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Sample records for serving vulnerable patients

  1. Leaf size serves as a proxy for xylem vulnerability to cavitation in plantation trees.

    PubMed

    Schreiber, Stefan G; Hacke, Uwe G; Chamberland, Sabrina; Lowe, Christopher W; Kamelchuk, David; Bräutigam, Katharina; Campbell, Malcolm M; Thomas, Barb R

    2016-02-01

    Hybrid poplars are an important renewable forest resource known for their high productivity. At the same time, they are highly vulnerable to water stress. Identifying traits that can serve as indicators for growth performance remains an important task, particularly under field conditions. Understanding which trait combinations translate to improved productivity is key in order to satisfy the demand for poplar wood in an uncertain future climate. In this study, we compared hydraulic and leaf traits among five hybrid poplar clones at 10 plantations in central Alberta. We also assessed the variation of these traits between 2- to 3-year-old branches from the lower to mid-crown and current-year long shoots from the mid to upper crown. Our results showed that (1) hybrid poplars differed in key hydraulic parameters between branch type, (2) variation of hydraulic traits among clones was relatively large for some clones and less for others, and (3) strong relationships between measured hydraulic traits, such as vessel diameter, cavitation resistance, xylem-specific and leaf-specific conductivity and leaf area, were observed. Our results suggest that leaf size could serve as an additional screening tool when selecting for drought-tolerant genotypes in forest management and tree improvement programmes. PMID:26177991

  2. Use of the NatureServe Climate Change Vulnerability Index as an Assessment Tool for Reptiles and Amphibians: Lessons Learned

    NASA Astrophysics Data System (ADS)

    Tuberville, Tracey D.; Andrews, Kimberly M.; Sperry, Jinelle H.; Grosse, Andrew M.

    2015-10-01

    Climate change threatens biodiversity globally, yet it can be challenging to predict which species may be most vulnerable. Given the scope of the problem, it is imperative to rapidly assess vulnerability and identify actions to decrease risk. Although a variety of tools have been developed to assess climate change vulnerability, few have been evaluated with regard to their suitability for certain taxonomic groups. Due to their ectothermic physiology, low vagility, and strong association with temporary wetlands, reptiles and amphibians may be particularly vulnerable relative to other groups. Here, we evaluate use of the NatureServe Climate Change Vulnerability Index (CCVI) to assess a large suite of herpetofauna from the Sand Hills Ecoregion of the southeastern United States. Although data were frequently lacking for certain variables (e.g., phenological response to climate change, genetic variation), sufficient data were available to evaluate all 117 species. Sensitivity analyses indicated that results were highly dependent on size of assessment area and climate scenario selection. In addition, several ecological traits common in, but relatively unique to, herpetofauna are likely to contribute to their vulnerability and need special consideration during the scoring process. Despite some limitations, the NatureServe CCVI was a useful tool for screening large numbers of reptile and amphibian species. We provide general recommendations as to how the CCVI tool's application to herpetofauna can be improved through more specific guidance to the user regarding how to incorporate unique physiological and behavioral traits into scoring existing sensitivity factors and through modification to the assessment tool itself.

  3. Use of the NatureServe Climate Change Vulnerability Index as an Assessment Tool for Reptiles and Amphibians: Lessons Learned.

    PubMed

    Tuberville, Tracey D; Andrews, Kimberly M; Sperry, Jinelle H; Grosse, Andrew M

    2015-10-01

    Climate change threatens biodiversity globally, yet it can be challenging to predict which species may be most vulnerable. Given the scope of the problem, it is imperative to rapidly assess vulnerability and identify actions to decrease risk. Although a variety of tools have been developed to assess climate change vulnerability, few have been evaluated with regard to their suitability for certain taxonomic groups. Due to their ectothermic physiology, low vagility, and strong association with temporary wetlands, reptiles and amphibians may be particularly vulnerable relative to other groups. Here, we evaluate use of the NatureServe Climate Change Vulnerability Index (CCVI) to assess a large suite of herpetofauna from the Sand Hills Ecoregion of the southeastern United States. Although data were frequently lacking for certain variables (e.g., phenological response to climate change, genetic variation), sufficient data were available to evaluate all 117 species. Sensitivity analyses indicated that results were highly dependent on size of assessment area and climate scenario selection. In addition, several ecological traits common in, but relatively unique to, herpetofauna are likely to contribute to their vulnerability and need special consideration during the scoring process. Despite some limitations, the NatureServe CCVI was a useful tool for screening large numbers of reptile and amphibian species. We provide general recommendations as to how the CCVI tool's application to herpetofauna can be improved through more specific guidance to the user regarding how to incorporate unique physiological and behavioral traits into scoring existing sensitivity factors and through modification to the assessment tool itself. PMID:25971738

  4. Vulnerability

    NASA Technical Reports Server (NTRS)

    Taback, I.

    1979-01-01

    The discussion of vulnerability begins with a description of some of the electrical characteristics of fibers before definiting how vulnerability calculations are done. The vulnerability results secured to date are presented. The discussion touches on post exposure vulnerability. After a description of some shock hazard work now underway, the discussion leads into a description of the planned effort and some preliminary conclusions are presented.

  5. What influences dental students to serve special care patients?

    PubMed

    Baumeister, Sebastian E; Davidson, Pamela L; Carreon, Daisy C; Nakazono, Terry T; Gutierrez, John J; Andersen, Ronald M

    2007-01-01

    This study examines factors associated with graduating dental students' motivation to deliver services to special care patients. We investigated community context and student characteristics, which would influence potential behavior. Higher percentages of older adults and low-income residents in the community were positively correlated with interest in serving special care populations. Factors which correlated with individual student characteristics included having a father with at least a college education, a higher number of weeks spent in extramural clinical rotations, preparedness to provide care to disabled patients, and service orientation and socially conscious attitudes. Frail elderly and disabled persons have limited access to dental care, which is compounded by a shortage of skilled dental professionals who are willing to treat these populations. Our findings suggest that interest in special care dentistry is partly conditioned by the dental school's demographic and dental market context. This study is important to dental educators and policymakers because the challenge of providing care to the "special patient" will increase in the future. PMID:17388225

  6. Vulnerability.

    PubMed

    Cunha, Thiago; Garrafa, Volnei

    2016-04-01

    Collating the concepts of vulnerability through five regional perspectives on bioethics from the United States, Europe, Latin America, Africa, and Asia, this article proposes a means of integration between the different approaches in order to seek a theoretical and normative basis for the field of global bioethics. It argues that only through opening continuous, critical, and self-critical dialogue within the international bioethical community will it be possible to achieve a sufficiently global understanding of vulnerability that is capable of identifying the means needed for addressing the conditions that leave certain groups and individuals more susceptible to "wounding" than others. PMID:26957445

  7. Responding to vulnerability in old age: patient-centred care.

    PubMed

    Abley, Clare

    Patient-centred care is a term widely used in health policy and is familiar to staff as a principle or commonly agreed approach to care. However, nursing and multidisciplinary teams often do not agree how it should be provided for older patients. This article outlines three different models of patient-centred care applicable to the care of older people. The article also explores the concept of vulnerability in old age, highlighting differences between the perspectives of older people and those of professionals and how clinical practice can be improved to achieve a more patient-centred approach. The links between patient-centred care and vulnerability in old age are considered along with the implications of this for clinical practice. PMID:23240515

  8. Clinical research centre serves 70,000 patients annually.

    PubMed

    1992-01-01

    The Bangladesh, ICDDR,B's Clinical Research Center (CPR) is described since its inception in 1960 as the former Dhaka Hospital. As 1 of 4 divisions, the CRC has increased admissions for diarrheal diseases, which is associated with the respect earned within the population, and averages 70,000/year. Included in the discussion is consideration of the objectives of the CRC and its predecessor, patient care, research, training, physical facilities, and new and other activities. Early research objectives were to find a better protocol for treatment of diarrheal diseases. Cholera and other diarrheal disease findings contributed to the formulation of an iv fluid for the treatment of severely dehydrated patients. Oral rehydration therapy (ORT) research was also conducted at the center. The cholera death rate with treatment has been reduced to 1%. 70% of patients are children under 15 years old and 65% have some malnutrition. Patients in general come from Dhaka city and suburbs, but they also come from outside the district. Current research focuses on clinical management and basic pathophysiological and nutritional issues; efforts are underway to develop a super oral rehydration solution to improve special diets, and to determine successful implementation strategies. Medical, paramedical, and health workers are trained in establishing diarrheal treatment and training programs in other locations and in research methodologies. The Public Health Institutes has increased capacity to include a 60-bed inpatient ward, an intensive care unit of 12 beds, a 120-bed observation unit, a 30-bed research ward, and a traveler's clinic. The research ward also has an office and laboratory facility and endoscopic facilities with computers, icemakers, centrifuge, deep freezers, and a biological safety hood for sample processing and storage. During epidemics the facilities are still inadequate. Water supply and air cooling and electronic precision weighing scales are available. The Child Health

  9. Aspects of vulnerable patients and informed consent in clinical trials

    PubMed Central

    Kuthning, Maria; Hundt, Ferdinand

    2013-01-01

    Scope: To discuss the rationale behind informed consent in clinical trials focusing on vulnerable patients from a European and German viewpoint. Methods: Scientific literature search via PubMed, Medline, Google. Results: Voluntary informed consent is the cornerstone of policies regulating clinical trials. To enroll a patient into a clinical trial without having obtained written and signed consent is to be considered as a serious issue in the conduct of a clinical trial. Development of ethical guidance for physicians started before Christ Era with the Hippocratic Oath. Main function of consent, as articulated in all guidelines developed for clinical research, is to facilitate an individual’s freedom of choice, respect autonomy, and thus to ensure welfare of the participants in clinical trials. Minors are unable to provide legally binding informed consent, this issue is addressed through a combination of parental permission and minor’s assent. Illiteracy is a critical problem that affects all corners of our earth; it has no boundaries and exists among every race and ethnicity, age group, and economic class. New strategies to improve communication with patients including the use of videotapes or animated cartoon illustrations could be taught. Finally the time with the potential participant seems to be the best way to improve understanding. Conclusion: Discovery of life saving and life enhancing new treatments requires partnership that is based on good communication and trust between patients and researchers, sponsors, ethics committees, authorities, lawyers and politicians so that vulnerable patients can benefit from the results of well controlled clinical trials. PMID:23346043

  10. Neurocognitive Vulnerability: Suicidal and Homicidal Behaviours in Patients With Schizophrenia

    PubMed Central

    Richard-Devantoy, Stéphane; Orsat, Manuel; Dumais, Alexandre; Turecki, Gustavo; Jollant, Fabrice

    2014-01-01

    Objective Schizophrenia is associated with an increase in the risk of both homicide and suicide. The objectives of this study were to systematically review all published articles that examined the relation between neurocognitive deficits and suicidal or homicidal behaviours in schizophrenia, and to identify vulnerabilities in suicidal and homicidal behaviour that may share a common pathway in schizophrenia. Methods: A systematic review of the literature was performed using MEDLINE to include all studies published up to August 31, 2012. Results: Among the 1760 studies, 7 neuropsychological and 12 brain imaging studies met the selection criteria and were included in the final analysis. The neuropsychological and functional neuroimaging studies were inconclusive. The structural imaging studies reported various alterations in patients with schizophrenia and a history of homicidal behaviour, including: reduced inferior frontal and temporal cortices, increased mediodorsal white matter, and increased amygdala volumes. Patients with a history of suicidal acts showed volumetric reductions in left orbitofrontal and superior temporal cortices, while right amygdala volume was increased, though, these findings have rarely been replicated. Finally, no study has directly compared neurocognitive markers of suicidal and homicidal risk. Conclusion: These results suggest that brain alterations, in addition to those associated with schizophrenia, may predispose some patients to a higher risk of homicide or suicide in particular circumstances. Moreover, some of these alterations may be shared between homicidal and suicidal patients. However, owing to several limitations, including the small number of available studies, no firm conclusions can be drawn and further investigations are necessary. PMID:24444320

  11. Support of vulnerable patients throughout TB treatment in the UK.

    PubMed

    Potter, J L; Inamdar, L; Okereke, E; Collinson, S; Dukes, R; Mandelbaum, M

    2016-06-01

    Despite well-established treatment regimens, tuberculosis (TB) remains a public health burden; it disproportionately affects poor and marginalized populations who may not have access to social support, including migrants, homeless people and those dependent on drugs or alcohol. There is a clearly demonstrated need for housing and other appropriate social support, as part of a package of integrated clinical and social care. However, TB prevention and control efforts in the UK often do not address the specific vulnerabilities of these groups and it can be a challenge to support the continued TB treatment of these underserved populations. This challenge is exacerbated by complex issues concerning funding, immigration and the law. In this paper, we have reviewed current UK guidance and legislation, discussed several case studies and highlighted examples of existing models of community support for TB patients. Finally, we lay out our recommendations for ensuring a co-ordinated, whole system approach to successful TB treatment. PMID:25889386

  12. Developing Dental Students' Awareness of Health Care Disparities and Desire to Serve Vulnerable Populations Through Service-Learning.

    PubMed

    Behar-Horenstein, Linda S; Feng, Xiaoying; Roberts, Kellie W; Gibbs, Micaela; Catalanotto, Frank A; Hudson-Vassell, Charisse M

    2015-10-01

    Service-learning in dental education helps students integrate knowledge with practice in an underserved community setting. The aim of this study was to explore how a service-learning experience affected a small group of dental students' beliefs about cultural competence, professionalism, career development, desire to practice in a community service setting, and perceptions about access and disparities issues. Prior to beginning their first year of dental school, five first-year dental students at one U.S. dental school participated in a six-week service-learning program in which they interned at one of three at-risk settings in order to experience health care delivery there. After the program, 60 reflective writing assignments completed by the participants were analyzed using grounded theory methods; interviews with the students were used to corroborate the findings from that analysis. Seven themes identified in the journal reflections and interview findings showed enhanced awareness of social health care issues and patient differences, as well as a social justice orientation and desire to address disparities. Building on this study, future research should explore the curricular components of service-learning programs to ensure students receive ample opportunity to reflect upon their experiences in order to integrate previously held assumptions with their newfound knowledge. PMID:26427778

  13. Defining the non-vulnerable and vulnerable patients with computed tomography coronary angiography: evaluation of atherosclerotic plaque burden and composition.

    PubMed

    Rodriguez-Granillo, Gaston A; Carrascosa, Patricia; Bruining, Nico; Waksman, Ron; Garcia-Garcia, Hector M

    2016-05-01

    The shift from coronary plaque stability to plaque instability remains poorly understood despite enormous efforts and expenditures have been assigned to the study of the subject. On the other hand, there have been serious advances in imaging helping us to characterizenon-vulnerable patients The latter has much more value in the clinical decision-making process since it provides high certainty that the patient's probability of a future acute event is low and treatment decisions should be made accordingly. Although coronary plaque rupture is still recognized as the main source of acute thrombotic events, numerous studies have shown that the prediction of events on an individual basis is far more complex and demands a more open approach aimed at characterizing patient risk rather than assessing the risk of thrombosis of a single plaque. Computed tomography coronary angiography (CTCA) has the ability to evaluate non-invasively the extent, burden, severity, and characteristics of coronary artery disease (CAD) and has a close relationship to intravascular ultrasound. On the basis of an excellent negative predictive value with an annualized event rate of ∼0.20% assessed over more than 6000 patients, thus providing a 5-year warranty period, CTCA has been identified as the finest non-invasive tool to exclude CAD. This means that CTCA is able to reliably characterize the non-vulnerable patient. Conversely, in the past few years, several studies have attempted to establish CTCA-derived predictors of acute coronary syndromes, both from a lesion level and a patient level basis with very low positive predictive value, thus questioning the vulnerable patient/plaque concept. PMID:26903599

  14. Can Erectile Dysfunction in Young Patients Serve as a Surrogate Marker for Coronary Artery Disease?

    PubMed Central

    Dattatrya, Kaje Yogesh; Gorakhnath, Wagaska Vinayak; kiran, Patwardhan Sujata

    2015-01-01

    Introduction Early diagnosis and expeditious management of coronary artery disease (CAD) has a rewarding survival benefit. Aim To study whether erectile dysfunction (ED) serves as a surrogate marker for CAD in a young patient. Settings and Design Males (n=207) between ages 20-60 years with ED were evaluated prospectively for risk factors for CAD. Materials and Methods Blood Glucose Levels (BGL) fasting and post meal), lipid profile (LP) and 12 lead electrocardiogram (ECG) was done in all of them. International Index of Erectile Function-5 (IEF-5) was used for the evaluation of ED. Those with abnormal parameters were assessed by cardiologists by echocardiography, stress test and if necessary coronary angiography (Non-Invasive or Invasive). Statistical Analysis All the data were analysed using SPSS. 16 statistical software (SPSS Inc., Chicago, IL, USA). All data are expressed as mean and standard deviation. The Student’s t-test was used to compare means between groups, and the chi-square test was used to compare proportions between the groups. P-value <0.05 was considered statistically significant. All confidence intervals (CIs) are two tailed and calculated at the 0.05 level. Results Out of 207, 149 patients had at least one abnormal screening parameter. All underwent cardiology consultation and 2D ECHO and Stress test. Thirty six patients underwent coronary angiography. CAD was found in 22 patients. Of these, 19 patients had severe ED. Nine patients were between 20-40 years of age (13.23%). All 9 young patients had deranged LP; severe ED. Six patients were smokers while nobody was hypertensive. Conclusion ED serves as a surrogate marker for CAD in young patients (p=0.001). Presence of risk factors and lab abnormalities in young patients with ED warrants a cardiology referral to detect CAD. PMID:26674799

  15. The validity of Psychosis Proneness Scales as vulnerability indicators in recent-onset schizophrenia patients.

    PubMed

    Horan, William P; Reise, Steven P; Subotnik, Kenneth L; Ventura, Joseph; Nuechterlein, Keith H

    2008-03-01

    The Psychosis Proneness Scales developed by the Chapmans and colleagues [Chapman, J.P., Chapman, L.J., Kwapil, T.R. Scales for the measurement of schizotypy. In: Raine., A., Lencz, T., Mednick, S.A., (Eds.). Schizotypal Personality. New York: Cambridge University Press, 1995. pp. 79-109] are widely used to identify non-patient individuals who are hypothesized to possess heightened vulnerability to schizophrenia and related psychopathology. Yet surprisingly little is known about whether schizophrenia patients themselves show abnormalities on these scales across different clinical states, as would be expected for vulnerability indicators. Scores on four of the Psychosis Proneness Scales were evaluated at three assessment points over a 15-month period in healthy controls (n=54) and in recent-onset schizophrenia patients (n=72) who experienced symptom fluctuations across assessments. Patients showed steady elevations on the Physical Anhedonia Scale across time and clinical state, consistent with a stable vulnerability indicator. Patients had higher scores on the Perceptual Aberration and Magical Ideation Scales than controls throughout the follow-up period but scores also changed across clinical states, consistent with a mediating vulnerability indicator. Patients had higher scores on the Impulsive Non-Conformity Scale than controls only during a psychotic state, reflecting an episode indicator. The longitudinal characteristics of these scales in people who are actually diagnosed with schizophrenia provide key evidence for the validity of three commonly used psychometric indicators of vulnerability to psychosis. PMID:18221857

  16. Development of a multivariable model to predict vulnerability in older American patients hospitalised with cardiovascular disease

    PubMed Central

    Bell, Susan P; Schnelle, John; Nwosu, Samuel K; Schildcrout, Jonathan; Goggins, Kathryn; Cawthon, Courtney; Mixon, Amanda S; Vasilevskis, Eduard E; Kripalani, Sunil

    2015-01-01

    Objectives To identify vulnerable cardiovascular patients in the hospital using a self-reported function-based screening tool. Participants Prospective observational cohort study of 445 individuals aged ≥65 years admitted to a university medical centre hospital within the USA with acute coronary syndrome and/or decompensated heart failure. Methods Participants completed an inperson interview during hospitalisation, which included vulnerable functional status using the Vulnerable Elders Survey (VES-13), sociodemographic, healthcare utilisation practices and clinical patient-specific measures. A multivariable proportional odds logistic regression model examined associations between VES-13 and prior healthcare utilisation, as well as other coincident medical and psychosocial risk factors for poor outcomes in cardiovascular disease. Results Vulnerability was highly prevalent (54%) and associated with a higher number of clinic visits, emergency room visits and hospitalisations (all p<0.001). A multivariable analysis demonstrating a 1-point increase in VES-13 (vulnerability) was independently associated with being female (OR 1.55, p=0.030), diagnosis of heart failure (OR 3.11, p<0.001), prior hospitalisations (OR 1.30, p<0.001), low social support (OR 1.42, p=0.007) and depression (p<0.001). A lower VES-13 score (lower vulnerability) was associated with increased health literacy (OR 0.70, p=0.002). Conclusions Vulnerability to functional decline is highly prevalent in hospitalised older cardiovascular patients and was associated with patient risk factors for adverse outcomes and an increased use of healthcare services. PMID:26316650

  17. Neonatal anesthesia: how we manage our most vulnerable patients

    PubMed Central

    2015-01-01

    Neonates undergoing surgery are at higher risk than older children for anesthesia-related adverse events. During the perioperative period, the maintenance of optimal hemodynamics in these patients is challenging and requires a thorough understanding of neonatal physiology and pharmacology. Data from animals and human cohort studies have shown relation of the currently used anesthetics may associate with neurotoxic brain injury that lead to later neurodevelopmental impairment in the developing brain. In this review, the unique neonatal physiologic and pharmacologic features and anesthesia-related neurotoxicity will be discussed. PMID:26495052

  18. Report of the ASHP Task Force on Caring for Patients Served by Specialty Suppliers.

    PubMed

    Caselnova, Dominick; Donley, Kathy; Ehlers, Diane; Hyduk, Amy E; Koontz, Susannah E; Nowobilski-Vasilios, Anna; Pawlicki, Kathleen S; Poikonen, John C; Poremba, Art C; Sasser, Cathy L; Schell, Kenneth H; Schwab, Jay L; Swinarski, Dave; Chen, David; Kirschenbaum, Bonnie; Armitstead, John

    2010-10-01

    Task Force recommendations are discussed in more detail in eAppendix A (available at www.ajhp.org). What follows is a brief summary of those recommendations. In very abbreviated terms, the Task Force suggested that ASHP: 1. Consider creating and maintaining a Web resource center on ASHP's website to provide information about restricted drug distributions systems (RDDSs), risk evaluation and mitigation strategies (REMSs), risk assessment and minimization plans (RiskMAPs), and specialty suppliers and products. 2. Provide comprehensive education to members, other health professionals, regulators, third-party payers, patients, and other stakeholders about RDDSs, REMSs, RiskMAPs, and specialty suppliers and products. 3. Develop policies to advocate that a. Pharmacists serve as the institutional leaders in compliance and utilization challenges of safely managing externally supplied medications and related drug administration devices, b. Agencies, organizations, and associations that influence the distribution, sale, and dispensing of medications under these alternative distribution models address issues these models create in continuity of care, reimbursement, and patient safety, c. The Centers for Medicare and Medicaid Services and the Joint Commission develop standards and interpretations that accommodate hospital use of these products and devices when currently available technology (e.g., cold-chain storage, e-pedigree) is used to ensure patient safety, d. Group purchasing organizations negotiate contractual arrangements for specialty pharmaceuticals for both acquisition costs and distribution arrangements, and e. Information technology (IT) be used to resolve issues created by alternative distribution models and that ASHP work with IT vendors to ensure that programs are designed to meet the needs of these evolving models. 4. Quantify through research, perhaps in cooperation with entities such as the Agency for Healthcare Research and Quality, the Institute of

  19. Older, vulnerable patient view: a pilot and feasibility study of the patient measure of safety (PMOS) with patients in Australia

    PubMed Central

    Taylor, Natalie; Hogden, Emily; Clay-Williams, Robyn; Li, Zhicheng; Lawton, Rebecca; Braithwaite, Jeffrey

    2016-01-01

    Objectives The UK-developed patient measure of safety (PMOS) is a validated tool which captures patient perceptions of safety in hospitals. We aimed (1) to investigate the extent to which the PMOS is appropriate for use with stroke, acute myocardial infarction (AMI) and hip fracture patients in Australian hospitals and (2) to pilot the PMOS for use in a large-scale, national study ‘Deepening our Understanding of Quality in Australia’ (DUQuA). Participants Stroke, AMI and hip fracture patients (n=34) receiving care in 3 wards in 1 large hospital. Methods 2 phases were conducted. First, a ‘think aloud’ study was used to determine the validity of PMOS with this population in an international setting, and to make amendments based on patient feedback. The second phase tested the revised measure to establish the internal consistency reliability of the revised subscales, and piloted the recruitment and administration processes to ensure feasibility of the PMOS for use in DUQuA. Results Of the 43 questions in the PMOS, 13 (30%) were amended based on issues patients highlighted for improvement in phase 1. In phase 2, a total of 34 patients were approached and 29 included, with a mean age of 71.3 years (SD=16.39). Internal consistency reliability was established using interitem correlation and Cronbach's α for all but 1 subscale. The most and least favourably rated aspects of safety differed between the 3 wards. A study log was categorised into 10 key feasibility factors, including liaising with wards to understand operational procedures and identify patterns of patient discharge. Conclusions Capturing patient perceptions of care is crucial in improving patient safety. The revised PMOS is appropriate for use with vulnerable older adult groups. The findings from this study have informed key decisions made for the deployment of this measure as part of the DUQuA study. PMID:27279478

  20. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... disproportionate share of low-income patients. 412.106 Section 412.106 Public Health CENTERS FOR MEDICARE... section, if a hospital serves a disproportionate number of low-income patients, its DRG revenues for.... Editorial Note: For Federal Register citations affecting § 412.106, see the List of CFR Sections...

  1. Medicare home health payment reform may jeopardize access for clinically complex and socially vulnerable patients.

    PubMed

    Rosati, Robert J; Russell, David; Peng, Timothy; Brickner, Carlin; Kurowski, Daniel; Christopher, Mary Ann; Sheehan, Kathleen M

    2014-06-01

    The Affordable Care Act directed Medicare to update its home health prospective payment system to reflect more recent data on costs and use of services-an exercise known as rebasing. As a result, the Centers for Medicare and Medicaid Services will reduce home health payments 3.5 percent per year in the period 2014-17. To determine the impact that these reductions could have on beneficiaries using home health care, we examined the Medicare reimbursement margins and the use of services in a national sample of 96,621 episodes of care provided by twenty-six not-for-profit home health agencies in 2011. We found that patients with clinically complex conditions and social vulnerability factors, such as living alone, had substantially higher service delivery costs than other home health patients. Thus, the socially vulnerable patients with complex conditions represent less profit-lower-to-negative Medicare margins-for home health agencies. This financial disincentive could reduce such patients' access to care as Medicare payments decline. Policy makers should consider the unique characteristics of these patients and ensure their continued access to Medicare's home health services when planning rebasing and future adjustments to the prospective payment system. PMID:24889943

  2. Narcissistic vulnerability is a common cause for depression in patients with Gilles de la Tourette syndrome.

    PubMed

    Trillini, Morounke O; Müller-Vahl, Kirsten R

    2015-12-15

    The aim of this study was to assess for the first time different dimensions of narcissistic self-regulation in a large cohort of adult patients with Gilles de la Tourette syndrome (GTS) (n=50). From preliminary studies it is suggested that narcissistic personality trait and disorder, respectively, are relatively uncommon and occur in only 6-10% of GTS patients. In this study we used the Narcissism Inventory (NI), a 163-items questionnaire that measures four different dimensions of narcissism. The main result was that the prevalence of narcissism strongly depends on the subtype of narcissism: while the vulnerable narcissism ("threatened self" and "hypochondriac self") was common, the "classic narcissistic self" (grandiose narcissism) was rare. From our data an association between comorbid depression and increased values of the "threatened self" and comorbid OCD with increased values of the "hypochondriac self" is suggested. Narcissism correlated positively with the personality domain neuroticism and had a significantly negative impact on patients' quality of life. Therefore it can be speculated that vulnerable narcissism is - among several others - one cause for depression in patients with GTS. These findings may open new psychotherapeutic perspectives in the treatment of depression in patients with GTS. PMID:26548979

  3. Feeling “overloaded” and “shortcomings”: milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients

    PubMed Central

    Bachmann, Liv; Michaelsen, Ragnhild A; Vatne, Solfrid

    2016-01-01

    Background Milieu therapists’ relationships with patients with severe mental illnesses are viewed as challenging. Elucidating vulnerability from their perspective in daily face-to-face encounters with patients might contribute to extending our knowledge about milieu therapists’ vulnerability and the dynamics of the interaction between patients in mental health services and expertise in building caring and therapeutic relationships. The aim of this project was to study educated milieu therapists’ experiences of their own vulnerability in their interactions with patients in mental health services. Materials and methods The data collection method was focus-group interviews. Thirteen part-time master’s in mental health students (eight nurses, three social workers, two social educators) participated. All participants had experience with community or specialized mental health services (2–8 years). Results The milieu therapists mainly related their experiences of vulnerability to negative feelings elicited by challenging work conditions, disclosed as two main themes: 1) “overloaded”, by the possibility of being physically and mentally hurt and the burdens of long-lasting close relationships; milieu therapists were extremely vulnerable because of their difficulty in protecting themselves; and 2) “shortcomings”, connected to feelings of despair associated with not acting in concordance with their professional standards and insecurity about their skills to handle challenging situations, which was a threat to their professional integrity. There seemed to be coherence between vulnerability and professional inauthenticity. A misunderstanding that professionalism refers to altruism seems to increase milieu therapist vulnerability. Conclusion Vulnerability in health care is of interest to multiple disciplines, and is of relevance for knowledge development in higher education. Extended knowledge and understanding about milieu therapists’ vulnerability might

  4. Vulnerability of husband and wife caregivers of Alzheimer disease patients to caregiving stressors.

    PubMed

    Croog, S H; Sudilovsky, A; Burleson, J A; Baume, R M

    2001-01-01

    This study assessed relationships between problem behaviors in 199 Alzheimer Disease patients and vulnerability factors in the well being and emotional health of their spouse caregivers. Among caregiver wives and the younger caregiver husbands (64 years old and under) the volume of patient problem behavior was significantly negatively associated with total scores on a summary well being measure. The association was not found within the older husband caregiver group. Considering five subdimensions of the summary well being scale (Anxiety, Depressive Symptoms, Positive Well Being, Vitality and General Health), correlational analyses showed that the total patient problems measure appeared to have impact primarily among wife caregivers, particularly those 64 years old and under. Multiple regression analyses showed that one patient problem behavior category, Emotional Lability, was the single strongest predictor of impaired well being of the caregiver among all five subdimensions of the caregiver well being measure. Although Destructive Behavior of the patient was not significant by itself, an Age by Destructive Behavior interaction showed that high levels of patient Destructive Behavior predicted high levels of Depression, Anxiety, and low levels of Positive Well Being more among younger caregivers. Husband caregivers had significantly higher Anxiety scores than wife caregivers. These findings document how particular patient problem behaviors can affect caregivers. They point up as well how both gender and age may help target which caregivers are most vulnerable to the stress of specific Alzheimer patient behavior problems. They also suggest the utility of examining specific dimensions of well being rather than a total score alone for purposes of understanding the relationship of particular patient behavior problems to caregiver emotional and physical health. PMID:11723371

  5. Overcoming barriers to osteoporosis care in vulnerable elderly patients with hip fractures.

    PubMed

    Switzer, Julie A; Jaglal, Susan; Bogoch, Earl R

    2009-07-01

    Indications for and benefits of providing osteoporosis (OP) care for hip fracture patients have become widely understood. The hip fracture patient is frequently over age 80 years, minimally ambulatory, has multiple medical comorbidities, and has cognitive impairment. Patient barriers to initiation of effective OP treatment include: age, dementia, medical comorbidities, polypharmacy, lack of adherence with treatment, alcohol abuse, postoperative delirium, language barriers, inadequate social support, and socioeconomic status. In a large teaching hospital, 244 patients presented with hip fracture over 2 years: 72% were female and 64% were over age 80. Forty percent had been diagnosed with dementia; another 29% had other severe medical comorbidities.Opportunities for OP diagnosis and treatment are numerous. In acute care hospitals, coordinator facilitated programs are effective for identification, education, assessment, referral, and treatment of underlying OP in fracture patients. System modifications may include an automated care path or automatic specialist referral for hip fracture patients. In the rehabilitation hospital, the patients are in a more stable condition, there is a focus on the recent fracture, and there are opportunities to initiate OP treatment and to promote adherence. In long-term care, dietary intake including calcium and vitamin D supplementation and persistence with pharmacotherapy can be monitored. Patient education and referral to the family physician for osteoporosis investigation and treatment have improved patient knowledge and diagnosis, but the reported impact on treatment has been limited.Effective OP care for the vulnerable hip fracture patient should be initiated early but may be complex and require coordination. In addition to calcium and vitamin D supplementation, most patients in this category have an indication for aminobisphosphonate therapy. Liaison between the orthopaedic team and the discharge destination caregivers, an

  6. The Spatial Distribution of Plaque Vulnerabilities in Patients with Acute Myocardial Infarction

    PubMed Central

    Zheng, Guian; Li, Yuxin; Takayama, Tadateru; Nishida, Toshihiko; Sudo, Mitsumasa; Haruta, Hironori; Fukamachi, Daisuke; Okubo, Kimie; Higuchi, Yoshiharu; Hiro, Takafumi; Saito, Satoshi; Hirayama, Atsushi

    2016-01-01

    Objective Although the plaque characteristics have been recognized in patients with acute myocardial infarction (AMI), the plaque spatial distribution is not well clarified. Using color-mapping intravascular ultrasound (iMAP-IVUS), we examined culprit lesions to clarify plaque morphology, composition and spatial distribution of the sites of potential vulnerability. Methods Sixty-eight culprit lesions in 64 consecutive AMI patients who underwent angiography and IVUS examinations before intervention were analyzed. Plaque morphology and composition were quantified with iMAP-IVUS. The spatial distribution of the sites of potential vulnerability was assessed with longitudinal reconstruction of the consecutive IVUS images. The plaque characteristics were also compared between ruptured and non-ruptured lesions, and between totally occlusive (TO) and non-TO lesions. Results The sites with maximum necrotic area (maxNA), maximum plaque burden (maxPB) and most severely narrowed (minimal luminal area, MLA) were recognized vulnerability. In the majority of cases, maxNA sites were proximal to the maxPB sites, and MLA sites were distal to the maxNA and maxPB sites. Ruptures usually occurred close to maxNA sites and proximal to maxPB and MLA sites. The average distance from the site of rupture to the maxNA site was 0.33 ± 4.04 mm. Ruptured lesions showed significant vessel remodeling, greater plaque volume, and greater lipidic volume compared to those of non-ruptured lesions. Both the length and plaque burden (PB) of TO lesions were greater than those of non-TO lesions. Conclusions Instead of overlapping on maxPB sites, most maxNA sites are proximal to the maxPB sites and are the sites most likely to rupture. Plaque morphology and composition play critical roles in plaque rupture and coronary occlusion. PMID:27031514

  7. Specific vulnerability of face perception to noise: A similar effect in schizophrenia patients and healthy individuals

    PubMed Central

    Chen, Yue; McBain, Ryan; Norton, Daniel

    2014-01-01

    Face perception plays a foundational role in the social world. This perceptual ability is deficient in schizophrenia. A noise-filtering mechanism is essential for perceptual processing. It remains unclear as to whether a specific noise-filtering mechanism is implicated in the face perception problem or a general noise-filtering mechanism is involved which also mediates non-face visual perception problems associated with this psychiatric disorder. This study examined and compared the effects of external noise on the performance of face discrimination and car discrimination in schizophrenia patients (n=25) and healthy controls (n=27). Superimposing the external visual noise on face or car stimuli elevated perceptual thresholds (i.e. degraded performance levels) for both face and car discrimination. However, the effect of noise was significantly larger on face than on car discrimination, both in patients and controls. This pattern of results suggests specific vulnerability of face processing to noise in healthy individuals and those with schizophrenia. PMID:25500350

  8. Library Services to Hospital Patients and Handicapped Readers Section. Libraries Serving the General Public Division. Papers.

