND METHODS This cross-sectional study examined associations between ethnicity, comorbidity, and intermediate outcomes for mean A1C, total cholesterol, and blood pressure levels in 6,690 diabetes patients in South West London. RESULTS The presence of ≥2 cardiovascular comorbidities was associated with similar blood pressure control among white and South Asian patients when compared with whites without comorbidity but with worse blood pressure control among black patients, with a mean difference in systolic blood pressure of +1.5, +1.4, and +6.2 mmHg, respectively. CONCLUSIONS Despite major reforms to improve quality, disparities in blood pressure management have persisted in the U.K., particularly among patients with cardiovascular comorbidities. Policy makers should consider the potential impacts of quality initiatives on high-risk groups. PMID:21282346

  1. Adherence behaviour with psychotropic medication is a form of self-medication.

    PubMed

    Mitchell, Alex J

    2007-01-01

    Adherence with psychotropic medication is at least at poor as adherence with medication for physical health problems. There has been an assumption this was due to loss of insight resulting from psychiatric disorders themselves. Consequently, interventions have focussed on treating the underlying psychiatric disorder and generating psychological strategies to promote awareness. Recent surveys of patient preferences for information and involvement in health care decisions highlight that most individuals want to participate in the process of medical care. Patients often have strong pre-existing beliefs about different therapeutic options. This is supported by the self-determination theory which distinguishes between autonomous behaviour and behaviours that are influenced by external forces. When considering the patient perspective in medication adherence, it is useful to consider the self-medication hypothesis. This can equally be applied to prescribed and non-prescribed drugs. The self-medication hypothesis states that patients decide to start, adjust or stop prescribed medication according to perceived health needs. Such decisions are often conducted intentionally and rationally, given the information available to the patient and their understanding of their condition. In this narrative review, the evidence for and against intentionality in psychotropic adherence behaviour is examined. Studies of compliance and related predictors are examined in depression, schizophrenia and bipolar affective disorder. Results suggest that although concordance depends on patient, illness and clinician factors, patient choice is usually the final common pathway. Illness severity and insight is important in some cases but can act in concert with cognitive factors. Individuals appear to prefer to take medication "as required" (symptomatically) rather than prophylactically. Significant influences upon self-medication habits are prior health beliefs, medication attitudes, adverse effects and adequacy of communication from the health care professional. The self-medication hypothesis applied to prescribed psychotropic medication should assist rather than heed clinicians in improving adherence by taking a patient centred approach and where possible promoting patient autonomy. PMID:16996228

  2. Clinical deterioration in the condition of patients with acute medical illness in Australian hospitals: improving detection and response.

    PubMed

    Jenkins, Paul F; Thompson, Campbell H; Barton, Lorna L

    2011-06-01

    Medical Assessment Units (MAUs) provide an opportunity for multidisciplinary staff to manage recently admitted acutely unwell patients with complex medical illnesses. We propose concerted development of robust mechanisms for identifying and managing patients whose condition is unstable as they move through hospital departments. Track, trigger and response (TTR) systems (eg, medical emergency team calls and early warning scores) have been introduced to hospital practice, but evidence for their effectiveness is, so far, incomplete. The current variation in TTR systems within and between hospitals impairs intersite comparisons. A range of outcome measures, including risk of physiological deterioration, mortality and projected hospital length of stay, could be usefully investigated by future intersite collaborative research. More deliberate, systematic, evidence-based design of "response" in TTR systems may help in identifying patients who need early attention from skilled medical staff. We need more uniform TTR systems, more research on TTR systems and more multisite research; MAUs are ideally situated to address this important area. PMID:21644875

  3. 42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... payment: Medically directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent...

  4. 42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... payment: Medically directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent...

  5. 42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... payment: Medically directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent...

  6. 42 CFR 482.24 - Condition of participation: Medical record services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... anesthesia services. The medical history and physical examination must be placed in the patient's medical... anesthesia services. (B) An updated examination of the patient, including any changes in the patient's... anesthesia services. (ii) Admitting diagnosis. (iii) Results of all consultative evaluations of the...

  7. Oral Assessment and Postgraduate Medical Examinations: Establishing Conditions for Validity, Reliability and Fairness

    ERIC Educational Resources Information Center

    Memon, Muhammed Ashraf; Joughin, Gordon Rowland; Memon, Breda

    2010-01-01

    The purpose of this review was to examine the practice of oral assessment in postgraduate medical education in the context of the core assessment constructs of validity, reliability and fairness. Although oral assessment has a long history in the certification process of medical specialists and is a well-established part of such proceedings for a…

  8. The prevalence of the pre-existing hepatitis C viral variants and the evolution of drug resistance in patients treated with the NS3-4a serine protease inhibitor telaprevir

    SciTech Connect

    Rong, Libin; Ribeiro, Ruy M; Perelson, Alan S

    2008-01-01

    Telaprevir (VX-950), a novel hepatitis C virus (HCV) NS3-4A serine protease inhibitor, has demonstrated substantial antiviral activity in patients infected with HCV genotype 1. Some patients experience viral breakthrough, which has been shown to be associated with emergence of telaprevir-resistant HCV variants during treatment. The exact mechanisms underlying the rapid selection of drug resistant viral variants during dosing are not fully understood. In this paper, we develop a two-strain model to study the pre-treatment prevalence of the mutant virus and derive an analytical solution of the mutant frequency after administration of the protease inhibitor. Our analysis suggests that the rapid increase of the mutant frequency during therapy is not due to mutant growth but rather due to the rapid and profound loss of wild-type virus, which uncovers the pre-existing mutant variants. We examine the effects of backward mutation and hepatocyte proliferation on the pre-existence of the mutant virus and the competition between wild-type and drug resistant virus during therapy. We then extend the simple model to a general model with multiple viral strains. Mutations during therapy do not play a significant role in the dynamics of various viral strains, although they are capable of generating low levels of HCV variants that would otherwise be completely suppressed because of fitness disadvantages. Hepatocyte proliferation may not affect the pretreatment frequency of mutant variants, but is able to influence the quasispecies dynamics during therapy. It is the relative fitness of each mutant strain compared with wild-type that determines which strain(s) will dominate the virus population. The study provides a theoretical framework for exploring the prevalence of pre-existing mutant variants and the evolution of drug resistance during treatment with other protease inhibitors or HCV polymerase inhibitors.

  9. Out-of-hours and weekend admissions to Danish medical departments: admission rates and 30-day mortality for 20 common medical conditions

    PubMed Central

    Sørensen, Henrik Toft; Christiansen, Christian Fynbo

    2015-01-01

    Objectives Knowledge on timing of admissions and mortality for acute medical patients is limited. The aim of the study was to examine hospital admission rates and mortality rates for patients with common medical conditions according to time of admission. Design Nationwide population-based cohort study. Setting Population of Denmark. Participants Using the Danish National Registry of Patients covering all Danish hospitals, we identified all adults with the first acute admission to a medical department in Denmark during 2010. Primary and secondary outcome measures Hourly admission rates and age-standardised and sex-standardised 30-day mortality rates comparing weekday office hours, weekday out of hours, weekend daytime hours and weekend night-time hours. Results In total, 174 192 acute medical patients were included in the study. The admission rates (patients per hour) were 38.7 (95% CI 38.4 to 38.9) during weekday office hours, 13.3 (95% CI 13.2 to 13.5) during weekday out of hours, 19.8 (95% CI 19.6 to 20.1) during weekend daytime hours and 7.9 (95% CI 7.8 to 8.0) during weekend night-time hours. Admission rates varied between medical conditions. The proportion of patients admitted to an intensive care unit (ICU) increased outside of office hours. The age-standardised and sex-standardised 30-day mortality rate was 5.1% (95% CI 5.0% to 5.3%) after admission during weekday office hours, 5.7% (95% CI 5.5% to 6.0%) after admission during weekday out of hours, 6.4% (95% CI 6.1% to 6.7%) after admission during weekend daytime hours and 6.3% (95% CI 5.9% to 6.8%) after admission during weekend night-time hours. For the majority of the medical conditions examined, weekend admission was associated with highest mortality. Conclusions While admission rates decreased from office hours to weekend hours there was an observed increase in mortality. This may reflect differences in severity of illness as the proportion admitted to an ICU increased during the weekend. PMID:25762233

  10. Dietary and Lifestyle Factors and Medical Conditions Associated with Urinary Citrate Excretion

    PubMed Central

    Taylor, Eric N.; Curhan, Gary C.

    2013-01-01

    Summary Background and objectives Lower urinary citrate excretion is a risk factor for nephrolithiasis and associated with metabolic acidosis and higher prevalence of hypertension and insulin resistance. This study sought to quantify the independent predictors of urinary citrate excretion in population-based cohorts. Design, setting, participants, & measurements A cross-sectional study of 2561 individuals from the Health Professionals Follow-Up Study and Nurses’ Health Studies I and II who provided two 24-hour urine collections was conducted. Dietary data were ascertained from the semiquantitative food frequency questionnaire. Lifestyle and disease data were derived from responses to biennial questionnaires. Multivariable linear regression was used to quantify the predictors of urinary citrate excretion. Results After adjusting for age, urinary creatinine, dietary, and other factors, higher intake of nondairy animal protein (per 10 g/d; −20 mg/d; 95% confidence interval [−29 to −11]), higher body mass index (per 1 kg/m2; −4 mg/d; [−6 to −2]), and history of nephrolithiasis (−57 mg/d; [−79 to −36]), hypertension (−95 mg/d; [−119 to −71]), gout (−104 mg/d; [−155 to −54]), and thiazide use (−34 mg/d; [−68 to −1]) were independently associated with lower 24-hour urinary citrate excretion. Higher intake of potassium (per 1000 mg/d; 53 mg/d; [33 to 74]), higher urinary sodium (per 100 mEq/d; 56 mg/d; [31 to 80]), and history of diabetes (61 mg/d; [21 to 100]) were independently associated with higher citrate excretion. Conclusions Several dietary and lifestyle factors and medical conditions are independently associated with urinary citrate excretion. PMID:23449767

  11. Men in extreme conditions: some medical and psychological aspects of the Auschwitz concentration camp.

    PubMed

    Radil-Weiss, T

    1983-08-01

    The second world war ended many years ago. Most of those who survived the stay at the German concentration camp at Auschwitz have already died of the consequences of their imprisonment; those still alive are already in the last third of their life. Is there any point in returning to the experiences of those days? Consideration of the mental hygiene of former prisoners cautions us that perhaps we should not do it. But consideration of the general interest holds that we are not entitled to ignore any knowledge that can contribute to social development--including medicine and psychology--even if acquired under unspeakably awful conditions. In addition, since the war new generations have grown up that play an increasingly significant role in various spheres of life but have little concrete information about those events; they can neither rationally nor emotionally understand how the horrors connected with fascism and the war could have happened. In a sense it is encouraging that they cannot grasp such inhuman behavior; nevertheless, we must adhere to the following motto: "Nothing must be forgotten, nobody will be forgotten." We owe it to those millions who did not survive--both the victims of the Holocaust and those who fought against it. These are arguments in favor of returning to the facts that are ineffaceably recorded somewhere in our memories. In doing so, however, we must remember that at times we are revisiting experiences of a boy of 14 as recalled by a 50-year-old man. The material below, examining the medical as well as psychological aspects of imprisonment at Auschwitz, is based on my own memories, as an adolescent imprisoned at Auschwitz. I have tried to move from this individual account to more general statements, although the methodological apparatus on which scientific analysis is usually based is absent. PMID:6622601

  12. Chronic kidney disease is associated with a higher 90-day mortality than other chronic medical conditions in patients with sepsis

    PubMed Central

    Mansur, Ashham; Mulwande, Evelyn; Steinau, Maximilian; Bergmann, Ingo; Frederik Popov, Aron; Ghadimi, Michael; Beissbarth, Tim; Bauer, Martin; Hinz, José

    2015-01-01

    According to previous studies, the clinical course of sepsis could be affected by preexisting medical conditions, which are very common among patients with sepsis. This observational study aimed at investigating whether common chronic medical conditions affect the 90-day mortality risk in adult Caucasian patients with sepsis. A total of 482 patients with sepsis were enrolled in this study. The ninety-day mortality was the primary outcome; organ failure was the secondary outcome. Sepsis-related organ failure assessment (SOFA) scores and the requirements for organ support were evaluated to assess organ failure. A multivariate Cox regression model for the association between the 90-day mortality risk and chronic preexisting medical conditions adjusted for all relevant confounders and mortality predictors revealed the highest hazard ratio for patients with chronic kidney disease (CKD) (hazard ratio, 2.25; 95% CI, 1.46-3.46; p = 0.0002). Patients with CKD had higher SOFA scores than patients without CKD (8.9 ± 4.0 and 6.5 ± 3.4, respectively; p < 0.0001). Additionally, an analysis of organ-specific SOFA scores revealed higher scores in three organ systems (kidney, cardiovascular and coagulation). Patients with CKD have the highest 90-day mortality risk compared with patients without CKD or with other chronic medical conditions. PMID:25995131

  13. Medical Conditions and Healthcare Utilization among Adults with Intellectual Disabilities Living in Group Homes in New York City

    ERIC Educational Resources Information Center

    Levy, Joel M.; Botuck, Shelly; Damiani, Marco R.; Levy, Philip H.; Dern, Thomas A.; Freeman, Stephen E.

    2006-01-01

    The shift in living situations for adults with intellectual and other developmental disabilities (IDDD) from family homes to group homes has raised questions about their healthcare needs and access to appropriate healthcare services. This study was undertaken to describe the disability characteristics and medical conditions in a sample of adults…

  14. Nine children over the age of one year with full trisomy 13: a case series describing medical conditions.

    PubMed

    Bruns, Deborah A; Campbell, Emily

    2014-12-01

    Trisomy 13 (Patau syndrome), identified by Patau and colleagues [1960; Lancet 1: 790-793] is the third most common autosomal condition. Population studies indicate less than one in 10 children reaches their first birthday. In the face of mixed findings and recommendations for treatment, additional research is needed to further determine what contributes to longevity and implications for treatment for presenting medical conditions. The purpose of the present study is to report on presenting medical conditions and the presence or absence of the specific conditions (age at survey completion). Data on nine survivors (seven female, two male) with trisomy 13 indicated mean gestational age of approximately 36 weeks, birth weight ranging from 1100 to 3290 g and mean length of 45.3 cm. Length of hospital stay after birth varied. The majority of infants presented with well-known physical characteristics. Medical conditions and their treatment varied at birth and at survey completion. Notably, several infants' cardiac anomalies resolved without surgical intervention. Surgeries were provided for a range of conditions including gastrostomy tube placement to address feeding issues and removal of intestinal blockage. There were no reports of holoprosencephaly. Implications and recommendations are provided. PMID:25323598

  15. 75 FR 27662 - Special Conditions: Boeing 747-468, Installation of a Medical Lift

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-18

    ... OPERATE LIFT DURING TAXI, TAKEOFF, LANDING, OR TURBULENCE. c. AN APPROVED MEDICAL STRETCHER OR WHEELCHAIR... operation. b. Operate the lift. c. Stow the lift for non-operation such as during TTL and turbulence....

  16. Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya

    PubMed Central

    Thirumurthy, Harsha; Masters, Samuel H.; Rao, Samwel; Bronson, Megan A.; Lanham, Michele; Omanga, Eunice; Evens, Emily; Agot, Kawango

    2014-01-01

    IMPORTANCE Novel strategies are needed to increase the uptake of voluntary medical male circumcision (VMMC) in sub-Saharan Africa and enhance the effectiveness of male circumcision as an HIV prevention strategy. OBJECTIVE To determine whether small economic incentives could increase circumcision prevalence by addressing reported economic barriers to VMMC and behavioral factors such as present-biased decision making. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted between June 22, 2013, and February 4, 2014, among 1504 uncircumcised men aged 25 to 49 years in Nyanza region, Kenya. VMMC services were provided free of charge and participants were randomized to 1 of 3 intervention groups or a control group. INTERVENTIONS Participants in the 3 intervention groups received varying amounts of compensation conditional on undergoing circumcision at 1 of 9 study clinics within 2 months of enrollment. Compensation took the form of food vouchers worth 200 Kenya shillings (≈US $2.50), 700 Kenya shillings (≈US $8.75), or 1200 Kenya shillings (≈US $15.00), which reflected a portion of transportation costs and lost wages associated with getting circumcised. The control group received no compensation. MAIN OUTCOMES AND MEASURES VMMC uptake within 2 months. RESULTS Analysis of data for 1502 participants with complete data showed that VMMC uptake within 2 months was higher in the US $8.75 group (6.6%; 95% CI, 4.3%–9.5% [25 of 381]) and the US $15.00 group (9.0%; 95% CI, 6.3%–12.4% [34 of 377]) than in the US $2.50 group (1.9%; 95% CI, 0.8%–3.8% [7 of 374]) and the control group (1.6%; 95% CI, 0.6%–3.5% [6 of 370]). In logistic regression analysis, the US $8.75 group had significantly higher VMMC uptake than the control group (adjusted odds ratio [AOR] 4.3; 95% CI, 1.7–10.7), as did the US $15.00 group (AOR 6.2; 95% CI, 2.6–15.0). Effect sizes for the US $8.75 and US $15.00 groups did not differ significantly (P = .20). CONCLUSIONS AND RELEVANCE Among uncircumcised men in Kenya, compensation in the form of food vouchers worth approximately US $8.75 or US $15.00, compared with lesser or no compensation, resulted in a modest increase in the prevalence of circumcision after 2 months. The effects of more intense promotion or longer implementation require further investigation. PMID:25042290

  17. Access to Health Insurance: Experiences and Attitudes of Those With Genetic Versus Non-Genetic Medical Conditions

    PubMed Central

    Kass, Nancy E.; Medley, Amy M.; Natowicz, Marvin R.; Hull, Sara Chandros; Faden, Ruth R.; Plantinga, Laura; Gostin, Lawrence O.

    2016-01-01

    While studies reveal that individuals with both genetic and other chronic medical conditions have difficulty obtaining health insurance, no large-scale studies have compared the health insurance experiences of these groups. The goal of this study was to document and compare the health insurance experiences, attitudes, and beliefs of persons with genetic conditions to those of persons with or at risk for other serious medical conditions. We interviewed approximately 100 adults or parents of children with one of each of the following medical conditions: sickle cell disease (SCD), cystic fibrosis (CF), diabetes, and HIV, and 200 adults with or at risk for breast (BC) or colon cancer (CC). The interview included items related to respondents’ experiences and attitudes regarding health insurance. Twenty-seven percent of 597 total respondents self-reported having been denied health insurance or offered insurance at a prohibitive rate. Respondents with single-gene disorders (CF and SCD) were twice as likely to report this as those with non-genetic conditions. Legislation that exists to limit genetic discrimination in insurance addresses genetic risks or traits only, however, rather than protecting those with actual disease. Thus, current legislation may not address the challenges faced by individuals like those in this study, who try to maintain access to health insurance when they or their children are symptomatic with a genetic or other serious health condition. More than one-third of all respondents thought there was a high chance they would be denied health insurance in the future or their insurance would become unaffordable. That individuals with all six health conditions expressed concern regarding their ability to obtain future health insurance suggests policy proposals should be broad-based, addressing the needs and concerns of individuals with diverse health conditions. PMID:17290434

  18. 42 CFR 410.38 - Durable medical equipment: Scope and conditions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... or purchase of durable medical equipment, including iron lungs, oxygen tents, hospital beds, and...) An institution that is used as a home may not be a hospital or a CAH or a SNF as defined in sections...) Beneficiaries discharged from a hospital do not need to receive a separate face-to-face examination as long...

  19. Prevalence of Chronic Medical Conditions in Adults with Mental Retardation: Comparison with the General Population.

    ERIC Educational Resources Information Center

    Kapell, Deborah; Nightingale, Beryle; Rodriguez, Ana; Lee, Joseph H.; Zigman, Warren B.; Schupf, Nicole

    1998-01-01

    A study interviewed caregivers and reviewed medical records of 278 adults with mental retardation with and without Down syndrome. The adults with mental retardation had age-related disorders comparable to those in the general population, but there was an increased frequency of thyroid disorders, nonischemic heart disorders, and sensory impairment.…

  20. Spiritually Competent Practice with Individuals and Families Dealing with Medical Conditions

    ERIC Educational Resources Information Center

    Sperry, Len

    2011-01-01

    Counselors and psychotherapists are increasingly expected to provide services that are spiritually competent. Those counseling individuals and families where medical concerns are a focus would do well to consider the implications of spiritual competence in their work. The article defines spiritual competence, describes spiritual competencies, and

  1. 42 CFR 482.24 - Condition of participation: Medical record services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... to surgery or a procedure requiring anesthesia services. The medical history and physical examination... prior to surgery or a procedure requiring anesthesia services. (B) An updated examination of the patient... surgery or a procedure requiring anesthesia services. (ii) Admitting diagnosis. (iii) Results of...