    ERIC Educational Resources Information Center

    International Federation of Library Associations, The Hague (Netherlands).

    Papers on library services to hospital personnel, hospital patients, and housebound or handicapped persons, which were presented at the 1983 International Federation of Library Associations (IFLA) conference, include: (1) "Education and Training for Health Care Librarianship," in which Antonia J. Bunch (United Kingdom) discusses the scope of and…

  9. Osteogenic Monocytes within the Coronary Circulation and their Association with Plaque Vulnerability in Patients with Early Atherosclerosis

    PubMed Central

    Collin, Julia; Gössl, Mario; Matsuo, Yoshiki; Cilluffo, Rebecca R.; Flammer, Andreas J.; Loeffler, Darrell; Lennon, Ryan J.; Simari, Robert D.; Spoon, Daniel B.; Erbel, Raimund; Lerman, Lilach O.; Khosla, Sundeep; Lerman, Amir

    2014-01-01

    Objectives This study tests the hypothesis that circulating mononuclear cells expressing osteocalcin (OCN) and bone alkaline phosphatase (BAP) are associated with distinct plaque tissue components in patients with early coronary atherosclerosis. Background Plaque characteristics implying vulnerability develop at the earliest stage of coronary atherosclerosis. Increasing evidence indicates that cells from the myeloid lineage might serve as important mediators of destabilization. Plaque burden and its components were assessed regarding their relationship to monocytes carrying both pro-inflammatory (CD14) and osteogenic surface markers OCN and BAP. Methods Twenty-three patients with angiographically non-obstructive coronary artery disease underwent coronary endothelial function assessment and virtual histology-intravascular ultrasound of the left coronary artery. Plaque composition was characterized in the total segment (TS) and in the target lesion (TL) containing the highest amount of plaque burden. Blood samples were collected simultaneously from the aorta and the coronary sinus. Circulating cell counts were then identified from each sample and a gradient across the coronary circulation was determined. Results Circulating CD14+/BAP+/OCN+ monocytes correlate with the extent of necrotic core and calcification (r=0.53, p=0.010; r=0.55, p=0.006, respectively). Importantly, coronary retention of CD14+/OCN+ cells also correlate with the amount of necrotic core and calcification (r=0.61, p=0.003; r=0.61, p=0.003) respectively. Conclusions Our study links CD14+/BAP+/OCN+ monocytes to the pathologic remodeling of the coronary circulation and therefore associates these cells with plaque destabilization in patients with early coronary atherosclerosis. PMID:25482280

  10. Implementing the Ten Steps for Successful Breastfeeding in Hospitals Serving Low-Wealth Patients

    PubMed Central

    Taylor, Emily C.; Nickel, Nathan C.

    2012-01-01

    Objectives. The Ten Steps to Successful Breastfeeding is a proven approach to support breastfeeding in maternity settings; however, scant literature exists on the relative impact and interpretation of each step on breastfeeding. We assessed the Ten Steps and their relationship with in-hospital breastfeeding rates at facilities serving low-wealth populations and explored the outcomes to identify step-specific actions. Methods. We present descriptive and nonparametric comparisons and qualitative findings to examine the relationship between the Ten Steps and breastfeeding rates from each hospital using baseline data collection. Results. Some steps (1-policy, 2-training, 4-skin-to-skin, 6-no supplements, and 9-no artificial nipples, followed by 3-prenatal counseling, 7-rooming-in) reflected differences in relative baseline breastfeeding rates between settings. Key informant interviews revealed misunderstanding of some steps. Conclusions. Self-appraisal may be less valid when not all elements of the criteria for evaluating Step implementation may be fully understood. Limited exposure and understanding may lead to self-appraisal errors, resulting in scores that are not reflective of actual practices. Nonetheless, the indication that breastfeeding rates may be better mirrored by a defined subset of steps may provide some constructive insight toward prioritizing implementation activities and simplifying assessment. These issues will be further explored in the next phase of this study. PMID:23078473

  11. HLA alleles may serve as a tool to discriminate atypical type 2 diabetic patients

    PubMed Central

    Fernández, Mariana; Fabregat, Matías; Javiel, Gerardo; Mimbacas, Adriana

    2014-01-01

    AIM: To investigate whether the presence of human leukocyte antigen (HLA) marker could add new information to discriminated atypical diabetic type 2 patients. METHODS: We analyzed 199 patients initially diagnosed as type 2 diabetes who are treated in special care diabetes clinics (3rd level). This population was classified in “atypical” (sample A) and “classic” (sample B) according to HLA typing. We consider “classic patient” when has absence of type 1 diabetes associated HLA alleles and no difficulties in their diagnosis and treatments. By the other hand, we considered “atypical patient” when show type 1 diabetes associated HLA alleles and difficulties in their diagnosis and treatments. The standard protocol Asociacion Latinoamericana de Diabetes 2006 was used for patients follow up. To analyze differences between both populations in paraclinical parameters we used unpaired t tests and contingence tables. Bivariate and multivariate analyses were carried out using the SPSS software program. In all studies we assume differences statistically significant, with a P-value < 0.05 corrected and 95%CI. RESULTS: The typing HLA in the “atypical” populations show that 92.47% patients presented at list one type 1 diabetes associated HLA alleles (DQB1*0201-0302 and DR 3-4) and 7.53% had two of its. The results showed for categorical variables (family history, presence or absence of hypertension and/or dyslipidemia, reason for initial consultation) the only difference found was at dyslipidemia (OR = 0.45, 0.243 < OD < 0.822 (P < 0.001). In relation to continuous variables we found significant differences between atypical vs classic only in cholesterol (5.07 ± 1.1 vs 5.56 ± 1.5, P < 0.05), high density lipoproteins (1.23 ± 0.3 vs 1.33 ± 0.3, P < 0.05) and low density lipoproteins (2.86 ± 0.9 vs 3.38 ± 1.7, P < 0.01). None of the variables had discriminating power when logistic regression was done. CONCLUSION: We propose an algorithm including HLA

  12. Social vulnerability in paediatric dentistry: an overview of ethical considerations of therapeutic patient education.

    PubMed

    Trentesaux, Thomas; Delfosse, Caroline; Rousset, Monique Marie; Hervé, Christian; Hamel, Olivier

    2014-03-01

    Dental caries is a multifactorial condition that remains a major public health issue in high income countries. The prevalence of dental caries in children has markedly declined in most countries over the past 30 years. However, the disease continues to affect a vulnerable population defined as a high-risk group. As many public health policies are inefficient in dealing with this underprivileged group, it is necessary to find other strategies to decrease the incidence and the burden of dental caries. Defining dental caries as a chronic disease enables us to develop the concept of 'therapeutic patient education.' It is meant to train patients to self-manage or adapt treatment to their particular chronic disease and to cope with new processes and skills. The purpose of this paper is to propose a new approach to dental caries, in particular to early childhood caries. That should decrease the gravity and prevalence of the disease in this specific population. As a result, this new approach could increase the quality of life of many children both in terms of function and aesthetics. PMID:24318642

  13. Serving Communities.

    ERIC Educational Resources Information Center

    Brook, Les, Ed.

    This book contains 15 articles about various aspects of community further education (FE) programs in Great Britain, including program rationales/benefits, administration, and delivery. The following articles are included: "Foreword" (Bradshaw); "Commitment to Community Is Good Business and Practical Politics" (Brook); "Can We Serve Communities in…

  14. Serving Families.

    ERIC Educational Resources Information Center

    Link, Geoffrey; Beggs, Marjorie; Seiderman, Ethel

    Parent Services Project (PSP), the first comprehensive program of resources and mental health activities for parents offered at child care centers in the San Francisco Bay Area (California), has expanded to centers in six states, serving over 19,000 families. This report describes the program's history, aims, and achievements, along with specific…

  15. Screening for Vulnerability in Older Cancer Patients: The ONCODAGE Prospective Multicenter Cohort Study

    PubMed Central

    Soubeyran, Pierre; Bellera, Carine; Goyard, Jean; Heitz, Damien; Curé, Hervé; Rousselot, Hubert; Albrand, Gilles; Servent, Véronique; Jean, Olivier Saint; van Praagh, Isabelle; Kurtz, Jean-Emmanuel; Périn, Stéphane; Verhaeghe, Jean-Luc; Terret, Catherine; Desauw, Christophe; Girre, Véronique; Mertens, Cécile; Mathoulin-Pélissier, Simone; Rainfray, Muriel

    2014-01-01

    Background Geriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13). Patients and Methods The diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate. Results Patient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P =  0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, P<0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival. Conclusion With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients

  16. Serum miR-128-2 serves as a prognostic marker for patients with hepatocellular carcinoma.

    PubMed

    Zhuang, Liping; Xu, Litao; Wang, Peng; Meng, Zhiqiang

    2015-01-01

    Circulating miRNAs are promising biomarkers for predicting the aggressiveness of hepatocellular carcinoma (HCC). We aimed to identify differentially expressed miRNAs in the serum of HCC patients with different Barcelona Clinic Liver Cancer (BCLC) stage, and to investigate the potential of serum miRNAs as biomarkers for patient outcomes. In the discovery stage, TaqMan Low-Density Array was used to test the difference in levels of serum miRNAs between 20 patients with portal vein tumor thrombosis (PVTT) and 20 patients without PVTT. The detected serum miRNAs then were validated in 182 patients. Fifteen serum miRNAs showed more than two-fold higher expression in patients with PVTT, and miR-128-2 was found to be significantly up-regulated and was selected for further validation. In the validation stage, patients were divided into two groups with low or high serum miR-128-2 using the median expression level of all 182 cases as the cut-off point. Kaplan-Meier analysis revealed that patients with low level of serum miR-128-2 had favorable trends of survival (log rank = 13.031, p < 0.001). The median survivals for patients with a low and high level of serum miR-128-2 were 625 (95% CI, 527-722) days and 426 (95% CI, 362-491) days, respectively. MiR-128-2 was also an independent factor of overall survival (p = 0.001, HR 2.793, 95%CI 1.550, 5.033). Serum levels of the ubiquitously expressed miR-128-2 showed no significant correlation with parameters of liver damage or liver function. In addition, expressions of miR-128-2 in HCC tissues were up-regulated in comparison with adjacent non-tumor tissues. In conclusion, serum level of miR-128-2 serves as a noninvasive biomarker for the overall survival of patients with hepatocellular carcinoma. PMID:25642945

  17. Academic health centers and community health centers partnering to build a system of care for vulnerable patients: lessons from Carolina Health Net.

    PubMed

    Denham, Amy C; Hay, Sherry S; Steiner, Beat D; Newton, Warren P

    2013-05-01

    Academic health centers (AHCs) are challenged to meet their core missions in a time of strain on the health care system from rising costs, an aging population, increased rates of chronic disease, and growing numbers of uninsured patients. AHCs should be leaders in developing creative solutions to these challenges and training future leaders in new models of care. The authors present a case study describing the development, implementation, and early results of Carolina Health Net, a partnership between an AHC and a community health center to manage the most vulnerable uninsured by providing access to primary care medical homes and care management systems. This partnership was formed in 2008 to help transform the delivery of health care for the uninsured. As a result, 4,400 uninsured patients have been connected to primary care services. Emergency department use by enrolled patients has decreased. Patients have begun accessing subspecialty care within the medical home. More than 2,200 uninsured patients have been assisted to enroll in Medicaid. The experience of Carolina Health Net demonstrates that developing a system of care with primary care and wrap-around services such as pharmacy and case management can improve the cost-effectiveness and quality of care, thereby helping AHCs meet their broader missions. This project can serve as a model for other AHCs looking to partner with community-based providers to improve care and control costs for underserved populations. PMID:23524915

  18. Restoration of root surface caries in vulnerable elderly patients: a review of the literature.

    PubMed

    Amer, R S; Kolker, J L

    2013-01-01

    The authors conducted a review to evaluate the current literature addressing root surface caries treatment in the vulnerable elderly, to identify any gaps in the literature that will need to be addressed in the future. The authors conducted a literature search of the electronic databases using MEDLINE, PubMed, to identify original clinical research articles regarding treatment of root caries lesions, with emphasis on research focused on the vulnerable elderly. Five articles were clinical studies of root caries restorations. Only one was conducted on a vulnerable elderly population. The results of the literature review show that there is a need for further studies addressing the restorative needs of the vulnerable elderly. With the aging of the American population, more research is needed to provide adequate care to this population. At this time, glass ionomers are a good treatment option. PMID:23600986

  19. Regional vulnerability in Huntington's disease: fMRI-guided molecular analysis in patients and a mouse model of disease.

    PubMed

    Lewandowski, Nicole M; Bordelon, Yvette; Brickman, Adam M; Angulo, Sergio; Khan, Usman; Muraskin, Jordan; Griffith, Erica Y; Wasserman, Paula; Menalled, Liliana; Vonsattel, Jean Paul; Marder, Karen; Small, Scott A; Moreno, Herman

    2013-04-01

    Although the huntingtin gene is expressed in brain throughout life, phenotypically Huntington's disease (HD) begins only in midlife and affects specific brain regions. Here, to investigate regional vulnerability in the disease, we used functional magnetic resonance imaging (fMRI) to translationally link studies in patients with a mouse model of disease. Using fMRI, we mapped cerebral blood volume (CBV) in three groups: HD patients, symptom-free carriers of the huntingtin genetic mutation, and age-matched controls. In contrast to a region in the anterior caudate, in which dysfunction was linked to genotype independent of phenotype, a region in the posterior body of the caudate was differentially associated with disease phenotype. Guided by these observations, we harvested regions from the anterior and posterior body of the caudate in postmortem control and HD human brain tissue. Gene-expression profiling identified two molecules whose expression levels were most strongly correlated with regional vulnerability - protein phosphatase 1 regulatory subunit 7 (PPP1R7) and Wnt inhibitory factor-1 (WIF-1). To verify and potentially extend these findings, we turned to the YAC128 (C57BL/6J) HD transgenic mice. By fMRI we longitudinally mapped CBV in transgenic and wildtype (WT) mice, and over time, abnormally low fMRI signal emerged selectively in the dorsal striatum. A relatively unaffected brain region, primary somatosensory cortex (S1), was used as a control. Both dorsal striatum and S1 were harvested from transgenic and WT mice and molecular analysis confirmed that PPP1R7 deficiency was strongly correlated with the phenotype. Together, converging findings in human HD patients and this HD mouse model suggest a functional pattern of caudate vulnerability and that variation in expression levels of herein identified molecules correlate with this pattern of vulnerability. PMID:23220414

  20. Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?

    PubMed Central

    Borghgraef, Cindy; Etienne, Anne-Marie; Merckaert, Isabelle; Paesmans, Marianne; Reynaert, Christine; Roos, Myriam; Slachmuylder, Jean-Louis; Vandenbossche, Sandrine; Bron, Dominique; Razavi, Darius

    2016-01-01

    Introduction Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. Purpose To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. Methods Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used. Results A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07–18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31–7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47–14.44; p <0.001). Conclusions During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying

  1. Vulnerable patients going to court: a psychiatrist's guide to special measures

    PubMed Central

    Cooper, Penny; Grace, Janet

    2016-01-01

    There have been significant changes to how vulnerable people are treated in the court system, including the introduction of special measures to support people both as witness and as accused. This paper summarises the use of special measures and their application to people with mental health diagnoses or cognitive impairment. PMID:27512594

  2. Vulnerable patients going to court: a psychiatrist's guide to special measures.

    PubMed

    Cooper, Penny; Grace, Janet

    2016-08-01

    There have been significant changes to how vulnerable people are treated in the court system, including the introduction of special measures to support people both as witness and as accused. This paper summarises the use of special measures and their application to people with mental health diagnoses or cognitive impairment. PMID:27512594

  3. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., see the List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume... 42 Public Health 2 2014-10-01 2014-10-01 false Special treatment: Hospitals that serve a... INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System...

  4. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... affecting § 412.106, see the List of CFR Sections Affected, which appears in the Finding Aids section of the... 42 Public Health 2 2013-10-01 2013-10-01 false Special treatment: Hospitals that serve a... INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System...

  5. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... citations affecting § 412.106, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2012-10-01 2012-10-01 false Special treatment: Hospitals that serve a... INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System...

  6. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... citations affecting § 412.106, see the List of CFR Sections Affected, which appears in the Finding Aids... 42 Public Health 2 2011-10-01 2011-10-01 false Special treatment: Hospitals that serve a... INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System...

  7. [Experience of surgical care administration to patients with closed abdominal trauma, serving on the ships of the Navy].

    PubMed

    Pleskach, V V; Mosyagin, I G

    2016-02-01

    The analysis of surgical care administration to personnel, serving on ships of the Navy of Russia and performing different tasks in off-shore maritime and ocean zones in 2012-2013 showed that there is a requirement to create seven additional ship groups of specialized medical care: on the Northern Fleet--2, on the Pacific Fleet--2, on the Baltic Fleet--1, on the Black Sea Fleet--1, on the Caspian Flotilla--1. There is also a reasonable requirement to include anaesthesiologist and nurse anaesthetist into these groups. PMID:27263212

  8. Morphological and Stress Vulnerability Indices for Human Coronary Plaques and Their Correlations with Cap Thickness and Lipid Percent: An IVUS-Based Fluid-Structure Interaction Multi-patient Study

    PubMed Central

    Wang, Liang; Zheng, Jie; Maehara, Akiko; Yang, Chun; Billiar, Kristen L.; Wu, Zheyang; Bach, Richard; Muccigrosso, David; Mintz, Gary S.; Tang, Dalin

    2015-01-01

    Plaque vulnerability, defined as the likelihood that a plaque would rupture, is difficult to quantify due to lack of in vivo plaque rupture data. Morphological and stress-based plaque vulnerability indices were introduced as alternatives to obtain quantitative vulnerability assessment. Correlations between these indices and key plaque features were investigated. In vivo intravascular ultrasound (IVUS) data were acquired from 14 patients and IVUS-based 3D fluid-structure interaction (FSI) coronary plaque models with cyclic bending were constructed to obtain plaque wall stress/strain and flow shear stress for analysis. For the 617 slices from the 14 patients, lipid percentage, min cap thickness, critical plaque wall stress (CPWS), strain (CPWSn) and flow shear stress (CFSS) were recorded, and cap index, lipid index and morphological index were assigned to each slice using methods consistent with American Heart Association (AHA) plaque classification schemes. A stress index was introduced based on CPWS. Linear Mixed-Effects (LME) models were used to analyze the correlations between the mechanical and morphological indices and key morphological factors associated with plaque rupture. Our results indicated that for all 617 slices, CPWS correlated with min cap thickness, cap index, morphological index with r = -0.6414, 0.7852, and 0.7411 respectively (p<0.0001). The correlation between CPWS and lipid percentage, lipid index were weaker (r = 0.2445, r = 0.2338, p<0.0001). Stress index correlated with cap index, lipid index, morphological index positively with r = 0.8185, 0.3067, and 0.7715, respectively, all with p<0.0001. For all 617 slices, the stress index has 66.77% agreement with morphological index. Morphological and stress indices may serve as quantitative plaque vulnerability assessment supported by their strong correlations with morphological features associated with plaque rupture. Differences between the two indices may lead to better plaque assessment schemes

  9. Cognitive Vulnerability in Patients with Generalized Anxiety Disorder, Dysthymic Disorder and Normal Individuals

    PubMed Central

    Al-Ghorabaie, Fateme Moin; Noferesti, Azam; Fadaee, Mahdi; Ganji, Nima

    2016-01-01

    Aim: The purpose of this study was to assess cognitive vulnerability and response style in clinical and normal individuals. Method: A sample of 90 individuals was selected for each of the 3 groups of Generalized Anxiety disorder, Dysthymic disorder and normal individuals. They completed MCQ and RSQ. Results: Results analyzed by MANOVA and post hoc showed significant differences among groups. Dysthymic group and GAD reported higher scores on cognitive confidence compared to the normal group. Individuals with GAD showed highly negative beliefs about need to control thought, compared to the other groups, but in cognitive self-consciousness they have no differences with the normal group. In regard to uncontrollability, danger and positive beliefs, GAD group had higher levels than the other groups. Although normal and GAD group didn’t show any significant differences in response style, there was a significant difference between Dysthymic group and other groups in all response styles. Discussion: Beliefs and meta-cognitive strategies can be distinguished between clinical and non clinical individuals. Also, findings support the Self-Regulatory Executive Function model. PMID:27045393

  10. New York's role as a center for health care: an analysis of nonresident patients served by New York City hospitals.

    PubMed

    Finkler, S; Knickman, J; Krasner, M; Szapiro, N

    1986-10-01

    Patients who reside outside of New York City have long been an important segment of the patient population at New York City hospitals. Each year, as far back as systematic data are available, approximately 10 percent of all patients at New York City hospitals have been non residents. Increasing competition and changing reimbursement policies compel hospitals in New York City to assess their role in caring for these patients and its economic implications. This report provides a comprehensive assessment of the characteristics of nonresident patients and their significance to the city's hospitals. Using data from all New York City hospitals, the report analyzes the demographics, insurance coverage, and case-mix characteristics of nonresident and resident patients. And, using more detailed data from New York University Medical Center and Columbia-Presbyterian Medical Center, it addresses the financial and reimbursement policy questions posed by the care of nonresident patients. The key findings of the report are as follows: A total of 115,307 nonresidents were hospitalized in New York City in 1982; this figure represents 10.4 percent of all patients in city hospitals. Over 80 percent of nonresident patients come from 14 counties surrounding New York City. Nonresident patients are a crucial component of the patient population at six hospitals that are the principal affiliates of a medical school and the six specialty hospitals. At academic health centers, nonresidents represent 25 percent of all inpatients; at the specialty hospitals, they represent 36 percent. Manhattan hospitals account for 69 percent of all nonresident discharges in the city. Outside of Manhattan, only Montefiore Medical Center and Long Island Jewish Medical Center have substantial numbers of nonresident patients. Among nonresident patients, 75 percent of admissions are scheduled in advance and 72 percent of hospital stays are for surgical procedures. In contrast, among resident patients, only 50

  11. A Highly Expressed Human Protein, Apolipoprotein B-100, Serves as an Autoantigen in a Subgroup of Patients With Lyme Disease.

    PubMed

    Crowley, Jameson T; Drouin, Elise E; Pianta, Annalisa; Strle, Klemen; Wang, Qi; Costello, Catherine E; Steere, Allen C

    2015-12-01

    To discover novel autoantigens associated with Lyme arthritis (LA), we identified T-cell epitopes presented in vivo by human leukocyte antigen (HLA)-DR molecules in patients' inflamed synovial tissue or joint fluid and tested each epitope for autoreactivity. Using this approach, we identified the highly expressed human protein, apolipoprotein B-100 (apoB-100), as a target of T- and B-cell responses in a subgroup of LA patients. Additionally, the joint fluid of these patients had markedly elevated levels of apoB-100 protein, which may contribute to its autoantigenicity. In patients with antibiotic-refractory LA, the magnitude of apoB-100 antibody responses correlated with increased numbers of plasma cells in synovial tissue, greater numbers and activation of endothelial cells, and more synovial fibroblast proliferation. Thus, a subset of LA patients have high levels of apoB-100 in their joints and autoreactive T- and B-cell responses to the protein, which likely contributes to pathogenic autoimmunity in patients with antibiotic-refractory LA. PMID:26014802

  12. The Challenge and Opportunity of Capturing Patient Reported Measures of Rheumatoid Arthritis Disease Activity in Vulnerable Populations with Limited Health Literacy and Limited English Proficiency.

    PubMed

    Hirsh, Joel M

    2016-05-01

    Limited health literacy and limited English proficiency are widely prevalent and contribute to rheumatoid arthritis (RA) health care disparities. The RA Patient Global Assessment of Disease Activity often introduces complexity to the health care encounters of patients and research subjects with limited health literacy and limited English proficiency. Important work is being done to ensure that patient-reported outcomes are validated and appropriate for diverse and vulnerable populations. PMID:27133494

  13. Guidelines for Libraries Serving Hospital Patients and Disabled People in the Community. IFLA Professional Reports, No. 2.

    ERIC Educational Resources Information Center

    International Federation of Library Associations, The Hague (Netherlands).

    These guidelines are based on the experiences of a number of librarians working in the area of library services for hospital patients and disabled people in the community, as well as work done previously by a number of national library associations. The guidelines indicate the essential features of services to disabled people and suggest…

  14. How practice contributes to trolley food waste. A qualitative study among staff involved in serving meals to hospital patients.

    PubMed

    Ofei, K T; Holst, M; Rasmussen, H H; Mikkelsen, B E

    2014-12-01

    This study investigated the generation of trolley food waste at the ward level in a hospital in order to provide recommendations for how practice could be changed to reduce food waste. Three separate focus group discussions were held with four nurses, four dietitians and four service assistants engaged in food service. Furthermore, single qualitative interviews were conducted with a nurse, a dietitian and two service assistants. Observations of procedures around trolley food serving were carried out during lunch and supper for a total of 10 weekdays in two different wards. All unserved food items discarded as waste were weighed after each service. Analysis of interview and observation data revealed five key themes. The findings indicate that trolley food waste generation is a practice embedded within the limitations related to the procedures of meal ordering. This includes portion size choices and delivery, communication, tools for menu information, portioning and monitoring of food waste, as well as the use of unserved food. Considering positive changes to these can be a way forward to develop strategies to reduce trolley food waste at the ward level. PMID:25108237

  15. Integrated Patient-Derived Models Delineate Individualized Therapeutic Vulnerabilities of Pancreatic Cancer.

    PubMed

    Witkiewicz, Agnieszka K; Balaji, Uthra; Eslinger, Cody; McMillan, Elizabeth; Conway, William; Posner, Bruce; Mills, Gordon B; O'Reilly, Eileen M; Knudsen, Erik S

    2016-08-16

    Pancreatic ductal adenocarcinoma (PDAC) harbors the worst prognosis of any common solid tumor, and multiple failed clinical trials indicate therapeutic recalcitrance. Here, we use exome sequencing of patient tumors and find multiple conserved genetic alterations. However, the majority of tumors exhibit no clearly defined therapeutic target. High-throughput drug screens using patient-derived cell lines found rare examples of sensitivity to monotherapy, with most models requiring combination therapy. Using PDX models, we confirmed the effectiveness and selectivity of the identified treatment responses. Out of more than 500 single and combination drug regimens tested, no single treatment was effective for the majority of PDAC tumors, and each case had unique sensitivity profiles that could not be predicted using genetic analyses. These data indicate a shortcoming of reliance on genetic analysis to predict efficacy of currently available agents against PDAC and suggest that sensitivity profiling of patient-derived models could inform personalized therapy design for PDAC. PMID:27498862

  16. Assessing long-term health and cost outcomes of patient-centered medical homes serving adults with poor diabetes control.