  2. 42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia services...

  3. 42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia services...

  4. 42 CFR 482.24 - Condition of participation: Medical record services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... to surgery or a procedure requiring anesthesia services. The medical history and physical examination... prior to surgery or a procedure requiring anesthesia services. (B) An updated examination of the patient... surgery or a procedure requiring anesthesia services. (ii) Admitting diagnosis. (iii) Results of...

  5. Manchester Clinical Placement Index (MCPI). Conditions for Medical Students' Learning in Hospital and Community Placements

    ERIC Educational Resources Information Center

    Dornan, Tim; Muijtjens, Arno; Graham, Jennifer; Scherpbier, Albert; Boshuizen, Henny

    2012-01-01

    The drive to quality-manage medical education has created a need for valid measurement instruments. Validity evidence includes the theoretical and contextual origin of items, choice of response processes, internal structure, and interrelationship of a measure's variables. This research set out to explore the validity and potential utility of an…

  6. 76 FR 15798 - Special Conditions: Boeing 747-468, Installation of a Medical Lift

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... airplane was published in the Federal Register on May 18, 2010 (75 FR 27662). No public comments were... APPROVED. b. DO NOT OPERATE LIFT DURING TAXI, TAKEOFF, LANDING, OR TURBULENCE. c. AN APPROVED MEDICAL... upper deck. b. Operate the lift. c. Stow the lift for non-operation such as during TTL and turbulence....

  7. Spiritually Competent Practice with Individuals and Families Dealing with Medical Conditions

    ERIC Educational Resources Information Center

    Sperry, Len

    2011-01-01

    Counselors and psychotherapists are increasingly expected to provide services that are spiritually competent. Those counseling individuals and families where medical concerns are a focus would do well to consider the implications of spiritual competence in their work. The article defines spiritual competence, describes spiritual competencies, and…

  8. Skin diseases and conditions among students of a medical college in southern India

    PubMed Central

    Joseph, Nitin; Kumar, Ganesh S; Nelliyanil, Maria

    2014-01-01

    Introduction: Skin diseases are a common problem among young adults. There is paucity of data about it among medical students. This study aimed to find out the pattern of skin disorders and to describe their association with various socio-demographic factors among medical students. Materials and Methods: This cross-sectional study was conducted in June 2011 in a medical college in Mangalore, Karnataka. Two-hundred and seventy eight medical students were chosen from the 4th, 6th and 8th semester through convenient sampling method. Data on hair and skin morbidities suffered over past 1 year and its associated factors were collected using a self-administered questionnaire. Results: Most of the participants 171 (61.5%) were of the age group 20-21 years and majority were females 148 (53.2%). The most common hair/skin morbidities suffered in the past one year were acne 185 (66.6%), hair loss 165 (59.3%), and sun tan 147 (52.9%). Fungal infection (P = 0.051) and severe type of acne (P = 0.041) were seen significantly more among males while hair morbidities like hair loss (P = 0.003), split ends of hairs (P < 0.0001) and dandruff (P =0.006) were seen significantly more among female students. Patterned baldness (P = 0.018) and sun tan (P < 0.0001) were significantly more among non-Mangalorean students than native Mangaloreans. Presence of dandruff was significantly associated with hair loss (P = 0.039) and usage of sunscreen was found to protect from developing sun tans (P = 0.049). Conclusion: Skin disorders, particularly the cosmetic problems are very common among medical students. Gender and place of origin were found to significantly influence the development of certain morbidities. PMID:24616849

  9. Association between a Hospital’s Quality Performance for In-Hospital Cardiac Arrest and Common Medical Conditions

    PubMed Central

    Chen, Lena M.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Spertus, John A.; Tang, Fengming; Chan, Paul S.

    2015-01-01

    Background Public reporting on hospital quality has been widely adopted for common medical conditions. Adding a measure of inpatient survival after cardiac arrest is being considered. It is unknown if this measure would be redundant, given evidence that hospital organization and culture can have hospital-wide effects on quality. Therefore, we sought to evaluate the correlation between inpatient survival after cardiac arrest and 30-day risk-standardized mortality rates for common medical conditions. Methods and Results Using data between 2007 and 2010 from a national in-hospital cardiac arrest registry, we calculated risk-standardized in-hospital survival rates for cardiac arrest at each hospital. We obtained risk-standardized 30-day mortality rates for acute myocardial infarction (AMI), heart failure (HF), and pneumonia from Hospital Compare for the same period. The relationship between a hospital’s performance on cardiac arrest and these other medical conditions was assessed using weighted Pearson correlation coefficients. Among 26,270 patients with in-hospital cardiac arrest at 130 hospitals, survival rates varied across hospitals, with a median risk-standardized hospital survival rate of 22.1% and an inter-quartile range (IQR) of 19.7% to 24.2%. There were no significant correlations between a hospital’s outcomes for its cardiac arrest patients and its patients admitted for AMI (correlation of −0.12; P=0.16), HF (correlation of −0.05; P=0.57), or pneumonia (correlation of −0.15, P=0.10). Conclusions Hospitals that performed better on publicly reported outcomes for three common medical conditions did not necessarily have better cardiac arrest survival rates. Public reporting on cardiac arrest outcomes could provide new information about hospital quality. PMID:24221831

  10. Neutralizing Antibody Response after Intramuscular Purified Vero Cell Rabies Vaccination (PVRV) in Iranian Patients with Specific Medical Conditions

    PubMed Central

    Rahimi, Pooneh; Vahabpour, RouhAllah; Aghasadeghi, Mohammad Reza; Sadat, Syed Mehdi; Howaizi, Nader; Mostafavi, Ehsan; Eslamifar, Ali; Fallahian, Vida

    2015-01-01

    Objective Post exposure prophylaxis using one of the WHO-approved vaccines is the method of choice for preventing rabies. Abnormal immune function in patients with some specific medical conditions, such as pregnancy, chronic hepatitis B virus infection, different types of cancers like lymphoma, diabetes I and II, corticosteroid consumption by patients with rheumatoid arthritis and lupus erythematosus, could impair the immunologic response to various vaccines. The immune response to rabies vaccination has never been examined in patients with any of these described medical conditions. This study purposed to evaluate the neutralyzing antibody response after vaccination with purified Vero cell rabies vaccine (PVRV) according to the WHO-recommended Post–Exposure Prophylaxis (PEP) "ESSEN" regimen. Methods Thirty healthy volunteers and 50 volunteers with different medical conditions who were exposed to a suspected rabid animal in the 2nd or 3rd category of exposure received 5 doses of PVRV under the ESSEN protocol. Three blood samples were collected on days 0 (before the first dose), 14, and 35. The anti-rabies antibody titer was measured using the Rapid Fluorescent Foci Inhibition Test (RFFIT) and an ELISA Bio-Rad, Platelia, Rabies II kit. Results All subjects reached NAb titers above 0.5 IU/ml by day 14 after vaccination. On day 35 (1 week after receiving the last rabies vaccine), anti-rabies antibodies were in the protective level (>0.5 IU/ml) in both groups. There was no statistically significant difference in anti-rabies antibody response due to the type of exposure (category 2 or 3), and successful seroconversion was confirmed in both groups. Conclusion In conclusion, the ESSEN protocol using the PVRV vaccine is sufficient for rabies prophylaxis in patients with specific medical conditions. PMID:26440665

  11. MedMinify: An Advice-giving System for Simplifying the Schedules of Daily Home Medication Regimens Used to Treat Chronic Conditions

    PubMed Central

    Flynn, Allen J.; Klasnja, Predrag; Friedman, Charles P.

    2014-01-01

    For those with high blood pressure, diabetes, or high cholesterol, adherence to a home medication regimen is important for health. Reductions in the number of daily medication-taking events or daily pill burden improve adherence. A novel advice-giving computer application was developed using the SMART platform to generate advice on how to potentially simplify home medication regimens. MedMinify generated advice for 41.3% of 1,500 home medication regimens for adults age 60 years and older with chronic medical conditions. If the advice given by MedMinify were implemented, 320 regimen changes would have reduced daily medication-taking events while an additional 295 changes would have decreased the daily pill burden. The application identified four serious drug-drug interactions and so advised against taking two pairs of medications simultaneously. MedMinify can give advice to change home medication regimens that could result in simpler home medication-taking schedules. PMID:25954445

  12. Impact of appropriate pharmaceutical therapy for chronic conditions on direct medical costs and workplace productivity: a review of the literature.

    PubMed

    Goldfarb, Neil; Weston, Christine; Hartmann, Christine W; Sikirica, Mirko; Crawford, Albert; He, Hope; Howell, Jamie; Maio, Vittorio; Clarke, Janice; Nuthulaganti, Bhaskar; Cobb, Nicole

    2004-01-01

    This paper presents the findings of a literature review investigating the economic impact of appropriate pharmaceutical therapy in treating four prevalent chronic conditions - asthma, diabetes, heart failure, and migraine. The goal of the review was to identify high-quality studies examining the extent to which appropriate pharmaceutical therapy impacts overall medical expenditure (direct costs) and workplace productivity (indirect costs). The working hypothesis in conducting the review was that the costs of pharmaceuticals for the selected chronic conditions are offset by savings in direct and indirect costs in other areas. The literature provides evidence that appropriate drug therapy improves the health status and quality of life of individuals with chronic illnesses while reducing costs associated with utilization of emergency room, inpatient, and other medical services. A growing body of evidence also suggests that workers whose chronic conditions are effectively controlled with medications are more productive. For employers, the evidence translates into potential direct and indirect cost savings. The findings also confirm the importance of pharmaceutical management as a cornerstone of disease management. PMID:15035834

  13. Contraceptive Use among Women with Chronic Medical Conditions and Factors Associated with Its Non-Use in Malaysia

    PubMed Central

    Manaf, Rosliza Abdul; Ismail, Irmi Zarina; Latiff, Latiffah A.

    2012-01-01

    Introduction: Women with chronic medical conditions are at higher risk of adverse pregnancy outcomes, which may be minimized through optimal preconception care and appropriate contraceptive use. This study aimed to describe contraceptive use among women with chronic medical conditions and factors associated with its non-use. Methods: This study used cross-sectional data from a family planning survey among women with chronic medical conditions conducted in three health facilities in a southern state of Malaysia. A total of 450 married women in reproductive age (18-50 year) with intact uterus, and do not plan to conceive were analysed for contraceptive use. Both univariate and multivariate analysis was conducted to identify factors associated with contraceptive non-use among the study participants. Results: A total of 312 (69.3%) of the study participants did not use contraceptive. Contraceptive non-use was highest among the diabetics (71.2%), connective tissue disease patients (68.6%) and hypertensive patients (65.3%). Only 26.3% of women with heart disease did not use contraceptive. In the multivariate analysis, contraceptive non-use was significantly more common among women who received their medical treatment in the health clinics as compared to those who received treatment in the hospital (adjusted odds ratio [OR]=1.75, 95% confidence interval [CI]: 1.09, 2.79), being in older age group of 41-50 year (adjusted OR=2.31, 95% CI: 1.19, 4.48), having children (adjusted OR=4.57, 95% CI: 1.66, 12.57) and having lower education (adjusted OR=2.87, 95% CI: 1.43, 5.77). Conclusion: About two-third of women with chronic medical conditions who needed contraceptive did not use them despite the higher risk of pregnancy related complications. The high unmet need warrant an effective health promotion programme to encourage the uptake of contraceptives especially targeting women of older age group, low education and those who received their medical treatment at health clinics. PMID:22980381

  14. Gestational Medication Use, Birth Conditions, and Early Postnatal Exposures for Childhood Asthma

    PubMed Central

    Chen, Yang-Ching; Tsai, Ching-Hui; Lee, Yungling

    2012-01-01

    Our aim is to explore (1) whether gestational medication use, mode of delivery, and early postnatal exposure correlate with childhood asthma, (2) the dose responsiveness of such exposure, and (3) their links to early- and late-onset asthma. We conducted a matched case-control study based on the Taiwan Children Health Study, which was a nationwide survey that recruited 12-to-14-year-old school children in 14 communities. 579 mothers of the participants were interviewed by telephone. Exclusive breastfeeding protected children from asthma. Notably, childhood asthma was significantly associated with maternal medication use during pregnancy, vacuum use during vaginal delivery, recurrent respiratory tract infections, hospitalization, main caregiver cared for other children, and early daycare attendance. Exposure to these factors led to dose responsiveness in relationships to asthma. Most of the exposures revealed a greater impact on early-onset asthma, except for vacuum use and daycare attendance. PMID:22203862

  15. Living conditions, ability to seek medical treatment, and awareness of health conditions and healthcare options among homeless persons in Tokyo, Japan.

    PubMed

    Ohtsu, Tadahiro; Toda, Ryouhei; Shiraishi, Tomonobu; Toyoda, Hirokuni; Toyozawa, Hideyasu; Kamioka, Yasuaki; Ochiai, Hirotaka; Shimada, Naoki; Shirasawa, Takako; Hoshino, Hiromi; Kokaze, Akatsuki

    2011-12-01

    Empirical data indicative of the health conditions and medical needs of homeless persons are scarce in Japan. In this study, with the aim of contributing to the formulation of future healthcare strategies for the homeless, we conducted a self-administered questionnaire survey and interviews at a park in Shinjuku Ward, Tokyo, to clarify the living conditions of homeless persons and their health conditions and awareness about the availability of medical treatment. Responses from 55 homeless men were recorded (response rate: 36.7%). With the exception of one person, none of them possessed a health insurance certificate. Half of the respondents reported having a current income source, although their modal monthly income was 30,000 yen($1 was approximately 90 yen). The number of individuals who responded "yes" to the questions regarding "Consulting a doctor on the basis of someone's recommendation" and "Being aware of the location of the nearest hospital or clinic" was significantly higher among those who had someone to consult when they were ill than among those who did not (the odds ratios [95% confidence intervals] were 15.00 [3.05-93.57] and 11.45 [1.42-510.68], respectively). This showed that whether or not a homeless person had a person to consult might influence his healthcare-seeking behavior. When queried about the entity they consulted (multiple responses acceptable), respondents mentioned "life support organizations" (61.1%) and "public offices" (33.3%). Overall, 94.5% of the respondents were aware of swine flu (novel influenza A (H1N1)). Their main sources of information were newspapers and magazines. On the basis of these findings, with regard to the aim of formulating healthcare strategies for homeless persons, while life support organizations and public offices play significant roles as conduits to medical institutions, print media should be considered useful for communicating messages to homeless persons. PMID:22189479

  16. [Bimanual antalgic maneuver on the parturient conditioned with hypnosis: delivery without medical assistance].

    PubMed

    Minella, E

    1975-11-01

    A personal bimanual antalgic manipulation on hypnotized parturient is proposed as a normal method of delivery assistance since it is quicker and takes less emotionally out of the physician than "delivery under hypnosis". The question of "childbirth without medical assistance" is also discussed, reference being made to an exceptional case of post-hypnotic control. This compared to all those cases of patients who deliver without the preparatory hypnotist being present. PMID:1223697

  17. The influence of basement structure on the evolution of the Bicorb-Quesa Diapir (eastern Betics, Iberian Peninsula): contractive thin-skinned deformation above a pre-existing extensional basement fault

    NASA Astrophysics Data System (ADS)

    Rubinat, M.; Roca, E.; Escalas, M.; Queralt, P.; Ferrer, O.; Ledo, J. J.

    2013-01-01

    On the basis of an analysis of structural surface data in addition to previously available and new magnetotelluric data, it was possible to reconstruct the evolution of Bicorb-Quesa Diapir. This was initiated as a reactive diapir in relation to a basement fault. The reactive diapir was rejuvenated by a thin-skinned compression during the Paleogene and rose during an extensional early-middle Miocene phase. Later, in the middle Miocene, the diapir was squeezed and then, in the late Miocene, was extensionally reactivated. The current reconstruction allows us to analyse a diapir affected by a thin-skinned contractional deformation located on top of a pre-existing basement fault. Our study highlights the role played by the geometric relationship between the propagation direction of the cover deformation and the basement fault.

  18. Perception of stress-related working conditions in hospitals (iCept-study): a comparison between physicians and medical students

    PubMed Central

    2013-01-01

    Background The students’ perception of working conditions in hospitals hasn’t been subject of research in Germany so far. However the perception plays an important role talking about the sustainability of working conditions. The iCept Study wants to examine the perception of medical students compared to the perception of practicing physicians. Methods/design The perception will be investigated with a redesigned questionnaire based upon two established and validated questionnaires. The two samples built for this study (students and physician) will be chosen from members of the labor union Marburger Bund. The iCept-Study is designed as an anonymized online-survey. Discussion The iCept-Study is thought to be the basis of ongoing further investigations regarding the perception of working conditions in hospitals. The results shall serve the facilitation of improving working conditions. PMID:23442606

  19. Are pre-existing markers of chronic kidney disease associated with short-term mortality following acute community-acquired pneumonia and sepsis? A cohort study among older people with diabetes using electronic health records

    PubMed Central

    McDonald, Helen I.; Nitsch, Dorothea; Millett, Elizabeth R. C.; Sinclair, Alan; Thomas, Sara L.

    2015-01-01

    Background We aimed to examine whether pre-existing impaired estimated glomerular filtration rate (eGFR) and proteinuria were associated with mortality following community-acquired pneumonia or sepsis among people aged ≥65 years with diabetes mellitus, without end-stage renal disease. Methods Patients were followed up from onset of first community-acquired pneumonia or sepsis episode in a cohort study using large, linked electronic health databases. Follow-up was for up to 90 days, unlimited by hospital discharge. We used generalized linear models with log link, normal distribution and robust standard errors to calculate risk ratios (RRs) for all-cause 28- and 90-day mortality according to two markers of chronic kidney disease: eGFR and proteinuria. Results All-cause mortality among the 4743 patients with pneumonia was 29.6% after 28 days and 37.4% after 90 days. Among the 1058 patients with sepsis, all-cause 28- and 90-day mortality were 35.6 and 44.2%, respectively. eGFR <30 mL/min/1.73 m2 was a risk marker of higher 28-day mortality for pneumonia (RR 1.27: 95% CI 1.12–1.43) and sepsis (RR 1.32: 95% CI 1.07–1.64), adjusted for age, sex, socio-economic status, smoking status and co-morbidities. Neither moderately impaired eGFR nor proteinuria were associated with short-term mortality following either infection. Conclusions People with pre-existing low eGFR but not on dialysis are at higher risk of death following pneumonia and sepsis. This association was not explained by existing co-morbidities. These patients need to be carefully monitored to prevent modifiable causes of death. PMID:25605811

  20. The Tumor Antigen Cyclin B1 Hosts Multiple CD4 T Cell Epitopes Differently Recognized by Pre-Existing Naive and Memory Cells in Both Healthy and Cancer Donors.

    PubMed

    Chevaleyre, Claire; Benhamouda, Nadine; Favry, Emmanuel; Fabre, Elizabeth; Mhoumadi, Anais; Nozach, Hervé; Marcon, Elodie; Cosler, Guillaume; Vinatier, Emeline; Oudard, Stephane; Hans, Stephane; Le Pimpec-Barthes, Françoise; Bats, Anne-Sophie; Castelli, Florence A; Tartour, Eric; Maillère, Bernard

    2015-08-15

    Cyclin B1 (CCNB1) is considered as a potential target for a cancer vaccine, as it is overexpressed in many malignant cells, while being transiently expressed in normal cells. To evaluate the CD4 T cell response to CCNB1, we derived T cell lines by multiple weekly rounds of stimulation with recombinant CCNB1 of T cells collected in healthy donors (long-term T cell assays). T cell lines were specific for 15 immunodominant peptides and derived preferentially from naive T cells. From 74 overlapping peptides, 20 peptides were selected for their broad specificity of binding to HLA class II molecules and included most of the immunodominant epitopes. They primed in vitro a large number of specific CD4 T cell lines in all the donors. Immunodominant epitopes were the most efficacious in long-term T cell assays, both in terms of number of specific T cell lines and number of responding donors. The 20 peptides were also submitted to short-term T cell assays using cells collected in healthy and cancer patients with the aim to evaluate the memory response. The recognized peptides differed from the immunodominant peptides and were part of the best promiscuous peptides. We also observed pre-existing CCNB1-specifc IgG Abs in both healthy and cancer donors. Long- and short-term T cell assays revealed that CCNB1 contained many CD4 T cell epitopes, which are differentially recognized by pre-existing naive and memory CD4 T cells. These observations are of value for the design of cancer vaccines. PMID:26136431

  1. 42 CFR 416.47 - Condition for coverage-Medical records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM AMBULATORY SURGICAL SERVICES Specific Conditions for Coverage § 416... the governing body. (5) Any allergies and abnormal drug reactions. (6) Entries related to...