    PubMed

    Pagán, José A; Carlson, Erin K

    2013-10-01

    The patient-centered medical home (PCMH) is an integrated primary care delivery model particularly suited for patients with poor diabetes control. Although PCMH models targeting adults with diabetes have shown some early success, little is known about the long-term benefits of medical homes in terms of health and cost outcomes. The performance of a PCMH model in adults with poor diabetes control was assessed using simulated controlled trial data obtained from the Archimedes model of disease progression and health care utilization. Using the Cardio-Metabolic Risk data set, we compared health and cost outcomes over a 20-year period between adults with poor diabetes control (HbA1c >9%) receiving standard care and these same adults receiving care under a PCMH model with a 49% HbA1c intervention improvement rate at a per-beneficiary per-month care management cost of $20 per month. The results suggest that the PCMH model has the potential to not only reduce the proportion of the population with bilateral blindness, foot amputations, and myocardial infarctions-and the mortality rate-but it can also do so in a cost-effective manner ($7898 per quality-adjusted life year). The PCMH model is cost saving for the population 50 to 64 years old and it is particularly cost-effective for men ($883 per quality-adjusted life year). Moreover, these effects are relatively large for adults 30 to 49 years old (lower bilateral blindness and death rates), women (lower foot amputation and death rates), and men (lower bilateral blindness and myocardial infarction rates). The PCMH model has potential long-term benefits to both patients with poor diabetes control as well as health care systems and providers willing to invest in this health care delivery approach. PMID:23799676

  17. Carbapenem-resistant Enterobacteriaceae: A menace to our most vulnerable patients

    PubMed Central

    PEREZ, FEDERICO; VAN DUIN, DAVID

    2014-01-01

    The emergence of carbapenem-resistant Enterobacteriaceae (CRE) highlights the importance of effective antibiotics to maintain the safety of our health care system. Clinicians will encounter CRE as a cause of difficult-to-treat and often fatal infections in hospitalized patients. We review the mechanisms of carbapenem resistance, the dissemination and clinical impact of these resistant organisms, and challenges to their detection, treatment, and control. PMID:23547093

  18. Relation between Anemia and Vulnerable Coronary Plaque Components in Patients with Acute Coronary Syndrome: Virtual Histology-Intravascular Ultrasound Analysis

    PubMed Central

    Hong, Young Joon; Choi, Yun Ha; Song, Jin A; Kim, Dong Han; Lee, Ki Hong; Yamanaka, Futoshi; Lee, Min Goo; Park, Keun Ho; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

    2012-01-01

    The aim of the present study was to evaluate the plaque components and the predictors of thin-cap fibroatheroma (TCFA) in anemic patients with acute coronary syndrome using virtual histology-intravascular ultrasound (VH-IVUS). Anemia was defined according to criteria of the World Health Organization, (i.e. , hemoglobin levels < 13 g/dL in men and < 12 g/dL in women) and we compared VH-IVUS findings between anemia group (171 patients, 260 lesions) and non-anemia group (569 patients, 881 lesions). Anemia group had greater % necrotic core (NC) volume (21% ± 9% vs 19% ± 9%, P = 0.001) compared with non-anemia group. Hemoglobin level correlated negatively with absolute NC volume (r = -0.235, P < 0.001) and %NC volume (r = -0.209, P < 0.001). Independent predictors of TCFA by multivariate analysis were diabetes mellitus (odds ratio [OR], 2.213; 95% confidence interval [CI], 1.403-3.612, P = 0.006), high-sensitivity C-reactive protein (OR, 1.143; 95% CI, 1.058-1.304, P = 0.012), microalbuminuria (albumin levels of 30 to 300 mg/g of creatinine) (OR, 2.124; 95% CI, 1.041-3.214, P = 0.018), and anemia (OR: 2.112; 95% CI 1.022-3.208, P = 0.028). VH-IVUS analysis demonstrates that anemia at the time of clinical presentation is associated with vulnerable plaque component in patients with acute coronary syndrome. PMID:22468099

  19. Vulnerability of white matter to insult during childhood: evidence from patients treated for medulloblastoma.

    PubMed

    Moxon-Emre, Iska; Bouffet, Eric; Taylor, Michael D; Laperriere, Normand; Sharpe, Michael B; Laughlin, Suzanne; Bartels, Ute; Scantlebury, Nadia; Law, Nicole; Malkin, David; Skocic, Jovanka; Richard, Logan; Mabbott, Donald J

    2016-07-01

    OBJECTIVE Craniospinal irradiation damages the white matter in children treated for medulloblastoma, but the treatment-intensity effects are unclear. In a cross-sectional retrospective study, the effects of treatment with the least intensive radiation protocol versus protocols that delivered more radiation to the brain, in addition to the effects of continuous radiation dose, on white matter architecture were evaluated. METHODS Diffusion tensor imaging was used to assess fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity. First, regional white matter analyses and tract-based spatial statistics were conducted in 34 medulloblastoma patients and 38 healthy controls. Patients were stratified according to those treated with 1) the least intensive radiation protocol, specifically reduced-dose craniospinal irradiation plus a boost to the tumor bed only (n = 17), or 2) any other dose and boost combination that delivered more radiation to the brain, which was also termed the "all-other-treatments" group (n = 17), and comprised patients treated with standard-dose craniospinal irradiation plus a posterior fossa boost, standard-dose craniospinal irradiation plus a tumor bed boost, or reduced-dose craniospinal irradiation plus a posterior fossa boost. Second, voxel-wise dose-distribution analyses were conducted on a separate cohort of medulloblastoma patients (n = 15). RESULTS The all-other-treatments group, but not the reduced-dose craniospinal irradiation plus tumor bed group, had lower fractional anisotropy and higher radial diffusivity than controls in all brain regions (all p < 0.05). The reduced-dose craniospinal irradiation plus tumor bed boost group had higher fractional anisotropy (p = 0.05) and lower radial diffusivity (p = 0.04) in the temporal region, and higher fractional anisotropy in the frontal region (p = 0.04), than the all-other-treatments group. Linear mixed-effects modeling revealed that the dose and age at diagnosis together

  20. Vulnerable Plaque

    MedlinePlus

    ... all vulnerable plaque ruptures, and researchers at the Texas Heart Institute are looking at ways to determine ... comments. Terms of Use and Privacy Policy © Copyright Texas Heart Institute All rights reserved.

  1. Executive (Dys)Functioning and Impulsivity as Possible Vulnerability Factors for Aggression in Forensic Patients.

    PubMed

    Tonnaer, Franca; Cima, Maaike; Arntz, Arnoud

    2016-04-01

    This study investigated whether executive dysfunction and impulsivity are both predictors of reactive aggression and is the first to use behavioral assessment of aggression in response to provocation by means of a personalized boxing body opponent bag giving harassing feedback. Aggressive behavior, self-reported aggression, executive functioning (ie, working memory, flexibility, and divided attention), and impulsivity dimensions (i.e., Sensation Seeking, Impulsive Decision Making, and [inadequate] Response Inhibition) were measured in 44 incarcerated psychiatric patients. Results show that both executive functioning (working memory) and impulsivity (Impulsive Decision Making) predicted self-reported reactive aggression, whereas Response Inhibition was the only predictor for reactive aggressive behavioral responses. The study suggests that Response Inhibition is a stronger predictor of reactive aggressive behavior than executive capacities of working memory, flexibility, and divided attention. Therefore, future research should investigate whether (inadequate) Response Inhibition could also be a valuable predictor for violent recidivism. PMID:26894312

  2. Effects of Self-Management Support on Structure, Process, and Outcomes Among Vulnerable Patients With Diabetes

    PubMed Central

    Schillinger, Dean; Handley, Margaret; Wang, Frances; Hammer, Hali

    2009-01-01

    OBJECTIVE Despite the importance of self-management support (SMS), few studies have compared SMS interventions, involved diverse populations, or entailed implementation in safety net settings. We examined the effects of two SMS strategies across outcomes corresponding to the Chronic Care Model. RESEARCH DESIGN AND METHODS A total of 339 outpatients with poorly controlled diabetes from county-run clinics were enrolled in a three-arm trial. Participants, more than half of whom spoke limited English, were uninsured, and/or had less than a high school education, were randomly assigned to usual care, interactive weekly automated telephone self-management support with nurse follow-up (ATSM), or monthly group medical visits with physician and health educator facilitation (GMV). We measured 1-year changes in structure (Patient Assessment of Chronic Illness Care [PACIC]), communication processes (Interpersonal Processes of Care [IPC]), and outcomes (behavioral, functional, and metabolic). RESULTS Compared with the usual care group, the ATSM and GMV groups showed improvements in PACIC, with effect sizes of 0.48 and 0.50, respectively (P < 0.01). Only the ATSM group showed improvements in IPC (effect sizes 0.40 vs. usual care and 0.25 vs. GMV, P < 0.05). Both SMS arms showed improvements in self-management behavior versus the usual care arm (P < 0.05), with gains being greater for the ATSM group than for the GMV group (effect size 0.27, P = 0.02). The ATSM group had fewer bed days per month than the usual care group (−1.7 days, P = 0.05) and the GMV group (−2.3 days, P < 0.01) and less interference with daily activities than the usual care group (odds ratio 0.37, P = 0.02). We observed no differences in A1C change. CONCLUSIONS Patient-centered SMS improves certain aspects of diabetes care and positively influences self-management behavior. ATSM seems to be a more effective communication vehicle than GMV in improving behavior and quality of life. PMID:19131469

  3. Fleshing out vulnerability.

    PubMed

    Tavaglione, Nicolas; Martin, Angela K; Mezger, Nathalie; Durieux-Paillard, Sophie; François, Anne; Jackson, Yves; Hurst, Samia A

    2015-02-01

    In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged - that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care - thus fleshing out a claim-based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to (i) physical integrity, (ii) autonomy, (iii) freedom, (iv) social provision, (v) impartial quality of government, (vi) social bases of self-respect or (vii) communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice. PMID:24602115

  4. MiR-486 and miR-92a Identified in Circulating HDL Discriminate between Stable and Vulnerable Coronary Artery Disease Patients

    PubMed Central

    Sanda, Gabriela M.; Carnuta, Mihaela G.; Stancu, Camelia S.; Popescu, Andreea C.; Popescu, Mihaela R.; Vlad, Adelina; Dimulescu, Doina R.; Simionescu, Maya; Sima, Anca V.

    2015-01-01

    Small non-coding microRNAs (miRNAs) are implicated in gene regulation, including those involved in coronary artery disease (CAD). Our aim was to identify whether specific serum miRNAs present in the circulating lipoproteins (Lp) are associated with stable or vulnerable CAD patients. A cardiovascular disease-focused screening array was used to assess miRNAs distribution in sera collected from 95 CAD patients: 30 with stable angina (SA), 39 with unstable angina (UA), 26 at one month after myocardial infarction (MI) and 16 healthy control subjects. We found that miR-486, miR-92a and miR-122 presented the highest expression in CAD sera. These miRNA together with miR-125a, miR-146a and miR-33a were further individually analyzed by TaqMan assays. The results were consistent with PCR-array screening data that all of these miRNAs were significantly increased in CAD patients compared to controls. Using a binary logistic regression model, we established that miR-486 and miR-92a in association with some high-density lipoprotein (HDL) components can designate vulnerable CAD patients. Further, all classes of Lp were isolated from sera by density gradient ultracentrifugation. Analysis of the selected miRNAs in each Lp class showed that they were associated mainly with HDL, miR-486 and miR-92a having the highest levels. In UA and MI patients, miR-486 prevailed in HDL2, while miR-92a prevailed in HDL3, and their levels discriminate between stable and vulnerable CAD patients. We identified two circulating miRNAs that in association with some lipid metabolism biomarkers can be used as an additional tool to designate vulnerable CAD patients. PMID:26485305

  5. Plasma levels of tumor necrosis factor-α in adolescent idiopathic scoliosis patients serve as a predictor for the incidence of early postoperative cognitive dysfunction following orthopedic surgery

    PubMed Central

    ZHENG, XU; MA, ZHENGLIANG; GU, XIAOPING

    2015-01-01

    The aim of the present study was to evaluate whether the levels of the plasma biomarkers, cortisol, interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor (TNF)-α, change in adolescent idiopathic scoliosis patients with postoperative cognitive dysfunction (POCD); thus, may serve as predictive factors for POCD. In total, 75 adolescent scoliosis patients, aged between 11 and 18 years and categorized as American Society of Anesthesiologists classification I or II, were scheduled for orthopedic surgery with general anesthesia. Blood samples were collected on the day of admission and at day 2 following surgery. The plasma levels of IL-1β, IL-6, IL-10 and TNF-α were measured using an enzyme-linked immunosorbent assay, while the concentrations of cortisol were determined using a radioimmunoassay. Cognitive function was assessed one day prior to and at day 7 following the surgery in a quiet room with the guidance of a Chinese version protocol. In total, 66 patients completed the sample collection and neurocognitive tests. According to the criteria for the diagnosis of POCD, 19 patients (28.8%) developed POCD within seven days of surgery. No statistically significant differences were observed in the baseline concentrations of cortisol, TNF-α, IL-1β, IL-10 or IL-6 between the POCD and non-POCD groups. However, the baseline plasma level of TNF-α on day 2 in the POCD group was found to be higher compared with the non-POCD group. In addition, at day 2 after surgery, the concentration of cortisol in the non-POCD group was higher compared with the POCD group. Therefore, the plasma level of TNF-α in adolescent idiopathic scoliosis patients at day 2 following orthopedic surgery may be a predictor for the incidence of early POCD. PMID:25780449

  6. Serving Vulnerable Families: The Important Work of Head Start Programs

    ERIC Educational Resources Information Center

    Vinci, Yasmina

    2012-01-01

    The Obama Administration's most recent regulation on designation renewal of Early/Head Start grantees opens opportunities for early childhood programs in some communities to compete with existing grantees for the federal funding. Understanding some of the behind-the-scenes work that goes into Head Start may be helpful to centers deciding whether…

  7. Comparing the effect of a decision aid plus patient navigation with usual care on colorectal cancer screening completion in vulnerable populations: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Screening can reduce colorectal cancer (CRC) incidence and mortality. However, screening is underutilized in vulnerable patient populations, particularly among Latinos. Patient-directed decision aids can increase CRC screening knowledge, self-efficacy, and intent; however, their effect on actual screening test completion tends to be modest. This is probably because decision aids do not address some of the patient-specific barriers that prevent successful completion of CRC screening in these populations. These individual barriers might be addressed though patient navigation interventions. This study will test a combined decision aid and patient navigator intervention on screening completion in diverse populations of vulnerable primary care patients. Methods/Design We will conduct a multisite, randomized controlled trial with patient-level randomization. Planned enrollment is 300 patients aged 50 to 75 years at average CRC risk presenting for appointments at two primary clinics in North Carolina and New Mexico. Intervention participants will view a video decision aid immediately before the clinic visit. The 14 to 16 minute video presents information about fecal occult blood tests and colonoscopy and will be viewed on a portable computer tablet in English or Spanish. Clinic-based patient navigators are bilingual and bicultural and will provide both face-to-face and telephone-based navigation. Control participants will view an unrelated food safety video and receive usual care. The primary outcome is completion of a CRC screening test at six months. Planned subgroup analyses include examining intervention effectiveness in Latinos, who will be oversampled. Secondarily, the trial will evaluate the intervention effects on knowledge of CRC screening, self-efficacy, intent, and patient-provider communication. The study will also examine whether patient ethnicity, acculturation, language preference, or health insurance status moderate the intervention effect on

  8. Assessment of Atrial Fibrillation and Vulnerability in Patients with Wolff-Parkinson-White Syndrome Using Two-Dimensional Speckle Tracking Echocardiography

    PubMed Central

    Li, Jing-Jie; Wei, Fang; Chen, Ju-Gang; Yu, Yan-Wei; Gu, Hong-Yue; Jiang, Rui; Wu, Xiu-Li; Sun, Qian

    2014-01-01

    Purpose The aim was to assess atrial fibrillation (AF) and vulnerability in Wolff-Parkinson-White (WPW) syndrome patients using two-dimensional speckle tracking echocardiography (2D-STE). Methods All patients were examined via transthoracic echocardiography and 2D-STE in order to assess atrial function 7 days before and 10 days after RF catheter ablation. A postoperative 3-month follow-up was performed via outpatient visit or telephone calls. Results Results showed significant differences in both body mass index (BMI) and supraventricular tachycardia (SVT) duration between WPW patients and DAVNP patients (both P<0.05). Echocardiography revealed that the maximum left atrial volume (LAVmax) and the left ventricular mass index (LVMI) in diastole increased noticeably in patients with WPW compared to patients with DAVNP both before and after ablation (all P<0.05). Before ablation, there were obvious differences in the levels of SRs, SRe, and SRa from the 4-chamber view (LA) in the WPW patients group compared with patients in the DAVNP group (all P<0.05). In the AF group, there were significant differences in the levels of systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) from the 4-chamber view (LA) both before and after ablation (all P<0.05). In the non-AF group, there were decreased SRe levels from the 4-chamber view (LA/RA) pre-ablation compared to post-ablation (all P<0.05). Conclusion Our findings provide convincing evidence that WPW syndrome may result in increased atrial vulnerability and contribute to the development of AF. Further, RF catheter ablation of AAV pathway can potentially improve atrial function in WPW syndrome patients. Two-dimensional speckle tracking echocardiography imaging in WPW patients would be necessary in the evaluation and improvement of the overall function of RF catheter ablation in a long-term follow-up period. PMID:25397668

  9. Implementing the ten steps to successful breastfeeding in multiple hospitals serving low-wealth patients in the US: innovative research design and baseline findings

    PubMed Central

    2013-01-01

    Background The Ten Steps to Successful Breastfeeding are maternity practices proven to support successful achievement of exclusive breastfeeding. They also are the basis for the WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI). This study explores implementation of these steps in hospitals that serve predominantly low wealth populations. Methods A quasi-experimental design with mixed methods for data collection and analysis was included within an intervention project. We compared the impact of a modified Ten Steps implementation approach to a control group. The intervention was carried out in hospitals where: 1) BFHI designation was not necessarily under consideration, and 2) the majority of the patient population was low wealth, i.e., eligible for Medicaid. Hospitals in the research aspect of this project were systematically assigned to one of two groups: Initial Intervention or Initial Control/Later Intervention. This paper includes analyses from the baseline data collection, which consisted of an eSurvey (i.e., Carolina B-KAP), Maternity Practices in Infant Nutrition and Care survey tool (mPINC), the BFHI Self-Appraisal, key informant interviews, breastfeeding data, and formatted feedback discussion. Results Comparability was ensured by statistical and non-parametric tests of baseline characteristics of the two groups. Additional findings of interest included: 1) a universal lack of consistent breastfeeding records and statistics for regular monitoring/review, 2) widespread misinterpretation of associated terminology, 3) health care providers’ reported practices not necessarily reflective of their knowledge and attitudes, and 4) specific steps were found to be associated with hospital breastfeeding rates. A comprehensive set of facilitators and obstacles to initiation of the Ten Steps emerged, and hospital-specific practice change challenges were identified. Discussion This is one of the first studies to examine introduction of the Ten Steps in multiple

  10. A Helpful Serving

    ERIC Educational Resources Information Center

    Rockower, David

    2006-01-01

    This article briefly describes how a fifth-grade class collaborated with a downtown diner for several months and then actually ran the restaurant for four hours. Through the Chatters Cafe, a local high school cafe that serves as a culinary arts training ground for high school students, fifth graders had the opportunity to prepare and serve dinner…

  11. Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups--another perspective on Oregon's data.

    PubMed

    Finlay, I G; George, R

    2011-03-01

    Battin et al examined data on deaths from physician-assisted suicide (PAS) in Oregon and on PAS and voluntary euthanasia (VE) in The Netherlands. This paper reviews the methodology used in their examination and questions the conclusions drawn from it-namely, that there is for the most part 'no evidence of heightened risk' to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues, on the basis of official reports from the Oregon Health Department on the working of the Oregon Death with Dignity Act since 2008, that, contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS. PMID:21071568

  12. Primary Care Provider Perceptions of the Effectiveness of Two Self-Management Support Programs for Vulnerable Patients with Diabetes

    PubMed Central

    Ratanawongsa, Neda; Bhandari, Vijay K; Handley, Margaret; Rundall, Thomas; Hammer, Hali; Schillinger, Dean

    2012-01-01

    Background Primary care providers (PCPs) in safety net settings face barriers to optimizing care for patients with diabetes. We conducted this study to assess PCPs' perspectives on the effectiveness of two language-concordant diabetes self-management support programs. Methods One year postintervention, we surveyed PCPs whose patients with diabetes participated in a three-arm multiclinic randomized controlled trial comparing usual care (UC), weekly automated telephone self-management (ATSM) support with nurse care management, and monthly group medical visits (GMVs). We compared PCP perspectives on patient activation to create and achieve goals, quality of care, and barriers to care using regression models accounting for within-PCP clustering. Results Of 113 eligible PCPs caring for 330 enrolled patients, 87 PCPs (77%) responded to surveys about 245 (74%) enrolled patients. Intervention patients were more likely to be perceived by PCPs as activated to create and achieve goals for chronic care when compared with UC patients (standardized effect size, ATSM vs UC, +0.41, p = 0.01; GMV vs UC, +0.31, p = 0.05). Primary care providers rated quality of care as higher for patients exposed to ATSM compared to UC (odds ratio 3.6, p < 0.01). Compared with GMV patients, ATSM patients were more likely to be perceived by PCPs as overcoming barriers related to limited English proficiency (82% ATSM vs 44% GMV, p = 0.01) and managing medications (80% ATSM vs 53% GMV, p = 0.01). Conclusions Primary care providers perceived that patients receiving ATSM support had overcome barriers, participated more actively, and received higher quality diabetes care. These views of clinician stakeholders lend additional evidence for the potential to upscale ATSM more broadly to support PCPs in their care of diverse, multilinguistic populations. PMID:22401329

  13. National Vulnerability Database (NVD)

    National Institute of Standards and Technology Data Gateway

    National Vulnerability Database (NVD) (Web, free access)   NVD is a comprehensive cyber security vulnerability database that integrates all publicly available U.S. Government vulnerability resources and provides references to industry resources. It is based on and synchronized with the CVE vulnerability naming standard.

  14. [Aging and becoming vulnerable].

    PubMed

    Monod, Stéfanie; Sautebin, Annelore

    2009-11-18

    "The vulnerable are those whose autonomy, dignity and integrity are capable of being threatened". Based on this ethical definition of vulnerability, four risk factors of vulnerability might be identified among elderly persons, and are described in this article: the functional limitation, the loss of autonomy, the social precariousness and the restriction of access to medical care. A clinical case of elderly abuse is presented to illustrate vulnerability. Finally, some recommendations to lower the risk of vulnerability in elderly persons are proposed. PMID:20052868

  15. HIV-AIDS Patients' Evaluation of Health Information on the Internet: The Digital Divide and Vulnerability to Fraudulent Claims

    ERIC Educational Resources Information Center

    Benotsch, Eric G.; Kalichman, Seth; Weinhardt, Lance S.

    2004-01-01

    Access to health information on the Internet has revolutionized how medical patients learn about their illnesses. Valuable information can be found online; however, many health Web sites contain inaccurate or misleading information. The authors surveyed 324 adults with HIV concerning their Internet use for obtaining health information. Health…

  16. Vulnerability and Trustworthiness.

    PubMed

    Barnard, David

    2016-04-01

    Although recent literature on professionalism in healthcare abounds in recommended character traits, attitudes, or behaviors, with a few exceptions, the recommendations are untethered to any serious consideration of the contours and ethical demands of the healing relationship. This article offers an approach based on the professional's commitment to trustworthiness in response to the vulnerability of those seeking professional help. Because our willingness and ability to trust health professionals or healthcare institutions are affected by our personality, culture, race, age, prior experiences with illness and healthcare, and socioeconomic and political circumstances-"the social determinants of trust"-the attitudes and behaviors that actually do gain trust are patient and context specific. Therefore, in addition to the commitment to cultivating attitudes and behaviors that embody trustworthiness, professionalism also includes the commitment to actually gaining a patient's or family's trust by learning, through individualized dialogue, which conditions would win their justified trust, given their particular history and social situation. PMID:26957454

  17. Selected Cytokines Serve as Potential Biomarkers for Predicting Liver Inflammation and Fibrosis in Chronic Hepatitis B Patients With Normal to Mildly Elevated Aminotransferases.

    PubMed

    Deng, Yong-Qiong; Zhao, Hong; Ma, An-Lin; Zhou, Ji-Yuan; Xie, Shi-Bin; Zhang, Xu-Qing; Zhang, Da-Zhi; Xie, Qing; Zhang, Guo; Shang, Jia; Cheng, Jun; Zhao, Wei-Feng; Zou, Zhi-Qiang; Zhang, Ming-Xiang; Wang, Gui-Qiang

    2015-11-01

    Previous studies of small cohorts have implicated several circulating cytokines with progression of chronic hepatitis B (CHB). However, to date there have been no reliable biomarkers for assessing histological liver damage in CHB patients with normal or mildly elevated alanine aminotransferase (ALT). The aim of the present study was to investigate the association between circulating cytokines and histological liver damage in a large cohort. Also, this study was designed to assess the utility of circulating cytokines in diagnosing liver inflammation and fibrosis in CHB patients with ALT less than 2 times the upper limit of normal range (ULN). A total of 227 CHB patients were prospectively enrolled. All patients underwent liver biopsy and staging by Ishak system. Patients with at least moderate inflammation showed significantly higher levels of CXCL-11, CXCL-10, and interleukin (IL)-2 receptor (R) than patients with less than moderate inflammation (P < 0.001). Patients with significant fibrosis had higher levels of IL-8 (P = 0.027), transforming growth factor alpha (TGF-α) (P = 0.011), IL-2R (P = 0.002), and CXCL-11 (P = 0.032) than the group without significant fibrosis. In addition, 31.8% and 29.1% of 151 patients with ALT < 2 × ULN had at least moderate inflammation and significant fibrosis, respectively. Multivariate analysis demonstrated that CXCL-11 was independently associated with at least moderate inflammation, and TGF-α and IL-2R independently correlated with significant fibrosis in patients with ALT < 2 × ULN. Based on certain cytokines and clinical parameters, an inflammation-index and fib-index were developed, which showed areas under the receiver operating characteristics curve (AUROC) of 0.75 (95% CI 0.66-0.84) for at least moderate inflammation and 0.82 (95% CI 0.75-0.90) for significant fibrosis, correspondingly. Compared to existing scores, fib-index was significantly superior to aspartate aminotransferase

  18. Genetic Variations of PIP4K2A Confer Vulnerability to Poor Antipsychotic Response in Severely Ill Schizophrenia Patients

    PubMed Central

    Kaur, Harpreet; Jajodia, Ajay; Grover, Sandeep; Baghel, Ruchi; Gupta, Meenal; Jain, Sanjeev; Kukreti, Ritushree

    2014-01-01

    Literature suggests that disease severity and neurotransmitter signaling pathway genes can accurately identify antipsychotic response in schizophrenia patients. However, putative role of signaling molecules has not been tested in schizophrenia patients based on severity of illness, despite its biological plausibility. In the present study we investigated the possible association of polymorphisms from five candidate genes RGS4, SLC6A3, PIP4K2A, BDNF, PI4KA with response to antipsychotic in variably ill schizophrenia patients. Thus in present study, a total 53 SNPs on the basis of previous reports and functional grounds were examined for their association with antipsychotic response in 423 schizophrenia patients segregated into low and high severity groups. Additionally, haplotype, diplotype, multivariate logistic regression and multifactor-dimensionality reduction (MDR) analyses were performed. Furthermore, observed associations were investigated in atypical monotherapy (n = 355) and risperidone (n = 260) treated subgroups. All associations were estimated as odds ratio (OR) and 95% confidence interval (CI) and test for multiple corrections was applied. Single locus analysis showed significant association of nine variants from SLC6A3, PIP4K2A and BDNF genes with incomplete antipsychotic response in schizophrenia patients with high severity. We identified significant association of six marker diplotype ATTGCT/ATTGCT (rs746203-rs10828317-rs7094131-rs2296624-rs11013052-rs1409396) of PIP4K2A gene in incomplete responders (corrected p-value = 0.001; adjusted-OR = 3.19, 95%-CI = 1.46–6.98) with high severity. These associations were further observed in atypical monotherapy and risperidone sub-groups. MDR approach identified gene-gene interaction among BDNF_rs7103411-BDNF_rs1491851-SLC6A3_rs40184 in severely ill incomplete responders (OR = 7.91, 95%-CI = 4.08–15.36). While RGS4_rs2842026-SLC6A3_rs2975226 interacted synergistically in

  19. Depression and anxiety in patients with and without same-sex attraction: differences in clinical expression, lifestyle factors, and vulnerability indicators

    PubMed Central

    Bos, Henny M W; Boschloo, Lynn; Schoevers, Robert A; Sandfort, Theo G M

    2015-01-01

    Background The aim of this study was to compare clinical expressions (severity and loneliness), lifestyle factors (substance use), and vulnerability indicators (stressful childhood experiences) in patients with any same-sex attraction versus heterosexual patients diagnosed with depression and/or anxiety disorder. Little is known about this, even though it is now well documented that depression and anxiety are more prevalent among persons with same-sex attraction. Method Data, derived from the Netherlands Study of Depression and Anxiety (NESDA), allowed us to compare patients with a same-sex (n = 122) and an exclusively opposite-sex (n = 1658) attraction. Persons with same-sex attraction included persons who were attracted to both sexes. Data were collected by means of the Composite International Diagnostic Interview and paper-and pencil questionnaires. Results Seven percent of the patients reported any same-sex orientation. Clinical expression of depression and anxiety did not differ in relation to sexual attraction. Regarding substance use, same-sex attracted women reported more drug use than heterosexual women (drug use: 16.2% vs. 6.6%, P = 0.003). Regarding stressful childhood experiences, men with any same-sex attraction reported more sexual abuse during childhood than men with a heterosexual orientation (20.4% vs. 8.5%, P = 0.005). Conclusions For women with same-sex attraction substance use (especially illicit drug use) might be a coping mechanism to deal with existing symptoms or with the minority stressors they have to deal with; for same-sex attracted men stressful childhood experiences might reflect an aspect of etiology. PMID:26445702

  20. Software Vulnerability Taxonomy Consolidation

    SciTech Connect

    Polepeddi, S

    2004-12-08

    In today's environment, computers and networks are increasing exposed to a number of software vulnerabilities. Information about these vulnerabilities is collected and disseminated via various large publicly available databases such as BugTraq, OSVDB and ICAT. Each of these databases, individually, do not cover all aspects of a vulnerability and lack a standard format among them, making it difficult for end-users to easily compare various vulnerabilities. A central database of vulnerabilities has not been available until today for a number of reasons, such as the non-uniform methods by which current vulnerability database providers receive information, disagreement over which features of a particular vulnerability are important and how best to present them, and the non-utility of the information presented in many databases. The goal of this software vulnerability taxonomy consolidation project is to address the need for a universally accepted vulnerability taxonomy that classifies vulnerabilities in an unambiguous manner. A consolidated vulnerability database (CVDB) was implemented that coalesces and organizes vulnerability data from disparate data sources. Based on the work done in this paper, there is strong evidence that a consolidated taxonomy encompassing and organizing all relevant data can be achieved. However, three primary obstacles remain: lack of referencing a common ''primary key'', un-structured and free-form descriptions of necessary vulnerability data, and lack of data on all aspects of a vulnerability. This work has only considered data that can be unambiguously extracted from various data sources by straightforward parsers. It is felt that even with the use of more advanced, information mining tools, which can wade through the sea of unstructured vulnerability data, this current integration methodology would still provide repeatable, unambiguous, and exhaustive results. Though the goal of coalescing all available data, which would be of use to

  1. Usefulness of High-Sensitive Troponin Elevation After Effort Stress to Unveil Vulnerable Myocardium in Patients With Heart Failure.

    PubMed

    Pastormerlo, Luigi Emilio; Agazio, Assunta; Benelli, Eleonora; Gabutti, Alessandra; Poletti, Roberta; Prontera, Concetta; Clerico, Aldo; Emdin, Michele; Passino, Claudio

    2015-08-15

    Elevation of resting high-sensitivity troponin (hs-Tn) holds prognostic value in heart failure (HF), but its pathophysiological meaning is unclear. We aimed to investigate hs-Tn elevation after maximal exercise in patients with systolic HF and its neurohormonal and hemodynamic correlates: 30 patients diagnosed with systolic HF (left ventricular ejection fraction 32 ± 8%, mean ± SD), on guideline-directed medical therapy and not recognized inducible ischemia, underwent maximal cardiopulmonary stress test, with assay of plasma N-terminal proB-type natriuretic peptide (NT-proBNP), norepinephrine (NE), and hs-TnT (hs-TnT) at baseline, peak, and 1 and 4 hours after exercise. Cardiac output (CO) was measured during effort, with a rebreathing technique. The natural logarithm of the ratio between percentage (%) increase in CO and NT-proBNP (ln[CO%/NT-proBNP% increase]) was evaluated, as a noninvasive estimate of Frank-Starling adaptation to effort, with NT-proBNP variation considered as a surrogate of end-diastolic left ventricular pressure variation. Hs-TnT increased during exercise with a 4-hour peak (p = 0.001); 10 patients had hs-TnT increase >20%. Patients with Hs-TnT increase >20% were more symptomatic at rest (p = 0.039) and showed greater NE at peak exercise (p = 0.003) and less ln[CO%/NT-proBNP% increase] (p = 0.034). A lower ln[CO%/NT-proBNP% increase] correlated with greater NE at peak exercise (r = -0.430, p = 0.018). In conclusion, acute troponin elevation after maximal exercise was detected in 1/3 of this series. The association of troponin release with NE, CO, and NT-proBNP changes after effort suggests a pathophysiological link among transient hemodynamic overload, adrenergic activation, and myocardial cell damage, likely identifying a clinical subset at greater risk for HF progression. PMID:26089013

  2. Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services

    PubMed Central

    While, Alison E

    2014-01-01

    General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model – the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management. PMID:25949736

  3. What Does Vulnerability Mean?

    ERIC Educational Resources Information Center

    Parley, Fiona F

    2011-01-01

    Protection of those deemed vulnerable has received increasing attention since 2000. This article reports on care staff views of vulnerability using original data from a research study (Parley. "Vulnerability and abuse: an exploration of views of care staff working with people who have learning disabilities," PhD Thesis, 2007) in which care staff…

  4. Optimization of psychopharmacotherapy for schizophrenia in a male, locked, non-acute unit serving for persistently ill patients over one year.

    PubMed

    Suzuki, Takefumi; Uchida, Hiroyuki; Takeuchi, Hiroyoshi; Tsunoda, Kenichi; Ishizuki, Tomomi; Mimura, Masaru

    2015-07-30

    We describe real-world psychopharmacological treatment in a Japanese, male, closed psychiatric unit where clozapie was still unavailable. Fifty-five persistently-ill patients with schizophrenia (ICD-10), mean ± S.D. age: 57.5 ± 13.0 y.o., duration of illness and admissions: 30.9 ± 15.2 years and 20.7 ± 14.5 years, respectively) treated longitudinally were evaluated. The rule was to treat with a simplest possible psychotropic regimen without polypharmacy. Compared to the baseline, the number and dose of antipsychotics were reduced from 1.9 to 1.1 and 1012 mg/day to 607 mg/day, respectively. The number of total psychotropics was minimized from 4.7 to 2.1, with a simplified once or twice daily dosing. Overall, the CGI-Severity and FACT-Sz (global functioning) improved slightly from 5.8 to 5.5 and 28.7 to 32.6, respectively. Of note, no patients got worse in comparison with the baseline clinical presentation. Forty-four patients were successfully treated with a single antipsychotic; only seven needed two antipsychotics simultaneously while 36 had been treated with antipsychotic polypharmacy at baseline. Benzodiazepines (mostly lorazepam) and antiparkinsonian drugs were prescribed in 28 and only two, respectively. Nineteen needed adjunctive valproate (average blood levels: 99.3 ± 21.8 μg/mL) and nine used lithium (0.61 ± 0.26 mEq/L). Optimization of psychopharmacotherapy is still possible for difficult-to-treat patients and, while augmentation of an antipsychotic with mood stabilizers is frequently needed, antipsychotic polypharmacy should be exceptional. PMID:25935376

  5. Variation in Resistance Traits, Phylogenetic Backgrounds, and Virulence Genotypes among Escherichia coli Clinical Isolates from Adjacent Hospital Campuses Serving Distinct Patient Populations

    PubMed Central

    Porter, Stephen; Kuskowski, Michael A.; Johnston, Brian; Clabots, Connie; Kline, Susan; Ferrieri, Patricia; Johnson, James R.

    2015-01-01

    Escherichia coli sequence type 13 (ST131), an emergent cause of multidrug-resistant extraintestinal infections, has important phylogenetic subsets, notably the H30 and H30Rx subclones, with distinctive resistance profiles and, possibly, clinical associations. To clarify the local prevalence of these ST131 subclones and their associations with antimicrobial resistance, ecological source, and virulence traits, we extensively characterized 233 consecutive E. coli clinical isolates (July and August 2013) from the University of Minnesota Medical Center-Fairview Infectious Diseases and Diagnostic Laboratory, Minneapolis, MN, which serves three adjacent facilities (a children's hospital and low- and high-acuity adult facilities). ST131 accounted for 26% of the study isolates (more than any other clonal group), was distributed similarly by facility, and was closely associated with ciprofloxacin resistance and extended-spectrum β-lactamase (ESBL) production. The H30 and H30Rx subclones accounted for most ST131 isolates and for the association of ST131 with fluoroquinolone resistance and ESBL production. Unlike ST131 per se, these subclones were distributed differentially by hospital, being most prevalent at the high-acuity adult facility and were absent from the children's hospital. The virulence gene profiles of ST131 and its subclones were distinctive and more extensive than those of other fluoroquinolone-resistant or ESBL-producing isolates. Within ST131, blaCTX-M-15 was confined to H30Rx isolates and other blaCTX-M variants to non-Rx H30 isolates. Pulsed-field gel electrophoresis documented a predominance of globally distributed pulsotypes and no local outbreak pattern. These findings help clarify the epidemiology, ecology, and bacterial correlates of the H30 and H30Rx ST131 subclones by documenting a high overall prevalence but significant segregation by facility, strong associations with fluoroquinolone resistance and specific ESBL variants, and distinctive virulence

  6. Variation in resistance traits, phylogenetic backgrounds, and virulence genotypes among Escherichia coli clinical isolates from adjacent hospital campuses serving distinct patient populations.

    PubMed

    Drawz, Sarah M; Porter, Stephen; Kuskowski, Michael A; Johnston, Brian; Clabots, Connie; Kline, Susan; Ferrieri, Patricia; Johnson, James R

    2015-09-01

    Escherichia coli sequence type 13 (ST131), an emergent cause of multidrug-resistant extraintestinal infections, has important phylogenetic subsets, notably the H30 and H30Rx subclones, with distinctive resistance profiles and, possibly, clinical associations. To clarify the local prevalence of these ST131 subclones and their associations with antimicrobial resistance, ecological source, and virulence traits, we extensively characterized 233 consecutive E. coli clinical isolates (July and August 2013) from the University of Minnesota Medical Center-Fairview Infectious Diseases and Diagnostic Laboratory, Minneapolis, MN, which serves three adjacent facilities (a children's hospital and low- and high-acuity adult facilities). ST131 accounted for 26% of the study isolates (more than any other clonal group), was distributed similarly by facility, and was closely associated with ciprofloxacin resistance and extended-spectrum β-lactamase (ESBL) production. The H30 and H30Rx subclones accounted for most ST131 isolates and for the association of ST131 with fluoroquinolone resistance and ESBL production. Unlike ST131 per se, these subclones were distributed differentially by hospital, being most prevalent at the high-acuity adult facility and were absent from the children's hospital. The virulence gene profiles of ST131 and its subclones were distinctive and more extensive than those of other fluoroquinolone-resistant or ESBL-producing isolates. Within ST131, bla CTX-M-15 was confined to H30Rx isolates and other bla CTX-M variants to non-Rx H30 isolates. Pulsed-field gel electrophoresis documented a predominance of globally distributed pulsotypes and no local outbreak pattern. These findings help clarify the epidemiology, ecology, and bacterial correlates of the H30 and H30Rx ST131 subclones by documenting a high overall prevalence but significant segregation by facility, strong associations with fluoroquinolone resistance and specific ESBL variants, and distinctive

  7. Mitochondrial Vulnerability and Increased Susceptibility to Nutrient-Induced Cytotoxicity in Fibroblasts from Leigh Syndrome French Canadian Patients

    PubMed Central

    Burelle, Yan; Thompson Legault, Julie; Boucher, Gabrielle; Morin, Charles; Coderre, Lise; Des Rosiers, Christine

    2015-01-01

    nature of the diets, particularly excess fat intake, as well as on the use of antioxidants in patients with LSFC and, possibly, other COX defects. PMID:25835550

  8. Pre-Exposure Prophylaxis (PrEP) for Safer Conception Among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities.

    PubMed

    Finocchario-Kessler, Sarah; Champassak, Sofie; Hoyt, Mary Jo; Short, William; Chakraborty, Rana; Weber, Shannon; Levison, Judy; Phillips, Joanne; Storm, Deborah; Anderson, Jean

    2016-03-01

    Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV transmission among serodifferent couples trying to conceive, yet provider knowledge, attitudes, and experience utilizing PrEP for this purpose are largely unexamined. Trained interviewers conducted phone interviews with healthcare providers treating patients with HIV in seven cities (Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco, N = 85 total). Quantitative and qualitative data were analyzed to describe experience, concerns, and perceived barriers to prescribing PrEP for safer conception. Providers (67.1% female, 43 mean years of age, 70.4% white, 10 mean years treating HIV+ patients, 56% in academic vs. community facilities, 62.2% MD) discussed both benefits and concerns of PrEP for safer conception among serodifferent couples. Only 18.8% of providers reported experience prescribing PrEP, 74.2% were willing to prescribe it under ideal circumstances, and 7.0% were not comfortable prescribing PrEP. Benefits included added protection and a greater sense of control for the HIV-negative partner. Concerns were categorized as clinical, system-level, cost, or behavioral. Significant differences in provider characteristics existed across sites, but experience with PrEP for safer conception did not, p = 0.14. Despite limited experience, most providers were open to recommending PrEP for safer conception as long as patients understood the range of concerns and could make informed decisions. Strategies to identify and link serodifferent couples to PrEP services and clinical guidance specific to PrEP for safer conception are needed. PMID:26824425

  9. Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure

    PubMed Central

    Cowie, Martin R.; Woehrle, Holger; Wegscheider, Karl; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita; Somers, Virend K.; Zannad, Faiez; Teschler, Helmut

    2013-01-01

    Aims Central sleep apnoea/Cheyne–Stokes respiration (CSA/CSR) is a risk factor for increased mortality and morbidity in heart failure (HF). Adaptive servo-ventilation (ASV) is a non-invasive ventilation modality for the treatment of CSA/CSR in patients with HF. Methods SERVE-HF is a multinational, multicentre, randomized, parallel trial designed to assess the effects of addition of ASV (PaceWave™, AutoSet CS™; ResMed) to optimal medical management compared with medical management alone (control group) in patients with symptomatic chronic HF, LVEF ≤45%, and predominant CSA. The trial is based on an event-driven group sequential design, and the final analysis will be performed when 651 events have been observed or the study is terminated at one of the two interim analyses. The aim is to randomize ∼1200 patients to be followed for a minimum of 2 years. Patients are to stay in the trial up to study termination. The first patient was randomized in February 2008 and the study is expected to end mid 2015. The primary combined endpoint is the time to first event of all-cause death, unplanned hospitalization (or unplanned prolongation of a planned hospitalization) for worsening (chronic) HF, cardiac transplantation, resuscitation of sudden cardiac arrest, or appropriate life-saving shock for ventricular fibrillation or fast ventricular tachycardia in implantable cardioverter defibrillator patients. Perspectives The SERVE-HF study is a randomized study that will provide important data on the effect of treatment with ASV on morbidity and mortality, as well as the cost-effectiveness of this therapy, in patients with chronic HF and predominantly CSA/CSR. Trial registration ISRCTN19572887 PMID:23535165

  10. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program

    PubMed Central

    Johnson, Erin E.; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

    2016-01-01

    Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a “homeless medical home” initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. Methods We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. Results More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Conclusion Integrating social determinants of health into clinical care can be effective for high

  11. Building Capacity for Trauma Intervention across Child-Serving Systems

    ERIC Educational Resources Information Center

    Chinitz, Susan; Stettler, Erin M.; Giammanco, Denise; Silverman, Marian; Briggs, Rahil D.; Loeb, Joanne

    2010-01-01

    Infants most vulnerable to trauma are often the least able to access interventions. Universal child-serving systems, such as primary pediatrics, early care and education, and the child welfare system, can offer a port of entry for millions of children annually for trauma-related supports and services. However, practitioners in these systems have…

  12. May serum levels of advanced oxidized protein products serve as a prognostic marker of disease duration in patients with idiopathic Parkinson's disease?

    PubMed

    García-Moreno, José-Manuel; Martín de Pablos, Angel; García-Sánchez, María-Isabel; Méndez-Lucena, Carolina; Damas-Hermoso, Fátima; Rus, Macarena; Chacón, José; Fernández, Emilio

    2013-04-10

    Protein and amine halogenation is a type of oxidative stress induced by phagocytic overstimulation, and its role in Parkinson's disease (PD) has not been discerned. We have detected that advanced oxidized protein products, markers of protein halogenation, are reliably enhanced in serum of patients with PD (n=60) relative to control subjects (n=45, p<0.012), and to a lesser extent in the cerebrospinal fluid. Amine halogenation, as evaluated through 3-chlorotyrosine, is not affected. Mieloperoxidase and hydrogen peroxide levels, halogenative factors of phagocytes, are devoid of changes. Levels of advanced oxidized protein products are progressively reduced over time, and the duration of PD is larger in the Hoehn-Yahr-stage-2/3 patients (n=34) with low serum levels (R(2)=0.0145, p<0.003). Levodopa treatment contributes to this reduction (R(2)=0.259, p<0.001). These protein products are not cytotoxic, unlike 3-chlorotyrosine, but they are known to form inflammatory mediators after conjugation with serum albumin. Our observations lead to the hypothesis that the serum level of advanced oxidized protein products is a prognostic marker of PD duration, and these oxidized proteins could participate in the development of parkinsonian neurodegeneration. PMID:23121480

  13. How Strong Is the Primary Care Safety Net? Assessing the Ability of Federally Qualified Health Centers to Serve as Patient-Centered Medical Homes.

    PubMed

    Ryan, Jamie; Riley, Pamela; Abrams, Melinda; Nocon, Robert

    2015-09-01

    By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. Ongoing federal funding and technical support for medical home transformation will be needed to ensure that FQHCs can fulfill their mission of providing high-quality, comprehensive care to low-income and minority populations. PMID:26372972

  14. Chromodomain-helicase-DNA binding protein 5, 7 and pronecrotic mixed lineage kinase domain-like protein serve as potential prognostic biomarkers in patients with resected pancreatic adenocarcinomas

    PubMed Central

    Seldon, Crystal S; Colbert, Lauren E; Hall, William A; Fisher, Sarah B; Yu, David S; Landry, Jerome C

    2016-01-01

    Pancreatic cancer is one of the deadliest cancers with a very poor prognosis. Recently, there has been a significant increase in research directed towards identifying potential biomarkers that can be used to diagnose and provide prognostic information for pancreatic cancer. These markers can be used clinically to optimize and personalize therapy for individual patients. In this review, we focused on 3 biomarkers involved in the DNA damage response pathway and the necroptosis pathway: Chromodomain-helicase-DNA binding protein 5, chromodomain-helicase-DNA binding protein 7, and mixed lineage kinase domain-like protein. The aim of this article is to review present literature provided for these biomarkers and current studies in which their effectiveness as prognostic biomarkers are analyzed in order to determine their future use as biomarkers in clinical medicine. Based on the data presented, these biomarkers warrant further investigation, and should be validated in future studies. PMID:27096031

  15. Serving Bowl Selection Biases the Amount of Food Served

    ERIC Educational Resources Information Center

    van Kleef, Ellen; Shimizu, Mitsuru; Wansink, Brian

    2012-01-01

    Objective: To determine how common serving bowls containing food for multiple persons influence serving behavior and consumption and whether they do so independently of satiation and food evaluation. Methods: In this between-subjects experiment, 68 participants were randomly assigned to either a group serving pasta from a large-sized bowl (6.9-L…

  16. Safeguarding vulnerable adults.

    PubMed

    Griffith, Richard

    Nurses have a professional duty to safeguard vulnerable adults from abuse under the provisions of the Nursing and Midwifery Council's (NMC) revised Code (2015). With adult abuse continuing to increase, all members of the nursing team are well placed to identify and take action to safeguard the vulnerable. This article sets out how the Care Act 2014 seeks to improve the safeguarding of vulnerable adults and the role of nurses in that process. PMID:26153813

  17. Lessons about vulnerability assessments.

    SciTech Connect

    Johnston, R. G.

    2004-01-01

    The Vulnerability Assessment Team (VAT) at Los Alamos National Laboratory believes that physical security can only be optimized through the use of effective vulnerability assessments. As a result of conducting vulnerability assessments on hundreds of different security devices and systems in the last few years, we have identified some of the attributes of effective assessments. These, along with our recommendations and observations about vulnerability assessments, are summarized in this paper. While our work has primarily involved physical security (in contrast to, for example, computer, network, or information security), our experiences may have applicability to other types of security as well.

  18. Emerging Hispanic-Serving Institutions (HSIs): Serving Latino Students

    ERIC Educational Resources Information Center

    Santiago, Deborah A.; Andrade, Sally J.

    2010-01-01

    In this fifth brief in "Excelencia" in Education's series on Hispanic-Serving Institutions (HSIs) the focus is on the methods and strategies that are producing successful results in a growing sector of colleges and universities we call, "Emerging" Hispanic-Serving Institutions. These Emerging HSIs are institutions that currently do not meet the…

  19. SERVE-HF: More Questions Than Answers.

    PubMed

    Javaheri, Shahrokh; Brown, Lee K; Randerath, Winfried; Khayat, Rami

    2016-04-01

    The recent online publication of the SERVE-HF trial that evaluated the effect of treating central sleep apnea (CSA) with an adaptive servoventilation (ASV) device in patients with heart failure and reduced ejection fraction (HFrEF) has raised serious concerns about the safety of ASV in these patients. Not only was ASV ineffective but post hoc analysis found excess cardiovascular mortality in treated patients. The authors cited as one explanation an unfounded notion that CSA is a compensatory mechanism with a protective effect in HFrEF patients. We believe that there are several possible considerations that are more likely to explain the results of SERVE-HF. In this commentary, we consider methodological issues including the use of a previous-generation ASV device that constrained therapeutic settings to choices that are no longer in wide clinical use. Patient selection, data collection, and treatment adherence as well as group crossovers were not discussed in the trial as potential confounding factors. We have developed alternative reasons that could potentially explain the results and that can be explored by post hoc analysis of the SERVE-HF data. We believe that our analysis is of critical value to the field and of particular importance to clinicians treating these patients. PMID:26836904

  20. S100A9 and ORM1 serve as predictors of therapeutic response and prognostic factors in advanced extranodal NK/T cell lymphoma patients treated with pegaspargase/gemcitabine

    PubMed Central

    Zhou, Zhiyuan; Li, Zhaoming; Sun, Zhenchang; Zhang, Xudong; Lu, Lisha; Wang, Yingjun; Zhang, Mingzhi

    2016-01-01

    Pegaspargase combined with gemcitabine have greatly improved the outcomes of advanced extranodal NK/T cell lymphoma (ENKL). However, patients frequently undergo recurrent disease due to chemoresistance, and few predictive parameters are available. The present study explored potential biomarkers to predict the therapeutic response of advanced ENKL treated with pegaspargase/gemcitabine and evaluate the prognostic significance. Through serum proteomic analysis, we identified 61 upregulated and 22 downregulated proteins in nonresponders compared with responders. We further validated that patients with unfavourable treatment outcomes displayed higher levels of S100A9 and ORM1 via enzyme-linked immunosorbent assay (ELISA). Moreover, the sensitivity and specificity for detecting refractory patients were 81.5% and 71.4% for S100A9 > 62.0 ng/ml, 85.2% and 77.1% for ORM1 > 1436 ug/ml, 100% and 57.1% for S100A9 combined with ORM1. Furthermore, in multivariate analysis elevated levels of S100A9 were associated with poor 2-year OS (40.2% vs. 76.6%, RR = 2.92, p = 0.005) and 2-year PFS (33.1% vs. 61.1%, RR = 2.61 p = 0.011). High ORM1 also predicted inferior 2-year OS (38.7% vs.76.1, RR = 2.46, p = 0.023) and 2-year PFS (18.4% vs. 73.2%, RR = 2.86, p = 0.009). Our results indicated that S100A9 and ORM1 could serve as reliable predictors of therapeutic response and independent prognostic factors of survival in advanced ENKL patients treated with pegaspargase/gemcitabine. PMID:27021626

  1. Could Local Dynamic Stability Serve as an Early Predictor of Falls in Patients with Moderate Neurological Gait Disorders? A Reliability and Comparison Study in Healthy Individuals and in Patients with Paresis of the Lower Extremities

    PubMed Central

    Reynard, Fabienne; Vuadens, Philippe; Deriaz, Olivier; Terrier, Philippe

    2014-01-01

    Falls while walking are frequent in patients with muscular dysfunction resulting from neurological disorders. Falls induce injuries that may lead to deconditioning and disabilities, which further increase the risk of falling. Therefore, an early gait stability index would be useful to evaluate patients in order to prevent the occurrence of future falls. Derived from chaos theory, local dynamic stability (LDS), defined by the maximal Lyapunov exponent, assesses the sensitivity of a dynamic system to small perturbations. LDS has already been used for fall risk prediction in elderly people. The aim of the present study was to provide information to facilitate future researches regarding gait stability in patients with neurological gait disorders. The main objectives were 1) to evaluate the intra-session repeatability of LDS in patients and 2) to assess the discriminative power of LDS to differentiate between healthy individuals and neurological patients. Eighty-three patients with mild to moderate neurological disorders associated with paresis of the lower extremities and 40 healthy controls participated in the study. The participants performed 2×30 s walking wearing a 3D accelerometer attached to the lower back, from which 2×35 steps were extracted. LDS was defined as the average exponential rate of divergence among trajectories in a reconstructed state-space that reflected the gait dynamics. LDS assessed along the medio-lateral axis offered the highest repeatability and discriminative power. Intra-session repeatability (intraclass correlation coefficient between the two repetitions) in the patients was 0.89 and the smallest detectable difference was 16%. LDS was substantially lower in the patients than in the controls (33% relative difference, standardized effect size 2.3). LDS measured in short over-ground walking tests seems sufficiently reliable. LDS exhibits good discriminative power to differentiate fall-prone individuals and opens up the possibility of

  2. Facility Environmental Vulnerability Assessment

    SciTech Connect

    Van Hoesen, S.D.

    2001-07-09

    From mid-April through the end of June 2001, a Facility Environmental Vulnerability Assessment (FEVA) was performed at Oak Ridge National Laboratory (ORNL). The primary goal of this FEVA was to establish an environmental vulnerability baseline at ORNL that could be used to support the Laboratory planning process and place environmental vulnerabilities in perspective. The information developed during the FEVA was intended to provide the basis for management to initiate immediate, near-term, and long-term actions to respond to the identified vulnerabilities. It was expected that further evaluation of the vulnerabilities identified during the FEVA could be carried out to support a more quantitative characterization of the sources, evaluation of contaminant pathways, and definition of risks. The FEVA was modeled after the Battelle-supported response to the problems identified at the High Flux Beam Reactor at Brookhaven National Laboratory. This FEVA report satisfies Corrective Action 3A1 contained in the Corrective Action Plan in Response to Independent Review of the High Flux Isotope Reactor Tritium Leak at the Oak Ridge National Laboratory, submitted to the Department of Energy (DOE) ORNL Site Office Manager on April 16, 2001. This assessment successfully achieved its primary goal as defined by Laboratory management. The assessment team was able to develop information about sources and pathway analyses although the following factors impacted the team's ability to provide additional quantitative information: the complexity and scope of the facilities, infrastructure, and programs; the significantly degraded physical condition of the facilities and infrastructure; the large number of known environmental vulnerabilities; the scope of legacy contamination issues [not currently addressed in the Environmental Management (EM) Program]; the lack of facility process and environmental pathway analysis performed by the accountable line management or facility owner; and poor

  3. Energy vulnerability relationships

    SciTech Connect

    Shaw, B.R.; Boesen, J.L.

    1998-02-01

    The US consumption of crude oil resources has been a steadily growing indicator of the vitality and strength of the US economy. At the same time import diversity has also been a rapidly developing dimension of the import picture. In the early 1970`s, embargoes of crude oil from Organization of Producing and Exporting Countries (OPEC) created economic and political havoc due to a significant lack of diversity and a unique set of economic, political and domestic regulatory circumstances. The continued rise of imports has again led to concerns over the security of our crude oil resource but threats to this system must be considered in light of the diversity and current setting of imported oil. This report develops several important issues concerning vulnerability to the disruption of oil imports: (1) The Middle East is not the major supplier of oil to the United States, (2) The US is not vulnerable to having its entire import stream disrupted, (3) Even in stable countries, there exist vulnerabilities to disruption of the export stream of oil, (4) Vulnerability reduction requires a focus on international solutions, and (5) DOE program and policy development must reflect the requirements of the diverse supply. Does this increasing proportion of imported oil create a {open_quotes}dependence{close_quotes}? Does this increasing proportion of imported oil present a vulnerability to {open_quotes}price shocks{close_quotes} and the tremendous dislocations experienced during the 1970`s? Finally, what is the vulnerability of supply disruptions from the current sources of imported oil? If oil is considered to be a finite, rapidly depleting resource, then the answers to these questions must be {open_quotes}yes.{close_quotes} However, if the supply of oil is expanding, and not limited, then dependence is relative to regional supply sources.

  4. Meals Served in Public Schools.

    ERIC Educational Resources Information Center

    Vivigal, Lisa

    The Physicians Committee for Responsible Medicine (PCRM) contacted public school districts around the United States to determine if they offered low-fat, healthful meals. The PCRM ranked the schools according to whether they served low-fat and vegetarian meals daily, whether these meals varied through the week, and whether children needed to…

  5. Offer Versus Serve. Training Manual.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Bureau of Health and Drug Education and Services.

    A growing awareness about food supplies, food shortages, and conservation of natural resources has resulted in public concern over food waste within the National School Lunch Program. Prior to 1976, all participating students were required to take all five items offered on a planned menu. In October 1975, the Offer v. Serve Provision was enacted…

  6. Vulnerability of dynamic systems

    NASA Technical Reports Server (NTRS)

    Siljak, D. D.

    1976-01-01

    Directed graphs are associated with dynamic systems in order to determine in any given system if each state can be reached by at least one input (input reachability), or can each state reach at least one output (output reachability). Then, the structural perturbations of a dynamic system are identified as lines or points removals from the corresponding digraph, and a system is considered vulnerable at those lines or points of the digraph whose removal destroys its input or output reachability. A suitable framework is formulated for resolving the problems of reachability and vulnerability which applies to both linear and nonlinear systems alike.

  7. Plutonium Vulnerability Management Plan

    SciTech Connect

    1995-03-01

    This Plutonium Vulnerability Management Plan describes the Department of Energy`s response to the vulnerabilities identified in the Plutonium Working Group Report which are a result of the cessation of nuclear weapons production. The responses contained in this document are only part of an overall, coordinated approach designed to enable the Department to accelerate conversion of all nuclear materials, including plutonium, to forms suitable for safe, interim storage. The overall actions being taken are discussed in detail in the Department`s Implementation Plan in response to the Defense Nuclear Facilities Safety Board (DNFSB) Recommendation 94-1. This is included as Attachment B.

  8. Vulnerabilities in snakebites in Sao Paulo, Brazil

    PubMed Central

    Bertolozzi, Maria Rita; Scatena, Camila Morato da Conceição; França, Francisco Oscar de Siqueira

    2015-01-01

    ABSTRACT OBJECTIVE To describe elements of vulnerability of victims of snakebite. METHODS This qualitative, descriptive, cross-sectional study had, as theoretical framework, the concept of vulnerability in individual, social, and programmatic dimensions. We interviewed 21 patients admitted into a hospital specialized in the care of accidents caused by venomous animals. The interviews were analyzed according to a discourse analysis technique. RESULTS Patients were mainly young men, living in remote countryside areas, where health services frequently have limited resources. We found social and individual conditions of vulnerability, such as precarious schooling, low professional qualification, housing without access to piped water, no sewage treated, and no regular garbage collection, and lack of knowledge on this health problem. Regarding the programmatic dimension, we found limited accessibility to the health services that could affect the prognosis and the frequency of sequelae and deaths. CONCLUSIONS Considering such vulnerabilities evoke the need to improve the program for control the Accidents by Venomous Animals and the training of health workers, we highlight the potential use of the concept of vulnerability, which may amplify the understanding and the recommendations for the practice and education related to snakebites. PMID:26603351

  9. Biological Vulnerability to Alcoholism.

    ERIC Educational Resources Information Center

    Schuckit, Marc A.

    1987-01-01

    Reviews the role of biological factors in the risk for alcoholism. Notes the importance of the definition of primary alcoholism and highlights data indicating that this disorder is genetically influenced. In studies of men at high risk for the future development of alcoholism, vulnerability shows up in reactions to ethanol brain wave amplitude and…

  10. Delinquent Recidivists: Vulnerable Children.

    ERIC Educational Resources Information Center

    Moore, Roslyn; And Others

    1984-01-01

    This study examines the relationship between vulnerability factors and recidivism of juvenile offenders. Four factors are identified which distinguish recedivists from nonrecidivists in a sample of 96 first offenders matched by age and sex. Results are discussed from an epidemiological and early intervention perspective. (Author/BS)

  11. Vulnerability to Climate Change in Rural Nicaragua

    NASA Astrophysics Data System (ADS)

    Byrne, T. R.; Townshend, I.; Byrne, J. M.; McDaniel, S. A.

    2013-12-01

    While there is a growing recognition of the impact that climate change may have on human development, there has been a shift in focus from an impacts-led assessment approach towards a vulnerability-led assessment approach. This research operationalizes the IPCC's definition of vulnerability in a sub-national assessment to understand how different factors that shape vulnerability to climate change vary spatially across rural Nicaragua. The research utilizes the Food and Agriculture Organization of the United Nations' (FAO UN) CropWat model to evaluate how the annual yield of two of Nicaragua's staple crops may change under projected changes in temperature and precipitation. This analysis of agricultural sensitivity under exposure to climate change is then overlain with an indicator-based assessment of adaptive capacity in rural Nicaraguan farming households. Adaptive capacity was evaluated using household survey data from the 2001 National Household Survey on Living Standards Measurement, which was provided to us by the FAO UN. The result is a map representing current vulnerability to future climate change, and can serve as a basis for targeting policy interventions in rural Nicaragua.