  2. 42 CFR 416.47 - Condition for coverage-Medical records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) AMBULATORY SURGICAL SERVICES Specific Conditions for... the governing body. (5) Any allergies and abnormal drug reactions. (6) Entries related to...

  3. 42 CFR 416.47 - Condition for coverage-Medical records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) AMBULATORY SURGICAL SERVICES Specific Conditions for... the governing body. (5) Any allergies and abnormal drug reactions. (6) Entries related to...

  4. "If"-Conditionals in Medical Discourse: From Theory to Disciplinary Practice

    ERIC Educational Resources Information Center

    Carter-Thomas, Shirley; Rowley-Jolivet, Elizabeth

    2008-01-01

    "If"-conditionals are a highly valuable resource in academic discourses, whether spoken or written, as they can be used to hypothesize, hedge, manage interaction with the addressee, and promote or on the contrary circumscribe the scope of research claims. This article analyses how "if"-conditionals are brought into play in three genres of medical…

  5. A description of medical conditions in adults with autism spectrum disorder: A follow-up of the 1980s Utah/UCLA Autism Epidemiologic Study.

    PubMed

    Jones, Kyle B; Cottle, Kristina; Bakian, Amanda; Farley, Megan; Bilder, Deborah; Coon, Hilary; McMahon, William M

    2016-07-01

    This study describes medical conditions experienced by a population-based cohort of adults with autism spectrum disorder whose significant developmental concerns were apparent during childhood. As part of a 25-year outcome study of autism spectrum disorder in adulthood, medical histories were collected on 92 participants (N = 69 males) who were first ascertained as children in the mid-1980s, 11 of whom were deceased at the time of follow-up. Questionnaires queried medical symptoms, disorders, hospitalizations, surgeries, and medication use. Median age at follow-up was 36 years (range: 23.5-50.5 years), and intellectual disability co-occurred in 62%. The most common medical conditions were seizures, obesity, insomnia, and constipation. The median number of medical conditions per person was 11. Increased medical comorbidity was associated with female gender (p = 0.01) and obesity (p = 0.03), but not intellectual disability (p = 0.79). Adults in this cohort of autism spectrum disorder first ascertained in the 1980s experience a high number of chronic medical conditions, regardless of intellectual ability. Understanding of these conditions commonly experienced should direct community-based and medical primary care for this population. PMID:26162628

  6. Associations between Medical Conditions and Breast Cancer Risk in Asians: A Nationwide Population-Based Study in Taiwan

    PubMed Central

    Chuang, Shu-Chun; Wu, Guo-Jie; Lu, Yen-Shen; Lin, Ching-Hung; Hsiung, Chao Agnes

    2015-01-01

    Background The breast cancer incidence in Asia is rising. To explore whether the etiology of breast cancer is different from the known risk factors from studies in Western countries, we conducted a nested case-control study using data from the Taiwan National Health Insurance Research Database (NHIRD). Methods All medical conditions based on the first three digits of the ICD-9 and a list of medical conditions based on literature review were retrieved for each case and control. The odds ratios (OR) and 95% confidence intervals (CI) of the associations between medical conditions and breast cancer risks were estimated using conditional logistic regression and adjusted for occupation, number of breast cancer screening, and the average number of outpatient visits prior the diagnosis. The associations were also estimated for younger (<50 years old) and older subjects separately. Results The analyses included 4,884 breast cancer cases and 19,536 age-matched controls. Prior breast diseases (OR, 95% CI: 2.47, 2.26–2.71), obesity (1.43, 1.04–1.96), endometriosis (1.44, 1.15–1.80), uterine leiomyoma (1.20, 1.03–1.40), hypertensive diseases (1.14, 1.05–1.25), and disorders in lipid metabolism (1.13, 1.04–1.24) were associated with increased breast cancer risk. No heterogeneity was observed between age groups (<50 and ≥50 years old). Conclusions In addition to benign breast diseases, obesity, endometriosis, uterine leiomyoma, hypertensive diseases, and disorders of lipid metabolism were associated with a subsequent breast cancer risk. Impacts Our results suggest that estrogen related factors may play an important role in breast cancer risks in the Taiwanese female population. PMID:26605792

  7. [Investigation of actual condition of management and disposal of medical radioactive waste in Korea].

    PubMed

    Watanabe, Hiroshi; Nagaoka, Hiroaki; Yamaguchi, Ichiro; Horiuchi, Shoji; Imoto, Atsushi

    2009-07-20

    In order to realize the rational management and disposal of radioactive waste like DIS or its clearance as performed in Europe, North America, and Japan, we investigated the situation of medical radioactive waste in Korea and its enforcement. We visited three major Korean facilities in May 2008 and confirmed details of the procedure being used by administering a questionnaire after our visit. From the results, we were able to verify that the governmental agency had established regulations for the clearance of radioactive waste as self-disposal based on the clearance level of IAEA in Korea and that the medical facilities performed suitable management and disposal of radioactive waste based on the regulations and superintendence of a radiation safety officer. The type of nuclear medicine was almost the same as that in Japan, and the half-life of all radiopharmaceuticals was 60 days or less. While performing regulatory adjustment concerning the rational management and disposal of radioactive waste in Korea for reference also in this country, it is important to provide an enforcement procedure with quality assurance in the regulations. PMID:19661730

  8. A geriatric and gerontologic perspective on the effects of medical conditions on older drivers: discussion of Waller.

    PubMed

    Wallace, R B; Retchin, S M

    1992-02-01

    In discussing Waller's paper, we build on his review of medical conditions and the risk of motor vehicle accidents (MVAs) using principles derived from geriatrics, gerontology, and health services research. Three approaches are suggested. The medical model uses discrete diseases as risk factors, but despite its utility and appeal, this model does not sufficiently characterize health and functional status to be the sole approach, and future investigative efforts should at least consider severity of illness concepts. The functional status model emphasizes a functional and physiological approach to health status, but despite its successful application in geriatric assessment and its investigative promise, functional status can be difficult to measure and has not been validated in relation to MVA risk. Finally we consider a behavioral model and within that framework discuss the relation of depressive and other emotional illnesses as well as social vitality to driving patterns and MVA occurrence. PMID:1577499

  9. An examination of co-occurring conditions and management of psychotropic medication use in soldiers with traumatic brain injury.

    PubMed

    Farinde, Abimbola

    2014-01-01

    There are approximately 1.4 million cases of traumatic brain injury (TBI) per year in the United States, with about 23 000 survivors requiring hospitalization. The incidence of TBI has increased in the patient population of the Department of Defense and Veterans Healthcare Administration as a result of injuries suffered during recent military and combat operations. Within the past few years, TBI has emerged as a common form of injury in service members with a subset of patients experiencing postinjury symptoms that greatly affect their quality of life. Traumatic brain injury can occur when sudden trauma (ie, penetration blast or blunt) causes damage to the brain. Traumatic brain injury produces a cascade of potentially injurious processes that include focal contusions and cytotoxic damage. The results of TBI can include impaired physical, cognitive, emotional, and behavioral functioning, which may or may not require the initiation of pharmacological and nonpharmacological interventions when deemed appropriate. Associated outcomes of TBI include alterations in mental state at the time of injury (confusion, disorientation, slowed thinking, and alteration of consciousness). Neurological deficits include loss of balance, praxis, aphasia, change in vision that may or may not be transient. Individuals who sustain a TBI are more likely to have or developed co-occurring conditions (ie, sleep problems, headaches, depression, anxiety, and posttraumatic stress disorder) that may require the administration of multiple medications. It has been identified that veterans being discharged on central nervous system and muscular skeletal drug classes can develop addiction and experience medication misadventures. With the severity of TBI being highly variable but typically categorized as either mild, moderate, or severe, it can assist health care providers in determining which patients are more susceptible to medication misadventures compared with others. The unique development of cognitive and emotional symptoms of TBI can lead to significant impairments, so it is important for all health care providers, including pharmacists, to promote proper use of high-risk psychotropic medications among this patient population by providing effective medication education. PMID:25023837

  10. Psychological aspects of painful medical conditions in children. I. Developmental aspects and assessment.

    PubMed

    Lavigne, J V; Schulein, M J; Hahn, Y S

    1986-11-01

    The assessment and development of pain in children is reviewed in the first part of a two-part series. Assessment of pain in children has relied on self-report measures that have included visual analogue procedures using concrete stimuli for ratings. Behavioral assessment procedures are more sophisticated, but research on behavioral assessment of pediatric pain has begun to emergy only recently. There has been very little research on the developmental aspects of pain tolerance and pain threshold in children. There are preliminary indications that children's thoughts and attitudes about pain may change with age in a manner that contributes to more intense feelings of pain in adolescence than childhood. Children undergoing painful medical procedures show declining emotional outbursts with age and increasing signs of self-control and muscular rigidity. Possibilities for integrating the study of the developmental aspects of pain with social learning theory, cognitive developmental theory, and the psychology of physical symptom perception are discussed. PMID:3540810

  11. Outcomes for Children with Chronic Conditions Associated with Parent- and Provider-reported Measures of the Medical Home

    PubMed Central

    Raphael, Jean L.; Cooley, W. Carl; Vega, Amanda; Kowalkowski, Marc A.; Tran, Xuan; Treadwell, Janet; Giardino, Angelo P.; Giordano, Thomas P.

    2015-01-01

    Purpose Assess relationships between having a patient-centered medical home (PCMH) and health care utilization among low-income children with chronic conditions using parent and practice perspectives. Methods We analyzed data from 240 publicly insured children with chronic conditions. Parents completed surveys assessing PCMH access and their child’s primary care practice completed the Medical Home Index (MHI) self-assessment. Multivariate negative binomial analyses were conducted to investigate relationships between PCMH and service use. Results Parent-report of a usual source of care was associated with lower rates of emergency care (ED) encounters and hospitalizations. Practice report of higher organizational capacity (e.g., communication, staff education) was associated with lower rates of ED visits and hospitalizations. Parent report of a PCMH was positively associated with practice MHI score. Conclusions Among low-income children with chronic conditions, having a usual source of care and higher quality organizational capacity were associated with lower rates of ED visits and hospitalizations. PMID:25913335

  12. An Index of Multiple Psychosocial, Syndemic Conditions Is Associated with Antiretroviral Medication Adherence Among HIV-Positive Youth.

    PubMed

    Kuhns, Lisa M; Hotton, Anna L; Garofalo, Rob; Muldoon, Abigail L; Jaffe, Kaitlyn; Bouris, Alida; Voisin, Dexter; Schneider, John

    2016-04-01

    Medication adherence among HIV-infected individuals is critical to limit disease progression and onward transmission. Evidence indicates that among youth living with HIV (YLH), adherence is suboptimal and related to co-morbid psychosocial conditions. Cross-sectional data from 212 YLH, ages 16-29, collected between 2011-2014 in Chicago were analyzed to assess the relationship of multiple psychosocial conditions (e.g., depressive symptoms, anxiety symptoms, moderate/heavy marijuana use, moderate/heavy alcohol use, HIV-related stigma) to ART adherence (i.e., a "syndemic.") Adherence was regressed on an index of increasing numbers of psychosocial conditions, controlling for demographic and treatment factors as well as enrollment site. The mean age of participants was 24, 89% were male, 87% black, and 91% behaviorally infected. Psychosocial conditions were prevalent, including 38% and 34% with high depressive and anxiety symptoms, respectively, 54% and 25% with a moderate/high level of marijuana and alcohol use, respectively, and 46% reporting high HIV-related stigma. In regression analysis, the likelihood of ART adherence decreased with the number of syndemic conditions (linear dose response, p = 0.02) as did the odds of viral load suppression (p = 0.008). Interventions to address these conditions in concert with biomedical treatment as prevention for YLH are needed. PMID:27028184

  13. Personal attitudes, perceived social norms, and health-risk behavior among female adolescents with chronic medical conditions.

    PubMed

    Kunz, Jennifer H; Greenley, Rachel N; Mussatto, Kathleen A; Roth-Wojcicki, Betsy; Miller, Tami; Freeman, Mary E; Lerand, Sarah

    2014-07-01

    To examine whether perceived peer/parent norms or personal beliefs about adolescent substance use influence substance use among female adolescents with chronic medical conditions. Sixty-eight females reported on substance use, personal beliefs, and perceived peer/parent norms. Personal beliefs and perceived peer/parent norms were associated with adolescent's current and future substance use. Although perceived peer norms accounted for variance in current substance use, only personal beliefs accounted for variance in future alcohol use. Targeting perceived peer norms may be effective for intervention efforts among adolescents endorsing current substance use, whereas alcohol use prevention efforts should target personal beliefs. PMID:23524992

  14. 42 CFR 410.38 - Durable medical equipment: Scope and conditions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... treating practitioner who performed the face-to-face examination and that includes the beneficiary's name, the date of the face-to-face examination, the diagnoses and conditions that the PMD is expected to... specialist as those terms are defined in section 1861(aa)(5) of the Act, who has conducted a...

  15. 42 CFR 410.38 - Durable medical equipment: Scope and conditions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... treating practitioner who performed the face-to-face examination and that includes the beneficiary's name, the date of the face-to-face examination, the diagnoses and conditions that the PMD is expected to... specialist as those terms are defined in section 1861(aa)(5) of the Act, who has conducted a...

  16. Evaluation of alternative standardized terminologies for medical conditions within a network of observational healthcare databases.

    PubMed

    Reich, Christian; Ryan, Patrick B; Stang, Paul E; Rocca, Mitra

    2012-08-01

    Large electronic databases of health care information, such as administrative claims and electronic health records, are available and are being used in a number of public health settings, including drug safety surveillance. However, because of a lack of standardization, clinical terminologies may differ across databases. With the aid of existing resources and expert coders, we have developed mapping tables to convert ICD-9-CM diagnosis codes used in some existing databases to SNOMED-CT and MedDRA. In addition, previously developed definitions for specific health outcomes of interest were mapped to the same standardized vocabularies. We evaluated how vocabulary mapping affected (1) the retention of clinical data from two test databases, (2) the semantic space of outcome definitions, (3) the prevalence of each outcome in the test databases, and (4) the reliability of analytic methods designed to detect drug-outcome associations in the test databases. Although vocabulary mapping affected the semantic space of some outcome definitions, as well as the prevalence of some outcomes in the test databases, it had only minor effects on the analysis of drug-outcome associations. Furthermore, both SNOMED-CT and MedDRA were viable for use as standardized vocabularies in systems designed to perform active medical product surveillance using disparate sources of observational data. PMID:22683994

  17. A historical glimpse of toothpick use: etiquette, oral and medical conditions.

    PubMed

    Christen, Arden G; Christen, Joan A

    2003-07-01

    This article traces various historical and geographical aspects of multicultural toothpick use, dating back from prehistoric times to the present. This behavior appears to be one of the oldest and best documented of all human habits. Toothpicks (composed of bone, ivory, metal, plastic, quills, wood or other substances) have been used for ceremonial, oral hygiene and religious purposes. Throughout the ages, the act of toothpicking has been both encouraged and discouraged. In the 19-20th centuries, it was generally viewed as a disgusting breach of social etiquette and a significant threat to oral and general health. Authors of numerous dental articles have cautioned that indiscriminate toothpick use can lead to halitosis, dental caries, injury to the interdental papilla, mouth ulcers, allergic reactions, embedment of the device in the back of the mouth or throat, gingival abscesses, sensitive teeth, or abraded enamel, dentin or cementum of both permanent and primary dentitions. Additionally, both the dental and medical literature report anecdotal cases of life-threatening injuries and death caused by toothpick ingestion. PMID:12846259

  18. Apparatus for detecting at least one predetermined condition and providing an informational signal in response thereto in a medication infusion system

    NASA Technical Reports Server (NTRS)

    Fischell, Robert E. (Inventor)

    1986-01-01

    A medication infusion system provides redundant safety and includes condition detecting and informational alarm signal generating apparatus for indicating if (1) a fluid leak occurs in different portions of the system; (2) a programmable input from a patient or physician would result in exceeding a safe dosage limit; (3) the reservoir containing medication has been filled; (4) the intended medication pumping does not correlate with the pumping actually effected; (5) battery voltage is low; (6) the medication reserve is low; and (7) the system has been switched off. The apparatus may provide subcutaneous electrical, thermal, or audible stimulation to the patient and also provides a signal which a physician may monitor. The stimulation may be coded to separately identify each above-listed deviation in nominal system performance. In addition, the number of medication requests are correlated with actual medication dispensing to assure proper operation. An identification scheme is provided which matches the patient with his or her corresponding medication.

  19. Survey of medical ethnobotanicals for dental and oral medicine conditions and pathologies.

    PubMed

    Colvard, Michael D; Cordell, Geoffrey A; Villalobos, Rodrigo; Sancho, Gina; Soejarto, Doel D; Pestle, William; Echeverri, Tatiana Lobo; Perkowitz, Kathleen M; Michel, Joanna

    2006-08-11

    Ethnomedical questionnaires were distributed in Chicago, Costa Rica, and Colombia to identify the most common over-the-counter (OTC) plant or plant-based products advocated for treating oral pain, ulcerative conditions, and cancer within these locations. Over 100 plants or plant-based herbal preparations and commercial products, purchased from local botanical markets and pharmacies, were advocated for the treatment of oral medicine conditions. Locally familiar and common language names were attributed to the plant products at the time of purchase. Plant products or plant-based commercial products containing plant-based essential oils, anesthetic constituents, and or chemical compounds recommended as OTC oral medicine preparations were systematized, tabulated, and correlated with the published phytotherapeutic literature. Though pharmacognostic research is available for some of the species collected, further ethnographic research is needed to correlate common names with the accurate taxonomic identification for each plant species. Furthermore, epidemiological research is needed to verify the use and standardized dosage for OTC ethnomedicine preparations for oral medicine conditions. Pharmacognostic research and clinical trails which can verify taxonomy, dose, safety, active principles, and efficacy of these OTC oral medicine products must be enhanced in order to verify the claimed validity in contemporary, global, oral medicine practice. PMID:16735102

  20. Predictors of all-cause mortality in patients with stable COPD: medical co-morbid conditions or high depressive symptoms.

    PubMed

    Maters, Gemma A; de Voogd, Jacob N; Sanderman, Robbert; Wempe, Johan B

    2014-08-01

    Co-morbid conditions are frequently found in patients with COPD. We evaluate the association of co-morbidities with mortality, in stable COPD. 224 patients, mean age 61.2 ( 10.00), 48.2% female, mean FEV1 1.1 ( 0.5) liters, median follow-up time 4.2 years, participated. Medical co-morbidities were scored according to the Charlson Co-morbidity Index (CCI). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist-90 (SCL-90). The Cox proportional hazard model was used for survival analyses. In our sample, 70% of all patients have a co-morbid medical condition or high depressive symptoms. During follow-up 51% of all patients died, and those with heart failure have the highest mortality rate (75%). Age, fat-free mass and exercise capacity were predictive factors, contrary to CCI-scores and high depressive symptoms. An unadjusted association between heart failure and survival was found. Although the presence of co-morbidities, using the CCI-score, is not related to survival, heart failure seems to have a detrimental effect on survival. Higher age and lower exercise capacity or fat-free mass predict mortality. PMID:24831411

  1. Family history of cancer, personal history of medical conditions and risk of oral cavity cancer in France: the ICARE study

    PubMed Central

    2013-01-01

    Background The aim of this study was to evaluate the role of family history of cancer and personal history of other medical conditions in the aetiology of the oral cavity cancer in France. Methods We used data from 689 cases of oral cavity squamous cell carcinoma and 3481 controls included in a population-based case–control study, the ICARE study. Odds-ratios (ORs) associated with family history of cancer and personal medical conditions and their 95% confidence intervals (95% CI) were estimated by unconditional logistic regression and were adjusted for age, gender, area of residence, education, body mass index, tobacco smoking and alcohol drinking. Results Personal history of oral candidiasis was related to a significantly increased risk of oral cavity cancer (OR 5.0, 95% CI 2.1-12.1). History of head and neck cancers among the first-degree relatives was associated with an OR of 1.9 (95% CI 1.2-2.8). The risk increased with the number of first-degree relatives with head and neck cancer. Conclusion A family history of head and neck cancer is a marker of an increased risk of oral cavity cancer and should be taken into account to target prevention efforts and screening. Further studies are needed to clarify the association between oral cavity cancer and personal history of candidiasis. PMID:24286495

  2. [Vaccination of cats against infection with feline leukemia virus (FeLV): first recombinant vaccine and the effect of a pre-existing infection with feline immunodeficiency virus (FIV)].