  12. Understanding the Safeguarding Vulnerable Groups Act 2006.

    PubMed

    Griffith, Richard; Tengnah, Cassam

    2009-07-01

    The Safeguarding Vulnerable Groups Act 2006 was enacted as a result of the Government adopting the recommendations of the Bichard Inquiry (2004), that looked into the circumstances surrounding the death of two children in Soham in 2002. The 2006 Act provides a new vetting and barring scheme to replace the existing arrangements for safeguarding children and vulnerable adults from harm, or the risk of harm, by employees and volunteers whose work gives them significant access to these vulnerable groups. The Act extends statutory vetting and barring schemes to the health service as well as the social care sector. It is therefore important that district nurses are aware of the provisions of the Act and the timetable for implementation. This will enable them to better understand their legal duties, in order to protect themselves from liability and to protect their patients from abuse. PMID:19597384

  13. Delinquent recidivists: Vulnerable children.

    PubMed

    Moore, R; Pauker, J D; Moore, T E

    1984-10-01

    This study examines the relationship between vulnerability factors and recidivism by testing the hypothesis that first offenders who repeat delinquencies display more high-risk factors than those who do not repeat delinquencies. Four factors are identified which distinguish recidivists from nonrecidivists in a sample of first offenders matched by age and sex. Results are discussed from an epidemiological and early-intervention perspective. PMID:24306838

  14. Neuroimaging of the Vulnerable Plaque

    PubMed Central

    Lovblad, Karl-Olof; Mendes-Pereira, Vitor; Garibotto, Valentina; Assal, Frédéric; Willi, Jean-Pierre; Stztajzel, Roman; Ratib, Osman; Vargas, Maria Isabel

    2015-01-01

    Plaque vulnerability due to inflammation has been shown to be a participating factor in the degenerative process in the arterial wall that contributes to stenosis and embolism. This is believed to have an important role to play also in the genesis of stroke or cerebrovascular diseases. In order to appropriately screen patients for treatment, there is an absolute need to directly or indirectly visualize both the normal carotid and the suspected plaque. This can be done with a variety of techniques ranging from ultrasound to computed tomography (CT) and magnetic resonance imaging (MRI). In addition to angiographic techniques, direct imaging of the plaque can be done either by ultrasound or by the so-called molecular imaging techniques, i.e. positron emission tomography (PET). These findings, together with other clinical and paraclinical parameters should finally guide the therapeutic choice. PMID:24188487

  15. The Role of Microvolt T-Wave Alternans to Assess Arrhythmia Vulnerability Among Patients with Heart Failure and Systolic Dysfunction: Primary Results from the TWA SCD-HeFT Substudy

    PubMed Central

    Gold, Michael R; Ip, John H; Costantini, Otto; Poole, Jeanne E; McNulty, Steven; Mark, Daniel B; Lee, Kerry L; Bardy, Gust H

    2009-01-01

    Background Sudden cardiac death remains a leading cause of mortality despite advances in medical treatment for the prevention of ischemic heart disease and heart failure. Recent studies showed a benefit of ICD implantation, but appropriate shocks for ventricular tachyarrhythmias were only noted in a minority of patients during 4-5 years of follow-up. Accordingly, better risk stratification is needed to optimize patient selection. In this regard microvolt T-wave alternans (TWA) has emerged as a potentially useful measure of arrhythmia vulnerability, but it has not been evaluated previously in a prospective randomized trial of ICD therapy. Methods and Results This investigation was a prospective substudy of the SCD-HeFT trial including 490 patients at 37 clinical sites. TWA tests were classified by blinded readers as + (37%), - (22%), or indeterminate (41%) by standard criteria. The composite primary endpoint was the first occurrence of any of the following events: sudden cardiac death, sustained ventricular tachycardia/fibrillation or appropriate ICD discharge. During a median follow-up of 30 months, there were no significant differences in event rates between TWA + or − patients (Hazard ratio 1.24, p=0.56, [CI 0.60, 2.59]), or TWA − and non − (+ and indeterminate) subjects (Hazard ratio 1.28, p=0.46, CI [0.65, 2.53]). Similar results were obtained including or excluding patients randomized to amiodarone in the analyses. Conclusions TWA testing did not predict arrhythmic events or mortality in SCD-HeFT, although a small reduction of events (20-25%) among TWA − patients cannot be excluded given the sample size of this study. Accordingly, these results suggest that TWA is not useful to help make clinical decisions regarding ICD therapy among patients with heart failure and left ventricular systolic dysfunction. PMID:18955671

  16. Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series

    PubMed Central

    Honda, Miwako; Ito, Mio; Ishikawa, Shogo; Takebayashi, Yoichi; Tierney, Lawrence

    2016-01-01

    Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient's shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients' acceptance of care. PMID:27069478

  17. A Systematic Review of Patients' Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity.

    PubMed

    Rocque, Rhea; Leanza, Yvan

    2015-01-01

    Communication difficulties persist between patients and physicians. In order to improve care, patients' experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients' experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients' experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients' experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients' evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion, all

  18. An Integrated Approach for Urban Earthquake Vulnerability Analyses

    NASA Astrophysics Data System (ADS)

    Düzgün, H. S.; Yücemen, M. S.; Kalaycioglu, H. S.

    2009-04-01

    -economical, structural, coastal, ground condition, organizational vulnerabilities, as well as accessibility to critical services within the framework. The proposed framework has the following eight components: Seismic hazard analysis, soil response analysis, tsunami inundation analysis, structural vulnerability analysis, socio-economic vulnerability analysis, accessibility to critical services, GIS-based integrated vulnerability assessment, and visualization of vulnerabilities in 3D virtual city model The integrated model for various vulnerabilities obtained for the urban area is developed in GIS environment by using individual vulnerability assessments for considered elements at risk and serve for establishing the backbone of the spatial decision support system. The stages followed in the model are: Determination of a common mapping unit for each aspect of urban earthquake vulnerability, formation of a geo-database for the vulnerabilities, evaluation of urban vulnerability based on multi attribute utility theory with various weighting algorithms, mapping of the evaluated integrated earthquake risk in geographic information systems (GIS) in the neighborhood scale. The framework is also applicable to larger geographical mapping scales, for example, the building scale. When illustrating the results in building scale, 3-D visualizations with remote sensing data is used so that decision-makers can easily interpret the outputs. The proposed vulnerability assessment framework is flexible and can easily be applied to urban environments at various geographical scales with different mapping units. The obtained total vulnerability maps for the urban area provide a baseline for the development of risk reduction strategies for the decision makers. Moreover, as several aspects of elements at risk for an urban area is considered through vulnerability analyses, effect on changes in vulnerability conditions on the total can easily be determined. The developed approach also enables decision makers to

  19. Vulnerability Assessment of Selected Buildings Designated as Shelters: Dominica.

    ERIC Educational Resources Information Center

    Agency for International Development (IDCA), Washington, DC.

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on Dominica to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with some of the…

  20. Vulnerability Assessment of Selected Buildings Designated as Shelters: Grenada.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools, located in Grenada, to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with some of the input…

  1. Vulnerability Assessment of Selected Buildings Designated as Shelters: Anguilla.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on Anguilla to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with some of the…

  2. Reduced cardiac autonomic response to deep breathing: A heritable vulnerability trait in patients with schizophrenia and their healthy first-degree relatives.

    PubMed

    Liu, Yu-Wen; Tzeng, Nian-Sheng; Yeh, Chin-Bin; Kuo, Terry B J; Huang, San-Yuan; Chang, Chuan-Chia; Chang, Hsin-An

    2016-09-30

    Reduced resting heart rate variability (HRV) has been observed in patients with schizophrenia and their relatives, suggesting genetic predispositions. However, findings have not been consistent. We assessed cardiac autonomic response to deep breathing in first-degree relatives of patients with schizophrenia (n=45; 26 female; aged 39.69±14.82 years). Data were compared to healthy controls (n=45; 26 female; aged 38.27±9.79 years) matched for age, gender, body mass index and physical activity as well as to unmedicated patients with acute schizophrenia (n=45; 25 female; aged 37.31±12.65 years). Electrocardiograms were recorded under supine resting and deep-breathing conditions (10-12breaths/min). We measured HRV components including variance, low-frequency (LF) power, which may reflect baroreflex function, high-frequency (HF) power, which reflects cardiac parasympathetic activity, and LF/HF ratio, which may reflect sympatho-vagal balance. Patients rather than relatives exhibited lower resting-state HRV (variance, LF, and HF) than controls. As expected, deep breathing induced an increase in variance and HF-HRV in controls. However, such a response was significantly reduced in both patients and their relatives. In conclusion, the diminished cardiac autonomic reactivity to deep breathing seen in patients and their unaffected relatives indicates that this pattern of cardiac autonomic dysregulation may be regarded as a genetic trait marker for schizophrenia. PMID:27442977

  3. Beyond 'vulnerable groups': contexts and dynamics of vulnerability.

    PubMed

    Zarowsky, Christina; Haddad, Slim; Nguyen, Vinh-Kim

    2013-03-01

    This paper reviews approaches to vulnerability in public health, introducing a series of 10 papers addressing vulnerability in health in Africa. We understand vulnerability as simultaneously a condition and a process. Social inequalities are manifest in and exacerbate three key dimensions of vulnerability: the initial level of wellbeing, the degree of exposure to risk, and the capacity to manage risk effectively. We stress the dynamic interactions linking material and social deprivation, poverty, powerlessness and ill health: risks or shocks and their health impacts are intimately interconnected and reinforce each other in a cycle which in the absence of effective interventions, increases vulnerability. An inductive process which does not begin with an a priori definition or measurement of 'vulnerability' and which does not assume the existence of fixed 'vulnerable groups' allowed us both to re-affirm core aspects of existing conceptual frameworks, and to engage in new ways with literature specifically addressing vulnerability and resilience at the population level as well as with literature - for example in ecology, and on the concept of frailty in research on aging - with which researchers on health and poverty in Africa may not be familiar. We invite conceptual and empirical work on vulnerability in complex systems frameworks. These perspectives emphasize contexts and nonlinear causality thus supporting analyses of vulnerability and resilience as both markers and emergent properties of dynamic interactions. We accept a working definition of vulnerability, and recognize that some definable groups of people are more likely than others to suffer harm from exposure to health risks. But we suggest that the real work - at both intellectual and policy/political levels - lies in understanding and responding to the dynamics, meanings and power relations underlying actual instances and processes of vulnerability and harm. PMID:23549696

  4. Vulnerability of weighted networks

    NASA Astrophysics Data System (ADS)

    Dall'Asta, Luca; Barrat, Alain; Barthélemy, Marc; Vespignani, Alessandro

    2006-04-01

    In real networks complex topological features are often associated with a diversity of interactions as measured by the weights of the links. Moreover, spatial constraints may also play an important role, resulting in a complex interplay between topology, weight, and geography. In order to study the vulnerability of such networks to intentional attacks, these attributes must therefore be considered along with the topological quantities. In order to tackle this issue, we consider the case of the worldwide airport network, which is a weighted heterogeneous network whose evolution and structure are influenced by traffic and geographical constraints. We first characterize relevant topological and weighted centrality measures and then use these quantities as selection criteria for the removal of vertices. We consider different attack strategies and different measures of the damage achieved in the network. The analysis of weighted properties shows that centrality driven attacks are capable of shattering the network's communication or transport properties even at a very low level of damage in the connectivity pattern. The inclusion of weight and traffic therefore provides evidence for the extreme vulnerability of complex networks to any targeted strategy and the need for them to be considered as key features in the finding and development of defensive strategies.

  5. A preliminary analysis of quantifying computer security vulnerability data in "the wild"

    NASA Astrophysics Data System (ADS)

    Farris, Katheryn A.; McNamara, Sean R.; Goldstein, Adam; Cybenko, George

    2016-05-01

    A system of computers, networks and software has some level of vulnerability exposure that puts it at risk to criminal hackers. Presently, most vulnerability research uses data from software vendors, and the National Vulnerability Database (NVD). We propose an alternative path forward through grounding our analysis in data from the operational information security community, i.e. vulnerability data from "the wild". In this paper, we propose a vulnerability data parsing algorithm and an in-depth univariate and multivariate analysis of the vulnerability arrival and deletion process (also referred to as the vulnerability birth-death process). We find that vulnerability arrivals are best characterized by the log-normal distribution and vulnerability deletions are best characterized by the exponential distribution. These distributions can serve as prior probabilities for future Bayesian analysis. We also find that over 22% of the deleted vulnerability data have a rate of zero, and that the arrival vulnerability data is always greater than zero. Finally, we quantify and visualize the dependencies between vulnerability arrivals and deletions through a bivariate scatterplot and statistical observations.

  6. Serving the world's poor, profitably.

    PubMed

    Prahalad, C K; Hammond, Allen

    2002-09-01

    By stimulating commerce and development at the bottom of the economic pyramid, multi-nationals could radically improve the lives of billions of people and help create a more stable, less dangerous world. Achieving this goal does not require MNCs to spearhead global social-development initiatives for charitable purposes. They need only act in their own self-interest. How? The authors lay out the business case for entering the world's poorest markets. Fully 65% of the world's population earns less than $2,000 per year--that's 4 billion people. But despite the vastness of this market, it remains largely untapped. The reluctance to invest is easy to understand, but it is, by and large, based on outdated assumptions of the developing world. While individual incomes may be low, the aggregate buying power of poor communities is actually quite large, representing a substantial market in many countries for what some might consider luxury goods like satellite television and phone services. Prices, and margins, are often much higher in poor neighborhoods than in their middle-class counterparts. And new technologies are already steadily reducing the effects of corruption, illiteracy, inadequate infrastructure, and other such barriers. Because these markets are in the earliest stages of economic development, revenue growth for multi-nationals entering them can be extremely rapid. MNCs can also lower costs, not only through low-cost labor but by transferring operating efficiencies and innovations developed to serve their existing operations. Certainly, succeeding in such markets requires MNCs to think creatively. The biggest change, though, has to come from executives: Unless business leaders confront their own preconceptions--particularly about the value of high-volume, low-margin businesses--companies are unlikely to master the challenges or reap the rewards of these developing markets. PMID:12227146

  7. VuWiki: An Ontology-Based Semantic Wiki for Vulnerability Assessments

    NASA Astrophysics Data System (ADS)

    Khazai, Bijan; Kunz-Plapp, Tina; Büscher, Christian; Wegner, Antje

    2014-05-01

    vulnerability assessments with the possibility for any user to retrieve assessments using specific research criteria. Furthermore, Vuwiki can serve as a collaborative knowledge platform that allows for the active participation of those generating and using the knowledge represented in the wiki.

  8. Markers of vulnerability in schizophrenia

    PubMed Central

    Prelipceanu, D

    2009-01-01

    Vulnerability in schizophrenia is an integrative concept, which tries to explain the development of schizophrenia as an interaction between different individual susceptibility factors and environmental risk factors. Vulnerability markers used in genetic studies include biochemical indicators, neuroanatomical, neurophysiologic, and cognitive abnormalities. Among those, the most extensive studied markers were: evoked potentials, smooth pursuit eye movements, and attentional deficits. Some of the potential indicators presented in this paper satisfy most of the criteria necessary for a vulnerability marker, but none meets all of them. Nevertheless, they represent important markers of risk to schizophrenia. Key words: vulnerability, evoked potentials, eye movements, attentional deficits PMID:20108534

  9. Attending to social vulnerability when rationing pandemic resources.

    PubMed

    Vawter, Dorothy E; Garrett, J Eline; Gervais, Karen G; Prehn, Angela Witt; DeBruin, Debra A

    2011-01-01

    Pandemic plans are increasingly attending to groups experiencing health disparities and other social vulnerabilities. Although some pandemic guidance is silent on the issue, guidance that attends to socially vulnerable groups ranges widely, some procedural (often calling for public engagement), and some substantive. Public engagement objectives vary from merely educational to seeking reflective input into the ethical commitments that should guide pandemic planning and response. Some plans that concern rationing during a severe pandemic recommend ways to protect socially vulnerable groups without prioritizing access to scarce resources based on social vulnerability per se. The Minnesota Pandemic Ethics Project (MPEP), a public engagement project on rationing scarce health resources during a severe influenza pandemic, agrees and recommends an integrated set of ways to attend to the needs of socially vulnerable people and avoid exacerbation of health disparities during a severe influenza pandemic. Among other things, MPEP recommends: 1. Engaging socially vulnerable populations to clarify unique needs and effective strategies; 2. Engaging socially vulnerable populations to elicit ethical values and perspectives on rationing; 3. Rejecting rationing based on race, socioeconomic class, citizenship, quality of life, length of life-extension and first-come, first-served; 4. Prioritizing those in the general population for access to resources based on combinations of risk (of death or severe complications from influenza, exposure to influenza, transmitting influenza to vulnerable groups) and the likelihood of responding well to the resource in question. 5. Protecting critical infrastructures on which vulnerable populations and the general public rely; 6. Identifying and removing access barriers during pandemic planning and response; and 7. Collecting and promptly analyzing data during the pandemic to identify groups at disproportionate risk of influenza-related mortality and

  10. Common Control System Vulnerability

    SciTech Connect

    Trent Nelson

    2005-12-01

    The Control Systems Security Program and other programs within the Idaho National Laboratory have discovered a vulnerability common to control systems in all sectors that allows an attacker to penetrate most control systems, spoof the operator, and gain full control of targeted system elements. This vulnerability has been identified on several systems that have been evaluated at INL, and in each case a 100% success rate of completing the attack paths that lead to full system compromise was observed. Since these systems are employed in multiple critical infrastructure sectors, this vulnerability is deemed common to control systems in all sectors. Modern control systems architectures can be considered analogous to today's information networks, and as such are usually approached by attackers using a common attack methodology to penetrate deeper and deeper into the network. This approach often is composed of several phases, including gaining access to the control network, reconnaissance, profiling of vulnerabilities, launching attacks, escalating privilege, maintaining access, and obscuring or removing information that indicates that an intruder was on the system. With irrefutable proof that an external attack can lead to a compromise of a computing resource on the organization's business local area network (LAN), access to the control network is usually considered the first phase in the attack plan. Once the attacker gains access to the control network through direct connections and/or the business LAN, the second phase of reconnaissance begins with traffic analysis within the control domain. Thus, the communications between the workstations and the field device controllers can be monitored and evaluated, allowing an attacker to capture, analyze, and evaluate the commands sent among the control equipment. Through manipulation of the communication protocols of control systems (a process generally referred to as ''reverse engineering''), an attacker can then map out the

  11. Vendor System Vulnerability Testing Test Plan

    SciTech Connect

    James R. Davidson

    2005-01-01

    The Idaho National Laboratory (INL) prepared this generic test plan to provide clients (vendors, end users, program sponsors, etc.) with a sense of the scope and depth of vulnerability testing performed at the INL’s Supervisory Control and Data Acquisition (SCADA) Test Bed and to serve as an example of such a plan. Although this test plan specifically addresses vulnerability testing of systems applied to the energy sector (electric/power transmission and distribution and oil and gas systems), it is generic enough to be applied to control systems used in other critical infrastructures such as the transportation sector, water/waste water sector, or hazardous chemical production facilities. The SCADA Test Bed is established at the INL as a testing environment to evaluate the security vulnerabilities of SCADA systems, energy management systems (EMS), and distributed control systems. It now supports multiple programs sponsored by the U.S. Department of Energy, the U.S. Department of Homeland Security, other government agencies, and private sector clients. This particular test plan applies to testing conducted on a SCADA/EMS provided by a vendor. Before performing detailed vulnerability testing of a SCADA/EMS, an as delivered baseline examination of the system is conducted, to establish a starting point for all-subsequent testing. The series of baseline tests document factory delivered defaults, system configuration, and potential configuration changes to aid in the development of a security plan for in depth vulnerability testing. The baseline test document is provided to the System Provider,a who evaluates the baseline report and provides recommendations to the system configuration to enhance the security profile of the baseline system. Vulnerability testing is then conducted at the SCADA Test Bed, which provides an in-depth security analysis of the Vendor’s system.b a. The term System Provider replaces the name of the company/organization providing the system

  12. The Naïve nurse: revisiting vulnerability for nursing

    PubMed Central

    2012-01-01

    Background Nurses in the Western world have given considerable attention to the concept of vulnerability in recent decades. However, nurses have tended to view vulnerability from an individualistic perspective, and have rarely taken into account structural or collective dimensions of the concept. As the need grows for health workers to engage in the global health agenda, nurses must broaden earlier works on vulnerability, noting that conventional conceptualizations and practical applications on the notion of vulnerability warrant extension to include more collective conceptualizations thereby making a more complete understanding of vulnerability in nursing discourse. Discussion The purpose of this paper is to examine nursing contributions to the concept of vulnerability and consider how a broader perspective that includes socio-political dimensions may assist nurses to reach beyond the immediate milieu of the patient into the dominant social, political, and economic structures that produce and sustain vulnerability. Summary By broadening nurse’s conceptualization of vulnerability, nurses can obtain the consciousness needed to move beyond a peripheral role of nursing that has been dominantly situated within institutional settings to contribute in the larger arena of social, economic, political and global affairs. PMID:22520841

  13. The Vulnerability of Elderly Consumers.

    ERIC Educational Resources Information Center

    McGhee, Jerrie L.

    1983-01-01

    Reviews research on the vulnerability of the elderly to consumer fraud. Patterns of consumption, situational characteristics, education and product knowledge, psychological losses, social isolation, and psychosocial transitions influence the elderly's vulnerability and ability to cope with consumer abuse. Higher educational attainment and greater…

  14. CompuServe in the Classroom.

    ERIC Educational Resources Information Center

    Riedl, Richard

    1986-01-01

    Describes a student magazine publishing project in which the participating junior high school students accessed the information utility, CompuServe, to gather current and accurate background information for their magazine articles. Student use of CompuServe is described, and the value and costs of using CompuServe are discussed. (MBR)

  15. Social experience among vulnerable populations: conflicts and negotiations between chronic patients and their doctors seen as a challenge to medical practice.

    PubMed

    Waissman, R

    2010-11-01

    This article attempts to explore the impact of a chronic illness, end-stage renal disease, on the management of every day life between the actors involved: lay people, the affected children and their families and the medical personnel. The focus is on the nature and the process of interaction between these parties which are confronted from the onset of the illness with fundamental uncertainty concerning length of survival and the reliability of sophisticated technology such as dialysis techniques and transplantation. Within the framework of the organization of this serious illness, such interaction is concretized in the form of certain tasks to be accomplished. These constitute medical work which combines to shape the social relationships between lay people and professionals into confrontation. First, information was gathered from direct observation and fieldwork in two Units of Pediatric Nephrology located in two different hospitals in Paris. Fieldwork was followed by surveys using semi-structured interviews carried out among patients in a private clinic and the unit's personnel, medical and non medical, the families in their homes, and some adolescents in the units. Then questions were raised about strategies and negotiations, in order to reach an agreement as to when a conflict arises. The medical work is carried out in a context of changing situations, constantly called into question by the illness, and thus discovering a social order in which lay people become actors in these new situations. PMID:20979979

  16. We are vulnerable, too.

    PubMed

    2016-04-01

    My transition to becoming a student midwife has not been straightforward: I bring baggage. I was raped 11 years ago and buried it, so did not consider that becoming a midwife would pose any problems. Little did I know that this journey would make me question my own experiences of pregnancy and motherhood, and would bring the rape and subsequent termination to the forefront of my mind, forcing me to confront issues that I would have preferred to leave unearthed. Reading around the subject has helped me to understand emotions that have surfaced, and put a name to how I am feeling, yet certain procedures in practice make me uncomfortable. It is thought that 20 per cent of women aged 16-59 have experienced a sexual assault of some type since turning 16 (Rape Crisis 2015), so being sensitive to vulnerabilities faced by service users, students and colleagues is crucial. I do not make recommendations for practice, but the reference list provides a starting point for those who wish to read more extensively. PMID:27172678

  17. Safeguard Vulnerability Analysis Program (SVAP)

    SciTech Connect

    Gilman, F.M.; Dittmore, M.H.; Orvis, W.J.; Wahler, P.S.

    1980-06-23

    This report gives an overview of the Safeguard Vulnerability Analysis Program (SVAP) developed at Lawrence Livermore National Laboratory. SVAP was designed as an automated method of analyzing the safeguard systems at nuclear facilities for vulnerabilities relating to the theft or diversion of nuclear materials. SVAP addresses one class of safeguard threat: theft or diversion of nuclear materials by nonviolent insiders, acting individually or in collusion. SVAP is a user-oriented tool which uses an interactive input medium for preprocessing the large amounts of safeguards data. Its output includes concise summary data as well as detailed vulnerability information.

  18. Identifying Frailty Among Vulnerable Populations

    PubMed Central

    Salem, Benissa E.; Nyamathi, Adeline; Phillips, Linda R.; Mentes, Janet; Sarkisian, Catherine; Brecht, Lynn

    2014-01-01

    Frailty is a significant public health issue which is experienced by homeless and other vulnerable adults; to date, a frailty framework has not been proposed to guide researchers who study this hard-to-reach population. The Frailty Framework among Homeless and other Vulnerable Populations (FFHVP) has been developed from empirical research and consultation with frailty experts in an effort to characterize antecedents, i.e. situational, health-related, behavioral, resource, biological, and environmental factors which contribute to physical, psychological and social frailty domains and impact adverse outcomes. As vulnerable populations continue to age, a greater understanding of frailty will enable the development of nursing interventions. PMID:24469090

  19. Cognitive vulnerabilities as mediators between emotional abuse and depressive symptoms.

    PubMed

    Padilla Paredes, Patricia; Calvete, Esther

    2014-01-01

    This study tested whether childhood parental emotional abuse and peer emotional bullying serve as antecedents of depression in adolescence and identified the cognitive mechanisms involved in this process. It was hypothesized that the experience of emotional abuse would predict depressive symptoms via development of rumination and negative inferences. A 3-wave longitudinal study was carried out with 998 adolescents (471 girls and 526 boys) between 13 and 17 years of age. Results showed that emotional abuse by parents and peers at Time 1 predicted a worsening of several cognitive vulnerabilities at Time 2. In addition, brooding mediated between the experiences of abuse and the increase of depressive symptoms at Time 3. Thus, findings suggest that the experiences of childhood emotional abuse by parents and peers serve as antecedents to develop a negative cognitive style, vulnerability that, once developed, is a risk factor for the onset of depressive symptoms in adolescence. PMID:24292965

  20. Multimodal spectroscopy detects features of vulnerable atherosclerotic plaque

    PubMed Central

    Šćepanović, Obrad R.; Fitzmaurice, Maryann; Miller, Arnold; Kong, Chae-Ryon; Volynskaya, Zoya; Dasari, Ramachandra R.; Kramer, John R.; Feld, Michael S.

    2011-01-01

    Early detection and treatment of rupture-prone vulnerable atherosclerotic plaques is critical to reducing patient mortality associated with cardiovascular disease. The combination of reflectance, fluorescence, and Raman spectroscopy—termed multimodal spectroscopy (MMS)—provides detailed biochemical information about tissue and can detect vulnerable plaque features: thin fibrous cap (TFC), necrotic core (NC), superficial foam cells (SFC), and thrombus. Ex vivo MMS spectra are collected from 12 patients that underwent carotid endarterectomy or femoral bypass surgery. Data are collected by means of a unitary MMS optical fiber probe and a portable clinical instrument. Blinded histopathological analysis is used to assess the vulnerability of each spectrally evaluated artery lesion. Modeling of the ex vivo MMS spectra produce objective parameters that correlate with the presence of vulnerable plaque features: TFC with fluorescence parameters indicative of collagen presence; NC∕SFC with a combination of diffuse reflectance β-carotene∕ceroid absorption and the Raman spectral signature of lipids; and thrombus with its Raman signature. Using these parameters, suspected vulnerable plaques can be detected with a sensitivity of 96% and specificity of 72%. These encouraging results warrant the continued development of MMS as a catheter-based clinical diagnostic technique for early detection of vulnerable plaques. PMID:21280896

  1. Multimodal spectroscopy detects features of vulnerable atherosclerotic plaque

    NASA Astrophysics Data System (ADS)

    Šćepanović, Obrad R.; Fitzmaurice, Maryann; Miller, Arnold; Kong, Chae-Ryon; Volynskaya, Zoya; Dasari, Ramachandra R.; Kramer, John R.; Feld, Michael S.

    2011-01-01

    Early detection and treatment of rupture-prone vulnerable atherosclerotic plaques is critical to reducing patient mortality associated with cardiovascular disease. The combination of reflectance, fluorescence, and Raman spectroscopy-termed multimodal spectroscopy (MMS)-provides detailed biochemical information about tissue and can detect vulnerable plaque features: thin fibrous cap (TFC), necrotic core (NC), superficial foam cells (SFC), and thrombus. Ex vivo MMS spectra are collected from 12 patients that underwent carotid endarterectomy or femoral bypass surgery. Data are collected by means of a unitary MMS optical fiber probe and a portable clinical instrument. Blinded histopathological analysis is used to assess the vulnerability of each spectrally evaluated artery lesion. Modeling of the ex vivo MMS spectra produce objective parameters that correlate with the presence of vulnerable plaque features: TFC with fluorescence parameters indicative of collagen presence; NC/SFC with a combination of diffuse reflectance β-carotene/ceroid absorption and the Raman spectral signature of lipids; and thrombus with its Raman signature. Using these parameters, suspected vulnerable plaques can be detected with a sensitivity of 96% and specificity of 72%. These encouraging results warrant the continued development of MMS as a catheter-based clinical diagnostic technique for early detection of vulnerable plaques.

  2. Evaluating intensity parameters for debris flow vulnerability

    NASA Astrophysics Data System (ADS)

    Keiler, Margreth

    2014-05-01

    In mountain regions natural hazard processes such as debris flows or hyper-concentrated flows repeatedly lead to high damages. After an event, detailed documentation of the meteorological, hydrological and geomorphological indicators are standardized, and additional data on debris covering run out areas, indicators for processes velocity and transported volumes are gathered. Information on deposition height of debris is an important parameter to estimate the intensity of the process impacting the buildings and infrastructure and hence to establish vulnerability curves. However, the deposition height of mobilized material in settlements and on infrastructure is mostly not directly evaluated because recovery work starts immediately or even during the event leading to a removal of accumulated material. Different approaches exist to reconstruct deposition heights after torrent events, such as mind mapping, comparison of LIDAR-based DEM before and after the event as well as the reconstruction by using photo documentation and the estimation of deposition heights according to standardised elements at buildings and infrastructure. In our study, these different approaches to estimate deposition height and the spatial distribution of the accumulated material are applied and compared against each other by using the case study of the debris flow event in Brienz (Switzerland) which occurred during the serve flood events of August 2005 in the Alps. Within the analysis, different factors including overall costs and time consumption (manpower, equipment), accuracy and preciseness are compared and evaluated to establish optimal maps of the extent and deposition depth after torrent events and to integrate this information in the vulnerability analysis.

  3. Selected items from the Charcot-Marie-Tooth (CMT) Neuropathy Score and secondary clinical outcome measures serve as sensitive clinical markers of disease severity in CMT1A patients.

    PubMed

    Mannil, Manoj; Solari, Alessandra; Leha, Andreas; Pelayo-Negro, Ana L; Berciano, José; Schlotter-Weigel, Beate; Walter, Maggie C; Rautenstrauss, Bernd; Schnizer, Tuuli J; Schenone, Angelo; Seeman, Pavel; Kadian, Chandini; Schreiber, Olivia; Angarita, Natalia G; Fabrizi, Gian Maria; Gemignani, Franco; Padua, Luca; Santoro, Lucio; Quattrone, Aldo; Vita, Giuseppe; Calabrese, Daniela; Young, Peter; Laurà, Matilde; Haberlová, Jana; Mazanec, Radim; Paulus, Walter; Beissbarth, Tim; Shy, Michael E; Reilly, Mary M; Pareyson, Davide; Sereda, Michael W

    2014-11-01

    This study evaluates primary and secondary clinical outcome measures in Charcot-Marie-Tooth disease type 1A (CMT1A) with regard to their contribution towards discrimination of disease severity. The nine components of the composite Charcot-Marie-Tooth disease Neuropathy Score and six additional secondary clinical outcome measures were assessed in 479 adult patients with genetically proven CMT1A and 126 healthy controls. Using hierarchical clustering, we identified four significant clusters of patients according to clinical severity. We then tested the impact of each of the CMTNS components and of the secondary clinical parameters with regard to their power to differentiate these four clusters. The CMTNS components ulnar sensory nerve action potential (SNAP), pin sensibility, vibration and strength of arms did not increase the discriminant value of the remaining five CMTNS components (Ulnar compound motor action potential [CMAP], leg motor symptoms, arm motor symptoms, leg strength and sensory symptoms). However, three of the six additional clinical outcome measures - the 10m-timed walking test (T10MW), 9 hole-peg test (9HPT), and foot dorsal flexion dynamometry - further improved discrimination between severely and mildly affected patients. From these findings, we identified three different composite measures as score hypotheses and compared their discriminant power with that of the CMTNS. A composite of eight components CMAP, Motor symptoms legs, Motor symptoms arms, Strength of Legs, Sensory symptoms), displayed the strongest power to discriminate between the clusters. As a conclusion, five items from the CMTNS and three secondary clinical outcome measures improve the clinical assessment of patients with CMT1A significantly and are beneficial for upcoming clinical and therapeutic trials. PMID:25085517

  4. Assessing the Agricultural Vulnerability for India under Changing Climate

    NASA Astrophysics Data System (ADS)

    Sharma, Tarul; Vardhan Murari, Harsha; Karmakar, Subhankar; Ghosh, Subimal; Singh, Jitendra

    2016-04-01

    Global climate change has proven to show majorly negative impacts for the far future. These negative impacts adversely affect almost all the fields including agriculture, water resources, tourism, and marine ecosystem. Among these, the effects on agriculture are considered to be of prime importance since its regional impacts can directly affect the global food security. Under such lines, it becomes essential to understand how climate change directs agricultural production for a region along with its vulnerability. In India, rice and wheat are considered as major staple diet and hence understanding its production loss/gain due to regional vulnerability to climate change becomes necessary. Here, an attempt has been made to understand the agricultural vulnerability for rice and wheat, considering yield as a function of temperature and precipitation during growing period. In order to accomplish this objective, the ratio of actual to potential evapo-transpiration has been considered which serves as a reliable indicator; with more this ratio towards unity, less vulnerable will be the region. The current objective needs an integration of climatic, hydrological and agricultural parameters; that can be achieved by simulating a climate data driven hydrologic (Variable Infiltration Capacity, VIC) model and a crop (Decision Support System for Agrotechnology Transfer, DSSAT) model. The proposed framework is an attempt to derive a crop vulnerability map that can facilitate in strategizing adaption practices which can reduce the adverse impacts of climate change in future.

  5. 5 CFR 1203.14 - Serving documents.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... REVIEW OF RULES AND REGULATIONS OF THE OFFICE OF PERSONNEL MANAGEMENT Procedures for Review § 1203.14 Serving documents. (a) Parties. In every case, the person requesting regulation review must serve a copy... business office or home of each party or representative and leaving it with the party or representative,...

  6. [Mapping environmental vulnerability from ETM + data in the Yellow River Mouth Area].

    PubMed

    Wang, Rui-Yan; Yu, Zhen-Wen; Xia, Yan-Ling; Wang, Xiang-Feng; Zhao, Geng-Xing; Jiang, Shu-Qian

    2013-10-01

    The environmental vulnerability retrieval is important to support continuing data. The spatial distribution of regional environmental vulnerability was got through remote sensing retrieval. In view of soil and vegetation, the environmental vulnerability evaluation index system was built, and the environmental vulnerability of sampling points was calculated by the AHP-fuzzy method, then the correlation between the sampling points environmental vulnerability and ETM + spectral reflectance ratio including some kinds of conversion data was analyzed to determine the sensitive spectral parameters. Based on that, models of correlation analysis, traditional regression, BP neural network and support vector regression were taken to explain the quantitative relationship between the spectral reflectance and the environmental vulnerability. With this model, the environmental vulnerability distribution was retrieved in the Yellow River Mouth Area. The results showed that the correlation between the environmental vulnerability and the spring NDVI, the September NDVI and the spring brightness was better than others, so they were selected as the sensitive spectral parameters. The model precision result showed that in addition to the support vector model, the other model reached the significant level. While all the multi-variable regression was better than all one-variable regression, and the model accuracy of BP neural network was the best. This study will serve as a reliable theoretical reference for the large spatial scale environmental vulnerability estimation based on remote sensing data. PMID:24409741

  7. The Vulnerable Plaque: the Real Villain in Acute Coronary Syndromes

    PubMed Central

    Liang, Michael; Puri, Aniket; Devlin, Gerard

    2011-01-01

    The term "vulnerable plaque" refers to a vascular lesion that is prone to rupture and may result in life-threatening events which include myocardial infarction. It consists of thin-cap fibroatheroma and a large lipid core which is highly thrombogenic. Acute coronary syndromes often result from rupture of vulnerable plaques which frequently are only moderately stenosed and not visible by conventional angiography. Several invasive and non-invasive strategies have been developed to assess the burden of vulnerable plaques. Intravascular ultrasound provides a two-dimensional cross-sectional image of the arterial wall and can help assess the plaque burden and composition. Optical coherent tomography offers superior resolution over intravascular ultrasound. High-resolution magnetic resonance imaging provides non-invasive imaging for visualizing fibrous cap thickness and rupture in plaques. In addition, it may be of value in assessing the effects of treatments, such as lipid-lowering therapy. Technical issues however limit its clinical applicability. The role of multi-slice computed tomography, a well established screening tool for coronary artery disease, remains to be determined. Fractional flow reserve (FFR) may provide physiological functional assessment of plaque vulnerability; however, its role in the management of vulnerable plaque requires further studies. Treatment of the vulnerable patient may involve systemic therapy which currently include statins, ACE inhibitors, beta-blockers, aspirin, and calcium-channel blockers and in the future local therapeutic options such as drug-eluting stents or photodynamic therapy. PMID:21673834

  8. Are Vulnerability Disclosure Deadlines Justified?

    SciTech Connect

    Miles McQueen; Jason L. Wright; Lawrence Wellman

    2011-09-01

    Vulnerability research organizations Rapid7, Google Security team, and Zero Day Initiative recently imposed grace periods for public disclosure of vulnerabilities. The grace periods ranged from 45 to 182 days, after which disclosure might occur with or without an effective mitigation from the affected software vendor. At this time there is indirect evidence that the shorter grace periods of 45 and 60 days may not be practical. However, there is strong evidence that the recently announced Zero Day Initiative grace period of 182 days yields benefit in speeding up the patch creation process, and may be practical for many software products. Unfortunately, there is also evidence that the 182 day grace period results in more vulnerability announcements without an available patch.

  9. Molecular Imaging of Plaque Vulnerability

    PubMed Central

    Tavakoli, Sina; Vashist, Aseem; Sadeghi, Mehran M.

    2014-01-01

    Over the past decade significant progress has been made in the development of novel imaging strategies focusing on the biology of the vessel wall for identification of vulnerable plaques. While the majority of these studies are still in the preclinical stage, few techniques (e.g., 18F-FDG and 18F-NaF PET imaging) have already been evaluated in clinical studies with promising results. Here, we will briefly review the pathobiology of atherosclerosis and discuss molecular imaging strategies that have been developed to target these events, with an emphasis on mechanisms that are associated with atherosclerotic plaque vulnerability. PMID:25124827

  10. Food Chain Security and Vulnerability

    NASA Astrophysics Data System (ADS)

    Brunet, Sébastien; Delvenne, Pierre; Claisse, Frédéric

    In our contemporary societies, the food chain could be defined as a macro-technical system, which depends on a wide variety of actors and risks analysis methods. In this contribution, risks related to the food chain are defined in terms of "modern risks" (Beck 1992). The whole national economic sector of food production/distribution is vulnerable to a local accident, which can affect the functioning of food chain, the export programs and even the political system. Such a complex socio-technical environment is undoubtedly vulnerable to intentional act such as terrorism.

  11. Calories and fat per serving (image)

    MedlinePlus

    ... and stores the rest in the form of fat. A calorie is a calorie, whether it comes ... between them is the number of calories, nutrients, fat, and other ingredients in a typical serving . Calories ...

  12. Nursing Student Birth Doulas' Influence On the Childbearing Outcomes of Vulnerable Populations.

    PubMed

    Van Zandt, Shirley E; Kim, Soohyun; Erickson, Amanda

    2016-01-01

    Of 1,511 women served by nursing student birth doulas (Birth Companions) between 1998 and 2014, 34.5% were identified as vulnerable (refugees, non-English speakers, teens, low income, low education). This retrospective evaluation of the Birth Companions Program showed that vulnerable mothers had more epidurals and smaller babies, and attempted breastfeeding less frequently than nonvulnerable. There was no difference in the frequency of caesarean births, pitocin induction/augmentation, low birth weight, or preterm newborns among the vulnerable women. Birth Companion interventions may have a role in influencing these outcomes. The Birth Companions program will use this analysis to identify additional services for these populations. PMID:27383776

  13. [Vulnerability and National Health Service].

    PubMed

    Lima, Cristina

    2006-01-01

    to value life. The article concludes drawing attention to the need to invest in health education, which is just as important as the fair distribution of precious health care resources in reducing harmful risks to the most vulnerable patients. PMID:16987443

  14. Vulnerable Subjects: Why Does Informed Consent Matter?

    PubMed

    Goodwin, Michele

    2016-09-01

    This special issue of the Journal Law, Medicine & Ethics takes up the concern of informed consent, particularly in times of controversy. The dominant moral dilemmas that frame traditional bioethical concerns address medical experimentation on vulnerable subjects; physicians assisting their patients in suicide or euthanasia; scarce resource allocation and medical futility; human trials to develop drugs; organ and tissue donation; cloning; xenotransplantation; abortion; human enhancement; mandatory vaccination; and much more. The term "bioethics" provides a lens, language, and guideposts to the study of medical ethics. It is worth noting, however, that medical experimentation is neither new nor exclusive to one country. Authors in this issue address thorny subjects that span borders and patients: from matters dealing with children and vaccination to the language and perception of consent. PMID:27587443

  15. Measuring Vulnerability to Stereotype Threat

    ERIC Educational Resources Information Center

    Barnard, Lucy; Burley, Hansel; Olivarez, Arturo; Crooks, Steven

    2008-01-01

    Introduction: In this study, we examined the psychometric properties of an instrument intended to measure vulnerability to stereotype threat. Method: We revised the instrument through assessing score reliability and then examined a domain specific model using confirmatory factor analyses. After examining the responses of the total sample…

  16. US Vulnerability to Natural Disasters

    NASA Astrophysics Data System (ADS)

    van der Vink, G.; Apgar, S.; Batchelor, A.; Carter, C.; Gail, D.; Jarrett, A.; Levine, N.; Morgan, W.; Orlikowski, M.; Pray, T.; Raymar, M.; Siebert, A.; Shawa, T. W.; Wallace, C.

    2002-05-01

    Natural disasters result from the coincidence of natural events with the built environment. Our nation's infrastructure is growing at an exponential rate in many areas of high risk, and the Federal government's liability is increasing proportionally. By superimposing population density with predicted ground motion from earthquakes, historical hurricane tracks, historical tornado locations, and areas within the flood plain, we are able to identify locations of high vulnerability within the United States. We present a comprehensive map of disaster risk for the United States that is being produced for the Senate Natural Hazards Caucus. The map allows for the geographic comparison of natural disaster risk with past disaster declarations, the expenditure of Federal dollars for disaster relief, population increase, and variations of GDP. Every state is vulnerable to natural disasters. Although their frequency varies considerably, the annualized losses for disaster relief from hurricanes, earthquakes, and floods are approximately equivalent. While fast-growing states such as California and Florida remain highly vulnerable, changes in the occurrence of natural events combined with population increases are making areas such as Texas, North Carolina, and the East Coast increasingly vulnerable.

  17. Childhood Cancer and Vulnerability for Significant Academic Underachievement.

    ERIC Educational Resources Information Center

    Ott, Jeanne S.; And Others

    1982-01-01

    Learning difficulties related to childhood cancer were examined by comparison of 22 oncology patients and 22 children (6 to 17 years old) referred for psychiatric/psychological evaluation. Findings demonstrated, among children undergoing treatment of cancer, some academic vulnerabilities for which psychosocial aspects may not fully account.…

  18. Unipolar Depression, Life Context Vulnerabilities, and Drinking to Cope

    ERIC Educational Resources Information Center

    Holahan, Charles J.; Moos, Rudolf H.; Holahan, Carole K.; Cronkite, Ruth C.; Randall, Patrick K.

    2004-01-01

    This study followed baseline samples of 424 unipolar depressed patients and 424 community controls across 10 years to investigate the association between depression and alcohol-related coping and to examine how life context vulnerabilities underlie the risk for depressed individuals to rely on drinking to cope. Findings supported all hypotheses.…

  19. Osteocytes serve as a progenitor cell of osteosarcoma

    PubMed Central

    Sottnik, Joseph L; Campbell, Brittany; Mehra, Rohit; Behbahani-Nejad, Omid; Hall, Christopher L.; Keller, Evan T.

    2016-01-01

    Osteosarcoma (OSA) is the most common primary bone tumor in humans. However, the cell of origin of OSA is not clearly defined although there is evidence that osteoblasts may serve as OSA progenitors. The role of osteocytes, terminally differentiated osteoblasts, as OSA progenitors has yet to be described. Analysis of patient cDNA from publicly available microarray data revealed that patients with OSA have increased expression of dentin matrix phosphoprotein 1 (DMP1), a marker of osteocytes. Analysis of multiple murine, human, and canine OSA cell lines revealed DMP1 expression. To test the tumorigenic potential of osteocytes, MLO-Y4, an SV-40 immortalized murine osteocyte cell line, was injected into subcutaneous and orthotopic (intratibial) sites of mice. Tumor growth occurred in both locations. Orthotopic MLO-Y4 tumors produced mixed osteoblastic/osteolytic radiographic lesions; a hallmark of OSA. Together, these data demonstrate for the first time that osteocytes can serve as OSA progenitors. PMID:24700678

  20. Osteocytes serve as a progenitor cell of osteosarcoma.

    PubMed

    Sottnik, Joseph L; Campbell, Brittany; Mehra, Rohit; Behbahani-Nejad, Omid; Hall, Christopher L; Keller, Evan T

    2014-08-01

    Osteosarcoma (OSA) is the most common primary bone tumor in humans. However, the cell of origin of OSA is not clearly defined although there is evidence that osteoblasts may serve as OSA progenitors. The role of osteocytes, terminally differentiated osteoblasts, as OSA progenitors has yet to be described. Analysis of patient cDNA from publicly available microarray data revealed that patients with OSA have increased expression of dentin matrix phosphoprotein 1 (DMP1), a marker of osteocytes. Analysis of multiple murine, human, and canine OSA cell lines revealed DMP1 expression. To test the tumorigenic potential of osteocytes, MLO-Y4, a SV-40 immortalized murine osteocyte cell line, was injected into subcutaneous and orthotopic (intratibial) sites of mice. Tumor growth occurred in both locations. Orthotopic MLO-Y4 tumors produced mixed osteoblastic/osteolytic radiographic lesions; a hallmark of OSA. Together, these data demonstrate for the first time that osteocytes can serve as OSA progenitors. PMID:24700678

  1. A notational analysis of elite tennis serve and serve-return strategies on slow surface.

    PubMed

    Gillet, Eric; Leroy, David; Thouvarecq, Régis; Stein, Jean-François

    2009-03-01

    A notational analysis of singles events at the French Open Grand Slam tournament was undertaken in 2005 and 2006 to characterize the game patterns and strategies of serve and serve-return and to determine their influence on the point issue on a clay court surface. One hundred sixteen men's singles matches were video analyzed. The flat serve (57.6%), particularly down the "T" location (50.3%), allowed servers to win significantly more points than the topspin (24.1%) and slice serves (18.3%). When the topspin was the first serve strategy, servers kept a high percentage of points won from the serve (52.4%). This strategy was essentially used on the second serve (91.6%) by playing the "T" location in the deuce court and the wide zone in the advantage court. Returns to the central zone allowed receivers to win more points (73.3% on first serve and 65.9% on second serve) than plays to external locations. The results highlight the high impact of the first shots of all opponents on the rally. Even on clay, the slowest court surface, serves and serve-returns remain the strokes that most influence the match results in modern tennis games. PMID:19197212

  2. Global trends and vulnerabilities of mangrove forests

    NASA Astrophysics Data System (ADS)

    Simard, M.; Fatoyinbo, T. E.; Rivera-Monroy, V. H.; Castaneda, E.; Roy Chowdhury, R.

    2015-12-01

    Mangrove forests are located along Earth's coastlines and estuaries within tropical and subtropical latitudes. They provide numerous services functioning as an extraordinary carbon sequestration system and serving as habitat and nursery for fish, crustaceans and amphibians. To coastal populations, they provide livelihood, food, lumber and act as an effective protection against tsunamis, storm surges and hurricanes. Their vulnerability to sea level rise is strongly related to their extraordinary ability to accumulate soils, which is in part related to their productivity and therefore canopy structure. As a first step to understand their vulnerability, we seek to understand mangrove dependencies on environmental and geophysical setting. To achieve this, we mapped mangrove canopy height and above ground biomass (AGB) at the Global scale. To identify mangrove forests, existing maps derived from a collection of Landsat data around the 2000 era were used. Using the Shuttle Radar Topography Mission elevation data collected in February of 2000, we produced a Global map of mangrove canopy height. The estimated heights were validated with the ICESat/Geoscience Altimeter System (GLAS) and in situ field data. Most importantly, field data were also used to derive relationships between canopy height and AGB. While the geographical coverage of in situ data is limited, ICESat/GLAS data provided extensive geographical coverage with independent estimates of maximum canopy height. These estimates were used to calibrate SRTM-estimates of height at the Global scale. We found the difference between GLAS RH100 and SRTM resulted from several sources of uncertainty that are difficult to isolate. These include natural variations of canopy structure with time, system errors from GLAS and SRTM, geo-location errors and discrepancies in spatial resolution. The Global canopy height map was trnasormed into AGB using the field-derived allometry. Depending on the scale of analysis and geographical

  3. Plantar pressures in the tennis serve.

    PubMed

    Girard, Olivier; Eicher, Frank; Micallef, Jean-Paul; Millet, Grégoire

    2010-06-01

    In-shoe loading patterns were examined in each foot (back and front) separately during two types of tennis serve [first (or flat) and second (or twist) serve] and two service stance styles [foot-up (back foot is moved forward next to front foot for push-off) and foot-back (feet remain at the same relative level)]. Ten competitive tennis players completed five trials for each type of serve and service stance style in random order. Plantar pressure distribution was recorded using Pedar insoles divided into nine areas for analysis. Mean and peak pressures (+15.2%, P < 0.01 and +12.8%, P < 0.05) as well as maximal forces (+20.2%, P < 0.01) were higher under the lateral forefoot of the front foot in first than in second serves, while mean forces were higher (+17.2%, P < 0.05) under the lesser toes. Relative load was higher on the lateral forefoot (+20.4%, P < 0.05) but lower (-32.5%, P < 0.05) on the medial heel of the front foot with foot-up compared with foot-back stance. Using a foot-up stance, loading of the back foot was higher (+31.8%, P < 0.01) under the lateral mid-foot but lower (-29.9%, P < 0.01) under the medial forefoot. The type of serve and the stance style adopted have a significant effect on foot loading. Such findings might help improve mechanical efficiency of the serve. PMID:20496222

  4. Assessing European wild fire vulnerability

    NASA Astrophysics Data System (ADS)

    Oehler, F.; Oliveira, S.; Barredo, J. I.; Camia, A.; Ayanz, J. San Miguel; Pettenella, D.; Mavsar, R.

    2012-04-01

    Wild fire vulnerability is a measure of potential socio-economic damage caused by a fire in a specific area. As such it is an important component of long-term fire risk management, helping policy-makers take informed decisions about adequate expenditures for fire prevention and suppression, and to target those regions at highest risk. This paper presents a first approach to assess wild fire vulnerability at the European level. A conservative approach was chosen that assesses the cost of restoring the previous land cover after a potential fire. Based on the CORINE Land Cover, a restoration cost was established for each land cover class at country level, and an average restoration time was assigned according to the recovery capacity of the land cover. The damage caused by fire was then assessed by discounting the cost of restoring the previous land cover over the restoration period. Three different vulnerability scenarios were considered assuming low, medium and high fire severity causing different levels of damage. Over Europe, the potential damage of wild land fires ranges from 10 - 13, 732 Euro*ha-1*yr-1 for low fire severity, 32 - 45,772 Euro*ha-1*yr-1 for medium fire severity and 54 - 77,812 Euro*ha-1*yr-1 for high fire severity. The least vulnerable are natural grasslands, moors and heathland and sclerophyllous vegetation, while the highest cost occurs for restoring broad-leaved forest. Preliminary validation comparing these estimates with official damage assessments for past fires shows reasonable results. The restoration cost approach allows for a straightforward, data extensive assessment of fire vulnerability at European level. A disadvantage is the inherent simplification of the evaluation procedure with the underestimation of non-markets goods and services. Thus, a second approach has been developed, valuing individual wild land goods and services and assessing their annual flow which is lost for a certain period of time in case of a fire event. However

  5. Reentry Preparedness among Soon-to-be-Released Inmates and the Role of Time Served

    PubMed Central

    Wolff, Nancy; Shi, Jing; Schumann, Brooke E.

    2014-01-01

    Purpose While reentry funding is flowing into states, its target efficiency and effectiveness depends on whether it goes to the right people in the right ways. The purpose of this study was to examine whether and how the amount of time incarcerated affects reentry readiness. Materials and Methods A population-based survey was conducted. Approximately 4000 soon-to-be-released male inmates were drawn from a state correctional system. Readiness is described in terms of feeling ready and material, social, and treatment resources available for reentry by time served on current conviction (episode effect) and since age 18 (cumulative effect). Generalized hierarchical linear models were used to estimate the effects of demographic, criminological, and time served variables on reentry readiness outcomes. Results Reentry vulnerability increased with time served since turning 18 (cumulative effect) but not with time served on the current conviction (episode effect). Inmates serving more than 10 years since turning 18 were at greatest reentry risk. Conclusions The findings indicate that inmates who have served more prison time over their lifetime have more pronounced needs and risks suggesting that reentry funding be targeted towards those who have served more time over the course of their lifetime. PMID:24431474

  6. MID-ATLANTIC REGIONAL VULNERABILITY ASSESSMENT

    EPA Science Inventory

    ORD's Regional Vulnerability Assessment (REVA) Program is developing and demonstrating approaches to assess current and future environmental vulnerabilities so that risk management activities can be targeted. The sister program to EMA.P (Environmental Monitoring Assessment Progr...

  7. Vulnerabilities to misinformation in online pharmaceutical marketing

    PubMed Central

    De Freitas, Julian; Falls, Brian A; Haque, Omar S; Bursztajn, Harold J

    2013-01-01

    Given the large percentage of Internet users who search for health information online, pharmaceutical companies have invested significantly in online marketing of their products. Although online pharmaceutical marketing can potentially benefit both physicians and patients, it can also harm these groups by misleading them. Indeed, some pharmaceutical companies have been guilty of undue influence, which has threatened public health and trust. We conducted a review of the available literature on online pharmaceutical marketing, undue influence and the psychology of decision-making, in order to identify factors that contribute to Internet users’ vulnerability to online pharmaceutical misinformation. We find five converging factors: Internet dependence, excessive trust in the veracity of online information, unawareness of pharmaceutical company influence, social isolation and detail fixation. As the Internet continues to change, it is important that regulators keep in mind not only misinformation that surrounds new web technologies and their contents, but also the factors that make Internet users vulnerable to misinformation in the first place. Psychological components are a critical, although often neglected, risk factor for Internet users becoming misinformed upon exposure to online pharmaceutical marketing. Awareness of these psychological factors may help Internet users attentively and safely navigate an evolving web terrain. PMID:23761527

  8. Vulnerabilities to misinformation in online pharmaceutical marketing.

    PubMed

    De Freitas, Julian; Falls, Brian A; Haque, Omar S; Bursztajn, Harold J

    2013-05-01

    Given the large percentage of Internet users who search for health information online, pharmaceutical companies have invested significantly in online marketing of their products. Although online pharmaceutical marketing can potentially benefit both physicians and patients, it can also harm these groups by misleading them. Indeed, some pharmaceutical companies have been guilty of undue influence, which has threatened public health and trust. We conducted a review of the available literature on online pharmaceutical marketing, undue influence and the psychology of decision-making, in order to identify factors that contribute to Internet users' vulnerability to online pharmaceutical misinformation. We find five converging factors: Internet dependence, excessive trust in the veracity of online information, unawareness of pharmaceutical company influence, social isolation and detail fixation. As the Internet continues to change, it is important that regulators keep in mind not only misinformation that surrounds new web technologies and their contents, but also the factors that make Internet users vulnerable to misinformation in the first place. Psychological components are a critical, although often neglected, risk factor for Internet users becoming misinformed upon exposure to online pharmaceutical marketing. Awareness of these psychological factors may help Internet users attentively and safely navigate an evolving web terrain. PMID:23761527

  9. [Precarity, vulnerability, anticipating end-of-life care at home].

    PubMed

    Bonneval, Camille

    2016-02-01

    Many patients want to end their life at home. Care teams adapt to these wishes and organise a form of treatment which blends safety of care and the respect of the expectations of the patients and family members. When factors of precarity increase the vulnerability inherent to the end of life, caregivers anticipate and support as best as they can the difficulties encountered as testified by a hospital at home team in Dax. PMID:26861082

  10. Serving Distant Learners through Instructional Technologies.

    ERIC Educational Resources Information Center

    Drea, John T.; Armistead, L. Pendleton

    John Wood Community College (JWCC) serves a district population of approximately 90,000 in a predominantly rural section of west-central Illinois. In an effort to address the needs of the rural long-distance learner, JWCC has implemented a variety of instructional delivery techniques. Since its inception, JWCC has contracted with other area…

  11. Making a Difference by Serving All Students

    ERIC Educational Resources Information Center

    Olley, Rivka I.

    2009-01-01

    Randi Brown came to school psychology almost as a family business. Her grandmother was a school psychologist and the first licensed psychologist in the state of New York. Randi graduated with a doctoral degree from Yeshiva University and has served students in Westchester County, New York, for 18 years. She exemplifies the dedication typical of so…

  12. Serving Rural Youth: A Regional Approach.

    ERIC Educational Resources Information Center

    Edington, Everett D.

    The regional approach as an alternative for meeting the needs of rural youth is discussed in comparison to the small school district which cannot possibly serve the broad spectrum of student needs in rural areas. The rural educational setting and its shortcomings are described as the lack of facilities, a lack of an obvious connection between…

  13. "Gateway" Districts Struggle to Serve Immigrant Parents

    ERIC Educational Resources Information Center

    Maxwell, Lesli A.

    2012-01-01

    As thousands of communities--especially in the South--became booming gateways for immigrant families during the 1990s and the early years of the new century, public schools struggled with the unfamiliar task of serving the large numbers of English-learners arriving in their classrooms. Instructional programs were built from scratch. Districts had…

  14. Pyramid Servings Database (PSDB) for NHANES III

    Cancer.gov

    The National Cancer Institute developed a database to examine dietary data from the National Center for Health Statistics' Third National Health and Nutrition Examination Survey in terms of servings from each of United States Department of Agriculture's The Food Guide Pyramid's major and minor food groups.

  15. Graduate Students Serve Extension as Evaluation Consultants

    ERIC Educational Resources Information Center

    McClure, Megan; Fuhrman, Nicholas E.

    2011-01-01

    In an effort to provide graduate students at a distance with field-based learning experiences and evaluation resources to statewide Extension programs, 24 Master's students participating in a distance-delivered program evaluation course served as evaluation consultants for Extension programs. State evaluation specialists unable to conduct…

  16. Getting It Together: Serving the Adult Community.

    ERIC Educational Resources Information Center

    Bakshis, Robert D.

    1979-01-01

    Describes a community needs assessment survey conducted by the College of DuPage (Illinois) which served to advertise existing programs, provide public relations for the adult education council, and obtain measures of need for existing or expanded educational and leisure activities. (MB)

  17. Serving Business in an Information Economy.

    ERIC Educational Resources Information Center

    The Bookmark, 1988

    1988-01-01

    The 23 articles in this theme issue focus on various aspects of library services to business in an information economy: "Serving Business in an Information Economy" (C. Bain); "New York's Resurging Economy and State Economic Development Information" (R. G. Paolino); "Department of Economic Development Library: Services to Business" (B. S.…

  18. Serving Stakeholders at a Small Regional University

    ERIC Educational Resources Information Center

    Burrage, Sean

    2015-01-01

    The Southeastern Oklahoma State University Honors Program serves a unique role in a small, rural setting such as Durant, Oklahoma. The honors program has a traditional mission in a university that offers a nontraditional setting and history within the context of higher education. The program thus offers special rewards to its students and to the…

  19. Science To Serve the Common Good.

    ERIC Educational Resources Information Center

    Brewer, Garry D.

    1997-01-01

    Reviews "Upstream: Salmon and Society in the Pacific Northwest", a report produced by a committee of the National Research Council that offers a model of a new and better approach to addressing environmental problems that could enable science to serve the common good. Demonstrates a successful approach to doing science and contributing to society.…

  20. Federal Assistance for Programs Serving the Handicapped.

    ERIC Educational Resources Information Center

    Office of Human Development (DHEW), Washington, DC. Office for Handicapped Individuals.

    Excerpted from the "1977 Catalog of Federal Domestic Assistance," the document describes federal programs and activities serving the handicapped or people working with or for them. Following initial sections which cover the Office for Handicapped Individuals and its clearinghouse, definitions, instructions for using the directory, and budget…

  1. How Finland Serves Gifted and Talented Pupils

    ERIC Educational Resources Information Center

    Tirri, Kirsi; Kuusisto, Elina

    2013-01-01

    The purpose of this article is to provide an overview of the ways gifted and talented pupils are served in Finland. The trend toward individualism and freedom of choice as well as national policy affecting gifted education are discussed. Empirical research on Finnish teachers' attitudes toward gifted education with respect to the national…

  2. Serving up Success! Team Nutrition Days, 1997.

    ERIC Educational Resources Information Center

    Food and Nutrition Service (USDA), Washington, DC.