    PubMed

    Hofmann-Lehmann, R; Aubert, A; Wolfensberger, C; Cronier, J; Lutz, H

    1994-01-01

    A new recombinant FeLV vaccine was evaluated in 30 specified pathogen-free cats 10 months of age cats. The vaccine consisted of the non-glycosylated FeLV envelope protein p45, aluminium hydroxide and a saponin adjuvant. The cats (n = 18) were vaccinated twice intramuscularly, 3 weeks apart. All animals were challenged intraperitoneally with FeLV subgroup A, 18 weeks later. While 94% of the vaccinated cats showed no viraemia or were only transiently viraemic, 80% of the non-vaccinated animals became persistently viraemic within 2 to 3 weeks. In our hands the preventable fraction of the vaccine was 93%. In order to determine the effect of a pre-existing infection with feline immunodeficiency virus on the efficacy of vaccination, 50% of the cats were previously infected with FIV. The infected cats were protected to the same degree as the non-infected animals. With prolonged duration of FIV infection the probability increases, that the immune system of the cat will fail and clinical signs will appear. In order to observe a state of possible immunodeficiency, an accurate clinical examination of every cat prior to vaccination seems of major importance. PMID:7801087

  3. Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review.

    PubMed

    McGinty, Emma E; Baller, Julia; Azrin, Susan T; Juliano-Bult, Denise; Daumit, Gail L

    2016-01-01

    People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings. PMID:26221050

  4. Self-rated Health and Medical Conditions in Refugees and Immigrants from the Same Country of Origin

    PubMed Central

    Jamil, Hikmet; Barkho, Evone; Broadbridge, Carissa L.; Ventimiglia, Matthew; Arnetz, Judith E.; Lami, Faris; Arnetz, Bengt B.

    2015-01-01

    Background Research suggests that refugees are at an increased risk for poor health outcomes as compared to immigrants. However, prior studies have compared refugees and immigrants from different countries and have failed to isolate specific war-related factors. Objective To compare health outcomes and their determinants in refugees and immigrants from the same country of origin. Methods A cross-sectional study based on a convenient sample and on self-report participants were conducted at Southeast Michigan during the period September to December 2009. A validated survey was used to examine refugees (n = 75) and immigrants (n = 65) from Iraq. The survey covered socioeconomics, lifestyle, violence exposure, self-rated health, and number of medical conditions (high blood pressure, fatigue, and backache, shortness of breath, gastrointestinal disorders, skin problems, and musculoskeletal problems). Group differences and predictors of health outcomes were assessed. Results Refugees reported significantly more violence exposure than immigrants (p < 0.001). There were no significant differences in self-rated health or medical disorders between groups; however, violence exposure was the main predictor of health outcomes in refugees, whereas age was the main predictor in immigrants. Other predictors also varied by migratory group. Conclusion Even though migration status did not directly influence health outcomes, results suggest that factors associated with migration status, e.g., violence exposure and age, do impact health. Future studies need to more carefully define and control for country-specific variables. PMID:26644795

  5. The choice dilemma in chronic hematological conditions: Why choosing is not only a medical issue? A psycho-cognitive perspective.

    PubMed

    Renzi, Chiara; Riva, Silvia; Masiero, Marianna; Pravettoni, Gabriella

    2016-03-01

    Research in cognitive psychology focused on risk perception and decision making was shown to facilitate treatment choice and patient's satisfaction with decision in a number of medical conditions, increasing perceived alliance between patient and physician, and adherence to treatment. However, this aspect has been mostly neglected in the literature investigating choice of treatment for chronic hematological conditions. In this paper, a patient centered model and a shared decision making (SDM) approach to treatment switch in chronic hematological conditions, in particular chronic myeloid leukemia, atrial fibrillation, and β-thalassemia is proposed. These pathologies have a series of implications requiring important decisions about new available treatments. Although new generation treatmentsmay provide a significant improvement in patient's health and health-related quality of life (HrQoL), a significant percentage of them is uncertain about or refuse treatment switch, even when strongly suggested by healthcare guidelines. Possible cognitive and emotional factors which may influence decision making in this field and may prevent appropriate risk-and-benefits evaluation of new treatment approaches are reviewed. Possible adaptive strategies to improve quality of care, patient participation, adherence to treatment and final satisfaction are proposed, and implications relatively to new treatment options available are discussed. PMID:26762858

  6. Assessing the Representativeness of Medical Expenditure Panel Survey Inpatient Utilization Data for Individuals With Psychiatric and Nonpsychiatric Conditions.

    PubMed

    Slade, Eric P; Goldman, Howard H; Dixon, Lisa B; Gibbons, Brent; Stuart, Elizabeth A

    2015-12-01

    Sampling and reporting biases in the Medical Expenditure Panel Survey (MEPS) survey could render data on inpatient utilization that are not representative for individuals with severe psychiatric conditions. The authors assessed the representativeness of MEPS data on psychiatric inpatient utilization, by comparing MEPS estimates of total annual psychiatric and nonpsychiatric inpatient admissions and bed days, and mean length of stay, for nonelderly U.S. adults in calendar years 2005 to 2010 (N = 9,288) to estimates from the Nationwide Inpatient Sample (NIS), a nationally representative inpatient care database derived from hospitals' administrative records (N = 21,934,378). Compared with the NIS, the MEPS indicated 34% as many psychiatric admissions and 86% as many nonpsychiatric admissions, while mean psychiatric length of stay was greater in MEPS than in NIS. In MEPS data, underrepresentation of psychiatric inpatient utilization at community hospitals may result in measurement distortions for commonly used statistics on psychiatric inpatient utilization and costs. PMID:26149973

  7. Bursts of high-frequency stimulation trigger rapid delivery of pre-existing alpha-CaMKII mRNA to synapses: a mechanism in dendritic protein synthesis during long-term potentiation in adult awake rats.

    PubMed

    Håvik, Bjarte; Røkke, Håvard; Bårdsen, Kjetil; Davanger, Svend; Bramham, Clive R

    2003-06-01

    Messenger ribonucleic acid encoding the alpha-subunit of calcium/calmodulin-dependent protein kinase II (camkII) is abundantly and constitutively expressed in dendrites of pyramidal and granule cell neurons of the adult hippocampus. Recent evidence suggests that camkII messenger ribonucleic acid is stored in a translationally dormant state within ribonucleic acid storage granules. Delivery of camkII messenger ribonucleic acid from sites of storage to sites of translation may therefore be a key step in activity-driven dendritic protein synthesis and synaptic plasticity. Here we explored possible camkII trafficking in the context of long-term potentiation in the dentate gyrus of awake, adult rats. Long-term potentiation was induced by patterned high-frequency stimulation, synaptodendrosomes containing pinched-off dendritic spines were obtained from microdissected dentate gyrus, and messenger ribonucleic acid levels were determined by real-time polymerase chain reaction. High-frequency stimulation triggered a rapid 2.5-fold increase in camkII messenger ribonucleic acid levels in the synaptodendrosome fraction. This increase occurred in the absence of camkII upregulation in the homogenate fraction, indicating trafficking of pre-existing messenger ribonucleic acid to synaptodendrosomes. The elevation in camkII messenger ribonucleic acid was paralleled by an increase in protein expression specific to the synaptodendrosome fraction, and followed by depletion of camkII message. Activity-dependent regulation of camkII messenger ribonucleic acid and protein did not require N-methyl-d-aspartate receptor activation. In contrast, N-methyl-d-aspartate receptor activation was required for induction of the immediate early genes zif268 and activity-regulated cytoskeleton-associated protein in dentate gyrus homogenates. The results support a model in which locally stored camkII messenger ribonucleic acid is rapidly transported to dendritic spines and translated during long-term potentiation in behaving rats. PMID:12823475

  8. Measurement of Serum Melatonin in Intensive Care Unit Patients: Changes in Traumatic Brain Injury, Trauma, and Medical Conditions

    PubMed Central

    Seifman, Marc A.; Gomes, Keith; Nguyen, Phuong N.; Bailey, Michael; Rosenfeld, Jeffrey V.; Cooper, David J.; Morganti-Kossmann, Maria Cristina

    2014-01-01

    Melatonin is an endogenous hormone mainly produced by the pineal gland whose dysfunction leads to abnormal sleeping patterns. Changes in melatonin have been reported in acute traumatic brain injury (TBI); however, the impact of environmental conditions typical of the intensive care unit (ICU) has not been assessed. The aim of this study was to compare daily melatonin production in three patient populations treated at the ICU to differentiate the role of TBI versus ICU conditions. Forty-five patients were recruited and divided into severe TBI, trauma without TBI, medical conditions without trauma, and compared to healthy volunteers. Serum melatonin levels were measured at four daily intervals at 0400 h, 1000 h, 1600 h, and 2200 h for 7 days post-ICU admission by commercial enzyme linked immunosorbent assay. The geometric mean concentrations (95% confidence intervals) of melatonin in these groups showed no difference being 8.3 (6.3–11.0), 9.3 (7.0–12.3), and 8.9 (6.6–11.9) pg/mL, respectively, in TBI, trauma, and intensive care cohorts. All of these patient groups demonstrated decreased melatonin concentrations when compared to control patients. This study suggests that TBI as well as ICU conditions, may have a role in the dysfunction of melatonin. Monitoring and possibly substituting melatonin acutely in these settings may assist in ameliorating long-term sleep dysfunction in all of these groups, and possibly contribute to reducing secondary brain injury in severe TBI. PMID:25477861

  9. Net Differences in Interview Data on Chronic Conditions and Information Derived from Medical Records. Vital and Health Statistics, Series 2, No. 57.

    ERIC Educational Resources Information Center

    Madow, William G.

    The California study, based on data from a national survey, compared accuracy and completeness of information on 7,182 chronic health conditions of persons, 17 years of age or older, given in household interviews with diagnostic information given by group medical plan physicians. Overreporting referred to conditions reported in the interview which…

  10. Frontal White Matter Alterations in Short-Term Medicated Panic Disorder Patients without Comorbid Conditions: A Diffusion Tensor Imaging Study

    PubMed Central

    Kim, Borah; Kim, Jeong Hoon; Kim, Min-Kyoung; Lee, Kang Soo; Kim, Youngki; Choi, Tai Kiu; Kim, Yun Tai; Lee, Sang-Hyuk

    2014-01-01

    The frontal cortex might play an important role in the fear network, and white matter (WM) integrity could be related to the pathophysiology of panic disorder (PD). A few studies have investigated alterations of WM integrity in PD. The aim of this study was to determine frontal WM integrity differences between patients with PD without comorbid conditions and healthy control (HC) subjects by using diffusion tensor imaging. Thirty-six patients with PD who had used medication within 1 week and 27 age- and sex-matched HC subjects participated in this study. Structural brain magnetic resonance imaging was performed on all participants. Panic Disorder Severity Scale and Beck Anxiety Inventory (BAI) scores were assessed. Tract-based spatial statistics (TBSS) was used for image analysis. TBSS analysis showed decreased fractional anisotropy (FA) in frontal WM and WM around the frontal lobe, including the corpus callosum of both hemispheres, in patients with PD compared to HC subjects. Moreover, voxel-wise correlation analysis revealed that the BAI scores for patients with PD were positively correlated with their FA values for regions showing group differences in the FA of frontal WM of both hemispheres. Altered integrity in frontal WM of patients with PD without comorbid conditions might represent the structural pathophysiology in these patients, and these changes could be related to clinical symptoms of PD. PMID:24788587

  11. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., plan of care, and medical supervision. 484.18 Section 484.18 Public Health CENTERS FOR MEDICARE..., and medical supervision. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in...

  12. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., plan of care, and medical supervision. 484.18 Section 484.18 Public Health CENTERS FOR MEDICARE..., and medical supervision. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in...

  13. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., plan of care, and medical supervision. 484.18 Section 484.18 Public Health CENTERS FOR MEDICARE..., and medical supervision. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in...

  14. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., plan of care, and medical supervision. 484.18 Section 484.18 Public Health CENTERS FOR MEDICARE..., and medical supervision. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in...

  15. Apparatus for detecting a condition of a medication infusion system and providing an informational signal in response thereto

    NASA Technical Reports Server (NTRS)

    Fischell, Robert E. (Inventor)

    1988-01-01

    A medication infusion system having a means for providing an informational signal when (1) medication in the reservoir falls below a threshold level; (2) a fluid leak occurs in different portions of the system; and (3) the intended medication pumping does not correlate with the pumping actually affected.

  16. Medication/Drug Allergy

    MedlinePlus

    ... Condition Information > Allergy: Allergens > Medication/Drug Allergy Medication/Drug Allergy Allergies to medications/drugs are complicated because ... allergy symptoms. Learn more. Doctors Who Treat Medication/Drug Allergy Rohit K. Katial Harold S. Nelson Richard W. ...

  17. Automatic de-identification of electronic medical records using token-level and character-level conditional random fields.

    PubMed

    Liu, Zengjian; Chen, Yangxin; Tang, Buzhou; Wang, Xiaolong; Chen, Qingcai; Li, Haodi; Wang, Jingfeng; Deng, Qiwen; Zhu, Suisong

    2015-12-01

    De-identification, identifying and removing all protected health information (PHI) present in clinical data including electronic medical records (EMRs), is a critical step in making clinical data publicly available. The 2014 i2b2 (Center of Informatics for Integrating Biology and Bedside) clinical natural language processing (NLP) challenge sets up a track for de-identification (track 1). In this study, we propose a hybrid system based on both machine learning and rule approaches for the de-identification track. In our system, PHI instances are first identified by two (token-level and character-level) conditional random fields (CRFs) and a rule-based classifier, and then are merged by some rules. Experiments conducted on the i2b2 corpus show that our system submitted for the challenge achieves the highest micro F-scores of 94.64%, 91.24% and 91.63% under the "token", "strict" and "relaxed" criteria respectively, which is among top-ranked systems of the 2014 i2b2 challenge. After integrating some refined localization dictionaries, our system is further improved with F-scores of 94.83%, 91.57% and 91.95% under the "token", "strict" and "relaxed" criteria respectively. PMID:26122526

  18. Costs of Venous Thromboembolism Associated with Hospitalization for Medical Illness

    PubMed Central

    Cohoon, Kevin P.; Leibson, Cynthia L.; Ransom, Jeanine E.; Ashrani, Aneel A.; Petterson, Tanya M.; Long, Kirsten Hall; Bailey, Kent R.; Heit, John A.

    2015-01-01

    Objective To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness. Study Design Population-based cohort study conducted in Olmsted County, Minn. Methods Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident VTE within 92 days of hospitalization for acute medical illness over the 18-year period, 1988–2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case on event date (± 1 year), duration of prior medical history and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or 12/31/2011 (study end date). We censored follow-up such that each case and match control had similar periods of observation. We also controlled for length of follow-up from index to up to 5-years post-index. We used generalized linear modeling (controlling for age, sex, pre-existing conditions and costs 1 year before index) to predict costs for cases and controls. Results Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P=<0.001) from index to up to 5-years post-index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared to controls for up to 3 years. Conclusions VTE during or after recent hospitalization for medical illness contributes a substantial economic burden. PMID:26244788

  19. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... potential, functional limitations, activities permitted, nutritional requirements, medications and... to the original plan. Orders for therapy services include the specific procedures and modalities...

  20. [Characteristics of the medical status and living conditions of the homeless registered as tuberculosis patients in Nagoya City].

    PubMed

    Yamanaka, K; Akashi, T; Miyao, M; Ishihara, S

    1999-02-01

    An Investigation by questionnaire was conducted in 1996 to know the tuberculosis (TB) status and living conditions of 50 homeless people registered as TB patients at one of Nagoya city's 16 health centers. 1. All patients had one or more symptoms of TB, 64% of them showed positive TB bacilli on smear, and 35.3% of them had a previous history of TB treatment. However, only 15.2% suspected they had TB at the onset of symptoms. 2. Main reasons of seeking medical treatment: 28.6% arrived by ambulance after falling down from exhaustion, 25.7% had consulted with welfare agencies after the onset of symptoms, and 20.0% had been diagnosed during the treatment of other diseases. 3. When they were admitted to the hospital they had many concerns: 29.0% loss of income, 19.4% living expenses, 19.4% smoking prohibition, 12.9% admission fee, and 9.7% privacy. 4. They lived in the following: 42.9% construction camps, 20.0% parks or streets, 17.1% single room occupancy hotels, 17.1% daily or monthly paid apartments, and 11.4% sauna baths. 5. Past medical histories of the subjects included 40.6% injuries by labor accidents, and 25.0% stomach ulcers. Current diseases were 15.6% mental diseases, 15.6% liver diseases, 15.6% diabetes mellitus, and 9.4% alcoholic dependence. Seventy percent of them consumed alcohol daily (average pure ethanol 125 ml per day). 6. From the results outlined above, the following proposals relating to TB control of the homeless should be considered. 1) Educating the homeless as to the need for a health check when TB symptoms are present. 2) Opening a clinic for the homeless for easy access to consultation on TB. 3) Directly observed therapy short-course, for TB in the homeless. 4) Health examination of the employees of single-room occupancy hotels and sauna baths which are used frequently by the homeless. 5) A fundamental countermeasure to deal with alcoholic dependency among the homeless. PMID:10191602

  1. Concurrent Medical Conditions and Health Care Use and Needs among Children with Learning and Behavioral Developmental Disabilities, National Health Interview Survey, 2006-2010

    ERIC Educational Resources Information Center

    Schieve, Laura A.; Gonzalez, Vanessa; Boulet, Sheree L.; Visser, Susanna N.; Rice, Catherine E.; Braun, Kim Van Naarden; Boyle, Coleen A.

    2012-01-01

    Studies document various associated health risks for children with developmental disabilities (DDs). Further study is needed by disability type. Using the 2006-2010 National Health Interview Surveys, we assessed the prevalence of numerous medical conditions (e.g. asthma, frequent diarrhea/colitis, seizures), health care use measures (e.g. seeing a

  2. Concurrent Medical Conditions and Health Care Use and Needs among Children with Learning and Behavioral Developmental Disabilities, National Health Interview Survey, 2006-2010

    ERIC Educational Resources Information Center

    Schieve, Laura A.; Gonzalez, Vanessa; Boulet, Sheree L.; Visser, Susanna N.; Rice, Catherine E.; Braun, Kim Van Naarden; Boyle, Coleen A.

    2012-01-01

    Studies document various associated health risks for children with developmental disabilities (DDs). Further study is needed by disability type. Using the 2006-2010 National Health Interview Surveys, we assessed the prevalence of numerous medical conditions (e.g. asthma, frequent diarrhea/colitis, seizures), health care use measures (e.g. seeing a…

  3. Human Factors/Usability Barriers to Home Medical Devices Among Individuals with Disabling Conditions: In-depth Interviews with Positive Airway Pressure Device Users

    PubMed Central

    Fung, Constance H.; Igodan, Uyi; Alessi, Cathy; Martin, Jennifer L.; Dzierzewski, Joseph M.; Josephson, Karen; Kramer, B. Josea

    2014-01-01

    Background Evidence suggests that medical equipment often fails to accommodate the needs of individuals with disabling conditions. Few studies have focused on the accessibility of home medical devices such as positive airway pressure (PAP), which is a type of home medical equipment prescribed for long-term therapy. Objective The purpose of this study was to explore in detail the types of difficulties experienced by patients with physical/sensory impairments who use PAP devices, as an initial step in designing a questionnaire to survey users about this topic. Methods In this descriptive study, in-depth interviews were conducted with 19 participants (9 patients with physical/sensory impairment and 10 healthcare providers). Interviews were coded and analyzed for major topics. Results Participants detailed the numerous ways in which current PAP devices fail to meet the needs of individuals with physical/sensory impairments (e.g., tremor, poor depth perception, paresis), by requiring patients to perform manually difficult tasks, such as inserting PAP parts through small apertures, attaching parts using a twisting motion, and lifting arms overhead to apply PAP headgear. These demands contributed to patients' frustration with and reduced usage of the home medical device. Conclusions Our findings suggest that home medical devices such as PAP may not be currently designed to meet the needs of some users with physical/sensory impairments. Additional studies are needed to measure the prevalence and impact of impairment-related barriers on PAP adherence for this common medical equipment. PMID:25126995

  4. EFFECTIVENESS OF THE EMERGENCY RESPONSE COURSE IN IMPROVING STUDENT PHYSICAL THERAPISTS' AND LICENSED PHYSICAL THERAPISTS' DECISION‐MAKING RELATED TO ACUTE SPORTS INJURIES AND MEDICAL CONDITIONS

    PubMed Central

    Cross, Patrick Stephen; Hauer, Patrick L.; Blom, Heather; Burcham, Jared; Myers, Amanda K.; Grimsrud, Casey

    2013-01-01

    Purpose: To analyze the effectiveness of the American Red Cross Emergency Response Course (ARC ERC) in improving decision‐making skills of physical therapists (PTs) and third semester clinical doctorate student physical therapists (SPTs) when assessing acute sports injuries and medical conditions. Methods: An existing questionnaire was modified, with permission from the original authors of the instrument. The questionnaire was administered to PTs and SPTs before the start of and immediately after the completion of 5 different ARC ERCs. The overall percentages of “Appropriate” responses for the 17 case scenarios were calculated for each participant for the pre‐and post‐tests. Participants also rated their perceived level of preparedness for managing various conditions using a 5‐point Likert Scale (ranging from Prepared to Unprepared). The overall percentage of “Prepared/Somewhat Prepared” responses for the 16 medical conditions was calculated for each participant for the pre‐and post‐tests. In addition, mean Likert scale scores were calculated for level of perceived preparedness for each of the 16 medical conditions. Paired t‐tests, calculated with SPSS 20.0, were used to analyze the data. Results: 37 of 37 (100.0%) of eligible PTs and 45 of 48 (93.8%) of eligible SPTs completed the pre‐ and post‐test questionnaires. The percentage of “Appropriate” responses for all 17 cases in the aggregate (PTs: 76.8% pre‐test, 89.0% post‐test; SPTs: 68.5%, 84.3%), as well as the percentage of “Prepared/Somewhat Prepared” responses for all conditions in the aggregate (PTs: 67.5%, 96.5%; SPTs: 37.1%, 90.6%) were significantly different from pre‐test to post‐test (P = .000). There was also a significant difference (P < .05) in the mean overall preparedness Likert scale scores from pre‐test to post‐test for each medical condition for the SPT's, and 15 of the 16 medical conditions (muscle strains: P = .119) for the PTs. Conclusions: The ARC ERC appears to be effective in improving both PTs' and SPTs' decision‐making skills related to acute sports injuries and medical conditions, as both “Appropriate” responses and perceived level of preparedness improved. Level of Evidence: Level 3 PMID:23772344

  5. Trends in self-medication for dental conditions among patients attending oral health outreach programs in coastal Karnataka, India

    PubMed Central

    Simon, Arun K.; Rao, Ashwini; Rajesh, Gururaghavendran; Shenoy, Ramya; Pai, Mithun B. H.

    2015-01-01

    Objectives: To determine the prevalence, pattern, and awareness of self-medication practices among patients presenting at oral health outreach programs in coastal Karnataka, India. Materials and Methods: The cross-sectional study, based on an interview conducted in randomly selected 400 study subjects from the patients presenting at these oral health outreach programs. Data were collected regarding demographic information and the interview schedule consisting of 14 questions was administered. Results: Prevalence of self-medication was 30%. Respondents’ gender (χ2 = 5.095, P < 0.05), occupation (χ2 = 10.215, P < 0.05), the time from the last dental visit (χ2 = 8.108, P < 0.05), recommendation of drug(s) to family members or friends (χ2 = 75.565, P < 0.001), and the likelihood of self-medication in the next 6 months (χ2 = 80.999, P < 0.001) were significantly associated with self-medication. Male respondents were less likely to have undertaken self-medication (odds ratio = 0.581 [0.361, 0.933]). The frequently self-medicated drug was analgesics (42.5%) for toothache (69.2%). The regression model explained 39.4% (Nagelkerke R2) of the variance in self-medication practices. Conclusions: Prevalence of self-medication was 30% with demographic influence. Hence, this study highlights the policy implications for drug control by government agencies and stresses on the need for dental health education to discourage irrational drug use. PMID:26600642

  6. Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs

    PubMed Central

    2011-01-01

    Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care. PMID:22032338

  7. Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006-2010.

    PubMed

    Schieve, Laura A; Gonzalez, Vanessa; Boulet, Sheree L; Visser, Susanna N; Rice, Catherine E; Van Naarden Braun, Kim; Boyle, Coleen A

    2012-01-01

    Studies document various associated health risks for children with developmental disabilities (DDs). Further study is needed by disability type. Using the 2006-2010 National Health Interview Surveys, we assessed the prevalence of numerous medical conditions (e.g. asthma, frequent diarrhea/colitis, seizures), health care use measures (e.g. seeing a medical specialist and >9 office visits in past year), health impact measures (e.g. needing help with personal care), and selected indicators of unmet health needs (e.g. unable to afford needed prescription medications) among a nationally representative sample of children ages 3-17 years, with and without DDs. Children in four mutually exclusive developmental disability groups: autism (N = 375), intellectual disability (ID) without autism (N = 238); attention-deficit/hyperactivity disorder (ADHD) without autism or ID (N = 2901); and learning disability (LD) or other developmental delay without ADHD, autism, or ID (N = 1955); were compared to children without DDs (N = 35,775) on each condition or health care measure of interest. Adjusted odds ratios (aORs) were calculated from weighted logistic regression models that accounted for the complex sample design. Prevalence estimates for most medical conditions examined were moderately to markedly higher for children in all four DD groups than children without DDs. Most differences were statistically significant after adjustment for child sex, age, race/ethnicity, and maternal education. Children in all DD groups also had significantly higher estimates for health care use, impact, and unmet needs measures than children without DDs. This study provides empirical evidence that children with DDs require increased pediatric and specialist services, both for their core functional deficits and concurrent medical conditions. PMID:22119694

  8. Adaptive multi-level conditional random fields for detection and segmentation of small enhanced pathology in medical images.

    PubMed

    Karimaghaloo, Zahra; Arnold, Douglas L; Arbel, Tal

    2016-01-01

    Detection and segmentation of large structures in an image or within a region of interest have received great attention in the medical image processing domains. However, the problem of small pathology detection and segmentation still remains an unresolved challenge due to the small size of these pathologies, their low contrast and variable position, shape and texture. In many contexts, early detection of these pathologies is critical in diagnosis and assessing the outcome of treatment. In this paper, we propose a probabilistic Adaptive Multi-level Conditional Random Fields (AMCRF) with the incorporation of higher order cliques for detecting and segmenting such pathologies. In the first level of our graphical model, a voxel-based CRF is used to identify candidate lesions. In the second level, in order to further remove falsely detected regions, a new CRF is developed that incorporates higher order textural features, which are invariant to rotation and local intensity distortions. At this level, higher order textures are considered together with the voxel-wise cliques to refine boundaries and is therefore adaptive. The proposed algorithm is tested in the context of detecting enhancing Multiple Sclerosis (MS) lesions in brain MRI, where the problem is further complicated as many of the enhancing voxels are associated with normal structures (i.e. blood vessels) or noise in the MRI. The algorithm is trained and tested on large multi-center clinical trials from Relapsing-Remitting MS patients. The effect of several different parameter learning and inference techniques is further investigated. When tested on 120 cases, the proposed method reaches a lesion detection rate of 90%, with very few false positive lesion counts on average, ranging from 0.17 for very small (3-5 voxels) to 0 for very large (50+ voxels) regions. The proposed model is further tested on a very large clinical trial containing 2770 scans where a high sensitivity of 91% with an average false positive count of 0.5 is achieved. Incorporation of contextual information at different scales is also explored. Finally, superior performance is shown upon comparing with Support Vector Machine (SVM), Random Forest and variant of an MRF. PMID:26211811

  9. Parent & Educators' Drug Reference: A Guide to Common Medical Conditions & Drugs Used in School-Aged Children.

    ERIC Educational Resources Information Center

    Agins, Alan P.

    This book provides a guide to more than 180 drugs used for children. An introduction precedes the four major sections of the guide. Section 1 provides an overview of pharmacology and therapeutics in chapters on the basics of pharmacology, the language of pharmacology and therapeutics, compliance, side effects, medications in school, and drug…

  10. Parent & Educators' Drug Reference: A Guide to Common Medical Conditions & Drugs Used in School-Aged Children.

    ERIC Educational Resources Information Center

    Agins, Alan P.

    This book provides a guide to more than 180 drugs used for children. An introduction precedes the four major sections of the guide. Section 1 provides an overview of pharmacology and therapeutics in chapters on the basics of pharmacology, the language of pharmacology and therapeutics, compliance, side effects, medications in school, and drug

  11. Teachers' Drug Reference: A Guide to Medical Conditions and Drugs Commonly Used in School-Aged Children.

    ERIC Educational Resources Information Center

    Agins, Alan P.

    This book provides a guide to approximately 175 drugs used with children. An introduction precedes the three major sections of the guide. Section 1 provides an overview of pharmacology and therapeutics in chapters on the basics of pharmacology, the language of pharmacology and therapeutics, compliance, side effects, and medications in school.…

  12. Reported biomedical causes and associated medical conditions for mental retardation among 10-year-old children, metropolitan Atlanta, 1985 to 1987.

    PubMed

    Yeargin-Allsopp, M; Murphy, C C; Cordero, J F; Decouflé, P; Hollowell, J G

    1997-03-01

    This report describes biomedical causes of mental retardation (MR) among school-age children and associated medical conditions in children for whom no cause was reported. This study involved 715, 10-year-old children with MR (intelligence quotient [IQ] 70 or less) born between 1975 and 1977. We determined biomedical causes of MR using a hierarchical approach based on the timing of the event (i.e. prenatal, perinatal, or postneonatal). Among children with no identified biomedical cause the occurrence of associated medical conditions was examined. No reported biomedical cause could be found in 78% of children with MR (87% mild, IQ 50 to 70; 57% severe, IQ < 50). Prenatal causes were present in 12%, perinatal causes in 6%, and postneonatal causes in 4%. On the basis of these findings it was concluded that intensive use of public health prevention strategies can reduce the number of children who receive a diagnosis of MR. PMID:9112961

  13. Association of maternal medical conditions and unfavorable birth outcomes: findings from the 1996-2003 Mississippi linked birth and death data.

    PubMed

    Zhang, Lei; Cox, Reagan G; Graham, Juanita; Johnson, Dick

    2011-10-01

    This study aimed to identify factors contributing to high rates of preterm birth (PTB), low birth weight (LBW) and infant mortality in Mississippi while considering both traditional risk factors and maternal medical conditions. The retrospective cohort study used 1996-2003 Mississippi linked birth and infant death files. Multiple logistic regression was used to investigate association between maternal medical conditions and unfavorable birth outcomes. Along with traditional risk factors, hypertension was significantly associated with PTB and LBW. Women with hypertension were about 2.2 and 3.2 times as likely to have PTB and LBW, respectively. Hydramnios/oligohydramnios increased 1.8-4.4 folds of risk for PTB, LBW and infant death and was significantly associated with the unfavorable birth outcomes. Non-Hispanic black women were about 1.5-2.0 times as likely to have an unfavorable birth outcome compared to non-Hispanic white women. Maternal education and prenatal care effect appeared to be modified by maternal race. Certain maternal medical conditions may be contributing to PTB, LBW and infant mortality rates identifying preconception and prenatal healthcare as possible strategies for reducing unfavorable outcomes. Results suggest that different risk profiles for unfavorable outcomes may exist according to maternal race highlighting the need to consider racial groups separately when further exploring the sociodemographic and/or health-related factors that contribute to unfavorable birth outcomes. PMID:19760166

  14. Medical Transcriptionists: Making Medical Histories.

    ERIC Educational Resources Information Center

    Shniper, Lynn

    2001-01-01

    Medical transcriptionists are experts in the language of medicine. Describes what they do and what their working conditions, earnings, employment prospects, and training requirements are. Includes sources of additional information. (Author)

  15. Astronomy for Special Needs Children (Low-income and/or Serious Medical Conditions) and Their Families

    NASA Astrophysics Data System (ADS)

    Lubowich, Donald

    2015-08-01

    I present the results of two NASA-IDEAS/STScI* sponsored and one IAU OAD grant for astronomy outreach programs for seriously ill or traumatically injured children and their families staying at the Ronald McDonald Houses of Long Island (New Hyde Park, NY) and Chicago or for children hospitalized at the Winthrop University Hospital Children’s Medical Center, (Mineola, NY). An astronomy program was also created for the five Fresh Air Fund Charity summer camps (low-income and special needs) and for a Hofstra summer camp for developmentally challenged youths.These programs are designed for children of all ages include” STSCi’s “Tonight’s Sky” (monthly guide to the sky); telescope observations of the Moon, Sun, planets, nebulae, and stars; and hands-on activities. During cloudy weather remote/robotic telescope observations are shown to the children.The staff and volunteers at the Ronald McDonald House and Children’s Medical Center are trained to use the telescope and to do astronony demonstrations. I created an Activity Book for the staff with demonstrations, participatory hands-on activities, and edible demonstrations using chocolate, marshmallows, and popcorn are to stimulate interest.These educational activities help children and their families learn about astronomy while providing a diversion to take their minds off their illness during a stressful time. The RMHs provide free or low-cost housing in a comfortable, supportive alternative atmosphere where family members sleep, eat, relax and find support from other families in similar situations. Families are kept united when mutual support is as critical as the medical treatment itself. The ill children and their families may stay for a few days or months because of chemotherapy, dialysis, or rehabilitative therapy. Children from 50 states and 50 countries stay the Chicago RMHs and there are 260 RMHs in the US and 65 worldwide.

  16. A Pooled Multisite Analysis of the Effects of Atopic Medical Conditions in Glioma Risk in Different Ethnic Groups

    PubMed Central

    Krishnamachari, Bhuma; Il’yasova, Dora; Scheurer, Michael E.; Bondy, Melissa; Zhou, Renke; Wrensch, Margaret; Davis, Faith

    2015-01-01

    Background The incidences of atopic conditions (allergies, asthma or eczema) and glioma vary by ethnicity. Atopic conditions are inversely associated with gliomas. We conducted a pooled multi-site study investigating the associations of atopic conditions with glioma in different race/ethnicity groups. Methods Using glioma cases and healthy controls, unconditional logistic regression was conducted to assess the associations of atopic conditions with glioma separately in White, Black, Asian and Hispanic subpopulations. Odds ratios (ORs) and 95% confidence intervals were calculated. Results Glioblastoma multiforme (GBM) cases were less likely than controls to report a history of atopic conditions in Whites (OR=0.46, [95% CI 0.38–0.54]) and Asians (OR=0.27, [95% C, 0.10–0.73]). The same trend was seen when looking at glioma cases of all histologies. An inverse association was not seen in Blacks for GBM or all histologies combined. Conclusions The inverse association between glioma and atopic conditions may vary by ethnicity due to a difference in the biology of atopic conditions in different ethnicities but may be due to chance because of the limitations of small non-White sample sizes. PMID:25691445

  17. Performance and microbial community variations in thermophilic anaerobic digesters treating OTC medicated cow manure under different operational conditions.

    PubMed

    Akyol, Çağrı; Turker, Gokhan; Ince, Orhan; Ertekin, Emine; Üstüner, Oya; Ince, Bahar

    2016-04-01

    This study aimed to determine the fate and effect of oxytetracycline (OTC) and its metabolites during thermophilic anaerobic digestion of cow manure. OTC-medicated and non-medicated digesters were operated at 55°C with different volatile solids (VS) concentrations (4% and 6%) and mixing rates (90 and 120rpm). OTC and its metabolites were measured by HPLC and LC/MS/MS, respectively. Microbial community dynamics were monitored by denaturing gradient gel electrophoresis (DGGE) and real-time PCR (qPCR). Approximately 2mg/L initial OTC concentration caused 10-30% inhibition on biogas production and higher inhibition was observed as mixing rate increased. DGGE results indicated that OTC caused a shift in bacterial community structure and several species became dominant with time. Archaeal community decreased throughout the digestion period. RNA based qPCR analyses showed that gene copy numbers of bacteria and Methanomicrobiales declined in all digesters whereas gene copy numbers of Methanobacteriales and Methanosarcinales increased in high mixing rate digesters. PMID:26826959

  18. Integrating Care for People With Co-Occurring Alcohol and Other Drug, Medical, and Mental Health Conditions

    PubMed Central

    Sterling, Stacy; Chi, Felicia; Hinman, Agatha

    2011-01-01

    Most people with alcohol and other drug (AOD) use disorders suffer from co-occurring disorders (CODs), including mental health and medical problems, which complicate treatment and may contribute to poorer outcomes. However, care for the patients’ AOD, mental health, and medical problems primarily is provided in separate treatment systems, and integrated care addressing all of a patient’s CODs in a coordinated fashion is the exception in most settings. A variety of barriers impede further integration of care for patients with CODs. These include differences in education and training of providers in the different fields, organizational factors, existing financing mechanisms, and the stigma still often associated with AOD use disorders and CODs. However, many programs are recognizing the disadvantages of separate treatment systems and are attempting to increase integrative approaches. Although few studies have been done in this field, findings suggest that patients receiving integrated treatment may have improved outcomes. However, the optimal degree of integration to ensure that patients with all types and degrees of severity of CODs receive appropriate care still remains to be determined, and barriers to the implementation of integrative models, such as one proposed by the Institute of Medicine, remain. PMID:23580018

  19. Medical Marijuana.

    PubMed

    Capriotti, Teri

    2016-01-01

    The use of medicinal marijuana is increasing. Marijuana has been shown to have therapeutic effects in certain patients, but further research is needed regarding the safety and efficacy of marijuana as a medical treatment for various conditions. A growing body of research validates the use of marijuana for a variety of healthcare problems, but there are many issues surrounding the use of this substance. This article discusses the use of medical marijuana and provides implications for home care clinicians. PMID:26645838

  20. Mothers of Children Diagnosed with Attention-Deficit/Hyperactivity Disorder: Health Conditions and Medical Care Utilization in Periods Before and After Birth of the Child

    PubMed Central

    Ray, G. Thomas; Croen, Lisa A.; Habel, Laurel A.

    2009-01-01

    Background Analyzing health conditions and medical utilization of mothers of children with attention-deficit/hyperactivity disorder (ADHD) can shed light on biological, environmental, and psychosocial factors relating to ADHD. Objective To examine health conditions, health care utilization, and costs of mothers of children with ADHD in periods before the child was diagnosed. Methods Using automated data from Northern California Kaiser Permanente we identified mothers of children with ADHD, mothers of children without ADHD, and mothers of children with asthma. Mothers’ diagnostic clusters, health care utilization, and costs were compared. Mothers of children with ADHD were compared to mothers of children without ADHD and, separately, to mothers of children with asthma. Results Compared to mothers of children without ADHD, mothers of children with ADHD were more likely to be diagnosed with numerous medical and mental health problems in the two years after birth of their child, including depression (Odds Ratio (OR): 1.88), anxiety neuroses (OR: 1.64), obesity (OR: 1.70), and musculoskeletal symptoms (OR: 1.51). Results were similar for the year before delivery. Mothers of children with ADHD also had higher total health care costs per person in the year before ($1003) and the two years after ($953) the birth of their child. Mothers of children with ADHD also were diagnosed with more health conditions and had higher health care costs than mothers of children with asthma. Conclusions Our findings suggest that the likelihood of being diagnosed with ADHD is related to maternal conditions and use of health services that precede the child’s diagnosis. Future studies are needed to clarify whether this is due to biologic, psychosocial, or environmental factors, or a combination. PMID:19106738

  1. Effect of hot-attribute aged ginger tea on chinese medical pulse condition of healthy young humans.

    PubMed

    Chao, Dan-Ping; Tyan, Chu-Chang; Chen, Jian-Jung; Hsieh, Ching-Liang; Sheen, Lee-Yan

    2011-10-01

    Young individuals typically have a dry-heat ( zào rè) constitution and feel overly stimulated. This study observes specialties on the right-bar ( yòu guān) section of the radial-arterial pulse of healthy young subjects, and investigates pulse variations induced by different attribute foods. Chinese medical doctors grouped thirty subjects into heat and non-heat constitutions. Each subject took water, aged ginger tea, and coconut water, well recognized as neutral, hot, and cold drinks, on different visits. The current study observed physiological signals induced by the samples using novel noninvasive sphygmography and a blood pressure monitor. As the baseline bigger percussion wave, dicrotic wave, and area in the sphygmogram of the non-heat constitution subjects, this work suggests that blood vessels of these subjects may be more relaxed than that of the heat constitution ones. Stroke volume increased and pulse pressure decreased in the non-heat constitution subjects after taking aged ginger tea, which may elevate arterial compliance corresponding to maintaining an estimated radial-arterial diameter in our study. However, the percussion wave widened and the valley increased in the heat constitution subjects after taking aged ginger tea. This corresponds to the markedly reduced radial-arterial diameter, indicating tighter blood vessels than the baseline status. Accordingly, this study confirms that selecting foods with attributes opposite to personal constitutions is important for reestablishing a healthy cold-heat balance within the human body. Moreover, novel noninvasive sphygmography may be a useful instrument to classify scientifically the heat personal constitution and the responses to different attribute foods. PMID:24716108

  2. Nonequilibrium structural condition in the medical TiNi-based alloy surface layer treated by electron beam

    SciTech Connect

    Neiman, Aleksei A. Lotkov, Aleksandr I.; Meisner, Ludmila L. Semin, Viktor O.; Koval, Nikolai N.; Teresov, Anton D.