    This publication presents success stories and actual activities from Team Nutrition Days 1997 to serve as a starting point for other schools wanting to create their own nutrition education activities. Team Nutrition Days was a 1-week celebration that used innovative, interactive activities to teach children that nutrition is the link between…

  3. Treating the most vulnerable and costly in diabetes.

    PubMed

    Wagner, David V; Stoeckel, Maggie; E Tudor, Megan; Harris, Michael A

    2015-06-01

    Diabetic ketoacidosis (DKA) is associated with negative health outcomes and high costs for patients, families, and communities. Interventions developed to effectively reduce DKA and related costs should target the multiple risk factors associated with DKA and adherence difficulties. Certain demographic, psychological, and family factors are associated with increased risk for adherence problems and DKA. Individuals with a combination of risk factors (e.g., mental health problems, low socioeconomic status, high family conflict) may be particularly vulnerable to DKA. Although several different interventions have demonstrated promise in improving adherence and/or decreasing the risk of DKA, the generalizability of treatment results to those individuals most vulnerable to DKA is limited. Approaches which include multiple evidence-based components of care, are flexible in treatment delivery (e.g., home- and community-based, utilize technology), and target the multiple risk factors across relevant systems (e.g., individual, family, school, medical) are warranted to effectively reduce DKA in vulnerable populations. PMID:25877049

  4. Soil vulnerability for cesium transfer.

    PubMed

    Vandenhove, Hildegarde; Sweeck, Lieve

    2011-07-01

    The recent events at the Fukushima Daiichi nuclear power plant in Japan have raised questions about the accumulation of radionuclides in soils and the possible impacts on agriculture surrounding nuclear power plants. This article summarizes the knowledge gained after the nuclear power plant accident in Chernobyl, Ukraine, on how soil parameters influence soil vulnerability for radiocesium bioavailability, discusses some potential agrochemical countermeasures, and presents some predictions of radiocesium crop concentrations for areas affected by the Fukushima accident. PMID:21608116

  5. Vulnerability to coastal cholera ecology.

    PubMed

    Collins, Andrew E

    2003-10-01

    The battle to completely control cholera continues. Multiple strains, high levels of morbidity in some regions of the world, and a complex of influences on its distribution in people and the environment are accompanied by only rough resolution prediction of outbreaks. Uncertainty as to the most effective array of interventions for one of the most researched infectious diseases thwarts further progress in providing cost-effective solutions. Progress on the research front consistently points towards the importance of disease ecology, coastal environments, and the sea. However, evaluation of the link between cholera in people and environment can only be effective with analysis of human vulnerability to variable coastal cholera ecologies. As there are some clear links between the organism, cholera incidence and the sea, it is appropriate that cholera research should examine the nature of coastal population vulnerability to the disease. The paper reviews the cholera risks of human-environment interactions in coastal areas as one component of the evaluation of cholera management. This points to effective intervention through integrative knowledge of changing human and environmental ecologies, requiring improved detection, but also an acceptance of complex causality. The challenge is to identify indicators and interventions for case specific ecologies in variable locales of human vulnerability and disease hazard. Further work will therefore aim to explore improved surveillance and intervention across the socio-behavioural and ecological spectrum. Furthermore, the story of cholera continues to inform us about how we should more effectively view emergent and resurgent infectious disease hazards more generally. PMID:12927470

  6. Measuring vulnerability to disaster displacement

    NASA Astrophysics Data System (ADS)

    Brink, Susan A.; Khazai, Bijan; Power, Christopher; Wenzel, Friedemann

    2015-04-01

    Large scale disasters can cause devastating impacts in terms of population displacement. Between 2008 and 2013, on average 27 million people were displaced annually by disasters (Yonetani 2014). After large events such as hurricane Katrina or the Port-au-Prince earthquake, images of inadequate public shelter and concerns about large scale and often inequitable migration have been broadcast around the world. Population displacement can often be one of the most devastating and visible impacts of a natural disaster. Despite the importance of population displacement in disaster events, measures to understand the socio-economic vulnerability of a community often use broad metrics to estimate the total socio-economic risk of an event rather than focusing on the specific impacts that a community faces in a disaster. Population displacement is complex and multi-causal with the physical impact of a disaster interacting with vulnerability arising from the response, environmental issues (e.g., weather), cultural concerns (e.g., expectations of adequate shelter), and many individual factors (e.g., mobility, risk perception). In addition to the complexity of the causes, population displacement is difficult to measure because of the wide variety of different terms and definitions and its multi-dimensional nature. When we speak of severe population displacement, we may refer to a large number of displaced people, an extended length of displacement or associated difficulties such as poor shelter quality, risk of violence and crime in shelter communities, discrimination in aid, a lack of access to employment or other difficulties that can be associated with large scale population displacement. We have completed a thorough review of the literature on disaster population displacement. Research has been conducted on historic events to understand the types of negative impacts associated with population displacement and also the vulnerability of different groups to these impacts. We

  7. Patterns of Freshwater Species Richness, Endemism, and Vulnerability in California.

    PubMed

    Howard, Jeanette K; Klausmeyer, Kirk R; Fesenmyer, Kurt A; Furnish, Joseph; Gardali, Thomas; Grantham, Ted; Katz, Jacob V E; Kupferberg, Sarah; McIntyre, Patrick; Moyle, Peter B; Ode, Peter R; Peek, Ryan; Quiñones, Rebecca M; Rehn, Andrew C; Santos, Nick; Schoenig, Steve; Serpa, Larry; Shedd, Jackson D; Slusark, Joe; Viers, Joshua H; Wright, Amber; Morrison, Scott A

    2015-01-01

    The ranges and abundances of species that depend on freshwater habitats are declining worldwide. Efforts to counteract those trends are often hampered by a lack of information about species distribution and conservation status and are often strongly biased toward a few well-studied groups. We identified the 3,906 vascular plants, macroinvertebrates, and vertebrates native to California, USA, that depend on fresh water for at least one stage of their life history. We evaluated the conservation status for these taxa using existing government and non-governmental organization assessments (e.g., endangered species act, NatureServe), created a spatial database of locality observations or distribution information from ~400 data sources, and mapped patterns of richness, endemism, and vulnerability. Although nearly half of all taxa with conservation status (n = 1,939) are vulnerable to extinction, only 114 (6%) of those vulnerable taxa have a legal mandate for protection in the form of formal inclusion on a state or federal endangered species list. Endemic taxa are at greater risk than non-endemics, with 90% of the 927 endemic taxa vulnerable to extinction. Records with spatial data were available for a total of 2,276 species (61%). The patterns of species richness differ depending on the taxonomic group analyzed, but are similar across taxonomic level. No particular taxonomic group represents an umbrella for all species, but hotspots of high richness for listed species cover 40% of the hotspots for all other species and 58% of the hotspots for vulnerable freshwater species. By mapping freshwater species hotspots we show locations that represent the top priority for conservation action in the state. This study identifies opportunities to fill gaps in the evaluation of conservation status for freshwater taxa in California, to address the lack of occurrence information for nearly 40% of freshwater taxa and nearly 40% of watersheds in the state, and to implement adequate

  8. Patterns of Freshwater Species Richness, Endemism, and Vulnerability in California

    PubMed Central

    Furnish, Joseph; Gardali, Thomas; Grantham, Ted; Katz, Jacob V. E.; Kupferberg, Sarah; McIntyre, Patrick; Moyle, Peter B.; Ode, Peter R.; Peek, Ryan; Quiñones, Rebecca M.; Rehn, Andrew C.; Santos, Nick; Schoenig, Steve; Serpa, Larry; Shedd, Jackson D.; Slusark, Joe; Viers, Joshua H.; Wright, Amber; Morrison, Scott A.

    2015-01-01

    The ranges and abundances of species that depend on freshwater habitats are declining worldwide. Efforts to counteract those trends are often hampered by a lack of information about species distribution and conservation status and are often strongly biased toward a few well-studied groups. We identified the 3,906 vascular plants, macroinvertebrates, and vertebrates native to California, USA, that depend on fresh water for at least one stage of their life history. We evaluated the conservation status for these taxa using existing government and non-governmental organization assessments (e.g., endangered species act, NatureServe), created a spatial database of locality observations or distribution information from ~400 data sources, and mapped patterns of richness, endemism, and vulnerability. Although nearly half of all taxa with conservation status (n = 1,939) are vulnerable to extinction, only 114 (6%) of those vulnerable taxa have a legal mandate for protection in the form of formal inclusion on a state or federal endangered species list. Endemic taxa are at greater risk than non-endemics, with 90% of the 927 endemic taxa vulnerable to extinction. Records with spatial data were available for a total of 2,276 species (61%). The patterns of species richness differ depending on the taxonomic group analyzed, but are similar across taxonomic level. No particular taxonomic group represents an umbrella for all species, but hotspots of high richness for listed species cover 40% of the hotspots for all other species and 58% of the hotspots for vulnerable freshwater species. By mapping freshwater species hotspots we show locations that represent the top priority for conservation action in the state. This study identifies opportunities to fill gaps in the evaluation of conservation status for freshwater taxa in California, to address the lack of occurrence information for nearly 40% of freshwater taxa and nearly 40% of watersheds in the state, and to implement adequate

  9. Acquaintance molestation and youth-serving organizations.

    PubMed

    Lanning, Kenneth V; Dietz, Park

    2014-10-01

    This article is based not only on the research literature but also on the extensive field experience of the authors in consulting with investigators, attorneys, and organizations on the prevention, investigation, prosecution, and civil litigation of molestation of children within or in connection with youth-serving organizations. Acquaintance molesters have often pursued careers or sought out paid or volunteer work with organizations through which they can meet children. To address the problem of such offenders, it is necessary for youth-serving organizations to recognize the diversity of sexual activity, the phenomena of "nice-guy" offenders and compliant child victims, and the grooming/seduction process, each of which is reviewed here. The four most important protection practices for organizations are screening; management, and supervision; response to suspicions, allegations, and complaints; and prevention and awareness programs. The authors recommend general approaches to each of these and describe the reasons many organizations resist implementing available preventive measures. PMID:24860081

  10. Minority-Serving Institutions of Higher Education: Serving Communities, Revitalizing the Nation

    ERIC Educational Resources Information Center

    US Department of Housing and Urban Development, 2009

    2009-01-01

    Institutions of higher education (IHEs) that serve minority populations are unique both in their missions and in their day-to-day operations. Some of these colleges and universities are located in remote regions of the country, while others serve congested urban neighborhoods. Their constituents range from Native Americans, the country's oldest…

  11. Culturally Relevant Practices That "Serve" Students at a Hispanic Serving Institution

    ERIC Educational Resources Information Center

    Garcia, Gina A.; Okhidoi, Otgonjargal

    2015-01-01

    As institutions not founded to "serve" Latina/o students, Hispanic Serving Institutions (HSIs) must actively change their curricula and programs to meet the needs of their diverse population, including Latina/o, low income, and first generation students. Using a case study approach, including interviews and focus groups, this study…

  12. Emerging Hispanic-Serving Institutions (HSIs): Serving Latino Students. Executive Summary

    ERIC Educational Resources Information Center

    Excelencia in Education (NJ1), 2010

    2010-01-01

    The invention of Hispanic-serving Institutions (HSIs) in the 1980s was grounded in the theory that institutions enrolling a large concentration of Latino students would adapt their institutional practices to serve these students better. Specifically, critical mass theory suggests once a definable group reaches a certain size within an…

  13. Equipment for Hot-to-serve Foods

    NASA Technical Reports Server (NTRS)

    Smith, D. P.

    1985-01-01

    Patented surface heating devices with a much faster air-to-solid heat transfer rate than previous air ovens were developed. The accelerated surface heating can brown, sear or crisp much more rapidly than in conventional ovens so that partially prepared food can be finished quickly and tastefully immediately before serving. The crisp, freshly browned surfaces result from the faster heat transfer which does not dry out the food. The devices are then compared to convection ovens and microwave heating processes.

  14. NASA Goddard and Minority Serving Institutions

    NASA Astrophysics Data System (ADS)

    Nall, J.

    2005-12-01

    NASA's Goddard Space Flight Center has worked closely with Minority Serving Institutions for many years. The presenter will detail specific approaches with selected institutions, or types of colleges to offer what has worked, and what has not, methodologies employed to engage students and faculty in our programs, and how such program development and collaboration have proven mutually beneficial. An interactive session with the audience will seek to encourage partnership connections at the conference.

  15. The Spitzer Extragalactic Representative Volume Survey (SERVS)

    NASA Astrophysics Data System (ADS)

    Mauduit, Jean-Christophe; Lacy, M.; Farrah, D.; Surace, J.; Jarvis, M.; Oliver, S.; Maraston, C.; SERVS Team

    2012-01-01

    We present details of the Spitzer Extragalactic Representative Volume Survey (SERVS), an 18 square degrees medium-deep survey at 3.6 and 4.5 μm with the post-cryogenic Spitzer Space Telescope to ≈ 2 μJy (AB=23.1) depth of five highly observed astronomical fields (Elais-N1, Elais-S1, Lockman Hole, Chandra-Deep Fied South and XMM). Data will be made available to the community in the Spring of 2012. SERVS is designed to enable the study of galaxy evolution as a function of environment from z ≈ 5 to the present day, and is the first extragalactic survey both large enough and deep enough to put rare objects such as luminous quasars and galaxy clusters at z ≥ 1 into their cosmological context. SERVS is designed to overlap with several key surveys at optical, near- through far-infrared, submillimeter and radio wavelengths to provide a coherent picture of the formation of massive galaxies.

  16. A Peer-to-Peer Health Education Program for Vulnerable Children in Uganda

    ERIC Educational Resources Information Center

    Falk, Diane S.; Pettet, Kristen; Mpagi, Charles

    2016-01-01

    In this paper, children attending a U.S.-sponsored private primary school serving orphaned and vulnerable children in Uganda were interviewed in focus groups about their participation in a peer-to-peer health education program in which they used music, dance, poetry, art, and drama to convey health information. The children reported enhanced…

  17. Vulnerability Assessment of Selected Buildings Designated as Shelters: St. Kitts--Nevis.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on St. Kitts and Nevis to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with…

  18. Vulnerability Assessment of Selected Buildings Designated as Shelters: Antigua and Barbuda.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on Antigua and Barbuda to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with…

  19. Integrated Estimation of Seismic Physical Vulnerability of Tehran Using Rule Based Granular Computing

    NASA Astrophysics Data System (ADS)

    Sheikhian, H.; Delavar, M. R.; Stein, A.

    2015-08-01

    Tehran, the capital of Iran, is surrounded by the North Tehran fault, the Mosha fault and the Rey fault. This exposes the city to possibly huge earthquakes followed by dramatic human loss and physical damage, in particular as it contains a large number of non-standard constructions and aged buildings. Estimation of the likely consequences of an earthquake facilitates mitigation of these losses. Mitigation of the earthquake fatalities may be achieved by promoting awareness of earthquake vulnerability and implementation of seismic vulnerability reduction measures. In this research, granular computing using generality and absolute support for rule extraction is applied. It uses coverage and entropy for rule prioritization. These rules are combined to form a granule tree that shows the order and relation of the extracted rules. In this way the seismic physical vulnerability is assessed, integrating the effects of the three major known faults. Effective parameters considered in the physical seismic vulnerability assessment are slope, seismic intensity, height and age of the buildings. Experts were asked to predict seismic vulnerability for 100 randomly selected samples among more than 3000 statistical units in Tehran. The integrated experts' point of views serve as input into granular computing. Non-redundant covering rules preserve the consistency in the model, which resulted in 84% accuracy in the seismic vulnerability assessment based on the validation of the predicted test data against expected vulnerability degree. The study concluded that granular computing is a useful method to assess the effects of earthquakes in an earthquake prone area.

  20. Mountain torrents: Quantifying vulnerability and assessing uncertainties

    PubMed Central

    Totschnig, Reinhold; Fuchs, Sven

    2013-01-01

    Vulnerability assessment for elements at risk is an important component in the framework of risk assessment. The vulnerability of buildings affected by torrent processes can be quantified by vulnerability functions that express a mathematical relationship between the degree of loss of individual elements at risk and the intensity of the impacting process. Based on data from the Austrian Alps, we extended a vulnerability curve for residential buildings affected by fluvial sediment transport processes to other torrent processes and other building types. With respect to this goal to merge different data based on different processes and building types, several statistical tests were conducted. The calculation of vulnerability functions was based on a nonlinear regression approach applying cumulative distribution functions. The results suggest that there is no need to distinguish between different sediment-laden torrent processes when assessing vulnerability of residential buildings towards torrent processes. The final vulnerability functions were further validated with data from the Italian Alps and different vulnerability functions presented in the literature. This comparison showed the wider applicability of the derived vulnerability functions. The uncertainty inherent to regression functions was quantified by the calculation of confidence bands. The derived vulnerability functions may be applied within the framework of risk management for mountain hazards within the European Alps. The method is transferable to other mountain regions if the input data needed are available. PMID:27087696

  1. Skylab Food Heating and Serving Tray

    NASA Technical Reports Server (NTRS)

    1970-01-01

    Shown here is the Skylab food heating and serving tray with food, drink, and utensils. The tray contained heating elements for preparing the individual food packets. The food on Skylab was a great improvement over that on earlier spaceflights. It was no longer necessary to squeeze liquified food from plastic tubes. Skylab's kitchen in the Orbital Workshop wardroom was so equipped that each crewman could select his own menu and prepare it to his own taste. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

  2. Vulnerability of network of networks

    NASA Astrophysics Data System (ADS)

    Havlin, S.; Kenett, D. Y.; Bashan, A.; Gao, J.; Stanley, H. E.

    2014-10-01

    Our dependence on networks - be they infrastructure, economic, social or others - leaves us prone to crises caused by the vulnerabilities of these networks. There is a great need to develop new methods to protect infrastructure networks and prevent cascade of failures (especially in cases of coupled networks). Terrorist attacks on transportation networks have traumatized modern societies. With a single blast, it has become possible to paralyze airline traffic, electric power supply, ground transportation or Internet communication. How, and at which cost can one restructure the network such that it will become more robust against malicious attacks? The gradual increase in attacks on the networks society depends on - Internet, mobile phone, transportation, air travel, banking, etc. - emphasize the need to develop new strategies to protect and defend these crucial networks of communication and infrastructure networks. One example is the threat of liquid explosives a few years ago, which completely shut down air travel for days, and has created extreme changes in regulations. Such threats and dangers warrant the need for new tools and strategies to defend critical infrastructure. In this paper we review recent advances in the theoretical understanding of the vulnerabilities of interdependent networks with and without spatial embedding, attack strategies and their affect on such networks of networks as well as recently developed strategies to optimize and repair failures caused by such attacks.

  3. Scenarios for coastal vulnerability assessment

    USGS Publications Warehouse

    Nicholls, Robert J.; Woodroffe, Colin D.; Burkett, Virginia; Hay, John; Wong, Poh Poh; Nurse, Leonard

    2011-01-01

    Coastal vulnerability assessments tend to focus mainly on climate change and especially on sea-level rise. Assessment of the influence of nonclimatic environmental change or socioeconomic change is less well developed and these drivers are often completely ignored. Given that the most profound coastal changes of the twentieth century due to nonclimate drivers are likely to continue through the twenty-first century, this is a major omission. It may result in not only overstating the importance of climate change but also overlooking significant interactions of climate change and other drivers. To support the development of policies relating to climate change and coastal management, integrated assessments of climatic change in coastal areas are required, including the effects of all the relevant drivers. This chapter explores the development of scenarios (or "plausible futures") of relevant climate and nonclimate drivers that can be used for coastal analysis, with an emphasis on the nonclimate drivers. It shows the importance of analyzing the impacts of climate change and sea-level rise in a broader context of coastal change and all its drivers. This will improve the analysis of impacts, key vulnerabilities, and adaptation needs and, hence, inform climate and coastal policy. Stakeholder engagement is important in the development of scenarios, and the underlying assumptions need to be explicit, transparent, and open to scientific debate concerning their uncertainties/realism and likelihood.

  4. [Genetic vulnerability of methamphetamine dependence].

    PubMed

    Moriya, Yuki; Kasahara, Yoshiyuki; Sora, Ichiro

    2013-08-01

    Methamphetamine (METH) dependence show strong familial and genetic influences in family and twin studies. METH exerts its reinforcing effects by modulating monoaminergic transmission, of which dopamine is supposed to be important. Previously, experimental animals were being used to identify mechanisms of action of METH that are related to its abuse and toxicity, and genetic mouse models have also been used to define genes that may predict risk for the development of drug addiction. We found that genetic variances of dopamine transporter, dopamine receptor, micro-opioid receptor, serotonin 1A receptor, serotonin 6 receptor, and adenosine 2A adenosine receptor could be vulnerability factors for METH dependence or psychosis in the Japanese population. Genetic analysis with a genome-wide association study (GWAS)-based approach has been successful for investigating the genetic influences of METH dependence and other complex features. Collaborative studies with JGIDA and NIDA/NIH have obtained the results that the genetic vulnerability to METH dependence contributes to other major drug addiction. The genetic studies for METH dependence might help to identify the risk of individuals and to develop treatments that take advantage of individual genetic information in the future. PMID:25069251

  5. An Eliminativist Approach to Vulnerability.

    PubMed

    Wrigley, Anthony

    2015-09-01

    The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysis and satisfactory definition leaves the concept open to an eliminativist move whereby we can question whether we need the concept at all. I highlight problems with various kinds of approach and explain why a satisfactory account of vulnerability is unlikely ever to be offered if we wish the concept to play a genuinely explanatory role in bioethical contexts. I outline why an eliminativist position should be taken with regard to this concept in light of these concerns but mitigate some of the severity of this position by arguing that we can still make sense of retaining our widespread use of the term by viewing it as nothing more than a useful pragmatic linguistic device that acts as a marker to draw attention to certain kinds of issue. These issues will be entirely governed by other, better understood ethical concepts and theories. PMID:25425540

  6. Dynamics of immune system vulnerabilities

    NASA Astrophysics Data System (ADS)

    Stromberg, Sean P.

    The adaptive immune system can be viewed as a complex system, which adapts, over time, to reflect the history of infections experienced by the organism. Understanding its operation requires viewing it in terms of tradeoffs under constraints and evolutionary history. It typically displays "robust, yet fragile" behavior, meaning common tasks are robust to small changes but novel threats or changes in environment can have dire consequences. In this dissertation we use mechanistic models to study several biological processes: the immune response, the homeostasis of cells in the lymphatic system, and the process that normally prevents autoreactive cells from entering the lymphatic system. Using these models we then study the effects of these processes interacting. We show that the mechanisms that regulate the numbers of cells in the immune system, in conjunction with the immune response, can act to suppress autoreactive cells from proliferating, thus showing quantitatively how pathogenic infections can suppress autoimmune disease. We also show that over long periods of time this same effect can thin the repertoire of cells that defend against novel threats, leading to an age correlated vulnerability. This vulnerability is shown to be a consequence of system dynamics, not due to degradation of immune system components with age. Finally, modeling a specific tolerance mechanism that normally prevents autoimmune disease, in conjunction with models of the immune response and homeostasis we look at the consequences of the immune system mistakenly incorporating pathogenic molecules into its tolerizing mechanisms. The signature of this dynamic matches closely that of the dengue virus system.

  7. Metadata for selecting or submitting generic seismic vulnerability functions via GEM's vulnerability database

    USGS Publications Warehouse

    Jaiswal, Kishor

    2013-01-01

    This memo lays out a procedure for the GEM software to offer an available vulnerability function for any acceptable set of attributes that the user specifies for a particular building category. The memo also provides general guidelines on how to submit the vulnerability or fragility functions to the GEM vulnerability repository, stipulating which attributes modelers must provide so that their vulnerability or fragility functions can be queried appropriately by the vulnerability database. An important objective is to provide users guidance on limitations and applicability by providing the associated modeling assumptions and applicability of each vulnerability or fragility function.

  8. An holistic view on aquifer vulnerability based on a distinction of different types of vulnerability

    NASA Astrophysics Data System (ADS)

    De Luca, Domenico Antonio; Lasagna, Manuela; Franchino, Elisa

    2016-04-01

    AN HOLISTIC VIEW ON AQUIFER VULNERABILITY BASED ON A DISTINCTION OF DIFFERENT TYPES OF VULNERABILITY D.A. De Luca1 , M. Lasagna1, E. Franchino1 1Department of Earth Sciences, University of Turin The concept of vulnerability is certainly useful in the field of groundwater protection. Nevertheless, within the scientific community, the definition of groundwater vulnerability is still debatable and not clear and conclusive. This is probably due to the fact that researchers often have very different experiences and education. A positive effect of it is a constant exchange of ideas, but there are also negative consequences and difficulties in deepening the issue. The different approaches are very important but they are usable only if the concept of vulnerability is standardized: thus, for the sake of clarity, a number of definitions should be laid down, based on the different types of vulnerability. These definitions can then provide the necessary holistic view for the aquifer vulnerability assessment. Nowadays vulnerability methods focus on the degree of vulnerability and the parameters needed for its evaluation, often neglecting to clarify what is the type of vulnerability the proposed methods are referred. The type of vulnerability, indeed, is both logically and hierarchically superior to the degree of vulnerability. More specifically the type of vulnerability represents the evaluation of the hydrogeological conditions considered in the vulnerability assessment and able to influence the way in which the contamination can take place. Currently the only distinction, based on of the type of vulnerability, is referred to intrinsic and specific vulnerability. Intrinsic vulnerability assesses the susceptibility of the receptor based on the natural properties of the land and subsurface; specific vulnerability also includes properties of the analyzed contaminant. This distinction is useful but not exhaustive. In addition to this, e.g., a distinction of vertical vulnerability

  9. Assessing human vulnerability: Daytime residential distribution as a vulnerability indicator

    NASA Astrophysics Data System (ADS)

    Gokesch, Karin; Promper, Catrin; Papathoma-Köhle, Maria; Glade, Thomas

    2014-05-01

    Natural hazard risk management is based on detailed information on potential impacts of natural hazards. Especially concerning fast onset hazards such as flash floods, earthquakes but also debris flows and landslides, knowing potential hotspots of impact to both, assets and human lives is essential. This information is important for emergency management and decision making in the response phase of the disaster management cycle. Emergency managers are in need of information regarding not only the number of humans being potentially affected but also the respective vulnerability of the group affected based on characteristics such as age, income, health condition, mobility, etc. regarding a certain hazard. The analysis presented focuses on the distribution of the population, assuming a certain pattern of people in a certain radius of action. The method applied is based on a regular pattern of movement of different groups of people and a pattern of presence in certain units, e.g. schools, businesses or residential buildings. The distribution is calculated on a minimum of available data including the average household size, as well as information on building types. The study area is located in the Southwest of Lower Austria, Austria. The city of Waidhofen/Ybbs can be regarded as a regional center providing basic infrastructure, shops and schools. The high concentration of buildings combining shops and residential units leads to a high damage potential throughout the whole study area. The presented results indicate the population distribution within the study area on an average working day. It is clear that explicitly high numbers of people are located in specific buildings (e.g. schools and hospitals) which also include highly vulnerable groups especially to fast onset hazards. The results provide emergency services with the information that they need in order to intervene directly where large numbers of victims or people that need to be evacuated are located. In this

  10. Assessing the security vulnerabilities of correctional facilities

    NASA Astrophysics Data System (ADS)

    Spencer, Debra D.; Morrison, G. Steve

    1998-12-01

    The National Institute of Justice has tasked their satellite facility at Sandia National Laboratories and their Southeast Regional Technology Center in Charleston, South Carolina to devise new procedures and tools for helping correctional facilities to assess their security vulnerabilities. Thus, a team is visiting selected correctional facilities and performing vulnerability assessments. A vulnerability assessment helps identify the easiest paths for inmate escape, for introduction of contraband such as drugs or weapons, for unexpected intrusion from outside of the facility, and for the perpetration of violent acts on other inmates and correctional employees. In addition, the vulnerability assessment helps to quantify the security risks for the facility. From these assessments will come better procedures for performing vulnerability assessments in general at other correctional facilities, as well as the development of tools to assist with the performance of such vulnerability assessments.

  11. Assessing the Security Vulnerabilities of Correctional Facilities

    SciTech Connect

    Morrison, G.S.; Spencer, D.S.

    1998-10-27

    The National Institute of Justice has tasked their Satellite Facility at Sandia National Laboratories and their Southeast Regional Technology Center in Charleston, South Carolina to devise new procedures and tools for helping correctional facilities to assess their security vulnerabilities. Thus, a team is visiting selected correctional facilities and performing vulnerability assessments. A vulnerability assessment helps to identi~ the easiest paths for inmate escape, for introduction of contraband such as drugs or weapons, for unexpected intrusion fi-om outside of the facility, and for the perpetration of violent acts on other inmates and correctional employees, In addition, the vulnerability assessment helps to quantify the security risks for the facility. From these initial assessments will come better procedures for performing vulnerability assessments in general at other correctional facilities, as well as the development of tools to assist with the performance of such vulnerability assessments.

  12. NV: Nessus Vulnerability Visualization for the Web

    SciTech Connect

    Harrison, Lane; Spahn, Riley B; Iannacone, Michael D; Downing, Evan P; Goodall, John R

    2012-01-01

    Network vulnerability is a critical component of network se- curity. Yet vulnerability analysis has received relatively lit- tle attention from the security visualization community. In this paper we describe nv, a web-based Nessus vulnerability visualization. Nv utilizes treemaps and linked histograms to allow system administrators to discover, analyze, and man- age vulnerabilities on their networks. In addition to visual- izing single Nessus scans, nv supports the analysis of sequen- tial scans by showing which vulnerabilities have been fixed, remain open, or are newly discovered. Nv was also designed to operate completely in-browser, to avoid sending sensitive data to outside servers. We discuss the design of nv, as well as provide case studies demonstrating vulnerability analysis workflows which include a multiple-node testbed and data from the 2011 VAST Challenge.

  13. Measuring and incorporating vulnerability into conservation planning.

    PubMed

    Wilson, Kerrie; Pressey, Robert L; Newton, Adrian; Burgman, Mark; Possingham, Hugh; Weston, Chris

    2005-05-01

    Conservation planning is the process of locating and designing conservation areas to promote the persistence of biodiversity in situ. To do this, conservation areas must be able to mitigate at least some of the proximate threats to biodiversity. Information on threatening processes and the relative vulnerability of areas and natural features to these processes is therefore crucial for effective conservation planning. However, measuring and incorporating vulnerability into conservation planning have been problematic. We develop a conceptual framework of the role of vulnerability assessments in conservation planning and propose a definition of vulnerability that incorporates three dimensions: exposure, intensity, and impact. We review and categorize methods for assessing the vulnerability of areas and the features they contain and identify the relative strengths and weaknesses of each broad approach. Our review highlights the need for further development and evaluation of approaches to assess vulnerability and for comparisons of their relative effectiveness. PMID:15920667

  14. Mining Bug Databases for Unidentified Software Vulnerabilities

    SciTech Connect

    Dumidu Wijayasekara; Milos Manic; Jason Wright; Miles McQueen

    2012-06-01

    Identifying software vulnerabilities is becoming more important as critical and sensitive systems increasingly rely on complex software systems. It has been suggested in previous work that some bugs are only identified as vulnerabilities long after the bug has been made public. These vulnerabilities are known as hidden impact vulnerabilities. This paper discusses the feasibility and necessity to mine common publicly available bug databases for vulnerabilities that are yet to be identified. We present bug database analysis of two well known and frequently used software packages, namely Linux kernel and MySQL. It is shown that for both Linux and MySQL, a significant portion of vulnerabilities that were discovered for the time period from January 2006 to April 2011 were hidden impact vulnerabilities. It is also shown that the percentage of hidden impact vulnerabilities has increased in the last two years, for both software packages. We then propose an improved hidden impact vulnerability identification methodology based on text mining bug databases, and conclude by discussing a few potential problems faced by such a classifier.

  15. Vulnerabilities of children admitted to a pediatric inpatient care unit☆

    PubMed Central

    de Oliveira, Larissa Natacha; Breigeiron, Márcia Koja; Hallmann, Sofia; Witkowski, Maria Carolina

    2014-01-01

    OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital. METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients, records, and analyzed by descriptive statistics. RESULTS: Of the total sample, 97.1% (n=132) of children had at least one type of vulnerability, the majority related to the caregiver's level of education, followed by caregiver's financial situation, health history of the child, caregiver's family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, family's living conditions, caregiver's schooling, and bonding between the caregiver and the child. Only 2.9% (n=4) of the children did not show any criteria to be classified in a category of vulnerability. CONCLUSIONS: Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family. PMID:25511001

  16. Proposal of a Mediterranean Diet Serving Score

    PubMed Central

    Monteagudo, Celia; Mariscal-Arcas, Miguel; Rivas, Ana; Lorenzo-Tovar, María Luisa; Tur, Josep A.; Olea-Serrano, Fátima

    2015-01-01

    Background and Aims Numerous studies have demonstrated a relationship between Mediterranean Diet (MD) adherence and the prevention of cardiovascular diseases, cancer, and diabetes, etc. The study aim was to validate a novel instrument to measure MD adherence based on the consumption of food servings and food groups, and apply it in a female population from southern Spain and determining influential factors. Methods and Results The study included 1,155 women aged 12-83 yrs, classified as adolescents, adults, and over-60-yr-olds. All completed a validated semi-quantitative food frequency questionnaire (FFQ). The Mediterranean Dietary Serving Score (MDSS) is based on the latest update of the Mediterranean Diet Pyramid, using the recommended consumption frequency of foods and food groups; the MDSS ranges from 0 to 24. The discriminative power or correct subject classification capacity of the MDSS was analyzed with the Receiver Operating Characteristic (ROC) curve, using the MDS as reference method. Predictive factors for higher MDSS adherence were determined with a logistic regression model, adjusting for age. According to ROC curve analysis, MDSS evidenced a significant discriminative capacity between adherents and non-adherents to the MD pattern (optimal cutoff point=13.50; sensitivity=74%; specificity=48%). The mean MDSS was 12.45 (2.69) and was significantly higher with older age (p<0.001). Logistic regression analysis showed highest MD adherence by over 60-year-olds with low BMI and no habit of eating between meals. Conclusions The MDSS is an updated, easy, valid, and accurate instrument to assess MD adherence based on the consumption of foods and food groups per meal, day, and week. It may be useful in future nutritional education programs to prevent the early onset of chronic non-transmittable diseases in younger populations. PMID:26035442

  17. Saudis awaken to their vulnerability

    SciTech Connect

    Tinnin, D.B.