    2014-11-14

    The research is devoted to study the structural condition and their evolution from the surface to the depth of TiNi specimens treated by low-energy high-current electron beams with surface melting at a beam energy density E = 10 J/cm{sup 2}, number of pulses N = 10, and pulse duration τ = 50 μs. Determined thickness of the remelted layer, found that it has a layered structure in which each layer differs in phase composition and structural phase state. Refinement B2 phase lattice parameters in local areas showed the presence of strong inhomogeneous lattice strain.

  3. A cross-sectional assessment of the prevalence of multiple chronic conditions and medication use in a sample of community-dwelling adults with fibromyalgia in Olmsted County, Minnesota

    PubMed Central

    Vincent, Ann; Whipple, Mary O; McAllister, Samantha J; Aleman, Katherine M; St Sauver, Jennifer L

    2015-01-01

    Objectives The objective of this study was to evaluate the problem of multiple chronic conditions and polypharmacy in patients with fibromyalgia. Design Retrospective medical record review. Setting Olmsted County, Minnesota. Participants 1111 adults with fibromyalgia. Primary and secondary outcome measures Number and type of chronic medical and psychiatric conditions, medication use. Results Medical record review demonstrated that greater than 50% of the sample had seven or more chronic conditions. Chronic joint pain/degenerative arthritis was the most frequent comorbidity (88.7%), followed by depression (75.1%), migraines/chronic headaches (62.4%) and anxiety (56.5%). Approximately, 40% of patients were taking three or more medications for symptoms of fibromyalgia. Sleep aids were the most commonly prescribed medications in our sample (33.3%) followed by selective serotonin reuptake inhibitors (28.7%), opioids (22.4%) and serotonin norepinephrine reuptake inhibitors (21.0%). Conclusions The results of our study highlight the problem of multiple chronic conditions and high prevalence of polypharmacy in fibromyalgia. Clinicians who care for patients with fibromyalgia should take into consideration the presence of multiple chronic conditions when recommending medications. PMID:25735301

  4. Mortality and Readmission at Safety Net and Non-Safety Net Hospitals for Three Common Medical Conditions

    PubMed Central

    Ross, Joseph S.; Bernheim, Susannah M.; Lin, Zhenqiu; Drye, Elizabeth E.; Chen, Jersey; Normand, Sharon-Lise T.; Krumholz, Harlan M.

    2012-01-01

    Safety net hospitals remain under financial strain, possibly affecting quality of care, and face uncertain financial consequences under the Patient Protection and Affordable Care Act. We compared risk-standardized mortality and readmission rates among fee-for-service Medicare beneficiaries admitted for acute myocardial infarction, heart failure, or pneumonia to urban hospitals within metropolitan statistical areas containing at least one safety net and non-safety net hospital. There was substantial variation in both mortality and readmission rates among safety-net and non-safety net hospitals for all three conditions, although safety-net hospitals had marginally worse outcomes. Herein we discuss the clinical and policy implications of these findings. PMID:22869652

  5. Impact of cardiovascular risk factors and medication use on the efficacy of remote ischaemic conditioning: post hoc subgroup analysis of a randomised controlled trial

    PubMed Central

    Sloth, Astrid Drivsholm; Schmidt, Michael Rahbek; Munk, Kim; Schmidt, Morten; Pedersen, Lars; Toft Sørensen, Henrik; Bøtker, Hans Erik; Bøttcher, M

    2015-01-01

    Objectives Remote ischaemic conditioning (RIC) promotes cardioprotection in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI). The effect of RIC may be modified by cardiovascular risk factors and their medications. We examined whether cardiovascular risk factors, lipid and glucose levels, and medication use influenced the efficacy of RIC in patients with STEMI treated with pPCI. Design Post hoc subgroup analysis of a single-centre randomised controlled trial. Participants A total of 139 patients with STEMI, randomised during ambulance transport to hospital for pPCI with (n=71) or without (n=68) RIC, met the trial criteria and achieved data for a myocardial salvage index (MSI). Interventions RIC was administered through intermittent arm ischaemia with four cycles of 5 min inflation and 5 min deflation of a blood pressure cuff. Primary outcome measures MSI, estimated by single-photon emission CT. We evaluated the efficacy of RIC on the MSI in patient subgroups of cardiovascular risk factors, lipid and glucose levels, and medication use. Results We found no significant difference in the efficacy of RIC in subgroups of cardiovascular risk factors, lipid and glucose levels, and medication use. However, point estimates indicated a reduced effect of RIC among smokers (median difference in MSI between RIC and control groups: −0.02 (95% CI −0.32 to 0.28) in smokers vs 0.25 (95% CI 0.08 to 0.42) in non-smokers, p value for interaction=0.13) and an increased effect of RIC in statin users (median difference in MSI between RIC and control groups: 0.34 (95% CI 0.03 to 0.65) in statin users vs 0.09 (95% CI −0.11 to 0.29) in non-statin users, p value for interaction=0.19). Conclusions RIC as an adjunct to pPCI seems to improve MSI in our trial population of patients with STEMI regardless of most cardiovascular risk factors and their medications. Our post hoc finding on a limited sample size calls for further investigation in large-scale multicentre trials. Trial registration number NCT00435266. PMID:25838505

  6. Pay for perfomance and the quality of diabetes management in individuals with and without co-morbid medical conditions

    PubMed Central

    Millett, Christopher; Bottle, Alex; Ng, Anthea; Curcin, Vasa; Molokhia, Mariam; Saxena, Sonia; Majeed, Azeem

    2009-01-01

    Summary Objective To examine the impact of the Quality and Outcomes Framework, a major pay-for-performance incentive introduced in the UK during 2004, on diabetes management in patients with and without co-morbidity. Design Cohort study comparing actual achievement of treatment targets in 2004 and 2005 with that predicted by the underlying (pre-intervention) trend in diabetes patients with and without co-morbid conditions. Setting A total of 422 general practices participating in the General Practice Research Database. Main outcomes measures Achievement of diabetes treatment targets for blood pressure (< 140/80 mm Hg), HbA1c (≤ 7.0%) and cholesterol (≤ 5 mmol/L). Results The percentage of diabetes patients with co-morbidity reaching blood pressure and cholesterol targets exceeded that predicted by the underlying trend during the first two years of pay for perfomance (by 3.1% [95% CI 1.1–5.1] for BP and 4.1% [95% CI 2.2–6.0] for cholesterol among patients with ≥ 5 co-morbidities in 2005). Similar improvements were evident in patients without co-morbidity, except for cholesterol control in 2004 (−0.2% [95% CI −1.7–1.4]). The percentage of patients meeting the HbA1c target in the first two years of this program was significantly lower than predicted by the underlying trend in all patients, with the greatest shortfall in patients without co-morbidity (3.8% [95% CI 2.6–5.0] lower in 2005). Patients with co-morbidity remained significantly more likely to meet treatment targets for cholesterol and HbA1c than those without after the introduction of pay for perfomance. Conclusions Diabetes patients with co-morbid conditions appear to have benefited more from this pay-for-performance program than those without co-morbidity. PMID:19734534

  7. Surveillance of Medication Use During Pregnancy in the Mini-Sentinel Program.

    PubMed

    Andrade, Susan E; Toh, Sengwee; Houstoun, Monika; Mott, Katrina; Pitts, Marilyn; Kieswetter, Caren; Ceresa, Carrie; Haffenreffer, Katherine; Reichman, Marsha E

    2016-04-01

    Objectives Mini-Sentinel is a pilot project sponsored by the U.S. Food and Drug Administration to create an active surveillance system to monitor the safety of FDA-regulated medical products. We assessed the capability of the Mini-Sentinel pilot to provide prevalence rates of medication use among pregnant women delivering a liveborn infant. Methods An algorithm was developed to identify pregnancies for a reusable analytic tool to be executed against the Mini-Sentinel Distributed Database. Diagnosis and procedure codes were used to identify women ages 10-54 years delivering a liveborn infant between April 2001 and December 2012. A comparison group of age- and date-matched nonpregnant women was identified. The analytic code was distributed to all 18 Mini-Sentinel data partners. The use of specific medications, selected because of concerns about their safe use during pregnancy, was identified from outpatient dispensing data. We determined the frequency of pregnancy episodes and nonpregnant episodes exposed to medications of interest, any time during the pregnant/matched nonpregnant period, and during each trimester. Results The analytic tool successfully identified 1,678,410 live birth deliveries meeting the eligibility criteria. The prevalence of use at any time during pregnancy was 0.38 % for angiotensin-converting enzyme inhibitors and 0.22 % for statins. For ≤0.05 % of pregnancy episodes, the woman was dispensed warfarin, methotrexate, ribavirin, or mycophenolate. Conclusions The analytic tool developed for this study can be used to assess the use of medications during pregnancy as safety issues arise, and is adaptable to include different medications, observation periods, pre-existing conditions, and enrollment criteria. PMID:26645616

  8. Weather conditions and visits to the medical wing of emergency rooms in a metropolitan area during the warm season in Israel: a predictive model

    NASA Astrophysics Data System (ADS)

    Novikov, Ilya; Kalter-Leibovici, Ofra; Chetrit, Angela; Stav, Nir; Epstein, Yoram

    2012-01-01

    Global climate changes affect health and present new challenges to healthcare systems. The aim of the present study was to analyze the pattern of visits to the medical wing of emergency rooms (ERs) in public hospitals during warm seasons, and to develop a predictive model that will forecast the number of visits to ERs 2 days ahead. Data on daily visits to the ERs of the four largest medical centers in the Tel-Aviv metropolitan area during the warm months of the year (April-October, 2001-2004), the corresponding daily meteorological data, daily electrical power consumption (a surrogate marker for air-conditioning), air-pollution parameters, and calendar information were obtained and used in the analyses. The predictive model employed a time series analysis with transitional Poisson regression. The concise multivariable model was highly accurate ( r 2 = 0.819). The contribution of mean daily temperature was small but significant: an increase of 1°C in ambient temperature was associated with a 1.47% increase in the number of ER visits ( P < 0.001). An increase in electrical power consumption significantly attenuated the effect of weather conditions on ER visits by 4% per 1,000 MWh ( P < 0.001). Higher daily mean SO2 concentrations were associated with a greater number of ER visits (1% per 1 ppb increment; P = 0.017). Calendar data were the main predictors of ER visits ( r 2 = 0.794). The predictive model was highly accurate in forecasting the number of visits to ERs 2 days ahead. The marginal effect of temperature on the number of ER visits can be attributed to behavioral adaptations, including the use of air-conditioning.

  9. Pre-existing brain states predict risky choices.

    PubMed

    Huang, Yu-Feng; Soon, Chun Siong; Mullette-Gillman, O'Dhaniel A; Hsieh, Po-Jang

    2014-11-01

    Rational decision-making models assume that people resolve an economic problem based on its properties and the underlying utility. Here we challenge this view by examining whether pre-stimulus endogenous neuronal fluctuations can bias economic decisions. We recorded subjects' pre-stimulus neural activation patterns with fMRI before presentation and choice between pairs of certain outcomes and risky gambles. Our results indicate that activities in the left nucleus accumbens and medial frontal gyrus can bias subsequent risky decision making, showing that neuronal activities in regions associated with uncertainty and reward processing are involved in biasing subsequent choice selection. This finding challenges theories which propose that choices merely reveal stable underlying distributions of hedonic utility. Endogenous brain states of this sort might originate from a systematic cause or a stochastic type of neural noise, which can be construed as contextual factors that shape people's decision making. PMID:25067816

  10. Managing work–family conflict in the medical profession: working conditions and individual resources as related factors

    PubMed Central

    Mache, Stefanie; Bernburg, Monika; Vitzthum, Karin; Groneberg, David A; Klapp, Burghard F; Danzer, Gerhard

    2015-01-01

    Objectives This study developed and tested a research model that examined the effects of working conditions and individual resources on work–family conflict (WFC) using data collected from physicians working at German clinics. Material and methods This is a cross-sectional study of 727 physicians working in German hospitals. The work environment, WFC and individual resources were measured by the Copenhagen Psychosocial Questionnaire, the WFC Scale, the Brief Resilient Coping Scale and the Questionnaire for Self-efficacy, Optimism and Pessimism. Descriptive, correlation and linear regression analyses were applied. Results Clinical doctors working in German hospitals perceived high levels of WFC (mean=76). Sociodemographic differences were found for age, marital status and presence of children with regard to WFC. No significant gender differences were found. WFCs were positively related to high workloads and quantitative job demands. Job resources (eg, influence at work, social support) and personal resources (eg, resilient coping behaviour and self-efficacy) were negatively associated with physicians’ WFCs. Interaction terms suggest that job and personal resources buffer the effects of job demands on WFC. Conclusions In this study, WFC was prevalent among German clinicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WFC. Our results give a strong indication that both individual and organisational factors are related to WFC. Results may play an important role in optimising clinical care. Practical implications for physicians’ career planning and recommendations for future research are discussed. PMID:25941177

  11. Diurnal and twenty-four hour patterning of human diseases: acute and chronic common and uncommon medical conditions.

    PubMed

    Smolensky, Michael H; Portaluppi, Francesco; Manfredini, Roberto; Hermida, Ramon C; Tiseo, Ruana; Sackett-Lundeen, Linda L; Haus, Erhard L

    2015-06-01

    The symptom intensity and mortality of human diseases, conditions, and syndromes exhibit diurnal or 24 h patterning, e.g., skin: atopic dermatitis, urticaria, psoriasis, and palmar hyperhidrosis; gastrointestinal: esophageal reflux, peptic ulcer (including perforation and hemorrhage), cyclic vomiting syndrome, biliary colic, hepatic variceal hemorrhage, and proctalgia fugax; infection: susceptibility, fever, and mortality; neural: frontal, parietal, temporal, and occipital lobe seizures, Parkinson's and Alzheimer's disease, hereditary progressive dystonia, and pain (cancer, post-surgical, diabetic neuropathic and foot ulcer, tooth caries, burning mouth and temporomandibular syndromes, fibromyalgia, sciatica, intervertebral vacuum phenomenon, multiple sclerosis muscle spasm, and migraine, tension, cluster, hypnic, and paroxysmal hemicranial headache); renal: colic and nocturnal enuresis and polyuria; ocular: bulbar conjunctival redness, keratoconjunctivitis sicca, intraocular pressure and anterior ischemic optic neuropathy, and recurrent corneal erosion syndrome; psychiatric/behavioral: major and seasonal affective depressive disorders, bipolar disorder, parasuicide and suicide, dementia-associated agitation, and addictive alcohol, tobacco, and heroin cravings and withdrawal phenomena; plus autoimmune and musculoskeletal: rheumatoid arthritis, osteoarthritis, axial spondylarthritis, gout, Sjögren's syndrome, and systemic lupus erythematosus. Knowledge of these and other 24 h patterns of human pathophysiology informs research of their underlying circadian and other endogenous mechanisms, external temporal triggers, and more effective patient care entailing clinical chronopreventive and chronotherapeutic strategies. PMID:25129839

  12. The Effect of Different Storage Conditions on the Physical Properties of Pigmented Medical Grade I Silicone Maxillofacial Material

    PubMed Central

    Al-Dharrab, Ayman A.; Tayel, Seham B.; Abodaya, Mona H.

    2013-01-01

    Objective. This study aimed to evaluate the effect of different storage solutions that simulate acidic, alkaline, and sebum conditiions on the physical properties of pigmented (colorant elastomer) cosmesil M511 maxillofacial prosthetic material. Materials and Methods. Sixty specimens were prepared according to the manufacturer's instructions and were tested before and after immersion of different storage conditions for six months at 37 °C. The following tests were performed: color changes (group I), solution absorption (group II), surface roughness (group III), and scanning electron microscopy (group IV). Results. There were no significant changes observed in the color and solution absorption tests while surface roughness revealed significant difference between control group and other testing storage medium groups, and this result was supported by SEM analysis that revealed limited surface changes. Conclusions. Cosmaseil material is an acceptable cross-linked formulation that withstands storage in different solutions with variable pH. The addition of pigment cannot vary the physical properties of these materials. Surface roughness test as well as SEM microscopic study showed moderate changes indicating a limited effect on the surface of the material. PMID:23606978

  13. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation

    PubMed Central

    2014-01-01

    Background The pediatric complex chronic conditions (CCC) classification system, developed in 2000, requires revision to accommodate the International Classification of Disease 10th Revision (ICD-10). To update the CCC classification system, we incorporated ICD-9 diagnostic codes that had been either omitted or incorrectly specified in the original system, and then translated between ICD-9 and ICD-10 using General Equivalence Mappings (GEMs). We further reviewed all codes in the ICD-9 and ICD-10 systems to include both diagnostic and procedural codes indicative of technology dependence or organ transplantation. We applied the provisional CCC version 2 (v2) system to death certificate information and 2 databases of health utilization, reviewed the resulting CCC classifications, and corrected any misclassifications. Finally, we evaluated performance of the CCC v2 system by assessing: 1) the stability of the system between ICD-9 and ICD-10 codes using data which included both ICD-9 codes and ICD-10 codes; 2) the year-to-year stability before and after ICD-10 implementation; and 3) the proportions of patients classified as having a CCC in both the v1 and v2 systems. Results The CCC v2 classification system consists of diagnostic and procedural codes that incorporate a new neonatal CCC category as well as domains of complexity arising from technology dependence or organ transplantation. CCC v2 demonstrated close comparability between ICD-9 and ICD-10 and did not detect significant discontinuity in temporal trends of death in the United States. Compared to the original system, CCC v2 resulted in a 1.0% absolute (10% relative) increase in the number of patients identified as having a CCC in national hospitalization dataset, and a 0.4% absolute (24% relative) increase in a national emergency department dataset. Conclusions The updated CCC v2 system is comprehensive and multidimensional, and provides a necessary update to accommodate widespread implementation of ICD-10. PMID:25102958

  14. Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care?

    PubMed Central

    2012-01-01

    Background Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking. Methods Cause-specific mortality data for people aged 30–74 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 30–74 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients. Results In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking. Conclusions We did not find evidence that inequalities in mortality from amenable conditions are related to inequalities in access or quality of health care. Further research is needed to find the causes of socio-economic inequalities in mortality from amenable conditions, and caution should be exercised in interpreting these inequalities as indicating health care deficiencies. PMID:22578154

  15. Medical Device Safety

    MedlinePlus

    A medical device is any product used to diagnose, cure, or treat a condition, or to prevent disease. They range ... may need one in a hospital. To use medical devices safely Know how your device works. Keep instructions ...

  16. The Medical Home

    MedlinePlus

    ... Giving Teens a Voice in Health Care Decisions Electronic Health Records Managing Your Medical Care Dealing With a Health Condition Health Insurance Basics Finding Low-Cost Medical Care Health Insurance: Cracking ...

  17. Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

    PubMed Central

    2011-01-01

    Background As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison with care in Kaiser Permanente (KP), an integrated delivery system based in the United States. We investigated population rates of hospitalisation and readmission rates for ambulatory care sensitive, chronic medical conditions in the two systems. Methods Using a historical cohort study design, age and gender adjusted population rates of hospitalisations for angina, heart failure, chronic obstructive pulmonary disease, and hypertension, plus rates of 30-day readmission and mortality were investigated for all individuals aged 65+ in the DHS and KP. Results DHS had substantially higher rates of hospitalisations, readmissions, and mean lengths of stay per hospitalisation, than KP had. For example, the adjusted angina hospitalisation rates in 2007 for the DHS and KP respectively were 1.01/100 persons (95%CI: 0.98-1.03) vs. 0.11/100 persons (95%CI: 0.10-0.13/100 persons); 21.6% vs. 9.9% readmission within 30 days (OR = 2.53; 95% CI: 1.84-3.47); and mean length of stay was 2.52 vs. 1.80 hospital days. Mortality up through 30 days post-discharge was not consistently different in the two systems. Conclusions There are substantial differences between the DHS and KP in the rates of preventable hospitalisations and subsequent readmissions associated with chronic conditions, which suggest much opportunity for improvement within the Danish healthcare system. Reductions in hospitalisations also could improve patient welfare and free considerable resources for use towards preventing disease exacerbations. These conclusions may also apply for similar public systems such as the US Medicare system, the NHS and other systems striving to improve the integration of care for persons with chronic conditions. PMID:22192270

  18. Abortion - medical

    MedlinePlus

    ... womb (uterus). There are different types of medical abortions: Therapeutic medical abortion is done because the woman has ... Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion

  19. Diagnosis and treatment of cancer in medical textbooks of ancient Iran.

    PubMed

    Tabatabaei, Seyed Mahmoud; Ali Tabatabaei, Seyed Mohammad

    2014-01-01

    Research shows that ancient Iranians were among the pioneers of medical science, and are therefore admired and praised by non-Iranian scholars for their efforts and accomplishments in this field. Investigations of medical and historical texts indicate that between the 10(th) and the 18(th) century A.D., ancient Iran experienced a golden age of medicine. Great physicians such as Rhazes, al-Ahwazi, Avicenna and others reviewed the medical textbooks of civilizations such as Greece and India, Theories were scientifically criticized, superstitious beliefs were discarded, valuable innovations were added to pre-existing knowledge and the ultimate achievements were compiled as precious textbooks. Alhawi by Rhazes, Cannon by Avicenna, and Kamil al-Sina'ah by al-Ahwazi are among the works that were treasured by domestic and foreign scientists alike, as well as future generations who continued to appreciate them for centuries. The above-mentioned textbooks discuss diseases and conditions related to neurosurgery, ophthalmology, ear, nose and throat, gastroenterology, urology, skeletomuscular system and other specialties, as well as cancer and similar subjects. One of the richest texts on the description, diagnosis, differential diagnosis, and prognosis of cancer and therapeutic approaches is Alhawi by Mohammad ibn Zakarya al Razi (Rhazes). This article presents a brief summary of Rhazes' views about the definition of cancer, types, signs and symptoms, prevalence, complications, medical care, treatment and even surgical indications and contraindications. Moreover, his opinions are compared against the views of other physicians and theories of modern medicine. It is also recommended to review the medical heritage of Iran and evaluate the proposed treatments based on modern methodologies and scientific approaches. PMID:25512835

  20. Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD): recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement.

    PubMed

    Guinchat, Vincent; Cravero, Cora; Diaz, Lautaro; Périsse, Didier; Xavier, Jean; Amiet, Claire; Gourfinkel-An, Isabelle; Bodeau, Nicolas; Wachtel, Lee; Cohen, David; Consoli, Angèle

    2015-03-01

    During adolescence, some individuals with autism spectrum disorder (ASD) engage in severe challenging behaviors, such as aggression, self-injury, disruption, agitation and tantrums. We aimed to assess risk factors associated with very acute behavioral crises in adolescents with ASD admitted to a dedicated neurobehavioral unit. We included retrospectively in 2008 and 2009 29 adolescents and young adults with ASD hospitalized for severe challenging behaviors and proposed a guideline (Perisse et al., 2010) that we applied prospectively for 29 patients recruited for the same indications between 2010 and 2012. In total, 58 patients were admitted (n=70 hospitalizations, mean age=15.66 (±4.07) years, 76% male). We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), comorbid organic conditions, etiologic diagnosis of the episode, and treatments. We explored predictors of Global Assessment Functioning Scale (GAFS) score and duration of hospitalization at discharge. All but 2 patients exhibited severe autistic symptoms and intellectual disability (ID), and two-thirds had no functional verbal language. During the inpatient stay (mean=84.3 (±94.9) days), patients doubled on average their GAFS scores (mean=17.66 (±9.05) at admission vs. mean=31.4 (±9.48) at discharge). Most common etiologies for acute behavioral crises were organic causes [n=20 (28%), including epilepsy: n=10 (14%) and painful medical conditions: n=10 (14%)], environmental causes [n=17 (25%) including lack of treatment: n=11 (16%) and adjustment disorder: n=6 (9%)], and non-ASD psychiatric condition [n=33 (48%) including catatonia: n=5 (7%), major depressive episode: n=6 (9%), bipolar disorder: n=4 (6%), schizophrenia: n=6 (9%), other/unknown diagnosis: n=12 (17%)]. We found no influence of age, gender, socio-economic status, migration, level of ID, or history of seizure on improvement of GAFS score at discharge. Severity of autism at admission was the only negative predictor (p<.001). Painful medical conditions (p=.04), non-ASD psychiatric diagnoses (p=.001), prior usage of specialized ASD care programs (p=.004), functional language (p=.007), as well as a higher number of challenging behaviors upon admission (p=.001) were associated with higher GAFS scores at discharge. Clinical severity at admission, based on the number of challenging behaviors (r=.35, p=.003) and GAFS score (r=-.32, p=.008) was correlated with a longer inpatient stay. Longer hospitalization was however correlated (r=.27, p=.03) with higher GAFS score at discharge even after adjustment for confounding factors. Challenging behaviors among adolescents with ASD may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic illness such as epilepsy or acute pain. The management of these behavioral challenges requires a unified, multidisciplinary approach. PMID:25575287

  1. The spectrum of medical conditions and symptoms before acquired immunodeficiency syndrome in homosexual and bisexual men infected with the human immunodeficiency virus.

    PubMed

    Holmberg, S D; Buchbinder, S P; Conley, L J; Wong, L C; Katz, M H; Penley, K A; Hershow, R C; Judson, F N

    1995-03-01

    The full range and occurrence of medical conditions in persons infected with human immunodeficiency virus (HIV) before they develop illnesses that define acquired immunodeficiency syndrome (AIDS) have not been systematically or completely described. In a retrospective and prospective cohort study, 1,073 homosexual and bisexual men in three US cities were interviewed and examined twice per year from January 1988 to September 1992. Study participants were from San Francisco, California (273 HIV-seropositive and 432 HIV-seronegative men), Denver, Colorado (107 positive and 129 negative men), and Chicago, Illinois (54 positive and 78 negative men). A total of 305 HIV-positive men had specifiable dates of HIV seroconversion (mean of 15.3 months between the last negative and the first positive HIV antibody test). Besides much increased incidences of thrush (incidence relative risk (IRR) = 23.3) and hairy leukoplakia (IRR = 551), the following conditions also occurred significantly more frequently in HIV-positive men than in HIV-negative men: anal herpes (incidence density (ID) = 10.7/100 person-years; IRR = 7.7); sinusitis requiring antibiotics (ID = 6.2/100 person-years; IRR = 2.1); anal warts (ID = 5.8/100 person-years; IRR = 2.7); seborrhea (ID = 3.8/100 person-years; IRR = 6.6); community-acquired pneumonia (ID = 1.4/100 person-years; IRR = 2.7); skin cancers (ID = 1.0/100 person-years; IRR = 2.2); and seizures, often apparently "breaking through" prior anticonvulsant therapy (ID = 0.8/100 person-years; IRR = 5.6). First episodes of hairy leukoplakia, thrush, and skin cancer occurred at low mean CD4 counts (mean counts were less than 350 cells/microliters) and late in HIV infection (mean times were more than 8 years after HIV seroconversion). Many medical problems, some not widely appreciated, occur in HIV-infected men before they develop AIDS-defining illnesses, signifying considerable morbidity from pre-AIDS HIV infection. PMID:7879784

  2. Towards a clinically useful diagnosis for mild-to-moderate conditions of medically unexplained symptoms in general practice: a mixed methods study

    PubMed Central

    2014-01-01

    Background Symptoms that cannot be attributed to any known conventionally defined disease are highly prevalent in general practice. Yet, only severe cases are captured by the current diagnostic classifications of medically unexplained symptoms (MUS). This study explores the clinical usefulness of a proposed new diagnostic category for mild-to-moderate conditions of MUS labelled ‘multiple symptoms’. Methods A mixed methods approach was used. For two weeks, 20 general practitioners (GPs) classified symptoms presented in consecutive consultations according to the International Classification of Primary Care (ICPC) supplemented with the new diagnostic category ‘multiple symptoms’. The GPs’ experiences were subsequently explored by focus group interviews. Interview data were analysed according to ethnographic principles. Results In 33% of patients, GPs classified symptoms as medically unexplained, but applied the category of ‘multiple symptoms’ only in 2.8%. The category was described as a useful tool for promoting communication and creating better awareness of patients with MUS; as such, the category was perceived to reduce the risk of unnecessary tests and referrals of these patients. Three main themes were found to affect the clinical usefulness of the diagnostic category of ‘multiple symptoms’: 1) lack of consensus on categorisation practices, 2) high complexity of patient cases and 3) relational continuity (i.e. continuity in the doctor-patient relationship over time). The first two were seen as barriers to usefulness, the latter as a prerequisite for application. The GPs’ diagnostic classifications were found to be informed by the GPs’ subjective pre-formed concepts of patients with MUS, which reflected more severe conditions than actually intended by the new category of ‘multiple symptoms’. Conclusions The study demonstrated possible clinical benefits of the category of ‘multiple symptoms’, such as GPs’ increased awareness and informational continuity in partnership practices. The use of the category was challenged by the GPs’ conceptual understanding of MUS and was applied only to a minority of patients. The study demonstrates a need for addressing these issues if sub-threshold categories for MUS are to be applied in routine care. The category of ‘multiple symptoms’ may profitably be used in the future as a risk indicator rather than a diagnostic category. PMID:24924564

  3. Medical marijuana.

    PubMed

    Marmor, J B

    1998-06-01

    Although many clinical studies suggest the medical utility of marijuana for some conditions, the scientific evidence is weak. Many patients in California are self-medicating with marijuana, and physicians need data to assess the risks and benefits. The only reasonable solution to this problem is to encourage research on the medical effects of marijuana. The current regulatory system should be modified to remove barriers to clinical research with marijuana. The NIH panel has identified several conditions for which there may be therapeutic benefit from marijuana use and that merit further research. Marijuana should be held to the same evaluation standards of safety and efficacy as other drugs (a major flaw in Proposition 215) but should not have to be proved better than current medications for its use to be adopted. The therapeutic window for marijuana and THC between desired effect and unpleasant side effects is narrow and is a major reason for discontinuing use. Although the inhaled route of administration has the benefit of allowing patients to self-titrate the dose, the smoking of crude plant material is problematic. The NIH panel recommended that a high priority be given to the development of a controlled inhaled form of THC. The presence of a naturally occurring cannabinoid-receptor system in the brain suggests that research on selective analogues of THC may be useful to enhance its therapeutic effects and minimize adverse effects. PMID:9656007

  4. [Social conditions in which medical students from the faculty of medicine of the National University of Mexico (UNAM) perform their Social Service in rural areas].

    PubMed

    Hamui-Sutton, Alicia

    2012-01-01

    The aim of this work is to describe the conditions in which medical students perform their Social Service, highlighting their experiences in areas such as: information before they move and the motivation to leave home; the perception of personal and environmental lack of safety; the institutional support that they receive during their work in the community and the financial support provided. The methodological design of the study included an exploratory phase, in which collective interviews were performed, using the focal group technique, with students who had been in rural areas. Three hundred sixty cases were considered, 72.8% corresponded to rural areas, and 27.7% to Mexico City. According to the findings, the following actions are proposed: give better information and improve the process of vacancy selection; increase the scholarship received by students in Social Service; establish legal, police, and community support mechanisms to guarantee the student's personal safety; pay attention to aspects such as the student's emotional and social situation, and design programs with gender perspective to enhance certainty and safety. PMID:22820362

  5. Influence of the presence of pre-existing thermal [var epsilon]-martensite on the formation of stress-induced [var epsilon]-martensite and on the shape memory effect of a Fe-Mn-Cr-Si-Ni shape memory alloy

    SciTech Connect

    Federzoni, L.; Guenin, G. )

    1994-07-01

    At present, many investigations are done on Fe-Mn-based shape memory alloys because of their particularly good one-way type shape memory effect and their low cost. With addition of Cr and Ni, it is possible to reach a good corrosion resistance, which confers to this type of alloys a commercial significance. The shape memory effect is associated with the formation of stress-induced [var epsilon]-martensite by deformation of an austenitic ([gamma]) sample. The reversion by heating of the [var epsilon]-martensite provides the shape memory effect. It is generally admitted that the presence of thermal [var epsilon]-martensite before deformation has a negative influence on the formation of the stress-induced martensite and on the shape memory effect. The authors' purpose is to evaluate the real influence of the pre-existing thermal [var epsilon]-martensite on the formation of the stress-induced [var epsilon]-martensite, its recovery and on the shape memory effect.

  6. Diagnostic recognition of facial changes associated with chronic conditions: use of an e-learning tool to enhance medical student education.

    PubMed

    McKenna, Danielle; Wilkinson, Caroline; Ker, Jean

    2010-06-16

    Facial characteristics serve as reliable indicators of numerous diseases, and their recognition can assist junior medical students in making an accurate diagnosis. At present, however, there is little data to support the incorporation of physiognomy in medical education. This pilot study involved the design, implementation and evaluation of e-learning tutorials as a means of teaching students to appreciate how careful observation of facial characteristics can enhance diagnosis. PMID:20557153

  7. [Social-hygienic features of health, life conditions and medical-social assistance to the veterans and disabled veterans of the Great patriotic war in Russia].

    PubMed

    Shchepin, O P; Maksimova, T M; Kakorina, E P; Ismailova, D I; Korol'kova, T A

    1995-01-01

    Disease incidence in participants and subjects disabled in the Great Patriotic War is analyzed as reflected by the records of consultation rate and medical check-ups of this population. Sociologic study provided information about the subjective assessment of the health status and some sociohygienic and biological characteristics of the cohort. The scope of medical care rendered and requirements in corrective devices and specific types of social care were studied. PMID:9273163

  8. A situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance (sIMB-CIM): an IMB model based approach to understanding and intervening in engagement in care for chronic medical conditions.

    PubMed

    Rivet Amico, K

    2011-10-01

    A sizable portion of adults living with chronic medical conditions (CMCs) delay initiation of care or maintain it inconsistently, which has tremendous personal and public costs. However, few explanatory models with high yield for intervention development and implementation have been proposed to date that would help to characterize and support care use for CMCs. A situated Information, Motivation, Behavioral Skills model of Care Initiation and Maintenance (sIMB-CIM) is presented here as an application of the IMB model to medical care use for CMCs. An example of a sIMB model for characterizing and intervening to support maintenance in HIV-care is provided. PMID:21459919

  9. Therapeutic Antioxidant Medical Gas

    PubMed Central

    Nakao, Atsunori; Sugimoto, Ryujiro; Billiar, Timothy R; McCurry, Kenneth R

    2009-01-01

    Medical gases are pharmaceutical gaseous molecules which offer solutions to medical needs and include traditional gases, such as oxygen and nitrous oxide, as well as gases with recently discovered roles as biological messenger molecules, such as carbon monoxide, nitric oxide and hydrogen sulphide. Medical gas therapy is a relatively unexplored field of medicine; however, a recent increasing in the number of publications on medical gas therapies clearly indicate that there are significant opportunities for use of gases as therapeutic tools for a variety of disease conditions. In this article, we review the recent advances in research on medical gases with antioxidant properties and discuss their clinical applications and therapeutic properties. PMID:19177183

  10. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity

    ERIC Educational Resources Information Center

    Emerson, Natacha D.; Morrell, Holly E. R.; Neece, Cameron

    2016-01-01

    Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent

  11. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity

    ERIC Educational Resources Information Center

    Emerson, Natacha D.; Morrell, Holly E. R.; Neece, Cameron

    2016-01-01

    Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent…

  12. 20 CFR 30.114 - What kind of evidence is needed to establish a compensable medical condition and how will that...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... certificates, x-rays, magnetic resonance images or reports, computer axial tomography or other imaging reports, lymphocyte proliferation testings, beryllium patch tests, pulmonary function or exercise testing results.... (1) For covered beryllium illnesses, additional medical evidence, as set forth in § 30.207,...

  13. 20 CFR 30.114 - What kind of evidence is needed to establish a compensable medical condition and how will that...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... certificates, x-rays, magnetic resonance images or reports, computer axial tomography or other imaging reports, lymphocyte proliferation testings, beryllium patch tests, pulmonary function or exercise testing results.... (1) For covered beryllium illnesses, additional medical evidence, as set forth in § 30.207,...

  14. [Actual condition of involuntary admission by order of the prefectural governor: focus on the effects of the Medical Treatment and Supervision Act].

    PubMed

    Koike, Junko; Morita, Nobuaki; Harima, Hirohiko; Nakatani, Yoji

    2009-01-01

    A survey was conducted involving 664 individuals admitted to a public psychiatric hospital in Tokyo Prefecture between July 15, 2004 and July 14, 2007 as a result of involuntary admission by order of the prefectural governor (hereafter, involuntarily admitted patients). The characteristics of patients with a focus on the effects of the Medical Treatment and Supervision Act were investigated in 656 patients, excluding eight patients for whom information at the time of involuntary admission was unclear. The proportion of patients in the present survey who had been reported by prosecutors was markedly low compared to nationwide and previous surveys. This was thought to be a result of the fact that the proportion of patients reported by the police, which tend to include emergency cases, was high due to the characteristics of the present hospital as well as the regional characteristics of Tokyo Prefecture. The characteristics of involuntarily admitted patients tended to be similar to those observed in previous surveys on involuntarily admitted patients at the present and other hospitals in Tokyo Prefecture. Comparison of the characteristics of involuntarily admitted patients and problem behaviors that instigated admission before and after implementation of the Medical Treatment and Supervision Act showed no clear differences, indicating that the act had no marked effect on involuntary admission by order of the prefectural governor. In addition, only a small proportion of patients with problem behaviors corresponding to actions described in the Medical Treatment and Supervision Act were reported by prosecutors, suggesting that such patients were mostly reported by the police. In cases where patients faced involuntary admission by order of the prefectural governor after being reported by the police, the prosecutor may have either been unaware of the patient or, if aware, had not filed a petition. Issues may include clues for investigation in addition to the roles of judicial police officers and prosecutors in investigation procedures in the former case, and the discretion of prosecutors in the latter case. While opinions on the appropriateness of actively applying the Medical Treatment and Supervision Act to these patients vary depending on the interpretation of the act's legal characteristics, it appeared that involuntary admission by order of the prefectural governor was at present not clearly distinguished from the Medical Treatment and Supervision Act. Involuntary admission by order of the prefectural governor and the Medical Treatment and Supervision Act are systems that have significant implications for patients with mental disorders, who are likely to cause injury to themselves or others. In order to facilitate the provision of appropriate medical care, it is important to clarify the systematic relationships within the legal system. PMID:20095438

  15. Medical marijuana

    MedlinePlus

    ... Possession of marijuana is illegal under federal law. Medical marijuana refers to using marijuana to treat certain medical ... Medical marijuana may be: Smoked Vaporized Eaten Taken as a liquid extract Marijuana leaves and buds contain substances ...

  16. Fecal Microbiota Transplantation Using Upper Gastrointestinal Tract for the Treatment of Refractory or Severe Complicated Clostridium difficile Infection in Elderly Patients in Poor Medical Condition: The First Study in an Asian Country

    PubMed Central

    Gweon, Tae-Geun; Kim, Jinsu; Lim, Chul-Hyun; Park, Jae Myung; Lee, Dong-Gun; Lee, In Seok; Cho, Young-Seok; Kim, Sang Woo; Choi, Myung-Gyu

    2016-01-01

    Background and Aims. Fecal microbiota transplantation (FMT) is a highly effective treatment option for refractory Clostridium difficile infection (CDI). FMT may be challenging in patients with a low performance status, because of their poor medical condition. The aims of this study were to describe our experience treating patients in poor medical condition with refractory or severe complicated CDI using FMT via the upper GI tract route. Methods. This study was a retrospective review of seven elderly patients with refractory or severe complicated CDI and a poor medical condition who were treated with FMT through the upper GI tract route from May 2012 through August 2013. The outcomes studied included the cure rate of CDI and adverse events. Results. Of these seven patients who received FMT via the upper GI tract route, all patients were cured. During the 11-month follow-up period, CDI recurrence was observed in two patients; rescue FMT was performed in these patients, which led to a full cure. Vomiting was observed in two patients. Conclusions. FMT via the upper gastrointestinal tract route may be effective for the treatment of refractory or severe complicated CDI in patients with a low performance status. Physicians should be aware of adverse events, especially vomiting. PMID:27127501

  17. Medical scribes.

    PubMed

    Baugh, Reginald; Jones, James E; Trott, K; Takyi, Valerie E; Abbas, Jihad T

    2012-01-01

    Medical scribes and electronic health records (EHRs) are increasingly being introduced into ambulatory clinics with variable outcomes. Characteristics of a successful implementation of medical scribes are described. Tips for optimization of the composition and presentation of the EHR as well as medical processes associated with medical documentation are presented. PMID:23373160

  18. Medications for back pain

    MedlinePlus

    ... narcotics, do not drink alcohol, drive, or operate heavy machinery. MUSCLE RELAXANTS Your provider may prescribe a medicine ... medical conditions worse. Do not drive or operate heavy machinery while taking muscle relaxants. Do not drink alcohol ...