    1980-03-10

    Saudi Arabia is becoming aware that it is vulnerable to internal and external pressures which threaten its security. The strains of rapid modernization and threats from hostile neighbors are undermining the consensus which has held the widely diverse country together in a system of open communication. Influence by the Bedouin (ruling) and the ulama (religious) groups has predominated a traditional society determined to modernize and still remain conservative. Members of the ruling class are seeking to profit from the modernization process, but the common Saudi resists becoming an industrial laborer. Recent events in Mecca, Afghanistan and elsewhere illustrate how political pressures are affecting the country's leadership in the threat of armed conflicts over its oil supplies. (DCK)

  18. Proliferation Vulnerability Red Team report

    SciTech Connect

    Hinton, J.P.; Barnard, R.W.; Bennett, D.E.

    1996-10-01

    This report is the product of a four-month independent technical assessment of potential proliferation vulnerabilities associated with the plutonium disposition alternatives currently under review by DOE/MD. The scope of this MD-chartered/Sandia-led study was limited to technical considerations that could reduce proliferation resistance during various stages of the disposition processes below the Stored Weapon/Spent Fuel standards. Both overt and covert threats from host nation and unauthorized parties were considered. The results of this study will be integrated with complementary work by others into an overall Nonproliferation and Arms Control Assessment in support of a Secretarial Record of Decision later this year for disposition of surplus U.S. weapons plutonium.

  19. Attack Vulnerability of Network Controllability.

    PubMed

    Lu, Zhe-Ming; Li, Xin-Feng

    2016-01-01

    Controllability of complex networks has attracted much attention, and understanding the robustness of network controllability against potential attacks and failures is of practical significance. In this paper, we systematically investigate the attack vulnerability of network controllability for the canonical model networks as well as the real-world networks subject to attacks on nodes and edges. The attack strategies are selected based on degree and betweenness centralities calculated for either the initial network or the current network during the removal, among which random failure is as a comparison. It is found that the node-based strategies are often more harmful to the network controllability than the edge-based ones, and so are the recalculated strategies than their counterparts. The Barabási-Albert scale-free model, which has a highly biased structure, proves to be the most vulnerable of the tested model networks. In contrast, the Erdős-Rényi random model, which lacks structural bias, exhibits much better robustness to both node-based and edge-based attacks. We also survey the control robustness of 25 real-world networks, and the numerical results show that most real networks are control robust to random node failures, which has not been observed in the model networks. And the recalculated betweenness-based strategy is the most efficient way to harm the controllability of real-world networks. Besides, we find that the edge degree is not a good quantity to measure the importance of an edge in terms of network controllability. PMID:27588941

  20. Le Bistro serves up cultural change.

    PubMed

    Leggitt, Mark S; Potrepka, Virginia N; Kukolja, Teresa J

    2003-01-01

    Bristol Hospital, a 134-bed community health care system in Connecticut, has consistently been nationally ranked in the top tier of hospitals for its patient satisfaction scores. A key to this long-term distinction has been its commitment to a culture built around patient satisfaction and service excellence. Empowerment, vigilance, recognition, and celebration are the cultural cornerstones. The change has enabled the hospital to increase its market share, increase its satisfaction rankings, increase its employee retention, and enjoy consistent financial success. PMID:14649023

  1. Ultrasound-guided imaging of junctional adhesion molecule-A-targeted microbubbles identifies vulnerable plaque in rabbits.

    PubMed

    Zhang, Ya-Jun; Bai, Dan-Na; Du, Jing-Xi; Jin, Liang; Ma, Jing; Yang, Jia-Lei; Cai, Wen-Bin; Feng, Yang; Xing, Chang-Yang; Yuan, Li-Jun; Duan, Yun-You

    2016-07-01

    Identification of vulnerable atherosclerotic plaques by imaging the molecular characteristics is intensively studied recently, in which verification of specific markers is the critical step. JAM-A, a junctional membrane protein, is involved in the plaque formation, while it is unknown whether it can serve as a marker for vulnerable plaques. Vulnerable and stable plaques were created in rabbits with high cholesterol diet with or without partial ligation of carotid artery respectively. Significant higher JAM-A expression was found in vulnerable plaques than that in stable plaques. Furthermore, JAM-A was not only expressed in the endothelium, but also abundantly expressed in CD68-positive area. Next, JAM-A antibody conjugated microbubbles (MBJAM-A) or control IgG-conjugated microbubbles (MBC) were developed by conjugating the biotinylated antibodies to the streptavidin modified microbubbles, and visualization by contrast-enhance ultrasound (CEUS). Signal intensity of MBJAM-A was substantially enhanced and prolonged in the vulnerable plaque and some of the MBJAM-A was found colocalized with CD68 positive macrophages. In addition, cell model revealed that MBJAM-A were able to be phagocytized by activated macrophages. Taken together, we have found that increase of JAM-A serves as a marker for vulnerable plaques and targeted CEUS would be possibly a novel non-invasive molecular imaging method for plaque vulnerability. PMID:27088407

  2. Vulnerable Youth and Transitions to Adulthood

    ERIC Educational Resources Information Center

    Xie, Rongbing; Sen, Bisakha; Foster, E. Michael

    2014-01-01

    This chapter focuses on vulnerable youth, the challenges they face during their transitions to adulthood, and the adverse effects of limited support systems on those transitions. The authors offer recommendations on how adult educators can help facilitate smooth transitions into adulthood for vulnerable youth.

  3. Predicting Vulnerability Risks Using Software Characteristics

    ERIC Educational Resources Information Center

    Roumani, Yaman

    2012-01-01

    Software vulnerabilities have been regarded as one of the key reasons for computer security breaches that have resulted in billions of dollars in losses per year (Telang and Wattal 2005). With the growth of the software industry and the Internet, the number of vulnerability attacks and the ease with which an attack can be made have increased. From…

  4. Design Vulnerability Assessments for Safeguards Sealing Systems

    SciTech Connect

    Brockman, Linda; Johnston, Roger; Kravtchenko, Victor; Undem, Halvor A.; Wishard, Bernard

    2010-08-11

    The International Atomic Energy Agency (the "Agency") engages in a rigorous equipment authorization process prior to deploying Safeguards instrumentation, including Safeguards sealing systems, for world-wide use. A positive result from a vulnerability assessment is one of the many requirements that must be met prior to instrumentation deployment. Given the long time period in the Safeguards instrumentation development cycle, the substantial Member State investments made, and the significant Agency staff time required, a negative result for the vulnerability assessment can result in the loss of time, considerable additional expense, or even the failure to deploy an instrument or sealing system at all. First suggested in 1998 by the General Physics Institute in Moscow, an approach that incorporates a design vulnerability assessment minimizes the risk of deployment failure by teaming a public sector vulnerability assessment team with the instrument or sealing system design team in order to identify, at the earliest possible design stage, inherent vulnerabilities. Involving the vulnerability assessors early and often in the design and development process avoids many of the problems inherent in evaluating security vulnerabilities only after the design is finalized. The disadvantages include increased costs and time to deployment. An improved pressure-sensitive adhesive label seal, called the "VOID-3 seal" was developed for the Agency using this design vulnerability assessment process.

  5. [Medical research and vulnerable subjects: unemployed people].

    PubMed

    Niebrój, Lesław

    2006-01-01

    Although the importance of medical research for the diagnosis and treatment of human diseases is unquestionable, the use of human subjects, however, still presents a complex ethical problem. Moral difficulties occur in particular when the medical research deals with vulnerable subjects. Vulnerable individuals are defined as those who experience diminished actual autonomy. Among the groups which should be considered as being vulnerable are usually listed the following: children, pregnant women, mentally or emotionally disabled, physically disabled, homeless, and institutionalized people. This study addresses key concerns that gave rise to the question of whether unemployed people had to be recognized as vulnerable subjects. The term "vulnerability" was clarified and it was assumed that the "vulnerability" of medical research subjects' had to be understood as a form of continuum from potential, through the circumstantial, temporal, episodic, permanent to inevitable vulnerability. The conclusion was drawn that unemployed people were, at least, potentially vulnerable subjects. Research involving unemployed people presents important moral challenges to researchers and should be undertaken very carefully, following special ethical guidelines. PMID:17441390

  6. Infrastructure Vulnerability Assessment Model (I-VAM).

    PubMed

    Ezell, Barry Charles

    2007-06-01

    Quantifying vulnerability to critical infrastructure has not been adequately addressed in the literature. Thus, the purpose of this article is to present a model that quantifies vulnerability. Vulnerability is defined as a measure of system susceptibility to threat scenarios. This article asserts that vulnerability is a condition of the system and it can be quantified using the Infrastructure Vulnerability Assessment Model (I-VAM). The model is presented and then applied to a medium-sized clean water system. The model requires subject matter experts (SMEs) to establish value functions and weights, and to assess protection measures of the system. Simulation is used to account for uncertainty in measurement, aggregate expert assessment, and to yield a vulnerability (Omega) density function. Results demonstrate that I-VAM is useful to decisionmakers who prefer quantification to qualitative treatment of vulnerability. I-VAM can be used to quantify vulnerability to other infrastructures, supervisory control and data acquisition systems (SCADA), and distributed control systems (DCS). PMID:17640208

  7. Opportunistic Interruptions: Interactional Vulnerabilities Deriving from Linearization

    ERIC Educational Resources Information Center

    Gibson, David R.

    2005-01-01

    Speaking involves "linearizing" a message into a string of words. This process leaves us vulnerable to being interrupted in such a way that the aborted turn is a misrepresentation of the intended message. Further, because we linearize our messages in standard ways, we are recurrently vulnerable to interruptions at particular turn-construction…

  8. SERV user`s guide. Final report

    SciTech Connect

    Koontz, M.D.; Bakhsh, H.; Lee, S.M.

    1995-01-01

    The Sizing of Energy Recovery Ventilator (SERV) software described in this manual is intended to size an energy recovery ventilator in new and existing single-family residences, based on ASHRAE guidelines for the rate at which outdoor air is to be delivered to an indoor space to ensure acceptable air quality. The user is asked to select a city that has climatic conditions most representative of the house under consideration. Other inputs required from the user include: (1) house leakiness and terrain sheltering factors; (2) estimated annual house energy costs; (3) number, capacity and weekly operation hours for vented exhaust fans; and (4) HVAC system COP/efficiency values. Default values (which the user can override) are provided for most input parameters, and help screens are provided to assist the user in determining appropriate input values. The program estimates the average air infiltration rates for summer and winter, and combines these calculations with estimates of ventilation due to intermittent use of exhaust fans in determining the baseline ventilation rate. An energy recovery ventilator is sized to provide any supplemental ventilation necessary to satisfy air change requirements imposed by ASHRAE Standard 62-1989 (Ventilation for Acceptable Air Quality). The program then calculates (1) the annual energy and associated cost for providing the supplemental ventilation, and (2) the relative impact of the added ventilation on indoor concentrations of four pollutants--carbon monoxide, nitrogen dioxide, formaldehyde and radon.

  9. Oxytocin promotes group-serving dishonesty.

    PubMed

    Shalvi, Shaul; De Dreu, Carsten K W

    2014-04-15

    To protect and promote the well-being of others, humans may bend the truth and behave unethically. Here we link such tendencies to oxytocin, a neuropeptide known to promote affiliation and cooperation with others. Using a simple coin-toss prediction task in which participants could dishonestly report their performance levels to benefit their group's outcome, we tested the prediction that oxytocin increases group-serving dishonesty. A double-blind, placebo-controlled experiment allowing individuals to lie privately and anonymously to benefit themselves and fellow group members showed that healthy males (n = 60) receiving intranasal oxytocin, rather than placebo, lied more to benefit their group, and did so faster, yet did not necessarily do so because they expected reciprocal dishonesty from fellow group members. Treatment effects emerged when lying had financial consequences and money could be gained; when losses were at stake, individuals in placebo and oxytocin conditions lied to similar degrees. In a control condition (n = 60) in which dishonesty only benefited participants themselves, but not fellow group members, oxytocin did not influence lying. Together, these findings fit a functional perspective on morality revealing dishonesty to be plastic and rooted in evolved neurobiological circuitries, and align with work showing that oxytocin shifts the decision-maker's focus from self to group interests. These findings highlight the role of bonding and cooperation in shaping dishonesty, providing insight into when and why collaboration turns into corruption. PMID:24706799

  10. Oxytocin promotes group-serving dishonesty

    PubMed Central

    Shalvi, Shaul; De Dreu, Carsten K. W.

    2014-01-01

    To protect and promote the well-being of others, humans may bend the truth and behave unethically. Here we link such tendencies to oxytocin, a neuropeptide known to promote affiliation and cooperation with others. Using a simple coin-toss prediction task in which participants could dishonestly report their performance levels to benefit their group’s outcome, we tested the prediction that oxytocin increases group-serving dishonesty. A double-blind, placebo-controlled experiment allowing individuals to lie privately and anonymously to benefit themselves and fellow group members showed that healthy males (n = 60) receiving intranasal oxytocin, rather than placebo, lied more to benefit their group, and did so faster, yet did not necessarily do so because they expected reciprocal dishonesty from fellow group members. Treatment effects emerged when lying had financial consequences and money could be gained; when losses were at stake, individuals in placebo and oxytocin conditions lied to similar degrees. In a control condition (n = 60) in which dishonesty only benefited participants themselves, but not fellow group members, oxytocin did not influence lying. Together, these findings fit a functional perspective on morality revealing dishonesty to be plastic and rooted in evolved neurobiological circuitries, and align with work showing that oxytocin shifts the decision-maker’s focus from self to group interests. These findings highlight the role of bonding and cooperation in shaping dishonesty, providing insight into when and why collaboration turns into corruption. PMID:24706799

  11. Serving Data to the GLAST Users Community

    SciTech Connect

    Stephens, Thomas E.

    2007-07-12

    The scientific community will access the public GLAST data through the website of the GLAST Science Support Center (GSSC). For most data products the GSSC website will link to the NASA High Energy Astrophysics Science Archive Research Center's (HEASARC) Browse interface, which will actually serve the data. For example, data from the GLAST Burst Monitor (GBM) from a given burst will be packaged together and accessible through Browse. However, the photon and event data produced by the Large Area Telescope (LAT), GLAST's primary instrument, will be distributed through a custom GSSC interface. These data will be collected over the LAT's large field-of-view, usually while the LAT is scanning the sky, and thus photons from a particular direction cannot be attributed to a single 'observation' in the traditional sense. Users will request all photons detected from a region on the sky over a specified time and energy range. Through its website the GSSC will also provide long and short term science timelines, spacecraft position and attitude histories, exposure maps and other scientific data products. The different data products provided by the GSSC will be described.

  12. Biodiversity Information Serving Our Nation (BISON)

    USGS Publications Warehouse

    U.S. Geological Survey Core Science Analytics and Synthesis

    2013-01-01

    Researchers collect species occurrence data, records of an organism at a particular time in a particular place, as a primary or ancillary function of many biological field investigations. Presently, these data reside in numerous distributed systems and formats (including publications) and are consequently not being used to their full potential. As a step toward addressing this challenge, the Core Science Analytics and Synthesis (CSAS) program of the US Geological Survey (USGS) is developing Biodiversity Information Serving Our Nation (BISON), an integrated and permanent resource for biological occurrence data from the United States. BISON will leverage the accumulated human and infrastructural resources of the long-term USGS investment in research and information management and delivery. CSAS is also the U.S. Node of the Global Biodiversity Information Facility (GBIF), an international, government-initiated and funded effort focused on making biodiversity data freely available for scientific research, conservation and sustainable development. CSAS, with its partners at Department of Energy's Oak Ridge National Laboratory (ORNL), hosts a full mirror of the hundreds of millions of global records to which GBIF provides access. BISON has been initiated with the 110 million records GBIF makes available from the U.S. and is integrating millions more records from other sources each year.

  13. The promise and peril of accountable care for vulnerable populations: a framework for overcoming obstacles.

    PubMed

    Lewis, Valerie A; Larson, Bridget Kennedy; McClurg, Asha Belle; Boswell, Rebecca Goldman; Fisher, Elliott S

    2012-08-01

    Accountable care organizations (ACOs) are a promising payment model aimed at reducing costs while also improving the quality of care. However, there is a risk that vulnerable populations may not be fully incorporated into this new model. We define two distinct vulnerable populations, clinically at-risk and socially disadvantaged, and we discuss how ACOs may benefit each group. We provide a framework to use in considering challenges for both vulnerable patients and health systems on the path to accountable care. We identify policies that can help overcome these obstacles: strategies that support ACO formation in diverse settings and that monitor, measure, and reward the performance of providers that reach all patients, including vulnerable populations. PMID:22869656

  14. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem

    PubMed Central

    Williams, Patricia AH; Woodward, Andrew J

    2015-01-01

    The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat. PMID:26229513

  15. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem.

    PubMed

    Williams, Patricia Ah; Woodward, Andrew J

    2015-01-01

    The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat. PMID:26229513

  16. Environmental Health Related Socio-Spatial Inequalities: Identifying "Hotspots" of Environmental Burdens and Social Vulnerability.

    PubMed

    Shrestha, Rehana; Flacke, Johannes; Martinez, Javier; van Maarseveen, Martin

    2016-01-01

    Differential exposure to multiple environmental burdens and benefits and their distribution across a population with varying vulnerability can contribute heavily to health inequalities. Particularly relevant are areas with high cumulative burdens and high social vulnerability termed as "hotspots". This paper develops an index-based approach to assess these multiple burdens and benefits in combination with vulnerability factors at detailed intra-urban level. The method is applied to the city of Dortmund, Germany. Using non-spatial and spatial methods we assessed inequalities and identified "hotspot" areas in the city. We found modest inequalities burdening higher vulnerable groups in Dortmund (CI = -0.020 at p < 0.05). At the detailed intra-urban level, however, inequalities showed strong geographical patterns. Large numbers of "hotspots" exist in the northern part of the city compared to the southern part. A holistic assessment, particularly at a detailed local level, considering both environmental burdens and benefits and their distribution across the population with the different vulnerability, is essential to inform environmental justice debates and to mobilize local stakeholders. Locating "hotspot" areas at this detailed spatial level can serve as a basis to develop interventions that target vulnerable groups to ensure a health conducive equal environment. PMID:27409625

  17. Serving Those Who Serve: Meeting the Complex Needs of Students Returning Home from War

    ERIC Educational Resources Information Center

    Veislind, Emili

    2013-01-01

    As community colleges across the country strive to improve completion rates and serve a growing number of students returned home from war, the need for programs that meet the unique needs of veterans--including job training, social acclimation, referral programs for mental health counseling, and academic tutoring, to name a few--is more pressing…

  18. How Online Schools Serve and Fail to Serve At-Risk Students

    ERIC Educational Resources Information Center

    Figueiredo-Brown, Regina

    2013-01-01

    Purpose: Online schools were initially designed to provide access to diverse courses to advanced and homeschooled students, however, many online schools now market their programs specifically to students whose needs place them at-risk in traditional schools. The capacity of technology to address any of the needs of under-served students is largely…

  19. Offer versus Serve or Serve Only: Does Service Method Affect Elementary Children's Fruit and Vegetable Consumption?

    ERIC Educational Resources Information Center

    Goggans, Margaret Harbison; Lambert, Laurel; Chang, Yunhee

    2011-01-01

    Purpose/Objectives: The purpose of this study was to determine if the use of the Offer versus Serve (OVS) provision in the National School Lunch Program would result in a significant difference in fruit and vegetable consumption by fourth and fifth grade elementary students, and in plate waste cost. Methods: Weighed and visual plate waste data…

  20. Dermatitis artefacta in a vulnerable adult with a dissociative state.

    PubMed

    Ahmed, A; Bewley, A; Taylor, R

    2013-12-01

    Dermatitis artefacta (DA), a factitious skin disorder, often occurs as a response to traumatic life events or as a factitious behaviour, which may result in secondary gain. It can be difficult to get patients to engage with health services, and they seldom admit to causing the lesions themselves. The possibility of DA lesions occurring in dissociative states is less well known. We present a case of DA diagnosed in a vulnerable adult, who we believe caused the lesions during periods of dissociation. We discuss the way in which the concept of dissociation can provide an acceptable way of discussing the behaviour with patients and initiating psychological therapy. PMID:23758341

  1. Amyotrophic lateral sclerosis: cell vulnerability or system vulnerability?

    PubMed Central

    Talbot, Kevin

    2014-01-01

    Amyotrophic lateral sclerosis (ALS) is a complex neurodegenerative disease with clinical, pathological and genetic overlap with frontotemporal dementia (FTD). No longer viewed as one disease with a single unified cause, ALS is now considered to be a clinicopathological syndrome resulting from a complex convergence of genetic susceptibility, age-related loss of cellular homeostasis, and possible environmental influences. The rapid increase in recent years of the number of genes in which mutations have been associated with ALS has led to in vitro and in vivo models that have generated a wealth of data indicating disruption of specific biochemical pathways and sub-cellular compartments. Data implicating pathways including protein misfolding, mRNA splicing, oxidative stress, proteosome and mitochondrial dysfunction in the pathogenesis of ALS reinforce a disease model based on selective age-dependent vulnerability of a specific population of cells. To the clinical neurologist, however, ALS presents as a disease of focal onset and contiguous spread. Characteristic regional patterns of involvement and progression suggest that the disease does not proceed randomly but via a restricted number of anatomical pathways. These clinical observations combined with electrophysiological and brain-imaging studies underpin the concept of ALS at the macroscopic level as a ‘system degeneration’. This dichotomy between cellular and systems neurobiology raises the fundamental questions of what initiates the disease process in a specific anatomical site and how the disease is propagated. Is the essence of ALS a cell-to-cell transmission of pathology with, for example, a ‘prion-like’ mechanism, or does the cellular pathology follow degeneration of specific synaptic networks? Elucidating the interaction between cellular degeneration and system level degeneration will aid modeling of the disease in the earliest phases, improve the development of sensitive markers of disease

  2. [Nurses' autonomy and vulnerability in the Nursing Assistance Systematization practice].

    PubMed

    Menezes, Silvia Regina Tamae; Priel, Margareth Rose; Pereira, Luciane Lucio

    2011-08-01

    The objective of this study was to recognize the autonomy and vulnerability of nurses in the implementation of the Sistema da Assistência de Enfermagem (SAE) Nursing Care System through an integrative literature review, using content analysis. A survey was conducted, and 40 articles published between 1998 and 2008 were selected based on their relevance. Results showed two main categories of meaning: Benefits associated to the SAE practice (to patients, to the profession and to the institution) and Determinants for the Implementation of SAE (nurse's competence, training and education, record-instruments, infrastructure and collective sharing-construction). From the integration of the two categories, the highlights were the autonomy in acting with freedom and responsibility, science-based decision-making, and being valued for their social work, as well as the vulnerability expressed by interpersonal relationships, the wear generated by professional stress and the risk inherent to the service. PMID:21876898

  3. Development and implementation of a Bayesian-based aquifer vulnerability assessment in Florida

    USGS Publications Warehouse

    Arthur, J.D.; Wood, H.A.R.; Baker, A.E.; Cichon, J.R.; Raines, G.L.

    2007-01-01

    The Florida Aquifer Vulnerability Assessment (FAVA) was designed to provide a tool for environmental, regulatory, resource management, and planning professionals to facilitate protection of groundwater resources from surface sources of contamination. The FAVA project implements weights-of-evidence (WofE), a data-driven, Bayesian-probabilistic model to generate a series of maps reflecting relative aquifer vulnerability of Florida's principal aquifer systems. The vulnerability assessment process, from project design to map implementation is described herein in reference to the Floridan aquifer system (FAS). The WofE model calculates weighted relationships between hydrogeologic data layers that influence aquifer vulnerability and ambient groundwater parameters in wells that reflect relative degrees of vulnerability. Statewide model input data layers (evidential themes) include soil hydraulic conductivity, density of karst features, thickness of aquifer confinement, and hydraulic head difference between the FAS and the watertable. Wells with median dissolved nitrogen concentrations exceeding statistically established thresholds serve as training points in the WofE model. The resulting vulnerability map (response theme) reflects classified posterior probabilities based on spatial relationships between the evidential themes and training points. The response theme is subjected to extensive sensitivity and validation testing. Among the model validation techniques is calculation of a response theme based on a different water-quality indicator of relative recharge or vulnerability: dissolved oxygen. Successful implementation of the FAVA maps was facilitated by the overall project design, which included a needs assessment and iterative technical advisory committee input and review. Ongoing programs to protect Florida's springsheds have led to development of larger-scale WofE-based vulnerability assessments. Additional applications of the maps include land-use planning

  4. Serving the needs of our future population.

    PubMed

    Nagel, Catie; Lenton, Carrie

    2016-05-01

    Less than 30% of doctors, across The Organisation for Economic Co-operation and Development (OECD) and within the UK are currently working in generalist careers. Our population is ageing and increasingly, multi-morbidity is becoming the norm rather than the exception. With an increasing proportion of graduates opting for specialist careers, how can we best equip them to deal with the challenges they are likely to face without an exponential rise in the cost of care or increasing risk to patients? We propose an approach by which community placements are present from the early years of medical training and to seek opportunities for interprofessional learning and teaching, with emphasis on continuity of care and holism. By involving students in longitudinal placements and encouraging them to develop relationships with patients and their carers, they will be more likely to understand the value of continuity and the need to undertake a whole person approach, rather than what Oldham described as 'body part' medicine. It is hoped that through teaching, training, and role modelling, more students might opt for generalist careers, or the effects of increasing specialisation might be mitigated. PMID:27102844

  5. Determining Vulnerability Importance in Environmental Impact Assessment

    SciTech Connect

    Toro, Javier; Duarte, Oscar; Requena, Ignacio; Zamorano, Montserrat

    2012-01-15

    The concept of vulnerability has been used to describe the susceptibility of physical, biotic, and social systems to harm or hazard. In this sense, it is a tool that reduces the uncertainties of Environmental Impact Assessment (EIA) since it does not depend exclusively on the value assessments of the evaluator, but rather is based on the environmental state indicators of the site where the projects or activities are being carried out. The concept of vulnerability thus reduces the possibility that evaluators will subjectively interpret results, and be influenced by outside interests and pressures during projects. However, up until now, EIA has been hindered by a lack of effective methods. This research study analyzes the concept of vulnerability, defines Vulnerability Importance and proposes its inclusion in qualitative EIA methodology. The method used to quantify Vulnerability Importance is based on a set of environmental factors and indicators that provide a comprehensive overview of the environmental state. The results obtained in Colombia highlight the usefulness and objectivity of this method since there is a direct relation between this value and the environmental state of the departments analyzed. - Research Highlights: Black-Right-Pointing-Pointer The concept of vulnerability could be considered defining Vulnerability Importance included in qualitative EIA methodology. Black-Right-Pointing-Pointer The use of the concept of environmental vulnerability could reduce the subjectivity of qualitative methods of EIA. Black-Right-Pointing-Pointer A method to quantify the Vulnerability Importance proposed provides a comprehensive overview of the environmental state. Black-Right-Pointing-Pointer Results in Colombia highlight the usefulness and objectivity of this method.

  6. Early Brain Vulnerability in Wolfram Syndrome

    PubMed Central

    Hershey, Tamara; Lugar, Heather M.; Shimony, Joshua S.; Rutlin, Jerrel; Koller, Jonathan M.; Perantie, Dana C.; Paciorkowski, Alex R.; Eisenstein, Sarah A.; Permutt, M. Alan

    2012-01-01

    Wolfram Syndrome (WFS) is a rare autosomal recessive disease characterized by insulin-dependent diabetes mellitus, optic nerve atrophy, diabetes insipidus, deafness, and neurological dysfunction leading to death in mid-adulthood. WFS is caused by mutations in the WFS1 gene, which lead to endoplasmic reticulum (ER) stress-mediated cell death. Case studies have found widespread brain atrophy in late stage WFS. However, it is not known when in the disease course these brain abnormalities arise, and whether there is differential vulnerability across brain regions and tissue classes. To address this limitation, we quantified regional brain abnormalities across multiple imaging modalities in a cohort of young patients in relatively early stages of WFS. Children and young adults with WFS were evaluated with neurological, cognitive and structural magnetic resonance imaging measures. Compared to normative data, the WFS group had intact cognition, significant anxiety and depression, and gait abnormalities. Compared to healthy and type 1 diabetic control groups, the WFS group had smaller intracranial volume and preferentially affected gray matter volume and white matter microstructural integrity in the brainstem, cerebellum and optic radiations. Abnormalities were detected in even the youngest patients with mildest symptoms, and some measures did not follow the typical age-dependent developmental trajectory. These results establish that WFS is associated with smaller intracranial volume with specific abnormalities in the brainstem and cerebellum, even at the earliest stage of clinical symptoms. This pattern of abnormalities suggests that WFS has a pronounced impact on early brain development in addition to later neurodegenerative effects, representing a significant new insight into the WFS disease process. Longitudinal studies will be critical for confirming and expanding our understanding of the impact of ER stress dysregulation on brain development. PMID:22792385

  7. Understanding the Code: safeguarding vulnerable adults.

    PubMed

    Griffith, Richard

    2015-11-01

    Under the provisions of the Nursing and Midwifery Council's revised Code (2015) , all district and community nurses have a professional duty to safeguard vulnerable adults from abuse. With adult abuse continuing to increase, all members of the district and community nursing teams are well placed to identify and take action to safeguard the vulnerable. In this article, Richard Griffith explains how the Care Act 2014 seeks to improve the safeguarding of vulnerable adults and the role of district and community nurses in that process. PMID:26551387

  8. Nuclear material production cycle vulnerability analysis

    SciTech Connect

    Bott, T.F.

    1996-07-01

    This paper discusses a method for rapidly and systematically identifying vulnerable equipment in a nuclear material or similar production process and ranking that equipment according to its attractiveness to a malevolent attacker. A multistep approach was used in the analysis. First, the entire production cycle was modeled as a flow diagram. This flow diagram was analyzed using graph theoretical methods to identify processes in the production cycle and their locations. Models of processes that were judged to be particularly vulnerable based on the cycle analysis then were developed in greater detail to identify equipment in that process that is vulnerable to intentional damage.

  9. Individual and social vulnerabilities upon acquiring tuberculosis: a literature systematic review

    PubMed Central

    2014-01-01

    Tuberculosis is a contagious infectious disease mainly caused by the bacteria Mycobacterium tuberculosis that still meets the priority criteria - high magnitude, transcendence and vulnerability - due to the threat it poses to public health. When taking into consideration the vulnerability conditions that favor the onset of the disease, this article aimed to investigate the implications originated from individual and social vulnerability conditions in which tuberculosis patients are inserted. Databases like MEDLINE, LILACS and SciELO were searched in Portuguese, Spanish and English using the descriptors tuberculosis and vulnerability, and 183 articles were found. After the selection criterion was applied, there were 22 publications left to be discussed. Some of the aspects that characterize the vulnerability to tuberculosis are: low-income and low-education families, age, poor living conditions, chemical dependency, pre-existing conditions/aggravations like diabetes mellitus and malnutrition, indigenous communities, variables related to health professionals, intense border crossings and migration, difficulty in accessing information and health services and lack of knowledge on tuberculosis. Much as such aspects are present and favor the onset of the disease, several reports show high incidence rates of tuberculosis in low vulnerability places, suggesting that some factors related to the disease are still unclear. In conclusion, health promotion is important in order to disfavor such conditions or factors of vulnerability to tuberculosis, making them a primary target in the public health planning process and disease control. PMID:25067955

  10. Challenges and strategies for recruitment and retention of vulnerable research participants: promoting the benefits of participation.

    PubMed

    Gemmill, Robin; Williams, Anna Cathy; Cooke, Liz; Grant, Marcia

    2012-05-01

    The purpose of this article was to describe recruitment and retention of vulnerable hematopoietic cell transplant patients participating in a longitudinal intervention study. Utilizing Swanson's theory of caring model, nurse researchers facilitated patients' visualization of how study participation could enable them to share their experience and further clinical insights. PMID:20974092