  19. Patients Hospitalized with pH1N1 Influenza in an Academic Community Medical Center

    PubMed Central

    Bergman, Hagit; Livornese Jr, Lawrence L; Sambhara, Suryaprakash; Santoro, Jerome; Dessain, Scott K

    2011-01-01

    Background: The emergence of a novel strain of pandemic influenza (pH1N1) in 2009 presented significant challenges to health care facilities worldwide. In our academic community medical center in suburban Philadelphia, we noted our first pH1N1 diagnosis in September 2009. We sought to assess the impact of pH1N1 disease on our hospitalized patient population. Methods: We prospectively collected clinical and epidemiological data on 29 consecutive patients that were admitted to our hospital with a primary or secondary diagnosis of influenza from October 1-November 30, 2009. Data were obtained through care of the patients and chart review. Results: Prominent symptoms on admission included fever, hypoxia, cough, myalgias, and diarrhea, with leukocytosis and neutrophilia. Pre-existing medical conditions included asthma, pregnancy, immunosuppressive therapy, and sickle cell disease. All but 5 of the patients were under 60 years of age. Three patients had culture-documented bacterial or mycoplasma infections. All but two of the patients received oseltamivir. Six required admission to the intensive care unit but only one patient died. Conclusions: Our population of hospitalized patients with novel pH1N1 influenza demonstrated many of the features that have been associated with pH1N1 disease in other populations. Most of the patients were women and none of the patients died directly as a complication of influenza. We observed a cluster of patients with a tetrad of features comprising a history of asthma, obesity, female gender, and African-American race. Individuals with this constellation of factors should be specifically targeted for pH1N1 vaccination. PMID:21754972

  20. Travel Medical Kit.

    PubMed

    Terry, Anne C; Haulman, N Jean

    2016-03-01

    "The traveler's medical kit is an essential tool for both the novice and expert traveler. It is designed to treat travel-related illness and injury and to ensure preexisting medical conditions are managed appropriately. Travelers are at increased risk for common gastrointestinal issues during travel. Respiratory illnesses make up approximately 8% of the ailments present in returned international travelers. Approximately 12% of travelers experience a travel-related skin condition. First aid treatment for minor injuries is essential to all travel medical kits. The complexity ranges from a small, simple case for the urban traveler to a larger, extensive case for wilderness travel." PMID:26900112

  1. Medical geography in Charaka Samhita

    PubMed Central

    Bhavana, K.R.; Shreevathsa

    2014-01-01

    Charaka Samhita is the oldest and the most authentic treatise on Ayurveda and is the ancient medical science of India. Apart from giving information on medical conditions and their treatment; it also gives valuable information on geographical, social, and economic conditions of India. This article is an attempt to explore geographical conditions of the ancient India, its geographical position in present India and its medical significance. PMID:26195898

  2. Medical geography in Charaka Samhita.

    PubMed

    Bhavana, K R; Shreevathsa

    2014-01-01

    Charaka Samhita is the oldest and the most authentic treatise on Ayurveda and is the ancient medical science of India. Apart from giving information on medical conditions and their treatment; it also gives valuable information on geographical, social, and economic conditions of India. This article is an attempt to explore geographical conditions of the ancient India, its geographical position in present India and its medical significance. PMID:26195898

  3. Exploration Medical Capability

    NASA Technical Reports Server (NTRS)

    Watkins, Sharmila; Baumann, David; Wu, Jimmy; Barsten, Kristina

    2010-01-01

    Exploration Medical Capability (ExMC) is an element of NASA's Human Research Program (HRP). ExMC's goal is to address the risk of the Inability to Adequately Recognize or Treat an Ill or Injured Crewmember. This poster highlights the approach ExMC has taken to address this goal and our current areas of interest. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to identify medical conditions of concern during exploration missions. The list was derived from space flight medical incidents, the shuttle medical checklist, the International Space Station medical checklist, and expert opinion. The conditions on the list were prioritized according to mission type by a panel comprised of flight surgeons, physician astronauts, engineers, and scientists. From the prioritized list, the ExMC element determined the capabilities needed to address the medical conditions of concern. Where such capabilities were not currently available, a gap was identified. The element s research plan outlines these gaps and the tasks identified to achieve the desired capabilities for exploration missions. This poster is being presented to inform the audience of the gaps and tasks being investigated by ExMC and to encourage discussions of shared interests and possible future collaborations.

  4. Variants Near FOXE1 Are Associated with Hypothyroidism and Other Thyroid Conditions: Using Electronic Medical Records for Genome- and Phenome-wide Studies

    PubMed Central

    Denny, Joshua C.; Crawford, Dana C.; Ritchie, Marylyn D.; Bielinski, Suzette J.; Basford, Melissa A.; Bradford, Yuki; Chai, High Seng; Bastarache, Lisa; Zuvich, Rebecca; Peissig, Peggy; Carrell, David; Ramirez, Andrea H.; Pathak, Jyotishman; Wilke, Russell A.; Rasmussen, Luke; Wang, Xiaoming; Pacheco, Jennifer A.; Kho, Abel N.; Hayes, M. Geoffrey; Weston, Noah; Matsumoto, Martha; Kopp, Peter A.; Newton, Katherine M.; Jarvik, Gail P.; Li, Rongling; Manolio, Teri A.; Kullo, Iftikhar J.; Chute, Christopher G.; Chisholm, Rex L.; Larson, Eric B.; McCarty, Catherine A.; Masys, Daniel R.; Roden, Dan M.; de Andrade, Mariza

    2011-01-01

    We repurposed existing genotypes in DNA biobanks across the Electronic Medical Records and Genomics network to perform a genome-wide association study for primary hypothyroidism, the most common thyroid disease. Electronic selection algorithms incorporating billing codes, laboratory values, text queries, and medication records identified 1317 cases and 5053 controls of European ancestry within five electronic medical records (EMRs); the algorithms' positive predictive values were 92.4% and 98.5% for cases and controls, respectively. Four single-nucleotide polymorphisms (SNPs) in linkage disequilibrium at 9q22 near FOXE1 were associated with hypothyroidism at genome-wide significance, the strongest being rs7850258 (odds ratio [OR] 0.74, p = 3.96 × 10−9). This association was replicated in a set of 263 cases and 1616 controls (OR = 0.60, p = 5.7 × 10−6). A phenome-wide association study (PheWAS) that was performed on this locus with 13,617 individuals and more than 200,000 patient-years of billing data identified associations with additional phenotypes: thyroiditis (OR = 0.58, p = 1.4 × 10−5), nodular (OR = 0.76, p = 3.1 × 10−5) and multinodular (OR = 0.69, p = 3.9 × 10−5) goiters, and thyrotoxicosis (OR = 0.76, p = 1.5 × 10−3), but not Graves disease (OR = 1.03, p = 0.82). Thyroid cancer, previously associated with this locus, was not significantly associated in the PheWAS (OR = 1.29, p = 0.09). The strongest association in the PheWAS was hypothyroidism (OR = 0.76, p = 2.7 × 10−13), which had an odds ratio that was nearly identical to that of the curated case-control population in the primary analysis, providing further validation of the PheWAS method. Our findings indicate that EMR-linked genomic data could allow discovery of genes associated with many diseases without additional genotyping cost. PMID:21981779

  5. Medical applications of artificial olfactometry

    NASA Technical Reports Server (NTRS)

    Lewis, Nathan S. (Inventor); Severin, Erik J. (Inventor); Wong, Bernard (Inventor); Kelso, David M. (Inventor); Munoz, Beth C. (Inventor)

    2005-01-01

    The present invention provides methods for detecting the presence of an analyte indicative of various medical conditions, including halitosis, periodontal disease and other diseases are also disclosed.

  6. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity.

    PubMed

    Emerson, Natacha D; Morrell, Holly E R; Neece, Cameron

    2016-01-01

    Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent source of care (CSC), and the interaction between these variables after controlling for birth cohort, birth order, poverty level, parental education, and health insurance. While African American children were diagnosed earlier than Caucasians, this effect was moderated by ASD severity and CSC. Having a CSC predicted earlier diagnosis for Caucasian but not African American children. Both physician and parent behaviors may contribute to diagnostic delays in minority children. PMID:26280401

  7. Medical marijuana: legal considerations.

    PubMed

    Schouten, J T

    1999-01-01

    In 1998, Washington State passed a law, Initiative 692 (I-692), that gives individuals who are charged with possession of marijuana for medical purposes a possible affirmative defense. The law lets these individuals provide a note from their doctor or a copy of their medical records stating they have a condition that may benefit from the use of marijuana. I-692 does not legalize the medical use of marijuana and does not affect Federal law, which makes obtaining, possessing, and growing marijuana illegal. The Washington law limits the amount of marijuana a patient can possess to a 60-day supply and defines the conditions for which medical marijuana may be used. These conditions include HIV, cancer, multiple sclerosis, and epilepsy. PMID:11366751

  8. Over-the-horizon, connected home/office (OCHO): situation management of environmental, medical, and security conditions at remote premises via broadband wireless access

    NASA Astrophysics Data System (ADS)

    Hortos, William S.

    2010-04-01

    Broadband wireless access standards, together with advances in the development of commercial sensing and actuator devices, enable the feasibility of a consumer service for a multi-sensor system that monitors the conditions within a residence or office: the environment/infrastructure, patient-occupant health, and physical security. The proposed service is a broadband reimplementation and combination of existing services to allow on-demand reports on and management of the conditions by remote subscribers. The flow of on-demand reports to subscribers and to specialists contracted to mitigate out-of-tolerance conditions is the foreground process. Service subscribers for an over-the-horizon connected home/office (OCHO) monitoring system are the occupant of the premises and agencies, contracted by the service provider, to mitigate or resolve any observed out-of-tolerance condition(s) at the premises. Collectively, these parties are the foreground users of the OCHO system; the implemented wireless standards allow the foreground users to be mobile as they request situation reports on demand from the subsystems on remote conditions that comprise OCHO via wireless devices. An OCHO subscriber, i.e., a foreground user, may select the level of detail found in on-demand reports, i.e., the amount of information displayed in the report of monitored conditions at the premises. This is one context of system operations. While foreground reports are sent only periodically to subscribers, the information generated by the monitored conditions at the premises is continuous and is transferred to a background configuration of servers on which databases reside. These databases are each used, generally, in non-real time, for the assessment and management of situations defined by attributes like those being monitored in the foreground by OCHO. This is the second context of system operations. Context awareness and management of conditions at the premises by a second group of analysts and decision makers who extract information from the OCHO data in the databases form the foundation of the situation management problem.

  9. RISK FACTORS IN DELIRIOUS GERIATRIC GENERAL MEDICAL INPATIENTS

    PubMed Central

    Khurana, Paramjeet Singh; Sharma, P.S.V.N.; Avasthi, Ajit

    2002-01-01

    The present study was carried out on the hospitalized geriatric general medical patients with the aim to identify the possible risk factors associated with delirium in the elderly. The assessment of the patients was carried out using Mini Mental Status Examination (MMSE), Delirium Symptom Interview (DSI), Delirium Rating Scale (DRS) and ICD-10 Diagnostic Criteria for Research for delirium Details of medical records were collected. An overall rate of delirium of 27% was found in the 100 patients who constituted the sample. Pre-existing cognitive deficits, neurological illnesses, urinary tract infections, visual impairment, hearing impairment, current proteinuria, leukocytosis, raised blood ammonia, hyponatremia and potassium level disturbances were the risk factors identified. PMID:21206582

  10. Risk factors in delirious geriatric general medical inpatients.

    PubMed

    Khurana, Paramjeet Singh; Sharma, P S V N; Avasthi, Ajit

    2002-07-01

    The present study was carried out on the hospitalized geriatric general medical patients with the aim to identify the possible risk factors associated with delirium in the elderly. The assessment of the patients was carried out using Mini Mental Status Examination (MMSE), Delirium Symptom Interview (DSI), Delirium Rating Scale (DRS) and ICD-10 Diagnostic Criteria for Research for delirium Details of medical records were collected. An overall rate of delirium of 27% was found in the 100 patients who constituted the sample. Pre-existing cognitive deficits, neurological illnesses, urinary tract infections, visual impairment, hearing impairment, current proteinuria, leukocytosis, raised blood ammonia, hyponatremia and potassium level disturbances were the risk factors identified. PMID:21206582

  11. 76 FR 14600 - Dental Conditions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-17

    ... aggravating a service-connected medical condition (Class III). Who are rated totally disabled due to service... the provision of such care and services, i.e., a dental condition is complicating a medical condition... surgery and help insure successful medical treatment) (Class VI). VHA will usually be able to...

  12. Medical Scenarios Relevant to Spaceflight

    NASA Technical Reports Server (NTRS)

    Bacal, Kira; Hurs, Victor; Doerr, Harold

    2004-01-01

    The Medical Operational Support Team (MOST) was tasked by the JSC Space Medicine and Life Sciences Directorate (SLSD) to incorporate medical simulation into 1) medical training for astronaut-crew medical officers (CMO) and medical flight control teams and 2) evaluations of procedures and resources required for medical care aboard the International Space Station (ISS). Development of evidence-based medical scenarios that mimic the physiology observed during spaceflight will be needed for the MOST to complete these two tasks. The MOST used a human patient simulator, the ISS-like resources in the Medical Simulation Laboratory (MSL), and evidence from space operations, military operations and medical literature to develop space relevant medical scenarios. These scenarios include conditions concerning airway management, Advanced Cardiac Life Support (ACLS) and mitigating anaphylactic symptoms. The MOST has used these space relevant medical scenarios to develop a preliminary space medical training regimen for NASA flight surgeons, Biomedical Flight Controllers (Biomedical Engineers; BME) and CMO-analogs. This regimen is conducted by the MOST in the MSL. The MOST has the capability to develop evidence-based space-relevant medical scenarios that can help SLSD I) demonstrate the proficiency of medical flight control teams to mitigate space-relevant medical events and 2) validate nextgeneration medical equipment and procedures for space medicine applications.

  13. Healthcare services for those with musculoskeletal conditions: a rheumatology service. Recommendations of the European Union of Medical Specialists Section of Rheumatology/European Board of Rheumatology 2006.

    PubMed

    Woolf, Anthony D

    2007-03-01

    Musculoskeletal conditions are very common across Europe. They affect all age groups, and the associated physical disability is an enormous burden on individuals and society. They can be effectively prevented and controlled in many situations, but this is not at present fully achieved. This report outlines what is required to achieve this and the role of rheumatology in providing these healthcare services. Strategies are given for the prevention and management of musculoskeletal conditions. The needs of people with these conditions are expressed in the PARE Manifesto and the clinical needs have been identified. The healthcare services required to implement these strategies and meet these needs are considered focusing on what services a rheumatology centre should provide. A key principle is that management of musculoskeletal conditions requires a coordinated, integrated, multidisciplinary and multiprofessional approach providing access to a combination of expertise and competencies. Guidance is given of what a rheumatology service should be expected to offer. For a rheumatology centre to provide these services, the need for appropriate facilities and resources is identified, which considers physical resources as well as personnel, training and management needs. Maintaining high standards of care and achieving the best outcomes at all times needs the monitoring of quality indicators as well as ongoing education and research. In conclusion, improving musculoskeletal health is dependent on access to effective treatments and this document shows how the services provided by a rheumatology centre is central to this. PMID:17158137

  14. MEDICAL "DEPRIVATION."

    ERIC Educational Resources Information Center

    SUCHMAN, EDWARD A.

    THE SOCIAL AND MEDICAL PROBLEM TODAY HAS SHIFTED FROM PROVIDING FOR THE EMERGENCY MEDICAL NEEDS OF THE INDIGENT SICK TO RAISING THE LEVEL OF LOWER CLASS PARTICIPATION IN THE BENEFITS OF MODERN MEDICINE. GREATER ATTENTION IS BEING FOCUSED ON MEDICAL DEPRIVATION SUFFERED BY LARGE SEGMENTS OF THE POPULATION WHO DO NOT SHARE EQUALLY IN MEDICAL…

  15. "You teach us to listen,… but you don't teach us about suffering": self-care and resilience strategies in medical school curricula.

    PubMed

    Outram, Sue; Kelly, Brian

    2014-11-01

    This article examines the pre-vocational preparation of doctors to cope with the demands of clinical practice, drawing on literature from across a number of domains: mental health, psychological stress among medical students and medical practitioners; and self-care strategies in medicine curricula. High rates of psychological distress in medical students and medical practitioners were consistently reported. A number of questions remain pertinent to medical education: how does the experience of medical education impact on this level of distress, and possibly exacerbate pre-existing student vulnerabilities? What will help future doctors respond to, and cope with, suffering in their patients? Can the formal curriculum build resilience? Medical schools and educators have a responsibility to address these questions and to provide effective self-care curricula. In this review promising interventions such as mindfulness training are reported, frameworks to guide self-awareness in medical students are suggested, and recommendations for a self-care curriculum are made. PMID:25395229

  16. Supporting Medical Decision Making with Argumentation Tools

    ERIC Educational Resources Information Center

    Lu, Jingyan; Lajoie, Susanne P.

    2008-01-01

    This study investigated the collaborative decision-making and communicative discourse of groups of learners engaged in a simulated medical emergency in two conditions. In one condition subgroups used a traditional whiteboard (TW group) to document medical arguments on how to solve a medical emergency. In the other condition subgroups used

  17. Supporting Medical Decision Making with Argumentation Tools

    ERIC Educational Resources Information Center

    Lu, Jingyan; Lajoie, Susanne P.

    2008-01-01

    This study investigated the collaborative decision-making and communicative discourse of groups of learners engaged in a simulated medical emergency in two conditions. In one condition subgroups used a traditional whiteboard (TW group) to document medical arguments on how to solve a medical emergency. In the other condition subgroups used…

  18. Medical tourism in India.

    PubMed

    Gupta, Vijay; Das, Poonam

    2012-06-01

    The term 'medical tourism' is under debate because health care is a serious business and rarely do patients combine the two. India is uniquely placed by virtue of its skilled manpower, common language, diverse medical conditions that doctors deal with, the volume of patients, and a large nonresident Indian population overseas. Medical tourism requires dedicated services to alleviate the anxiety of foreign patients. These include translation, currency conversion, travel, visa, posttreatment care system,and accommodation of patient relatives during and after treatment. PMID:22727009

  19. [The death of Yasser Arafat: molecular-genetic authentication of the remains as an indispensable condition for the evaluation of the medical hypotheses of the cause of his death].

    PubMed

    Zemskova, E Yu; Kvacheva, Yu E; Kovalev, A V; Ivanov, P L

    2015-01-01

    The objective of the present study was the molecular-genetic authentication of the remains as an indispensable condition for the evaluation of the medical hypotheses of the cause of death in 2004 of Yasser Arafat, the former Palestinian leader and the first president of the Palestinian National Administration, the Nobel Peace Prize laureate. We carried out molecular-genetic investigations aimed at establishing the circumstances and cause of the death of Yasser Arafat including the analysis of the relevant medical documentation, the examination of the burial place at Ramallah, remains, and personal belongings stored in his Al Muqata'ah residence at Ramallah. The objective of the present molecular- genetic investigations was to confirm the authenticity of the fragments of Yasser Arafat's remains available for radio-toxicological, chemical toxicological, and other laboratory studies. The reference objects were the contact traces left on the personal belongings by their owner. The aggregate probabilistic estimate of the coincidence of genotype traits of autosomal DNA, Y-chromosomal DNA, and mtDNA was at least 99,(9)29 4% which gives evidence of the genetic identity of the objects of study. It is this value (99.999999 <...> 9999999(29) 4%) that characterizes the probability that the bone fragments provided for the laboratory studies are actually authentic remains of Yasser Arafat. PMID:26856052

  20. Medication reviews.

    PubMed

    Blenkinsopp, Alison; Bond, Christine; Raynor, David K

    2012-10-01

    Recent years have seen a formalization of medication review by pharmacists in all settings of care. This article describes the different types of medication review provided in primary care in the UK National Health Service (NHS), summarizes the evidence of effectiveness and considers how such reviews might develop in the future. Medication review is, at heart, a diagnostic intervention which aims to identify problems for action by the prescriber, the clinician conducting the review, the patient or all three but can also be regarded as an educational intervention to support patient knowledge and adherence. There is good evidence that medication review improves process outcomes of prescribing including reduced polypharmacy, use of more appropriate medicines formulation and more appropriate choice of medicine. When 'harder' outcome measures have been included, such as hospitalizations or mortality in elderly patients, available evidence indicates that whilst interventions could improve knowledge and adherence they did not reduce mortality or hospital admissions with one study showing an increase in hospital admissions. Robust health economic studies of medication reviews remain rare. However a review of cost-effectiveness analyses of medication reviews found no studies in which the cost of the intervention was greater than the benefit. The value of medication reviews is now generally accepted despite lack of robust research evidence consistently demonstrating cost or clinical effectiveness compared with traditional care. Medication reviews can be more effectively deployed in the future by targeting, multi-professional involvement and paying greater attention to medicines which could be safely stopped. PMID:22607195